An Ethnobotanical and Ethnomedicinal Investigation of Phytomedical Knowledge and Practice of Medicinal Plants in Lingchuan County, Shanxi, China


 BackgroundLingchuan County is the main producing area of Chinese medicinal materials in Shanxi Province, rich in medicinal plant resources. The aboriginal residents of Lingchuan County have certain traditional knowledge and experience in the use of medicinal plants and can effectively use medicinal plants to treat common diseases. MethodologyA field survey in 53 villages was carried out over one year, i.e., November 2017—August 2018. Ethnomedicinal data was collected through designed questionaries/interviews by involving 180 informants familiar with medicinal plants utilization. Documented data were evaluated using the quantitative indices. ResultsA total of 138 traditional medicinal plants were investigated, belonging to 123 genera of 60 families. Among them, Asteraceae was the dominant plant family with 19 species. Roots were the most commonly used plant parts, and the dominant life form was herbs. Quantitative analysis revealed that Forsythia suspensa was with higher (0.33) RFC value, and Scutellaria baicalensis was recorded with higher (0.91) UV. Treated diseases were categorized in 12 groups and evaluated by their FIC value, in which gynecological diseases having higher (0.93) FIC value followed by urinary system diseases. The most medicinal plants are used to clear away heat and relieve the surface. At the same time, people use boiled water to use medicinal plants. Most of the plants investigated are non-toxic. ConclusionThis study reported traditional herbal medicines for the first time to be used against various disorders in Lingchuan County, China and are still practiced by the local communities. Some of the new ethnobotanical claims documented in this investigation should need to be further explored clinically. The medicinal plants with the highest use values recorded in this study may signpost the probable existence of valuable phytochemical compounds that requires a search for prospective new drugs to cure many human disorders.

Lingchuan County is located in Jincheng City with a higher altitude in the southern section of Taihang Mountain (Fig. 1). It has 12 towns and villages under its jurisdiction, with a population of more than 250,000, and the total area of the county is 1,751 square kilometers. The average elevation is about 1058 m. It is a rocky, hilly area. It is mainly divided into three different terrain areas: the rocky mountainous area in the east, the rocky, hilly area in the middle, and the Pingchuan area in the southwest. The east and south have large elevation differences and steep terrain. The relative height difference is generally between 600 and 1000 m, which is high in the northeast and low in the southwest. The local plant diversity corresponds to the topography. The area has a continental monsoon climate with a cool climate and abundant rainfall. The annual average temperature is 7℃ 9℃, and the annual precipitation is 700 1000 mm. The county has a frost-free period of 160 days throughout the year, and the average sunshine duration is 2380 2730 h [7]. The forest coverage rate in Lingchuan County is 51.07%, and the timber stock volume is 1.48 million cubic meters. There are not only natural forests and arti cial forests but also unique tree species and Taxus Chinensis. More than 400 kinds of wild medicinal materials have provided a material basis for the formation of knowledge of Lingchuan traditional medicinal plants. However, in recent years, due to environmental changes and human activities, many rivers in Lingchuan County have dried up, reducing the diversity of medicinal plants [8].

Ethnobotanical eld survey and data collection
Ethnomedicinal information about the use of plant species for the treatment of various disorders in the study area were documented from 53 localities. This survey was carried out from November 2017 to August 2018, following the protocols for ethnobotanical data documentation [9]. Mainly adopt key person interview method, structured interview method, and free enumeration method, ask according to the previously designed questions, record the local name, use part, use method, e cacy, etc. of medicinal plants and ethnographical information of the total informants (180) such as age, class, gender, experience, and educational background (Table 1, Fig. 2) [10] .  Plant species used to treat various disorders were collected, dried, preserved, and mounted on herbarium sheets [11]. Subsequently, with the help of plant taxonomists at Changzhi University, the number of the voucher specimen was assigned and determined and compared with the specimens in the herbarium of

Quantitative analysis of the ethnomedicinal information
Relative frequency Citation (RFC) The RFC was calculated without taking into account the use categories by following the formula [13]. = /N (0 > > 1) RFC shows the importance of each species in the study area given by the FC (FC is the number of local informants reported the uses of the species) divided by the total number of informants (N).
Use value (UV) of plant species Use value (UV) determines the relative importance of plant species uses. It was calculated using the following formula [14].

UV = UR/N
Where "UV" indicates the use-value of individual species for a given disease range from 0 to 1, "UR" is the number of uses for particular disease of a given species by each informant, and "N" represents the number of informants who reports the given species.
Information consensus factor (F IC ) The knowledge of medicinal ethnobotany will vary to a certain extent due to different investigators and interviewees in the survey process. Therefore, in order to examine the distribution of information and nd plants with biological activity, the consistency index can be used for evaluation [15].
F IC =(nur-nt)/ nur-1 Where: F IC is the information provider's information consistency index (informant consensus factor); nur is the number of a certain information provider using plants to treat a certain type of disease; nt is the amount used by all information providers to treat the disease Number of plant species.
F IC is between 0 and 1. The larger the value, the higher the consistency between herbalists. In other words, the greater the F IC value, the more concentrated the plant species used by herbalists to treat a certain disease.

Regression analysis and Pearson correlation
Regression analysis was performed between demographic variables in response to gender (male, female) variables using SAS 9.4. Pearson's correlation, SPSS (ver. 16 [16]. According to theory, the older people have more traditional knowledge. However, the 75-91 age group has a smaller population base, results less contribution to the documentation of traditional knowledge. It was noted in regression analysis that all the demographic category were signi cant in response to gender group except age group (Table 3).   (Fig. 3A). The other plant families were recorded with only one species (Fig. 3B). The recorded medicinal plants are categorized according to their life form (Fig. 5A). Among them, herbs (96 ssp.) were dominant, followed shrubs and trees (15 ssp. each), and vines with 12 species only. The domination of herbs in utilization over other life form may not only because the e cacy of medicinal plants but also because the density of the distribution of herbs is higher, the growth cycle is fast, and the yield is higher [17]. They are determined by the characteristics of the collection [18]. Some of the medicinal plant materials collected by local inhabitants for medicinal purposes are shown in Fig. 4.

Parts used of folk traditional medicinal plants
The recorded traditional medicinal plants in Lingchuan County are classi ed according to their parts utilization (Fig. 5B). Among them, the most used parts were roots, with 58 species, accounting for 42%, followed by whole plant and fruit (28 spp [20,21]. People will choose the most effective method of use according to the severity of the disease and other symptoms [22]. At the same time, it is also related to the medicinal parts of plants. Boiling water is the simplest and most effective way to extract the medicinal ingredients of plant roots.

Disease categories treated by folk medicinal plants
According to the e cacy and applicable diseases of medicinal plants, the medicinal plants in Lingchuan County are divided into 12 categories [23] (Fig. 7). I) Most plants were utilized as surface-relieving plants recoded with 70 species, generally used for the effect of clearing away heat, detoxifying, reducing heat, reducing in ammation, and reducing swelling. It is used to treat sore throat, sinusitis, ear disease, nosebleeds, eye pain, oral ulcers, colds, etc. Common plants used to treat these diseases include Scutellaria baicalensis, Nepeta tenuifolia, and Xanthium sibiricum, etc. II) twenty-eight kinds of plants were used as nourishing plants which has nourishing and diseases preventing properties. They are used for improving eyesight, black hair, xing teeth, preventing heatstroke, etc. Common plants include Reynoutria multi ora, Lycium barbarum, and Epimedium brevicornu, etc. III) Twenty-seven kinds of plants were utilized for the management of respiratory disease, mainly for coughs, including tuberculosis, asthma, qi inversion, and other diseases. Common treatment plants include Allium stulosum, Nepeta tenuifolia, and Platycodon grandi orus, etc. IV) Twenty-six plants species were utilized for the treatment of digestive system diseases, mainly used for gastritis, appendicitis, constipation, hemorrhoids, and gastrointestinal bleeding with common plants includes Plantago asiatica, Morus alba, Bupleurum chinense. V) Twenty-two kinds of plants were employed for skin diseases, which were generally used for burns, vitiligo, acne, and other diseases with common plants includes Sophora avescens, Styphnolobium japonicum, Stellera chamaejasme, and so on. VI) nineteen plants were utilized for circulatory system diseases; these plants have the effect of promoting blood circulation and removing blood stasis. They are used for high blood pressure, hyperlipidemia, heart disease, etc. Common therapeutic plants include Sonchus arvensis, Carthamus tinctorius, Reynoutria multi ora, and so on. VII) sixteen plant species were used for the treatment of nervous system diseases. They are used to treat numbness, insomnia, headaches, convulsions in children, etc.

Toxicity of medicinal plants
According to the toxicity level of plants, plants are divided into four types: non-toxic, unknown, small-toxic, and toxic (Fig. 8) (Fig.9). The higher RFC value demonstrated that informants contribution were more for a particular plant species, and they have knowledge of particular plant uses. In fact, the plants with low RFC value are not medicinally less important but the informants may not know about the uses of these plants or the plants may not be common to an area. In addition, it was observed during survey that young generations were less familiar with the traditional utilization of medicinal plants, alarming threats to indigenous knowledge of medicinal plants.

Use value (UV)
Use value determines the importance of each species for particular diseases. The present study recorded the UV range (0.08 to 0.9 value) of the total recorded species. Among them, most of the plant species (79 spp.) were recorded at the range of 0.01 to <0.2, followed by UV range 0.2 to <0.3 with 34 plant species.
Thirty-ve plants species were recoded with UV value≥0.3 (Fig.10) or an area to area [17,24]. Use values were signi cant correlated to RFC (R 2 =0.52), demonstrated that UV can be de ne 50% by RFC value (Fig.11). These ndings revealed that the number of informants for given species reported 50% similar uses.

Disease categories with F IC value
The results of F IC value of the disease categories of recorded medicinal plants are given in Table 4. The higher F IC value was recorded for the treatment of gynecological diseases (F IC =0.93) with total of 109 citation. The plants that cause this high consensus are Nepeta tenuifolia and Taraxacum mongolicum, which has 37 citation each. Nepeta tenuifolia is mainly used to treat colds, coughs, hypertension, and other diseases. The fresh leaves of Nepeta tenuifolia are mixed with our, kneaded into cakes, and deep-fried; it becomes a refreshing food that can prevent colds [25]. After frying, Nepeta forms a black powder called "Nepeta Carbon", which can be used to treat rhinitis with the fruits of burdock and mint. Nepeta tenuifolia has a glandular point and can volatilize a special fragrance. Therefore, this characteristic of Nepeta tenuifolia can be used to extract avors as food additives or cosmetics. Taraxacum mongolicum is locally known "Bubuying", "Wooden Pueraria", "Diding", and have widespread growth in the study area, it can be collected except in winter. The informants claims that it has anti-in ammatory effect is equivalent to penicillin. As a traditional remedy, it only needs to be washed and soaked in water, and used as a wild vegetable, but it can be eaten after boiling. Modern studies have shown that dandelion has antibacterial, anti-oxidant, and anti-tumor effects. The dualpurpose of Dandelion, such as a medicine and food, will have broad research prospects [26].
The 2nd highest F IC value was recorded for the treatment of the urinary system (F IC =0.91). Among the total of 123 citations, Plantago asiatica were cited 29 times, and Atractylodes lancea with 28 citations by informants. Plantago asiatica is a plant of the Plantago genus, from which more than 60 compounds have been discovered, which can treat a variety of diseases. This single plant has a good therapeutic effect, and multiple parts can be used. such as the leaves of plantain can be eaten directly by washing [27].
The 3rd highest F IC value was recorded for the treatment of respiratory diseases (F IC =0.90). The more contribution was by Scutellaria baicalensis species which appeared 41 times. Its main medicinal part is root, and it takes at least 2 years of growth to have the effect of curing colds, reducing re, and reducing in ammation. After 5 years, the root of Scutellaria baicalensis become hollow. The locals call it "Bitter Qin" which has anti tuberculosis potential. The aerial part of Scutellaria baicalensis is distilled, dried, and soaked in tea, further use it for colds prevention. Shen et al demonstrated that Scutellaria baicalensis mainly contains avonoids, volatile oils, polysaccharides, and other compounds, which have obvious anti-virus, anti-tumor, and anti-oxidation activities [28].
Digestive system diseases were found with 0.9 F IC value, Nepeta tenuifolia and Atractylodes lancea were the plants frequently used for diseases management in the study area. Moreover, for the surface-resolving plants (F IC value = 0.89), the most important plants are Scutellaria baicalensis with 41 citations, and Forsythia suspense with 39 citations. The fruit of Forsythia suspense, locally called "fu pimple" is effective in colds. The best time of its collection is summer, and thought to more effective against disease than other seasons. However, because of its high price, people often collect in advance in pursuit of economic bene ts, which has brought undesirable consequences.
For the treatment of orthopedic diseases (F IC =0.89), the most important plant is Nepeta tenuifolia. For nourishing plants (F IC =0.87), the most important plant is Codonopsis pilosula. it is one of the commonly used bulk medicinal materials in China, and well-known species throughout the country for their uses (wine and drink) as an authentic medicinal material and is cultivated in large scale, but most of the its medicinal materials are purchased, and only a small part is used by people. Modern research has shown that Codonopsis pilosula contains many essential substances for the human body, which can protect some internal injuries and enhance the body's immunity [29].
16 citation. During our investigation, local people in Lingchuan County used Sophora avescens to for skin diseases. In modern research, it has been found that Sophora avescens has anti-in ammatory, analgesic, anti-tumor, and antibacterial effects [30,31]. For the treatment of skin diseases (F IC =0.81), the most important plant is Arctium lappa, which has active ingredients are inulin and polyphenols. Arctium lappa seeds are proceeds to deep-fry, grinded and take with water for the treatment of sore throat [32]. For the treatment of infectious and functional diseases (F IC =0.65), the plants used by people are relatively inconsistent. This type of disease has a relatively large impact and requires timely medical treatment. However, most of the informants did not share relevant information or may feel shy to mention such diseases and generally they had not share treatment experience, which may lead to low consistency of medicinal plants to treat such diseases.

Cultural Signi cance And Recommendation
Among the medicinal plants purchased, the economic value of the medicinal materials is signi cantly higher than the self-use value. Therefore, people may choose the most effective plants to keep a little bit to prevent and treat diseases. However, for their own bene t, people often go up to the mountain to collect immature plants, which reduces the e cacy of the medicine. Predatory logging also destroyed the local medicinal plant resources to a certain extent. Therefore, professionals need to calculate the diversity and universality of traditional medicinal plants, stipulate the collection time and quantity, and facilitate people to collect them in time so as to protect traditional medicinal plants and ensure people's sustainable use and strengthen detection by using sophisticated instruments. Efforts needs to ensure that every medicinal plant has a good effect. At the same time, it is necessary to strengthen the domestication and large-scale planting of wild species to relieve the pressure on wild medicinal plant resources and bring economic income to local people.

Conclusion
The present study reported the important ethnomedicinal plants of Lingchuan County, Shanxi, China. Indigenous people still practice medicinal plants for their healthcare needs. It was noted that roots were most widely used parts in the study area, which may threaten the survival of plants if over collected compared to the collection of other plant parts. Plants with high quantitative indices value, demonstrated that the plants have been practiced widely by inhabitants, which maybe because it is more common to an area or its traditional knowledge have been transferred generation after generation due to its e cacy against diseases. Thus, better understanding is required thorough scienti c investigation of these recorded medicinal plants considering their traditional utilization.
Sustainable utilization and scienti c collection awareness of medicinal plant among communities is the need of the time. Government must ensure the conservation of these medicinal plants for future human development.

Declarations
Ethics approval and consent to participate This study was authorized by the Faculty of Biological Science and Technology, Changzhi University, Shanxi, China. Informed consent was obtained from each participant prior to the interview process.

Consent for publication
All authors read and approved the nal manuscript for publication Ethnomedicinal data (interviews) and plants collection Figure 3 Taxonomic diversity of the study area   Relative frequency citation of the recorded medicinal plants Figure 10 Use values of the recorded medicinal plants Figure 11 Correlation between Use value and Relative frequency citation