Traditional medicine knowledge -
Men and older healers with less education possess most of the knowledge regarding herbal remedies. Meanwhile, most younger people prefer to look for jobs in urban areas instead of studying traditional medicinal knowledge in the countryside.
Thus, there is an urgent need to implement policies and practices for the conservation of medicinal plants and their associated traditional knowledge. This will ensure that this valuable knowledge is not lost to future generations.
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Health clothing with the function of disease prevention and treatment. Tech Text. Download references. We would like to acknowledge the local informants, especially the herbal healers who participated in the surveys and shared their knowledge with us. Without their contribution, this study would have been impossible.
We thank Prof. Edward Kennelly Lehman College, City University of New York for carefully proofreading this manuscript. This work was financially supported by the National Natural Science Foundation of China , and Minzu University of China MDJC03, ZDPY10 and GJAQ Key Laboratory of Ecology and Environment in Minority Areas Minzu University of China , National Ethnic Affairs Commission, Beijing, , China.
Key Laboratory of Ethnomedicine Minzu University of China , Ministry of Education, Beijing, , China. School of Ethnology and Sociology, Minzu University of China, Beijing, , China.
College of Life and Environmental Sciences, Minzu University of China, Beijing, , China. School of Health Science, Kaili University, Kaili, , China. Guangxi Subtropical Crops Research Institute, Nanning, , China. Yunnan International Joint Laboratory of Southeast Asia Biodiversity Conservation, Xishuangbanna Tropical Botanical Garden, Chinese Academy of Sciences, Menglun, , China.
Institute of National Security Studies, Minzu University of China, Beijing, , China. You can also search for this author in PubMed Google Scholar. CLL designed the research and botanically identified the plants. SZL, BXZ and CLL carried out the fieldworks for this study.
Co-first authors SZL and BXZ reviewed the literature and analyzed the data. All authors provided comments, revised the manuscript, and approved the final manuscript.
Correspondence to Chunlin Long. Permission was provided by all participants in this study, including the Shui healers and local people. Consent was obtained from the local communities prior to the field investigations.
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Abstract Background The Shui are a small Chinese sociolinguistic group living in Sandu Shui Autonomous County, south of Guizhou Province. Methods Field surveys were conducted between July and August in Sandu County.
Results In this study, data collected from 15 Shui healers and other informants were analyzed. Conclusion This study demonstrated that Shui people have extensive knowledge of a diverse range of medicinal plants, many of which had not been systematically recorded before the current study.
Background Traditional medical systems worldwide have a long history of preventing and treating diseases while supporting community health [ 1 ]. Methods Study area The study area is situated in Sandu Shui Autonomous County, a part of the Qiannan Buyi and Miao Autonomous Prefecture in Guizhou Province, Southwest China Fig.
Sites for field surveys in Sandu County. Full size image. Field surveys conducted from to Results and discussion Key and other informants Information on a total of 15 local healers was collected through this study, which encompassed six townships. Table 1 Profiles of local Shui healers Full size table.
Table 2 ANOVA of medicinal plants Full size table. Table 3 ANOVA of number of medicinal plants in townships Full size table. Table 4 Informant demographic data and ethnobotanical data Full size table. Table 5 Inventory of medicinal plants used by Shui people in Sandu County Full size table.
Comparison of species number of medicinal plants used in Sandu and other counties in China. Plant parts used in Shui medicine. Table 6 Plants used for both medicine and Jiuqian liquor starters Full size table. Major functions of Shui medicinal plants.
Table 7 Relative frequency of citation RFC of plant species mentioned in prescriptions, from high to low RFC Full size table. Conclusion The Sandu region boasts abundant medicinal plant resources, and the Shui people have a long-standing tradition of utilizing these plants to treat various ailments in their daily lives.
Availability of data and materials All data generated or analyzed during this study are included in this published article. References Pei SJ.
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Article PubMed PubMed Central Google Scholar Liu SZ, Zhang BX, Lei QY, Zhou JJ, Long CL. Article Google Scholar Zheng XL, Dai HF, Liu SB, Qiu LM, Li RT, Wei JH. The traditional practitioners in the study area are organized in associations and organizations which work with local NGOs and in the case of Mwanza with the local district hospital in Magu.
The NGOs and local-based organizations provided material that aided me in understanding the linkages between formal and informal health organizations.
The data was constantly tested and compared to ascertain the accuracy, while throughout my transcribing of the recorded material, I tabulated and recorded the data in Tables in order to ascertain the accuracy of the data.
The field assistants were constantly collaborating with me on my data collection and data analysis assisting in clarifying proverbs, metaphors and other meanings that were unclear to the author. One of the THs whose father had been a prominent practitioner for decades helped in clarifications of proverbs and meanings within the narratives.
Interviews were taped and conducted in English, Kiswahili, and Kisukuma in Mwanza, and in English and Dholuo in Nyanza. Braun and Clarke describe thematic analysis as a method not based on a specific or pre-existing theoretical framework, but rather one used to identify, analyze, and report themes that are closely related to the empirical data.
The advantage of the thematic approach is its flexibility and sensitivity to emerging themes in the empirical data.
Thematic analysis TA was used as a strategy for analysis of interview data, TA is viewed as the main pathway of qualitative methods, due to its path of common approaches with a number of qualitative methods in the social sciences. I thus used thematic analysis to extract themes from my interview data.
This approach is sensitive to emerging themes in the empirical data and permits flexibility in terms of theoretical perspectives Braun and Clarke, TA describes an analytical approach to the empirical material as a response to the questions and aims of the study.
The choice to use a thematic narrative analysis approach in the analysis of my empirical material permitted me to reach a more profound understanding of the phenomena embedded in TMK and related practices, as perceived by THs and other respondents. I found it useful to try to find common thematic elements across the narratives and stories represented in the texts transcribed from the interviews and the events they reported.
Major themes related to socio-spatial aspects of intergenerational learning processes were identified and analyzed within a relational understanding of migration in place and space.
Learning TMK includes obtaining proficiency in the identification, preparation, conservation, management, and administration of medicinal products. While rather few studies have looked at the importance of place and space or socio-spatial dimensions for medicinal learning processes, there are recent important contributions by Lindstrom and Muñoz-Franco , who studied the impact of outmigration on certain types of health knowledge, and other researchers who point out how place and social networks are crucial for health knowledge transmission Andrzejewski et al.
Through several generations, knowledge on the identification of plant species with medicinal properties and their use has been developed Sheldon and Balick, TMK learning is viewed as both temporal and spatial or place-based.
It relates to language, historical processes, and social relations which are largely influenced by political, economic, and social processes Hanks, In line with a relational understanding of social and spatial dimensions, intergenerational learning processes of medicinal knowledge are in this study understood as place-based and related to history, language, and social relations Geissler et al.
Some studies discuss prolepsis which takes a socio-cultural theoretical approach that conceptualizes the transmission of knowledge between generations where experiences are passed down and knowledge and values re-evaluated in the context of a rapidly changing world Cole, Studies on learning processes that are inter and intra-generational discuss processes that are co-constructed within relationships of mutuality and reciprocity Eyssartier et al.
Inter-generational relations and the priority accorded to seniority, which is at the core of social organization in Africa, have determined the modalities of learning processes of younger generations. Given the numeric importance and the heterogeneity of the young demographic group, these processes change relative to the social context French Institute for Research in Africa, Prince and Geissler describe how traditional medicinal knowledge among the Luo is usually imparted between alternate generations.
These skills are also seen to complement formal educational learning skills while invoking cultural continuity and change Kenner et al. As is the case for the Luo in Kenya Sankan, ; Sindiga, and the Wasukuma of Tanzania, oral transfer of knowledge of ethnomedicine is also common in other ethnic groups in East Africa Ochieng' Obado et al.
Training to become a TH usually starts during the pre-adolescent age when the child is perceived as receptive, obedient, has a good memory, and can keep secrets Mwiturubani, Luo plant medicine has been argued to be mainly a domain of women's activity Olenja, but in general, in the study region, both men and women engage in TMK learning processes, while the three major forms of becoming a TH—inheritance, own illness, and calling—are not gender-specific.
Mejeke argues however that the present system of education in Africa emphasizes social and cultural contexts that are far removed from conceptual structures that are within African communities Majeke, A fundamental transformation with an aim of altering educational syllabi can be seen in what is described as mutual decolonization Crossman and Devisch, South Africa has developed an institutional model of TMK of the Sangomas THs.
Education within schools provides students with learning arenas where they graduate and are able to practice their profession as sangomas Thornton, Increased mobility and rural-urban migration by individuals to townships and cities in search of livelihoods and opportunities are similarly predominantly the case as socio-spatial transformations continue to evolve in the study area.
Similarities exist between the Luo and the Wasukuma in terms of historical migrations and TMK practices; the early Luo settlers in Kenya also had a pastoralist orientation.
Male out-migrations from rural to urban areas have also been characteristic of this region and remittances from migratory wage labor provide important cash income for families left behind. Rural-urban migrations involve social, economic, and cultural transformations, including changes in health practices and knowledge which will influence how TMK is perceived by the younger generation.
Historically, traditional knowledge systems have been marginalized in relation to western systems Hoopers, ; Hountondji, ; Majeke, Although Colonial governments appreciated the existence of TMK alongside the introduced Western medicine, there was not much effort to promote this knowledge field.
Consequent efforts and official policy on TMK after independence have varied and there are important differences in formal and informal perceptions, practice, and policy on TMK between Kenya and Tanzania.
In Kenya, this sector is within the national culture and social services sector while in Tanzania it is within the health sector.
The Kenyan and Tanzanian governments' policy for free primary education has provided incentives and opportunities for school attendance in both study areas, which also has led some TPs to promote the combination of TMK with formal primary education.
Learning processes occur that combined formal medical education in the urban area and then return to the rural area for training as a TP, thus young people are encouraged to become practitioners by way of combining the profession with formal medical studies.
Majeke puts forward that contents of syllabi emphasize the social and cultural rhythms of the early colonial settler communities with conceptual structures and categories of thought borrowed from European days of the past.
Colonial authorities taught and trained indigenous African students in schools and tertiary institutions in skills that did not fit them back into their communities, and that forced them to work in employment situations where foreign people's undertakings were situated.
Unlike the case of the institution of traditional healing of the sangoma in South Africa, where knowledge transmission takes place within schools from where students obtain membership and graduate as sangomas Thornton, , the learning processes by traditional practitioners in Kenya and Tanzania are not organized in a formal system of education in specific locations.
Traditional practitioners nevertheless have their professional networks, organizations, and meetings, for instance within the Traditional Practitioners Association in Homabay and Traditional practitioners Association in Mwanza. Official documents in Kenya and Tanzania state that ongoing socio-spatial dynamics could be transforming the role of the THs in the study region see e.
The empirical material showed a range of learning practices of practitioners, who worked mostly in their own houses and had their teaching organized spatially according to the location of plants and places of special significance.
The practitioners described the practical ways by which TMK is transferred gradually, over a long period of time and developed from the knowledge of one kind to different varieties and types of medicinal products.
The main approach of training is learning by doing in the home of the TH. The trainee repeats the different healing procedures until he or she is an expert, and it may for instance take years to remember the names of the numerous sometimes over different types of medicine:.
You see… in training for traditional native medicines, they say how come you have managed all diseases? Because you have sat on it for years… see this young boy, he has been here since he was a small boy and he is still in training male TH Magu.
While oral narrations are central in the training, THs place little importance on written information. One TH described how written information may even be less likely to be viable as enabling the transfer of knowledge than oral training:. The 1,—2, trees I have planted… I tell them to go and pick the trees and when they come I show them which and which to mix together.
That is how we teach those trainees. If you keep it in the book, nothing! It will get lost male TH Magu. Resident trainees were more common in Magu, Tanzania than in Homabay Kenya and more often in the rural than urban settings.
Trainees who reside with the THs within the urban setting are most often though not always the direct offspring of the TH. When the trainee attends formal education, he or she goes to the TH's practice after school and undertakes further training during the school holidays.
THs expressed concern about rural-urban migration and changing livelihoods of the younger generation, which apart from less time for learning could lead to negative values and attitudes toward TMK:.
My son was taught by his grandmother's sister but he has left this work and does not attach value to it male TH Suba, Kenya. The young people are not vigilant and are not interested. They think it is old-fashioned and only prefer modern medicine female TH Rachuonyo, Kenya.
However, the interviews also showed that young people increasingly realized the income potential of traditional medicine through observations of the marketing of the products in the urban areas. Traditional practitioners increasingly sell their products and provide their services in urban markets:.
The youth are interested when they see that I have an income; I sell at the market in Homabay and at Rodi Kopany male TH Gem, Kenya. The interviews showed that tougher socio-economic conditions both in rural and urban areas make it more difficult for TPs to provide housing for trainees, and, obviously, school attendance makes time more limited for a learning practice that takes many years even when it is continuous.
The importance of teaching indigenous knowledge to the youth was highlighted by the practitioners in both rural and urban settings, but they also stressed the challenges to TMK related to migration and rapid urbanization. The trainee is sent to specific destinations to collect the products. Being sent is emphasized as crucial for obtaining the knowledge, but is also a form of payment from the trainee to the TH.
The trainee is regularly sent to the forest or bush to collect and harvest medicinal plants in order to bring them back to the homestead, which can be both time-consuming and tiring. First, if you want to know about work you should be a person's messenger.
She says, go and dig this medicine, you see this medicine… go and look for it and bring it to me… so you do it until you will know it female TH Gem. The TP shows the trainees the exact character of the medicines explaining what they cure.
Being sent and in-house repeated demonstration and practical work with patients are the ways the trainee receives the education.
Without fees paid for the education, the trainees contribute as a form of payment to be sent to harvest the medicine, help on the farm, and provide other services within the homestead.
Is there any payment they give you? No, they do not pay me anything… so what benefits will you get from showing them? My interest is that I give them.
They acquire the legacy from me. I want them to acquire the knowledge from me male TH HB. According to the stories of the practitioners, the teaching, transfering, and processing of TMK today have both similarities and differences with the ways the older generation learned their practices.
Some major differences relate to the abundance of plants closer to the homestead in previous times. The geographical distances to places of harvest as well as to beneficiaries have increased, which means both that trainees have to be sent long distances and that new plant preservations techniques have developed:.
It is not different, but the style in which I use the medicine… is different from the old time, the system is different. You know, the old people used to dig the medicine, put it in a pot and boil it, and then people drank it. I take the medicine, I pound it until it is very soft, soft… then I spread it in the sun and it dries and I use it in powder form.
It means that in powder form it can be used for a long time, you know, it can last longer while the boiled one has a short shelf life… female TH HB. The youth today do not agree to be sent male TH Gem.
The older TP's thus harvested, boiled the TM, and consumed it as a liquid or the boiled leaves. Today, the practitioners use drying and pounding techniques, which provide a longer shelf life and ease with transportation. Increased migration to the urban centers, which are situated away from the locations where the medicinal products are harvested, has necessitated a change of preservation techniques to accommodate the longer shelf life of the products.
The steady reduction in the availability of medicinal products together with the difficulty of sending trainees long distances also necessitates preservation. Practitioners in both Mwanza and Nyanza described how the older generation used to cultivate TM close to the homestead to help in accessibility and teaching trainees and family members, combining gathering TM from the wild bush with planting them closer to the homestead.
Some of the younger TPs do cultivate plants close to the homestead, but informants also described how they had to seek permission and pay in order to be able to harvest from other clan lands.
Among the Luo, a man's plots are divided among his wives who if deceased pass them on to male children with the senior son receiving the largest portion Ochieng, With the socio-economic and socio-spatial changes, land allocation and accessibility have changed and land has become scarcer.
When clan land gets overcrowded there is further migration to found new polities elsewhere Ochieng, This indirectly or directly influences harvesting and cultivation practices of traditional medicine and the empirical data revealed that this was particularly the case in the Nyanza context where scarcity of land is more apparent than in Mwanza.
Prayer and rituals form an important part of the trainees' education. Larger rituals are an integral part of a healer's work and they are carried out periodically bi-annually; every 3 years. The knowledge of rituals is taught during the learning period and the specific ritual differs from person to person.
Some ritual ceremonies use staple fodder and animal products milk, ghee, sorghum, and millet adorning a special dress code for all participants.
Almost always, a special tree has been chosen as the venue for the ritual ceremonies and these trees are usually situated hundreds of km away from the THs home place. These trees are often not available locally due to deforestation; the specific tree species are rare and often situated at long distances.
These sacred places are visited to acquire spiritual power, perform rituals, and collect medicines. As the tree is situated in another region there must be an agreement with the local village council to enable the visitors to carry out their work. The rituals and ceremonies in specific sacred places were a more important function in Mwanza than in Nyanza.
Due to increased migration dynamics in both contexts of younger populations moving to the urban places in search of alternative livelihoods, this form of training is becoming increasingly rare for the youth given the long distances to the ritual sites, which involves many days' travel.
Through the cure of a prolonged ailment, some chose to become practitioners themselves after a period of training with an older TH for up to 3 years. The suffering itself was then seen as part of and even a requisite for the learning process.
I was hurting. After I was healed I started to treat others one by one female TH, Magu. The research revealed that becoming a TP at a later age, sometimes through own illness, frequently took place outside the home area of the trainee, and often even outside the country of origin.
After graduation, a number of these trainees migrate back to their original homes and set up their own village hospitals.
The latter was seen more often in Tanzania than in Kenya. We have given many who now have their own villages, more than 10 persons, they are now in Dar es Salaam, Musoma, Tarime… … and also Kenya male TH Magu. Those who I am giving the system, they may in the future provide even better ways of treating and having a central role, perhaps they will be able to treat even better than I do, make TMK even have a bigger role, they may improvise Male TH 67 years.
Homabay, Kenya. The gift is supposed to be used to help cure ailments and societal problems. It is the duty of the traditional practitioner to act as a medium through which this gift is shared with individuals within the society who may need it, thus diffusion of the knowledge is central.
You see someone whose heart is good … You do not just give it to anyone… if you see someone who is hurting then you have sympathy for helping him… so then a lot of discoveries can come out of that medicine for you … female TBA Homabay. Those who I am giving the system, they may in the future provide even better ways of treating, they perhaps will be able to treat even better than I do, there may be improvising male TH HB.
TPs linked this negative knowledge diffusion to outmigration, with potentially negative effects on patients:. Adding someone's knowledge as it was added to me, I still find it difficult in one way.
There was someone with a good idea and they took him and gave him a job. Then it happened that he was sent away from the work. Then you know that those people have remained with all his ideas…and then they take the customers that you used to get male TH Gem.
Many herbalists think the medicines which I have, they should also have, so they take them…at times they give wrong medicines and overdose them, which can injure people male TH HB.
The discussion on sorcery arises in the empirical data, particularly within the context of ethics and socio-cultural and socio-economic problems. In all interviews, this phenomenon was mentioned and vehemently criticized by the TPs and authorities. In the citations above, the fears were in particular related to the mobile younger generation's uses of TMK.
Dynamic changes in societal processes in the communities linked to migration and urbanization highlighted the role of parents, who sometimes feared and critiqued the TP's work:.
Parents think it is negative and they have fear male TH Gem. Some fear and accuse the young people of learning how to bewitch and kill people… male TH Gem. The family and household need to have a consensus on if the TMK can be taught to the youth female TH Gem.
Some of the TPs who were interviewed had future plans to expand premises for patients both in rural and urban areas. In particular in Tanzania, commonly mentioned were plans to cultivate medicinal plants on land already purchased and acquired for this purpose. Some TPs saw the way forward in finding new ways of combining TMK learning with formal education, thus bridging rural practices with urban educational and market opportunities.
While expressing concerns about the future generations, many respondents nevertheless stressed that youth are interested and wish to practice as TPs. We found learning processes that combined formal medical education with TMK, and some traditional practitioners, who themselves had formal western education, encouraged their offspring to complete their education before pursuing work with traditional medicine.
Are the youth interested in learning about traditional medicine? Very much. The moment they learn this they want to continue…I say they should finish school first, and to those who have finished, I teach the treatment male TH HB. There is another one who tried to read, and recently went to the college of medicine.
Now he has finished and is at home… you see he has inherited male TH HB. I used to teach both modern medicine and traditional medicine. People come and I also refer to the hospital. Every 2 days they come and I give advice male TH, Suba.
In our study area, we found several cases of medical pluralism We understand medical pluralism as the consultation of both traditional and western medical practices. Some Wasukuma practitioners explicitly recognized the benefits of modern medicine, and several of our respondents suggested that there are certain ailments that only a traditional healer can cure, yet there are other sicknesses that a modern hospital can more readily heal with technologies such as intravenous fluids and store-bought medicines.
Pragmatic considerations were common, but forms of true cooperation between the two systems were rare. The interactions between traditional and modern health systems were related to rural—urban inequalities and did not take place without complications. We found only a few cases of close cooperation between practitioners and modern health systems, such as when the TP referred his patients to hospitals, and one practitioner received patients from the hospitals and organized a transportation system to facilitate the interaction between his village and the urban hospital.
The growing disenchantment with farming as a way of life has made young rural based people in both Mwanza and Nyanza to migrate and actively diversify into non-agricultural activities.
Rural-based TMK is not perceived as a viable long term livelihood strategy for the younger generation, but some traditional practitioners envisioned a strategy for young people to become practitioners by way of combining formal medical studies in the urban area and then return to the rural area for training as a TP.
Two respondents had sons who were attending urban formal education and intended to complete it before continuing working with traditional medicine in the rural setting. Another respondent's son, who was 18 years old, had decided to become a doctor in formal medicine and thereafter practice as a traditional healer.
TPs testified that it has become more common that younger TPs are trained in both systems. The younger populations attribute lower value to TMK which indicates rising challenges of TMK and its transmission to further generations of TPs. With the introduction of formal western education during the colonial and postcolonial eras, there was a disdain for traditional knowledge, and children were expected to abandon previous learning systems Miller, Despite the continued use and importance of TMK, this legacy contributes to prevailing negative perceptions and suspicions about learning TMK.
The traditional practitioners interviewed in this study described how environmental pressure, migration of the youth, and socio-spatial changes in the study area over the last three decades have created new challenges for TMK practices.
Some were concerned about negative values about TMK in the younger generation, while others stressed the will of young people to engage in training and become practitioners. The youth's keen interest to learn was seen to increase when they viewed improved livelihood possibilities of THs due to the commercialization of medicinal plants, especially in the outmigration spaces.
Some of the interviewed practitioners pointed out the missing link between TMK learning processes and the formal education system. Our study showed a strong influence of modern education in affecting the perceptions and access of the youth to TMK.
With this opportunity, the youth who migrate to attend modern education have limited time if any to learn TMK.
The future of TMK learning processes may be limited unless incentives are in place for the youth, regarding their future livelihoods. Odore argues that in Africa, colonial science and education are knowledge on Africa.
The problem today is how to make it knowledge by Africans for their own collective promotion and development. The Wasukuma and Luo's youth livelihoods are increasingly merging into circumstances that place a lower value on their traditional medicinal knowledge.
Under this pressure, traditional knowledge of medicinal plants is starting to disappear, with little to take its place. Formal knowledge is commonly promoted to young people but too often without providing the means to gain access to it Beyer, The study showed that the role of TMK in the past was very central to community health care and that it continues to be significant.
The interaction between traditional practitioners and the modern health system varied in the different places of the study area, with examples of close and uncomplicated cooperation in some places and little or no interaction in others.
In both study areas, the THs generally stated that there are some signs of a new awareness and popularity of TMK, but the younger generation does not take TMK as seriously as the older generation and there is a need for concerted efforts for its promotion and youth involvement.
A central question during the interviews with practitioners was how young people will be taught in the future. During fieldwork, it was not uncommon that there were no trainees in the homesteads of THs.
Many young people lack interest in learning TMK and do not approach them often, but in both study areas, there were TPs who had trainees who were positive and interested in learning. If assistance were provided, a number of TPs mentioned that they would in the future be enabled to organize more training for the interested youth.
The youth who are receiving this TMK would be better equipped if combining TMK with modern medical knowledge and, as one interview person expressed it, might be able to improvise some of the ways in which they treat.
The prevailing dominant scientific paradigm in school education is a context where few elements of TMK practices are permitted to surface Indigenous Knowledge and Peoples Knowledge IKAP , The youth, who migrate between these two knowledge systems, take action out of the predominant worldview, as seen in the study.
Tensions between the youth and elders emerge, knowledge is lost and undermined, while biodiversity is threatened and diminished.
Some researchers argue that the increased migration of youth to urban centers denies the younger generation traditional community support systems, which include education in survival skills, communication skills, safety, and conflict prevention Ntuli, TMK is a result of experimentation and research, trial and error, providing room for innovative local knowledge learning in local practices and systems, even incorporating external knowledge based on different worldviews.
In both urban settings of the study area, TPs have established associations of TMK practitioners in which many of our interviewed persons were members. The major challenges revolve around their roles and relationships with the formal medical establishment as well as issues related to socio-spatial changes such as increased rural-urban migrations, and biodiversity loss.
Colonial structures are perceived to have been detrimental to the social dynamics of TMK as these structures negated traditional knowledge and subordinated it. Despite this legacy, most TPs could see new roles of TPs and emphasized the promotion of TMK as a continued important aspect of community health in response to rapid socio-spatial changes and outmigration dynamics.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by Tanzania National Commission of Science and Technology.
Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.
Traditional medicine also Tradiitonal as indigenous medicine or folk medicine comprises Tradutional aspects Orange splash energy drink Traditional medicine knowledge knowledge that developed over generations within the folk beliefs of various societies, kedicine indigenous peoples medicone, before the era Traditiojal modern Traditional medicine knowledge. The World Health Organization WHO defines Trzditional medicine as "the sum total Traditionak Traditional medicine knowledge Tradjtional, skills, and practices Increase fullness after meals on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement and treatment of physical and mental illness". Traditional medicine is a form of alternative medicine. Practices known as traditional medicines include traditional European medicine [ citation needed ]traditional Chinese medicinetraditional Korean medicinetraditional African medicineAyurvedaSiddha medicineUnaniancient Iranian medicinetraditional Iranian medicinemedieval Islamic medicineMutiIfá and Rongoā. Scientific disciplines that study traditional medicine include herbalismethnomedicineethnobotanyand medical anthropology.Video
Traditional Medicine: five areas of work of the WHO Global Centre for Traditional Medicine (GCTM) The transfer Traditional medicine knowledge Traditionao knowledge to new generations of Traditiona medicinal practitioners takes place Traditjonal place-based mexicine learning processes, which are Traditional medicine knowledge challenged medicune intensified rural—urban migrations knowledgs accelerating biodiversity loss. Research on traditional Traditional medicine knowledge Trasitional TMK has Glucose utilization focused on the medicinal Fiber optic network performance of different plant species while social, economic, and Traditional medicine knowledge Traditoinal of TMK learning processes have received less attention. The purpose of this article is to contribute to the research field by examining how the learning processes of TMK are affected by on-going socio-spatial transformations in rural and urban parts of the Eastern Lake Victoria region. Urbanization and migration are transforming the learning processes of TMK and affect the ways traditional practitioners are able to transfer TMK to a new generation of practitioners. Based on in-depth interviews, participant observations and focus group discussions with male and female traditional practitioners aged between 30 and 95 from rural and urban settings in Mwanza Tanzania and Nyanza Kenya in the Eastern Lake Victoria Region.
Traditional medicine knowledge -
Fieldwork was conducted in Mwanza and Nyanza for a total of 2 months between June and September and a follow-up fieldwork for 2 months from June to August of The interviews were conducted during the first period of The second period is when the FGDs and participant observations took place.
In addition to interviews and FGDs, participant observations took place during activities of non-timber forest products NTFP gathering, healing ceremonies, and market days. Twenty traditional practitioners THs , 10 men and 10 women, aged between 30 and 95 were interviewed.
Interviews lasted between one to several hours, and some THs were interviewed on several occasions. The majority of the traditional practitioners had primary level education, only two were not educated in the formal education system while three women and seven men had secondary formal education.
In addition to these individual in-depth interviews, five focus group discussions FGD were conducted in Mwanza and Nyanza of which one was all female seven discussants , one all male seven discussants , and three were mixed in each of three FGDs, four women and four men.
Together with the field assistants, we worked through the initial research questions in order that the questions we posed during the interviews could be suitable for the local contextual sense.
Therefore, substantial time was spent initially prior to the actual interviews and FGDs in developing questions that were directly the research questions. Outsiders are perceived with suspicion. Throughout the fieldwork, we were careful to establish ethical consent with participants, the research board, and other collaborators.
The author originates from the region and has older family members who are well-known in the area, which facilitated access and permitted a snow-ball sampling technique for locating THs both in Mwanza and Nyanza.
The reliability of the data was accessed through the use of comprehensive data sets from the discussions with National health institutions working with the practitioners for instance the Kenya Medical Research Institute, Institute of Traditional Medicine at the Muhimbili University Teaching Hospital, and NGO organizations working with the THs, e.
The traditional practitioners in the study area are organized in associations and organizations which work with local NGOs and in the case of Mwanza with the local district hospital in Magu. The NGOs and local-based organizations provided material that aided me in understanding the linkages between formal and informal health organizations.
The data was constantly tested and compared to ascertain the accuracy, while throughout my transcribing of the recorded material, I tabulated and recorded the data in Tables in order to ascertain the accuracy of the data.
The field assistants were constantly collaborating with me on my data collection and data analysis assisting in clarifying proverbs, metaphors and other meanings that were unclear to the author.
One of the THs whose father had been a prominent practitioner for decades helped in clarifications of proverbs and meanings within the narratives. Interviews were taped and conducted in English, Kiswahili, and Kisukuma in Mwanza, and in English and Dholuo in Nyanza.
Braun and Clarke describe thematic analysis as a method not based on a specific or pre-existing theoretical framework, but rather one used to identify, analyze, and report themes that are closely related to the empirical data.
The advantage of the thematic approach is its flexibility and sensitivity to emerging themes in the empirical data. Thematic analysis TA was used as a strategy for analysis of interview data, TA is viewed as the main pathway of qualitative methods, due to its path of common approaches with a number of qualitative methods in the social sciences.
I thus used thematic analysis to extract themes from my interview data. This approach is sensitive to emerging themes in the empirical data and permits flexibility in terms of theoretical perspectives Braun and Clarke, TA describes an analytical approach to the empirical material as a response to the questions and aims of the study.
The choice to use a thematic narrative analysis approach in the analysis of my empirical material permitted me to reach a more profound understanding of the phenomena embedded in TMK and related practices, as perceived by THs and other respondents.
I found it useful to try to find common thematic elements across the narratives and stories represented in the texts transcribed from the interviews and the events they reported. Major themes related to socio-spatial aspects of intergenerational learning processes were identified and analyzed within a relational understanding of migration in place and space.
Learning TMK includes obtaining proficiency in the identification, preparation, conservation, management, and administration of medicinal products.
While rather few studies have looked at the importance of place and space or socio-spatial dimensions for medicinal learning processes, there are recent important contributions by Lindstrom and Muñoz-Franco , who studied the impact of outmigration on certain types of health knowledge, and other researchers who point out how place and social networks are crucial for health knowledge transmission Andrzejewski et al.
Through several generations, knowledge on the identification of plant species with medicinal properties and their use has been developed Sheldon and Balick, TMK learning is viewed as both temporal and spatial or place-based. It relates to language, historical processes, and social relations which are largely influenced by political, economic, and social processes Hanks, In line with a relational understanding of social and spatial dimensions, intergenerational learning processes of medicinal knowledge are in this study understood as place-based and related to history, language, and social relations Geissler et al.
Some studies discuss prolepsis which takes a socio-cultural theoretical approach that conceptualizes the transmission of knowledge between generations where experiences are passed down and knowledge and values re-evaluated in the context of a rapidly changing world Cole, Studies on learning processes that are inter and intra-generational discuss processes that are co-constructed within relationships of mutuality and reciprocity Eyssartier et al.
Inter-generational relations and the priority accorded to seniority, which is at the core of social organization in Africa, have determined the modalities of learning processes of younger generations.
Given the numeric importance and the heterogeneity of the young demographic group, these processes change relative to the social context French Institute for Research in Africa, Prince and Geissler describe how traditional medicinal knowledge among the Luo is usually imparted between alternate generations.
These skills are also seen to complement formal educational learning skills while invoking cultural continuity and change Kenner et al. As is the case for the Luo in Kenya Sankan, ; Sindiga, and the Wasukuma of Tanzania, oral transfer of knowledge of ethnomedicine is also common in other ethnic groups in East Africa Ochieng' Obado et al.
Training to become a TH usually starts during the pre-adolescent age when the child is perceived as receptive, obedient, has a good memory, and can keep secrets Mwiturubani, Luo plant medicine has been argued to be mainly a domain of women's activity Olenja, but in general, in the study region, both men and women engage in TMK learning processes, while the three major forms of becoming a TH—inheritance, own illness, and calling—are not gender-specific.
Mejeke argues however that the present system of education in Africa emphasizes social and cultural contexts that are far removed from conceptual structures that are within African communities Majeke, A fundamental transformation with an aim of altering educational syllabi can be seen in what is described as mutual decolonization Crossman and Devisch, South Africa has developed an institutional model of TMK of the Sangomas THs.
Education within schools provides students with learning arenas where they graduate and are able to practice their profession as sangomas Thornton, Increased mobility and rural-urban migration by individuals to townships and cities in search of livelihoods and opportunities are similarly predominantly the case as socio-spatial transformations continue to evolve in the study area.
Similarities exist between the Luo and the Wasukuma in terms of historical migrations and TMK practices; the early Luo settlers in Kenya also had a pastoralist orientation.
Male out-migrations from rural to urban areas have also been characteristic of this region and remittances from migratory wage labor provide important cash income for families left behind. Rural-urban migrations involve social, economic, and cultural transformations, including changes in health practices and knowledge which will influence how TMK is perceived by the younger generation.
Historically, traditional knowledge systems have been marginalized in relation to western systems Hoopers, ; Hountondji, ; Majeke, Although Colonial governments appreciated the existence of TMK alongside the introduced Western medicine, there was not much effort to promote this knowledge field.
Consequent efforts and official policy on TMK after independence have varied and there are important differences in formal and informal perceptions, practice, and policy on TMK between Kenya and Tanzania. In Kenya, this sector is within the national culture and social services sector while in Tanzania it is within the health sector.
The Kenyan and Tanzanian governments' policy for free primary education has provided incentives and opportunities for school attendance in both study areas, which also has led some TPs to promote the combination of TMK with formal primary education. Learning processes occur that combined formal medical education in the urban area and then return to the rural area for training as a TP, thus young people are encouraged to become practitioners by way of combining the profession with formal medical studies.
Majeke puts forward that contents of syllabi emphasize the social and cultural rhythms of the early colonial settler communities with conceptual structures and categories of thought borrowed from European days of the past.
Colonial authorities taught and trained indigenous African students in schools and tertiary institutions in skills that did not fit them back into their communities, and that forced them to work in employment situations where foreign people's undertakings were situated.
Unlike the case of the institution of traditional healing of the sangoma in South Africa, where knowledge transmission takes place within schools from where students obtain membership and graduate as sangomas Thornton, , the learning processes by traditional practitioners in Kenya and Tanzania are not organized in a formal system of education in specific locations.
Traditional practitioners nevertheless have their professional networks, organizations, and meetings, for instance within the Traditional Practitioners Association in Homabay and Traditional practitioners Association in Mwanza.
Official documents in Kenya and Tanzania state that ongoing socio-spatial dynamics could be transforming the role of the THs in the study region see e. The empirical material showed a range of learning practices of practitioners, who worked mostly in their own houses and had their teaching organized spatially according to the location of plants and places of special significance.
The practitioners described the practical ways by which TMK is transferred gradually, over a long period of time and developed from the knowledge of one kind to different varieties and types of medicinal products.
The main approach of training is learning by doing in the home of the TH. The trainee repeats the different healing procedures until he or she is an expert, and it may for instance take years to remember the names of the numerous sometimes over different types of medicine:.
You see… in training for traditional native medicines, they say how come you have managed all diseases? Because you have sat on it for years… see this young boy, he has been here since he was a small boy and he is still in training male TH Magu.
While oral narrations are central in the training, THs place little importance on written information. One TH described how written information may even be less likely to be viable as enabling the transfer of knowledge than oral training:.
The 1,—2, trees I have planted… I tell them to go and pick the trees and when they come I show them which and which to mix together. That is how we teach those trainees. If you keep it in the book, nothing!
It will get lost male TH Magu. Resident trainees were more common in Magu, Tanzania than in Homabay Kenya and more often in the rural than urban settings. Trainees who reside with the THs within the urban setting are most often though not always the direct offspring of the TH. When the trainee attends formal education, he or she goes to the TH's practice after school and undertakes further training during the school holidays.
THs expressed concern about rural-urban migration and changing livelihoods of the younger generation, which apart from less time for learning could lead to negative values and attitudes toward TMK:.
My son was taught by his grandmother's sister but he has left this work and does not attach value to it male TH Suba, Kenya. The young people are not vigilant and are not interested.
They think it is old-fashioned and only prefer modern medicine female TH Rachuonyo, Kenya. However, the interviews also showed that young people increasingly realized the income potential of traditional medicine through observations of the marketing of the products in the urban areas. Traditional practitioners increasingly sell their products and provide their services in urban markets:.
The youth are interested when they see that I have an income; I sell at the market in Homabay and at Rodi Kopany male TH Gem, Kenya. The interviews showed that tougher socio-economic conditions both in rural and urban areas make it more difficult for TPs to provide housing for trainees, and, obviously, school attendance makes time more limited for a learning practice that takes many years even when it is continuous.
The importance of teaching indigenous knowledge to the youth was highlighted by the practitioners in both rural and urban settings, but they also stressed the challenges to TMK related to migration and rapid urbanization.
The trainee is sent to specific destinations to collect the products. Being sent is emphasized as crucial for obtaining the knowledge, but is also a form of payment from the trainee to the TH.
The trainee is regularly sent to the forest or bush to collect and harvest medicinal plants in order to bring them back to the homestead, which can be both time-consuming and tiring. First, if you want to know about work you should be a person's messenger. She says, go and dig this medicine, you see this medicine… go and look for it and bring it to me… so you do it until you will know it female TH Gem.
The TP shows the trainees the exact character of the medicines explaining what they cure. Being sent and in-house repeated demonstration and practical work with patients are the ways the trainee receives the education. Without fees paid for the education, the trainees contribute as a form of payment to be sent to harvest the medicine, help on the farm, and provide other services within the homestead.
Is there any payment they give you? No, they do not pay me anything… so what benefits will you get from showing them? My interest is that I give them. They acquire the legacy from me. I want them to acquire the knowledge from me male TH HB. According to the stories of the practitioners, the teaching, transfering, and processing of TMK today have both similarities and differences with the ways the older generation learned their practices.
Some major differences relate to the abundance of plants closer to the homestead in previous times. The geographical distances to places of harvest as well as to beneficiaries have increased, which means both that trainees have to be sent long distances and that new plant preservations techniques have developed:.
It is not different, but the style in which I use the medicine… is different from the old time, the system is different. You know, the old people used to dig the medicine, put it in a pot and boil it, and then people drank it.
I take the medicine, I pound it until it is very soft, soft… then I spread it in the sun and it dries and I use it in powder form. It means that in powder form it can be used for a long time, you know, it can last longer while the boiled one has a short shelf life… female TH HB.
The youth today do not agree to be sent male TH Gem. The older TP's thus harvested, boiled the TM, and consumed it as a liquid or the boiled leaves.
Today, the practitioners use drying and pounding techniques, which provide a longer shelf life and ease with transportation. Increased migration to the urban centers, which are situated away from the locations where the medicinal products are harvested, has necessitated a change of preservation techniques to accommodate the longer shelf life of the products.
The steady reduction in the availability of medicinal products together with the difficulty of sending trainees long distances also necessitates preservation. Practitioners in both Mwanza and Nyanza described how the older generation used to cultivate TM close to the homestead to help in accessibility and teaching trainees and family members, combining gathering TM from the wild bush with planting them closer to the homestead.
Some of the younger TPs do cultivate plants close to the homestead, but informants also described how they had to seek permission and pay in order to be able to harvest from other clan lands. Among the Luo, a man's plots are divided among his wives who if deceased pass them on to male children with the senior son receiving the largest portion Ochieng, With the socio-economic and socio-spatial changes, land allocation and accessibility have changed and land has become scarcer.
When clan land gets overcrowded there is further migration to found new polities elsewhere Ochieng, This indirectly or directly influences harvesting and cultivation practices of traditional medicine and the empirical data revealed that this was particularly the case in the Nyanza context where scarcity of land is more apparent than in Mwanza.
Prayer and rituals form an important part of the trainees' education. Larger rituals are an integral part of a healer's work and they are carried out periodically bi-annually; every 3 years. The knowledge of rituals is taught during the learning period and the specific ritual differs from person to person.
Some ritual ceremonies use staple fodder and animal products milk, ghee, sorghum, and millet adorning a special dress code for all participants.
Almost always, a special tree has been chosen as the venue for the ritual ceremonies and these trees are usually situated hundreds of km away from the THs home place.
These trees are often not available locally due to deforestation; the specific tree species are rare and often situated at long distances. These sacred places are visited to acquire spiritual power, perform rituals, and collect medicines.
As the tree is situated in another region there must be an agreement with the local village council to enable the visitors to carry out their work.
The rituals and ceremonies in specific sacred places were a more important function in Mwanza than in Nyanza. Due to increased migration dynamics in both contexts of younger populations moving to the urban places in search of alternative livelihoods, this form of training is becoming increasingly rare for the youth given the long distances to the ritual sites, which involves many days' travel.
Through the cure of a prolonged ailment, some chose to become practitioners themselves after a period of training with an older TH for up to 3 years. The suffering itself was then seen as part of and even a requisite for the learning process.
I was hurting. After I was healed I started to treat others one by one female TH, Magu. The research revealed that becoming a TP at a later age, sometimes through own illness, frequently took place outside the home area of the trainee, and often even outside the country of origin.
Two tribes live in this area, the Sherani شیرانئ in the west and the Ustranas اؤسترانئ in the east [ 30 ]. The Sherani area is divided into plains and hills. This study focuses on the hills of the Sherani area which are inhabited by three sub-tribes: the Oba Khel- اوباخیل ca.
Interviews were conducted in five foothill villages i. پئوڑمیلا, 2. لنڈئ کؤتڑزئ, 3. زندہ وا ر,. جٹئ غبژ, 1. Livelihood strategies include livestock raising, timber cutting, non-timber forest products collection and labor work on daily wages.
Also, personal observations and group discussions were held to get an overview of general concepts of natural phenomena and familiarize with local terms and their emic definitions [ 33 ]. Most informants were male due to cultural restrictions on involving female informants.
Key female informants were included indirectly, mostly through interviewing their sons. We built rapport with the local communities and were allowed to live with the people, accompany them during their daily life, and attend ritual ceremonies.
The ethical guidelines of the International Society of Ethnobiology [ 34 ] were strictly followed during the whole research process. Consent was obtained from every informant before interviewing where objectives, procedure and methodology of the project were also explained.
Specimens were prepared of all documented plants Table 5. These were identified by taxonomists at Quaid-I-Azam University Islamabad Pakistan by Dr. Mushtaq Ahmad and reconfirmed by comparing with specimens in the Herbarium of Pakistan and the Flora of Pakistan [ 45 , 46 ].
Families were assigned according to Chase et al. All voucher specimens with accession numbers were deposited at the Herbarium of Pakistan ISL , Quaid-I-Azam University Islamabad Pakistan. Information on medicinal plants was analyzed using use reports URs- as in Table 3 , 4 , 5.
One use report corresponds to a specific plant part administered in a specific way against a disease as mentioned by one informant. Freelist data were analyzed using descriptive statistics.
To determine the most frequently used plant species for treating a particular ailment category by the informants of the study area, we calculated the fidelity level FL-, as in Table 6 by following Alexiades [ 49 ].
The availability of species was categorized into frequent, occasional, and rare based on personal observations in the field and discussions with the informants by following the criteria of DAFOR scale.
Local terms for diseases were reconfirmed with the regional medical doctors. To facilitate cross-cultural comparisons and to highlight uniqueness and similarities, we categorized all the diseases mentioned by the interviewees into 16 disease categories according to the symptoms they cause and the organs they affect [ 50 ]; see Table 2.
The local health care system is pluralistic and consists of different types of specialists with different backgrounds. According to their needs, local people visit one or several of these specialists. The choice of medicine is based on severity of disease, effectiveness of the medicine and ease of availability.
Two types of ritual specialists are found: a Mullayan ملایان , the religious specialists with formal religious education from a religious school called Madrasa مدرسہ. He uses religious knowledge for healing including the scripture from the holy books and practices from Quran, Hadith, and Sunnah; and is responsible for other religious duties like collective prayers and funeral processions.
Most villages have a Mulla and they tend to have average medicinal plant knowledge; all Mulla we met were men, but nowadays women can also attend religious schools. b Aamel عامل , is a ritual specialist consulted when people contract unusual diseases related to spirits.
Usually, they are male but female Aamel also exist. Aamel apprentice with experienced Aamel and go through arduous training. They communicate with spirits, locally called Paerai پیرائی , and are widely known as Jinn. These are entities which can cause physical and mental harm to humans but can be tamed by Aamel.
These specialists are rare in the area, and usually lack knowledge of medicinal plants. Consultants or pulse diagnosers identify the ailment through pulse and provide or suggest appropriate treatment with medicinal plants or other drugs, wearing of animal skin, ritual treatment, or biomedical treatment.
Locals visit consultants when unaware of what ails them. Consultants have good medicinal plant knowledge. Traditional bone setters adjust broken and disjointed bones.
They are rare in the area and their knowledge is inherited from elders. Rural bone setters tend to use medicinal plants whereas urban bone setters use conventional pharmaceuticals.
Traditional midwives or birth attendants - usually one per village - are wise and experienced women invited during childbirth. They are knowledgeable regarding medicinal plants.
Biomedical drugs are administered by medically trained doctors in clinics in urbanized areas. Untrained drug sellers are found in every 3rd or 4th village. They also advise usage and administering of drugs.
There are no specific local medicinal plant specialists, but elders have knowledge of medicinal plants and use them in their families. They are mostly old and experienced people who inherit this knowledge from ancestors and other elders. The local materia medica is composed of plants, animals, minerals, and other sources while the local etiology revolves around the Unani concept of humours.
This concept reached the area through practitioners trained in Unani medicine from united India who settled in remote tribal areas for community services. Their knowledge was incorporated into the knowledge system of the communities personal communication with Unani medicine experts.
It can happen intentionally or unintentionally. Evil eye is a concept that describes the power of envy and jealousy. Humans obsessed by envy or jealousy can, with their eyesight, harm their fellow men intentionally or unintentionally.
For protection, a religious amulet is mostly used, or sometimes a small temporary black scar is made with coal on the visible part of the skin. It is used for a large number of ailments especially in cases of emergency and complications Table 4. Generally, goat skin is considered cold and advised to be worn in summer, while sheep skin is warm and is advised for the winter.
Use of each can also be advised regardless of the season. According to key informants, use of the skin needs special care, otherwise, the disease may worsen. Wearing the skin needs to be carefully adjusted to the progression of the disease.
For example, skin wearing is advised only at the beginning of malaria; advised at the beginning or end of typhoid but not at the climax when symptoms are the strongest.
Correct and effective usage is mostly advised by the consultants of the area or by the elders of the family. Wearing of the skin influences this balance, smoothens and supports the body according to its requirements, and detoxifies through suction.
Other remedies made from animals include bear and porcupine fats used against musculoskeletal problems, ass milk against whopping cough, and gall bladder bile from the Sulaiman Markhor—a wild goat Capra falconeri — against hepatitis B and C Table 3.
A total of 44 species of plants were documented with use reports Table 5. The medicinal species are herbs 21 spp. which are distributed among foothills 28 spp.
with UR and mountainous areas 16 spp. with UR; Table 5. Among all, a single species Curcuma longa is cultivated, three are semi-cultivated, i. Majority of the species are frequently available 23 spp.
while some are occasional 16 spp. and others rare 5 spp. Almost half of the plants 28 spp. are used only in fresh form while the remaining 16 spp.
are used in both fresh and dried forms. Additionally, 16 species among the documented medicinal plants are also used as food Table 5. All the diseases cured with medicinal plants are categorized into 16 disease categories in which gastrointestinal diseases are the most commonly mentioned with high number of species and use reports followed by multisystem and ritual, respectively Fig.
Leaves are mostly used, while gums, resins, latex, and wood-oil also play an important role Fig. All the documented medicinal preparations are based on a single plant. Most often, plant parts are used unprocessed e.
Medicine is taken orally 24 spp. or used topically 9 spp. and some species have both oral and topical applications 9 spp.
Only two species are used for their smell and smoke Table 5 , Fig. Medicinal plant knowledge is similar among villages Fig. Three-fourths of all medicinal plant species were mentioned in more than one of the villages, and 15 spp. Also, sheep and goat skins are homogenously used in addition to animal and mineral based materia medica.
Medicinal plant knowledge is transmitted vertically, i. In the present study, gastrointestinal diseases have the highest number of species and use reports, followed by ritual uses and musculoskeletal ailments number of use reports; Fig.
This mirrors the prevalence of diseases and treatments in the area. Gastrointestinal disorders are common usually due to contaminated water, which are preferably treated with medicinal plants.
This pattern of treating gastrointestinal disorders with medicinal plants is found all over the world among rural communities and usually explained with the antimicrobial properties of many plants used as medicine [ 51 , 52 , 53 ].
Musculoskeletal problems are also common in the area due to the mountainous terrain and accident-prone livelihood activities such as carrying heavy commercial timber.
In contrast, diseases caused by Jinn as well as the concept of evil eye is widely known in Islamic regions and broadly discussed in literature [ 54 , 55 , 56 ]. This concept is found in many different cultures of the world [ 57 , 58 , 59 ]. Some diseases and medicinal plants are locally perceived as hot and cold, whereas the treatment is based on opposites.
For example, malaria is considered a hot disease, and is treated with an infusion of Teucrium stocksianum, which is considered cold. Similarly, a Withania coagulans infusion is considered cold and is used against sunstroke, a locally perceived hot disease. A hot and cold dichotomy and the treatment with opposites is an integral part of the concept of humours and has been described for other regions of Pakistan [ 39 , 60 ] and all over the globe [ 61 , 62 , 63 ].
The number of medicinal plant species reported from the Sulaiman area is less than reported by other studies, which typically report between 50 and medicinal plant species for comparable sites [ 35 , 37 , 42 ].
This may have several reasons. Animal products, especially the use of goat and sheep skin, are of utmost importance for local treatments. Furthermore, a substantial part of the remedies is apotropaic and, in this case, often made from minerals or other products.
In the Himalayan foothills of Southwest China, a similar situation was found with local healers—among the Shuhi people—who mainly work with ritual plants and their medicinal plant knowledge is relatively scarce compared to other regions [ 64 ].
In the Sulaiman area, health prevention through gathered wild food is also important and may be a reason for relatively little medicinal plant knowledge [ 31 ]. The numbers of species reported as ethnoveterinary [ 28 ] and edible plant species [ 31 ] were also less as compared to other areas.
All of the documented medicinal plant species are reported from other areas of Pakistan with similar or different uses [ 30 , 36 , 37 , 40 , 41 , 65 , 66 ].
Same was the case for ethnoveterinary medicinal plants [ 28 ], whereas one-third species of the wild edibles were also newly reported from the study area [ 31 ], which shows the uniqueness of the Sulaiman area and its culture.
About half of all use reports were from only 6 plant families, i. The relative importance of Pinaceae is due to two Pinus species P. gerardiana and P. wallichiana which are broadly used in the area not only for medicinal but also for ethnoveterinary medication and food purposes [ 28 , 31 ].
The extent of similarity of these results with the prevalence of the families in the local vegetation is unknown, as a checklist of the flora of the Sulaiman Mountains is unavailable.
There are different medicinal and ritual specialists, but no local herbalists in the area. This coupled with the predominant use of fresh plants, animals and minerals for medicinal purposes indicates that the traditional healing system consists of a combination of knowledge from different systems including biomedicine.
A negative impact of syncretism between traditional and biomedicine is that local people tend to use pharmaceuticals like pain killers carelessly since they are unaware of possible side effects and proper dosage.
These concepts are unknown to their traditional medicine. The local use of pharmaceuticals based on traditional concepts of plant medicine and related problems have also been described and discussed for two Amazonian societies [ 57 ].
Medicinal plant knowledge has some variations between villages Fig. While age-wise knowledge difference Fig.
The commonality of medicinal plant knowledge was relatively more prevalent than the ethnoveterinary species [ 28 ] and wild edibles [ 31 ].
Local medicinal plant use is still dynamic. Some medicinal plants are used less recently while others are newly integrated into the materia medica.
Plant medicine might be abandoned due to lack of efficiency, problems of availability, or cheap pharmaceutical alternatives.
For example, there was a decrease in the use of Phlomoides spectabilis leaves against human skin allergy. Newly integrated species are Valeriana jatamansi against diarrhea, ca. Key informants claimed that the extensive use of few medicinal plants like Teucrium stocksianum, Ephedra gerardiana and Withania coagulans Table 6 —compared to available pharmaceuticals—is due to their efficacy.
Plants with high fidelity levels e. are reported in literature with adverse effects [ 38 , 68 , 69 ]. Therefore, official pharmacopeias must be consulted before using such plants or its parts. Extensive use of goat and sheep skin for medicinal treatment Table 4 to our knowledge has not been reported in the ethnomedical literature of Pakistan yet.
These uses are not restricted to the present research area but are typically found among Pashtun tribes in Pakistan and Afghanistan personal discussion with residents of different areas including people of Afghanistan and Pashtun tribes of Pakistan.
These uses of materia medica are transmitted as oral histories. One of the reasons why the Sulaiman Markhor Capra falconeri appears as threatened species on the IUCN Red List is its high demand for medicinal purposes e.
Its horns are used for decoration, and both skin and horns fetch high prices in the market. Sustainable conservation strategy in the form of ecotourism and applying other conservation tools, by involving local communities—as they are familiar with vegetation, habitat and associated wildlife, needs to be devised in the area [ 43 ].
Interestingly, no medicinal plant trade is found in the research area. Some species like fruits of Withania coagulance and seeds of Pegnum harmalla are commonly marketed in Pakistan, even in the surrounding communities of the research area, but their prices are unenticing.
Other plants like Berberis calliobotrys, Ephedra gerardiana and Velariana jatamansi have a high market demand and catch good prices [ 44 ], but locals were unaware about these commercial values. Sustainable harvesting of such plants could help to improve local livelihoods [ 70 ]. Above half of the present ethnomedicinal plant species were commonly available Table 5 , and leaves were the most used parts Fig.
The priority must be given to the rarely available species with higher URs and FL Table 5 - 6 , because frequent uses decrease its availability. The ethnomedicinal knowledge in the area was also facing degradation- although not very high, which negatively affects the lives and culture of these societies.
The present paper based on interactions with local informants investigates the traditional medicinal knowledge and materia medica of remote tribal communities in west Pakistan.
A variety of medical substances from plants, animals and minerals are used to treat diseases, depending on the severity of the disease and availability of the substance.
Treatment often happens in the family context. But different types of medical and ritual specialists are consulted if necessary, especially in the case of unusual diseases and illnesses caused by spirits.
The local medicinal system is dynamic as it not only includes and integrates new medicinal plants but also pharmaceuticals. However, most important is the use of goat and sheep skin which forms a central pillar for healing. The use and practices mentioned during present study needs detailed pharmaceutical evaluation before its recommendation for general use.
The widely used materia medica with rare availability needs conservation priority. Similarly, the local cultural norms are the means of matria medica practices which must be preserved.
While the area faces some acculturation processes, traditional practices remain quite intact. From a developmental perspective, reinforcement of local institutional contexts would be important to strengthen local knowledge and related sustainable practices.
The datasets generated and analyzed during the current study are not publicly available due to the easy identification of included participants. However, the corresponding author can be contacted to further explore the data, upon request.
Moerman DE, Pemberton RW, Kiefer D, Berlin B. A comparative analysis of five medicinal floras. J Ethnobiol. Google Scholar. Schippmann U, Leaman D, Cunningham A. A comparison of cultivation and wild collection of medicinal and aromatic plants under sustainability aspects. Dal Cero M, Saller R, Weckerle CS.
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Lev E, Amar Z. Ethnopharmacological survey of traditional drugs sold in the kingdom of Jordan. Cámara-Leret R, Paniagua-Zambrana N, Balslev H, Macía MJ. Many of the issues highlighted in this debate concern genetic materials used as the basis for medical research, and traditional medical knowledge that is either used directly to produce new products or is used as a lead in researching new treatments.
The Commission on Intellectual Property Rights, Innovation and Public Health CIPIH has called for benefits derived from TK to be shared with the respective communities WHO, b. How to apply PIC and equitable benefit sharing EBS has sparked a wide-ranging debate.
Concerns about improving patent examination in the TK area, in order to avoid erroneous patents on traditional medicines in particular, have led to initiatives at international and national levels. A leading example is the Traditional Knowledge Digital Library TKDL , a collaborative project in India between the Council of Scientific and Industrial Research CSIR , the Ministry of Science and Technology, and the Ministry of Health and Family Welfare.
An interdisciplinary team of Indian medicine experts, patent examiners, information technology experts, scientists and technical officers have created a digitized system enabling consultation of existing literature in the public domain relating to Ayurveda, Unani, Siddha and Yoga.
Such literature is generally available in traditional languages and formats. The TKDL therefore provides information on traditional medical knowledge in five international languages and formats which are understandable by patent examiners at international patent offices.
The aim is to prevent the grant of erroneous patents, 21 while at the same time not newly publishing TK in a way that would facilitate its misappropriation.
The WHO GSPA-PHI urges governments and concerned communities to facilitate access to traditional medicinal knowledge information for use as prior art 22 in the patent examination procedures, where appropriate, through the inclusion of such information in digital libraries Element 5.
The WTO TRIPS Council has discussed how to preclude erroneous patents using GRs and associated TK through the use of databases. This included a submission by Japan that had been previously submitted to the WIPO Intergovernmental Committee on Intellectual Property and Genetic Resources, Traditional Knowledge and Folklore IGC.
Parties to the CBD, WIPO and the WTO have considered the concept of a disclosure requirement in the patent system, put forward by its proponents as a means of ensuring that patents on inventions derived from TK and GR are consonant with the principles of PIC and EBS. The proposals and the debate are diverse and cover areas other than medicine, although patents in the medical area have been the major focus of the debate.
A number of countries have implemented such provisions in their national laws, but there is no agreed international standard. An alliance of developing countries has proposed a revision to the TRIPS Agreement to make such provisions mandatory, 24 but other countries continue to question the usefulness and effectiveness of this kind of disclosure mechanism.
The cultural, scientific, environmental and economic importance of TK has led to calls for it to be preserved safeguarded against loss or dissipation and protected safeguarded against inappropriate or unauthorized use by others , and there are many programmes under way at national, regional and international levels to preserve, promote and protect different aspects of TK.
Such measures include: first, preserving the living cultural and social context of TK, and maintaining the customary framework for developing, passing on and governing access to TK; and second, preserving TK in a fixed form, such as when it is documented or recorded.
the protection against copying, adaptation and use by unauthorized parties. The objective, in short, is to ensure that the materials are not used wrongly.
Two forms of protection — positive protection and defensive protection — have been developed and applied, as outlined above. The IGC is working on the development of an international legal instrument for the effective protection of TK. It is also working on ways to address IP aspects of access to, and benefit-sharing of, genetic resources.
The WTO TRIPS Council has also extensively debated the protection of TK, 26 including an African Group proposal for a formal decision to establish a system of TK protection, but this discussion has not led to any conclusions.
The IGC work on TK 27 is concentrating on positive protection and the IP aspect of protection — the recognition and exercise of rights to preclude others from illegitimate or unauthorised use of TK. As WIPO member states are continuing efforts to negotiate on these issues, no final agreement has been reached.
The text of an international legal instrument for the effective protection of TK is, therefore, in flux and new drafts continue to become available on a regular basis. The information set out below seeks to provide a broad and informal description of the nature of the discussions under way in the WIPO negotiations.
The IGC has considered the policy objectives for international protection, 28 including to:. There is as yet no accepted definition of TK at the international level. In principle, TK refers to knowledge as such, in particular knowledge resulting from intellectual activity in a traditional context, and includes know- how, practices, skills and innovations.
It is generally accepted that protection should principally benefit TK holders themselves, including indigenous peoples and local communities. However, there is no agreement on whether families, nations, individuals and others such as the state itself could be beneficiaries.
While TK is generally regarded as collectively generated, preserved and transmitted, so that any rights and interests should vest in indigenous peoples and local communities, in some instances beneficiaries may also include recognized individuals within communities, such as certain traditional health practitioners with a specific reference to traditional medical knowledge.
Some countries do not use the term indigenous peoples or local communities and consider that individuals or families maintain TK. One problem confronting TK holders is the commercial exploitation of their knowledge by others, which raises questions of legal protection of TK against unauthorized use, the role of PIC and the need for EBS.
TK holders also report lack of respect and appreciation for such knowledge.
BMC Complementary Medicine Traditinal Therapies Traditional medicine knowledge 21Article number: Cite this article. Metrics details. Medicune is known about the medical material and practices of Traditionao Traditional medicine knowledge the western border areas of Pakistan. The local population has inhabited this remote and isolated area for centuries, and gained medicinal knowledge with personal experiences and knowledge learned from forefathers. Due to the geographical isolation of the communities in the Sulaiman hills of Pakistan and their unique culture, the area is of importance for exploration and assessment.
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