Use of medicinal plants in traditional health care practices: A case study in Talwandi Sabo, Bathinda District, Punjab (India)

A comprehensive study was conducted to document the available medicinal plants and their traditional applications among the local people from July 2018 to June 2019 in Talwandi Sabo town of Bathinda District of Punjab. Purposive sampling method was used to select traditional medicinal practitioners of the study area. A semi-structured questionnaire was prepared and personal interviews were conducted to gather firsthand information about ethno-medicinal plants. Analysis of data revealed the use of 88 medicinal plant species belonging to 77 genera and 42 families for the treatment of about 60 ailments. The highest number of plants were used for gastrointestinal problems, skin problems followed by respiratory diseases, skeletomuscular diseases and dental problems. Traditional healers are still playing a great role in the primary health care system of Talwandi Sabo. Some practitioners were ensuring the 100% results of their formulations against many serious diseases. Further, the scientific validation of these formulations should be done for getting new alternative medicines against these diseases.


INTRODUCTION
India is the country gifted with a great variety of vegetation among which most occurring plant species are medicinal plants. Medicinal plants are commonly used by tribal and rural people to cure minor ailments. According to WHO, majority of the people living in rural areas are dependent on medicinal plants for curing common diseases. The wide range of medicinal plants are wild and the traditional healers commonly purify the plants and prepare medicines. It is worthwhile to mention that before the availability of synthetic drug, people were completely dependent on traditional remedies for primary healthcare system. In the Indian context, these household remedies are better known as Ghrelu nuskhe (Home remedies). However due to modernization, transformation in cultural practices and development of allopathic systems of medicine, herbal medicines gradually lost its popularity among people.
Latterly herbal medicine has gained popularity due to drug resistance, unaffordable cost and many side effects of allopathic medicines. The efficacy of some herbal products is beyond doubt, e.g. Artemisia annua (i.e. artemesinin: anticanceric), Silybum diseases, medication and side effects [6]. Traditional knowledge of medicinal plants and their use by indigenous cultures are not only useful for community healthcare and drug development but also for conservation of cultural traditions and biodiversity.
Recently, several steps have been taken by Indian government to conserve medicinal plants and their associated traditional knowledge. Medicinal plant boards have been constituted at state and center level to inspire farmers for adopting cultivation of medicinal plants. Herbal gardens have been developed to make the common man conversant with the rich heritage of Indian system of medicine [7]. National Biodiversity Authority (NBA) at central level, State Biodiversity Board (SBB) at state level and Biodiversity Management Committees (BMCs) at local level has been constituted under Biodiversity Act, 2002 to conserve biodiversity or its associated traditional knowledge. NBA has initiated the preparation of People Biodiversity Register (PBR) at local level to document local biological resources and its associated traditional knowledge. Hence the current study is a small step in this direction to document and preserve the plant based traditional medicines used by locals for healthcare and for sharing it with other communities through publish literature.

The Study Area
The area selected for present study was Talwandi Sabo located in Bathinda district of Punjab. Bathinda is one of the largest districts of Punjab. Talwandi Sabo is the municipal council in this district. It lies between the coordinates of 29.988268° North latitude to 75.078678° East longitude ( Figure 1). In 2011 this region consists of 13 wards but recently in 2018, the area is divided into 15 wards. It is one of the famous Takht among five Takhts of Sikhism known as Takht Sri Damdama Sahib. Total geographical area of Talwandi Sabo nagar panchayat is 17 km 2 . Although several workers have worked on the indigenous medical practices of aboriginal people, tribals and other folk healers of India using medicinal herbs, there are only a few works on medicinal plants used by natives of Punjab in traditional healthcare practices. After screening the available literature, it was found that no study on traditional medicinal plants was ever carried out in this region; hence this area was selected for the present investigation.

Methodology
The present study was carried out in Talwandi Sabo town of Bathinda district of Punjab. A comprehensive study was conducted to document the available medicinal plants and their traditional applications among the local people from July 2018 to June 2019. Purposive sampling method was used to select traditional medicinal practitioners of the study area. Ethno-medicinal data was collected from 25 knowledgeable informants or practitioners for this investigation. The informants were selected in such a way that all ward of the study area have been covered. A semistructured questionnaire was prepared and personal interviews were conducted to gather first-hand information about ethnomedicinal plants used for human and livestock ailments.
Usually, the survey was started with the interview of elderly and experienced members, locally known as Hakims or Vaids (Traditional healers). Often, they were accompanied to the field for the identification of plant species used and authentication of plant specimens collected from their wild habitats. Besides this, the accuracy of the curative features of these plants have also been proved by interviewing the common people of surveyed localities who themselves have used these plants for health treatments. Photographs of some locally available plants have been taken in their natural habitat.

Data Interpretation
The collected information was screened for number of plants used in medicinal purposes, their mode of preparation, part used, their habits, administration and treatment of different diseases. The demographic data was also analyzed to know the relationship of traditional knowledge with age, gender, education and occupation.

Statistical Analysis
The data was analyzed statistically by calculating informant consensus factor, fidelity level and frequency of citation.

Informant Consensus Factor (ICF)
Informant consensus factor for different ailment categories was calculated by using this formula [8].

ICF Nur
Nt Where Nur = Number of use report in a particular disease category and Nt = number of taxa used to treat that particular disease by the informants.
The ICF provide a range of 0-1, where high value (close to 1) of ICF for a given disease means only one or few plant species are used by large number of informants to treat that particular disease. On the other hand, low ICF value (close to 0) indicates that informants are disagree over the use of plant species to cure any particular disease. This may be due to random choosing or lack of communication among the informants. It means the information is not uniform.

Fidelity Level (FL)
Fidelity level was calculated to determine the most frequently used plant species for treating a particular ailment by the local people of the study area [9]. The fidelity level of each species for a particular disease has been calculated by using following formula: Where Np is the number of informants who cited a given plant species for the treatment of particular ailment and N is number of informants that use the given plant species for all diseases.

Frequency of Citation
The frequency of citation of a particular species is calculated as follow:

Demographic Data of the Informants
The present study deals with documentation of medicinal plants and their associated traditional knowledge used by natives of Talwandi Sabo. During the investigation, the information was collected from 25 respondents in which 80% were men and 20% women. The age varies from 22-75 years from which 16% respondents were >35 age group, 40% respondent were between 36-50 years age group and 44% were between 51-75 years. Based on their education it was found that most of the informants were above matriculation (44%) followed by under metric (36%) and matriculate (20%). Occupation of informants included farmers (28%), housewives (16%), traditional healers (40%) and others like students, drivers, workers etc. (16%) (

Medicinal Plants and their Associated Traditional Knowledge
A total of 88 plant species belonging to 77 genera and 42 families were used in traditional healthcare practices by the natives of study area. During survey, detailed information about traditional formulations like plants or plant parts used, local name of plants, habit, mode of preparation, mode of administration, etc. was documented ( Table 2). Maximum number of plants of family Fabaceae (10) were used in traditional remedies followed by Solanaceae (6), Apiaceae, Myrtaceae, Lamiaceae (4 species each), Acanthaceae, Amaranthaceae, Amaryllidaceae (3 species each), etc. Treatment of about 60 major and minor ailments was done with these medicinal formulations. Herbs, shrubs, trees and climbers were the plant habits used for preparation of these remedies. From these, widely used plants were herbs (43.18%) Bark is boiled in water and used as antiseptic. Fruit in the form of pickle is used to increase male potency and also good for indigestion. Decoction of fruits is used to cure bleeding gums. Decoction of leaves is used to cure many eye problems and to improve immunity. Decoction of kikar and neem bark along with lahsun is prepared to cure several ear problems. It also cures many hair problems. Achyranthes aspera L. The ash of roots is mixed with honey and given orally to cure cough. Decoction of spiny seeds is also used to cure cough. Mixture of Achyranthes and Tinospora stem powder is used to cure asthma. Paste of bulb is applied dermally to cure many skin disorders. Bulb extract is used as antiemetic.
Juice of pyaz along with hing powder is used to cure asthma and T.B. Allium sativum L. (Amaryllidaceae) Lahsun/garlic Herb Cultivated Raw bulblets are taken orally in empty stomach is said to be effective to treat Atherosclerosis disease. Lahsun eaten in morning cures heart problems. Bulblets along with Calotropis procera leaves are fried in mustard oil and oil is dropped in the ear for relieving earache. It is also used to control uric acid and rheumatic pain. Paste of black soil and garlic extract is applied dermally on aching teeth. Aloe vera (L.) Burm. f. (Xanthorrhoeaceae) Kuwar gandal/aloe Herb Cultivated In the form of vegetable aloe is used for treatment of rheumatism, arthritis and as antidiabetic.
Gel is commonly used in preparation of many cosmetic products. Juice of aloe is a good body tonic and also controls diabetes and obesity. Gel powder is used to cure many stomach problems, liver problems and menstrual problems. Leaf powder is used to cure many eye problems. Argemone mexicana L. (Papavaraceae)

Satyanashi/Mexican poppy Herb
Wild Leaves extract is applied dermally to cure skin problems and wound healing. Roots powder is used as blood purifier and during pregnancy, it is used to expand uterus. Seeds powder is taken orally to control diabetes. Seeds powder is also taken orally to cure joint pain.
Fruit paste is applied dermally to cure skin disorders. Leaves boiled in water used as antiseptic and astringent. Bark in powdered form is also applied dermally to cure skin problems. Decoction of leaves is taken orally as it is antidiabetic. Leaves of neem along with fatkadi, boiled in water and used externally to cure skin problems. Fruit paste is also antiseptic, antiallergic and anti-poisonous. Decoction of leaves is used to cure ulcers. Twig is used as toothbrush.
Leaf decoction is also a good blood purifier and used to remove stomach worms.  Powder of ajwain seeds along with fruit of kaur tuma is used for cattle diseases. Fruit powdered is used as antidiabetic.
Powder of dry burnt fruit along with 4 kinds of salt and ajwain seeds is good for indigestion. Fruit powder mixed with salt and lemon juice is also good for indigestion in human as well as animals. Fruit powder is used to cure stomach pain, indigestion and constipation. Fruit along with haldi rhizome is packed in cotton cloth and boiled in water. Then grind to fine powder which is used to cure asthma. Roots of kaur tuma is used to cure tumor. Fruit powder is said to be effective to cure piles. Wild/ Cultivated Milky exudate is used to cure asthma, as a body tonic and also help to increase immunity. Milk is applied dermally for many skin problems. Fruit milk is affective in increasing sperm count in men. Milk of tree is also a good body tonic. Leaf extract is used in treatment of hair problems. Milk along with mustard oil used in treatment of ear pain. Roots boiled in water is used in herbal medicines against cough. Powder of aerial roots of peepal is given to women to enhance chances of pregnancy.
Leaves are used to cure heart blockage and other heart problems. Raw fruit are eaten to enhance appetite. Leaves extract is applied on snake bite. Bark of peepal and neem in powdered form is used to cure kidney problems. Decoction of leaves and bark is used to cure small pox and fever. Oil extracted from seeds is used for rheumatism. Purified seed oil is taken with milk as laxative.
Fruit also have laxative properties. Leaves boiled in water is used for joint pain. Extracted oil is also used for many stomach problems and breast problems.
Leaves are tied externally for rheumatism. Wild Decoction of stem is used against cough, cold, dengu, flu, fever, malaria and typhoid. It also has antibiotic properties. Decoction is also good for curing kala azaar, indigestion and good for RBCs enhancement. It is also used for many respiratory disorders. Trachyspermum ammi L. (Apiaceae) Ajwain/ajowan caraway Herb Cultivated Seeds of ajwain along with 4 kinds of salt is used to cure stomach ache. Ajwain seeds along with saunf boiled in water is used for stomach ache. Fruit powder is used to cure cough. Paste of Ajwain seeds and garlic bulblets in mustard oil is applied dermally for chikungunia. Tribulus terrestris L. (Zygophyllaceae) Bakhra/devil's-thorn Herb Wild Fruit is used to cure gynaecological problems like leukorrhea. Fruits of pakhra and seeds of ajwain are roasted on medium fire and ground to form powder which is used for indigestion in animals. Fruits also have diuretic and antibiotic properties. Dried fruits are fried in desi ghee are used to relieve back ache. Fruit powder is used to remove kidney stone through micturition. Powdered form of fruit is taken orally with water for joint pain. Seeds in powdered form are also good for back ache. Fruit crushed in paste form applied dermally on joints to get relief from pain. Fruit is also used against cough and cold. followed by trees (35.22%), shrubs (11.36%), climbers (9.09%) and creepers (1.13%).
Commonly each plant part is used in the preparation of medicines, but most frequently used plant part is leaf (34.16%). Other plant parts are fruits (29.16%), roots (10.83%), stem (5.83%), flower (1.66%), twig (1.66%) etc. (Figure 2). In traditional medicines, leaves and herbs are used more often because of their common availability (leaves available throughout the year) and formulations are easier to prepare (as they are soft). According to informants, leaves are highly effective in cure of various ailments. Therefore, scientific evaluation or phytochemical screening of leaves of medicinal plants should be preferred in place of other plant parts.
Most of the plant species used by local people were cultivated and some were purchased from the market. But traditional healers mainly collected the wild herbs for the preparation of medicinal formulations. Unfortunately, that wild herbs are eliminating from the study area due to increasing urbanization and improved agricultural practices. The mode of preparation of these medicines was in powder, paste, decoction and extract form. Natives commonly used these household remedies to cure the small ailments like fever, cough, cold, wounds, indigestion, infection, inflammation etc. The most common mode of administration is oral and it may be taken in the form of powder or decoction. Some of the remedies were applied dermally to cure the skin problems. Maximum number of plant species were used to cure gastro-intestinal diseases & skin diseases (32 each) followed by respiratory diseases (22), skeletomuscular diseases (20) and dental problems (15) ( Figure 3).
Some plants were used in the preparation of medicines to cure cancer such as seeds of Cannabis sativa, rhizome of Curcuma longa, fruit of Momordica dioica and seedlings of Triticum aestivum. Seeds powder of Abrus precatorius was used to abort child. Decoction of Kal megh (Andrographis paniculata) was used to cure liver disorders like jaundice. Eating murabba of bamboo shoots (Bambusa vulgaris) in empty stomach was used as herbal remedy for increasing height. Plant powder of Crinum latifolium (Sudarshan) is used to cure fever. Leaf extract is also used for earache. Fruits of Ashoka (Polyalthia longifolia) are used in preparation of medicines for RBCs enhancement. Seeds of kala datura are used as good antidepressant and to cure paralysis. According to respondents, the formulation is prepared by the mixture of two or more plant species are more effective than a single plant. For example, the combination of Achyranthes and Tinospora in powdered form is used to cure Asthma. These plant species were also used singly to control the disease.
During survey it was observed that traditional healers learn these practices from their ancestors. They are now further trying to pass this knowledge to their next generations. But young generation is To cure old cough (kali khansi), Ashwagandha and Achyranthes aspera powder are mixed and given orally. It is also a good body tonic. Leaves boiled in tea are best for cough and cold. It is also a good painkiller and increases male potency. Roots powder or decoction is a good body and brain tonic. It also reduces inflammation. Plant powder is taken with milk to increase height. Stem powder taken with milk is good for back pain and weakness. It is also taken orally to cure many sexual disorders.

Informant consensus factor (ICF)
For testing the homogeneity in informant's knowledge, informant consensus factor for the common health problems of area was calculated. Based on the information collected from informants, the ailments were grouped into different disease categories. The value of ICF could be useful in practicing the medicinal plants for the further scientific research. The ICF value mainly ranges from 0.01-1.00. The results show that the value of ICF calculations in the study area ranges from 0.14 to 0.81 (Table-3    respiratory infections (0.72) and skin infections (0.73) [13]. The least ICF factor from the study area was of Cancer (0.16) and Veterinary problems (0.14). The high ICF Value of the diseases in study area conclude that these diseases are common in the area. This also mean that there is better communication between the informants for treating these ailment categories. The low ICF value means lack of information about the use of plant.

Fidelity level (FL)
The plant species with highest FL value is known to be the most preferred species for a particular ailment. The FL 100% indicate that all the use report mentions the same plant species for the particular disease. In the present study, the FL of some important plants was calculated. These are the plant species which were preferred for treating 11 different ailments. Syzygium cumini has the highest FL value (95.2%) for the diabetes. This means Syzygium cumini is the most common plant species known to natives of the area to control diabetes. So high fidelity level of Syzygium cumini indicates that the scientific study can be further done on this plant for making the better drug to cure the disease. The high-fidelity level of Momordica charantia (89.9%) and Syzygium cumini (82.2%) for diabetes was also recorded in Doaba region of Punjab [6]. The Fidelity level of Aloe vera for the cure of skin diseases is 100%, that means the value of (Np, N) is (25, 25). Azadirachta indica has (90.4%) fidelity level for the cure of skin diseases. The more plant species were also observed with 100% fidelity level for the particular ailments like syzygium aromaticum (13, 13) for dental use, Zingiber officinale for respiratory problems (13,13), Terminalia arjuna for cardiovascular problems (8,8), Convolvulus pluricaulis for mental disorders (17, 17). For cancer Triticum aestivum has the fidelity level of (3,4). Curcuma longa had 90.9% fidelity level for skeletomuscular diseases. The least fidelity level means the lack of knowledge about the plant species for a particular disease such as for skeletomuscular diseases the plant used Tribulus terrestris has fidelity level 26.6 % ( Table-4).

CONCLUSIONS
Present survey for documentation of medicinal plants and their associated traditional knowledge was carried out in Talwandi Sabo town of district Bathinda, Punjab. This study reveals that even though the accessibility of modern medicines is available at door steps, many medicinal plants are still broadly used by the natives of study area, at least for the treatment of common ailments like cough, cold, fever, headache, body ache, indigestion, skin problems, dental problems etc. People believe that although these medicines are time consuming but eliminate the disease from roots. The plants with 100% fidelity level are known to be the most preferred species for a particular ailment. Therefore, scientific validation of these plants for their ethnomedicinal claim and their phytochemical screening can be utilized for the development of new and alternate drugs against a particular disease with due benefit sharing with the traditional knowledge holders. It is also worthwhile to mention that, this knowledge is only limited to traditional healers and elderly persons. Young generation has little interest in these practices which shows that traditional knowledge of medicinal plants is in severe danger of being lost. Therefore, the use of these medicinal plants should be kept safe in written form, so that this should be helpful in future also. In present investigation, some unique plants and traditional formulations have been reported which should be recorded in Traditional Knowledge Digital Library (TKDL) so that these medicinal plants and their associated traditional knowledge can be protect from biopiracy.