Volume 194, 24 December 2016, Pages 827–849
Abstract
Ethnopharmacological relevance
Reproductive
healthcare has been highlighted as a major challenge in Lesotho mainly
due to the high prevalence of HIV/AIDS and sexually transmitted
infections. As a result other reproductive ailments have not received
much attention, particularly because healthcare facilities are already
limited and many of them are inaccessible. For these reasons, medicinal
plants play a major role in primary healthcare system in the country, in
addition the plants are easily accessible, more affordable, and their
use forms part of the cultural heritage. However, documentation of
medicinal plants used for reproductive ailments is scattered, more
importantly the biological and pharmacological properties, as well as
toxicity of many of these plants are not yet known.
Aim of the study
To
document the plants used by both male and female Basotho (residing in
Lesotho) for the treatment of reproductive ailments, to explore their
recorded biological and pharmacological effects as well as their
toxicity, and to establish if these plants are used for similar purposes
in other southern African cultures.
Materials and methods
The
results stem from published findings of recent interviews of
traditional medicinal practitioners in the Maseru District of Lesotho,
first author's own experiences and observations from the Qacha's Nek
District as well as comprehensive literature survey including numerous
books and unpublished data. Electronic databases such as Google, Google
Scholar, PubMed, and ScienceDirect were also used to search for the
chemical compounds, pharmacological activity, and toxicity of the
plants.
Results
A total of 87
plant species are reported to be used for the treatment of several
reproductive problems such as infertility, complications associated with
pregnancy (twelve plants are used to treat conditions such as colic,
heartburn, nausea, and constipation), cleansing and/ or toning of the
uterus (with a purpose either to induce pregnancy or to get rid of the
placenta, for example Withania somnifera and Zantedeschia albomaculata), difficult childbirth, as well treatment of breast and cervical cancer, cysts, fibroids, and testicular tumours (e.g. Hypoxis hemerocallidea). For the toning of the uterus, it is common to use a combination of plants, e.g. Gunnera perpensa, Scabiosa columbaria, and Eriospermum ornithogaloides.
Conclusions
Of
the 87 plants used for reproductive healthcare, the highest number (31)
is used for the treatment of infertility (in both men and women). The
pharmacological effects, active compounds, and toxicology of many of
these plants are not yet known.
Graphical abstract
Chemical compounds studied in this article
- Aloin (PubChem CID: 12305761);
- Anthraquinone (PubChem CID: 6770);
- Berberine (PubChem CID: 2353);
- Coumestrol (PubChem CID: 5281707);
- Genistein (PubChem CID: 5280961);
- Loganin (PubChem CID: 87691);
- Protopine (PubChem CID: 4970);
- Sanguinarine (PubChem CID: 5154);
- Sesquisabinene (PubChem CID: 25202482);
- Swerodside (PubChem CID: 161036);
- Thujone (PubChem CID: 91456);
- Uzarin (PubChem CID: 20055063);
- Withanolide (PubChem CID: 161671);
- Xysmalorin (PubChem CID: 208007), www.ncbi.nlm.nih.gov/pccompound (accessed 07-06-2016)
Keywords
- Childbirth;
- Dysmenorrhoea;
- Infertility;
- Menorrhagia;
- Reproductive problems
1. Introduction
It has been argued that reproductive health is the second most prevalent health care problem in Africa (Diame, 2010), furthermore, World Health Organization statistics (WHO, 2012)
show that maternal conditions, birth asphyxia and trauma, and preterm
birth complications rank among the top 20 causes of death in Africa. McPherson et al. (2014)
have also pointed out that the burden of disease in Eastern and
Southern Africa “due to infectious disease and diseases related to
reproductive and sexual health is extremely high”.
It
is reported that at least 4 000 plant species are used for medicinal
purposes in southern Africa, with approximately 3 000 used in South
Africa (Van Wyk et al., 2009) and over 300 in Lesotho (Moteetee and Van Wyk, 2011).
Traditional medicine in Lesotho still plays a vital role in rural areas
for a number of reasons including: 1) Easy access to medicinal plants;
since traditionally information is transferred orally through
generations, some people are able to treat minor ailments such as
headaches and stomach aches by simply picking and self-administering the
correct plant, even without having to consult a traditional healer
(pers. obs.). 2) It is part of a strong cultural heritage; as in many
other cultures, medicinal plants are not only used for their curative
properties, but for symbolic and spiritual importance. In fact, the
majority of participants (pregnant women) in a study by Mugomeri et al. (2015),
indicated that they use herbs for no particular reason, other than
because it is tradition. Furthermore people believe that illness is not
triggered only by physical causes but also as a result of witchcraft or
punishment from the ancestors (Mafimisebi et al., 2010; Gruca et al., 2014),
acts which a western doctor cannot deal with. Traditional medicine is
therefore considered to provide holistic treatment including
psychosocial health, as opposed to Western medicine (Cocks and Møller, 2002).
3) Lack of adequate healthcare facilities; the country still faces
challenges in providing healthcare services attributable to the
increasing burden of disease brought about by HIV/AIDS (Lesotho has the
second highest prevalence of HIV/AIDS in the world) and the shortage of
expertise and human resources (http://www.commonwealthhealth.org/africa/lesotho/health_systems_in_lesotho/).
These challenges are worsened by the country’s demographic and
geographic profile. 4) Inaccessibility to available healthcare services;
the majority of the country’s population resides in the rural areas
which are isolated by the mountainous terrain, thus presenting a
physical barrier to both staff and patients to the already limited
facilities. In fact, WHO estimates that around three-quarters of the
rural population is outside of walking distance of a health facility (http://www.lesothoreview.com/healthcare-2015.php).
5) Unaffordability of pharmaceutical medicines; with 26.2% unemployment
rates in 2014, Lesotho was ranked 2nd highest in Africa and 5th highest
in the World (www.theglobaleconomy.com/rankings/Unemplyment_rate/).
Published
literature on medicinal plant use in Lesotho is limited, the only
publications that included ethnobotanical uses are those documenting the
flora of Lesotho, these are Phillips (1917), Jacot Guillarmod (1971), and Schmitz (1982). A more recent ethnomedical review by Moteetee and Van Wyk (2011)
presented a relatively comprehensive ethnobotanical data for Lesotho.
Only three studies have recently (past 16 years) been published on the
basis of ethnobotanical information sourced mainly from traditional
medical practitioners. These are Shale et al. (1999), who concentrated on plants with antibacterial and anti-inflammatory activities, Seleteng Kose et al. (2015), and Mugomeri et al. (2016),
with a focus on plants used for common ailments. However none of these
focussed specifically on plants used for treatment of reproductive
ailments, therefore such information is scattered. Recently published
results on the use of medicinal plants in the Maseru District (Seleteng Kose et al., 2015),
showed that reproductive problems (excluding degenerative illnesses
such as breast and cervical cancer) were the most commonly treated
afflictions by the traditional medicine practitioners, with 47 plants.
Of these, 47% are used for treatment of infections [i.e. human
immunodeficiency virus (HIV), sexually transmitted infections (STIs)],
while 53% are utilised for other reproductive problems such as
sterility. In that study, infertility and difficult pregnancy/labour are
ranked among the top 10 most treated conditions together with
tuberculosis (TB) and opportunistic infections related to HIV (including
reduction of mother to child transmission) (Seleteng Kose et al., 2015). Mugomeri et al. (2016)
recorded only six medicinal plants used for reproductive problems. The
important role played by medicinal plants in the complementing of
reproductive healthcare is underscored by the numerous recent studies
that have been conducted across the globe to document plants used
traditionally for this purpose (e.g. Bussmann and Glenn, 2010; Ramakrishna and Saidulu, 2014; Ramihantaniariyo et al., 2003; Semenya et al., 2013; Torri, 2013; Tsobou et al., 2016), with many of them focussing on maternal reproductive health problems (e.g. Abdillahi and Van Staden, 2013; Ali-Shtayeh et al., 2015; De Boer and Cotingting, 2014; Kankara et al., 2015; Kamatenesi-Mugisha and Oryem-Origa, 2007; Martínez, 2008; Ogbe et al., 2009; Srithi et al., 2012; Steenkamp, 2003; Yazbek et al., 2016; Yemele et al., 2015) and a few on male reproductive health (e.g. Abdillahi and Van Staden, 2012; Chauhan et al., 2014; Erhabor et al., 2013; Nantia et al., 2009). Other studies have focussed on specific conditions, for example Van Andel et al. (2014)
have reported that over 2 000 species are used in Latin America, the
Caribbean, sub-Saharan Africa, South and Southeast Asia for treatment of
menstrual disorders alone (i.e. dysmenorrhoea, induce or regulate
menses, and induce abortion).
The
aim of this paper is to present an ethnobotanical review of plants
traditionally used by the Basotho for the treatment of reproductive
problems, with the exclusion of sexually transmitted infections (STIs).
Antimicrobial activity and phytochemical properties of the plants used
for the latter will be presented elsewhere. Known active chemicals,
pharmacology effects (antioxidant and anti-inflammatory activities), as
well as toxicology are also listed.
2. Materials and methods
The
review stems from published results of recent interviews of traditional
medicinal practitioners in the Maseru District of Lesotho, first
author’s own experiences while growing up in the Qacha’s Nek District in
that country, as well as comprehensive literature survey (which
included numerous books and unpublished dissertations and theses).
Details of data collection of the published results are as outlined in Seleteng Kose et al. (2015).
As far as we are aware, diagnosis by both herbalists and diviners is
based on the presented symptoms, in addition diviners throw bones and
consult ancestors during consultation. Electronic databases such as
Google, Google Scholar, PubMed, and ScienceDirect were also used to
search for the chemical compounds, pharmacological activity, and
toxicity of the plants using scientific names of the plants (as well as
their synonyms) and keywords such as anti-inflammatory, antioxidant,
chemical constituents, childbirth, dysmenorrhoea, infertility,
menorrhagia, phytochemicals, reproductive ailments, reproductive
disorders, reproductive health, reproductive problems, and toxicity.
Species names were validated at www.theplantlist.org, however, in some cases the database has retained older names (and lists the newer names as ‘unresolved’), for example Rhus divaricata Eckl. & Zeyh is upheld over Searsia divaricata (Eckl. & Zeyh.) Moffett, in this case the South African Red Data List database http://redlist.sanbi.org was followed.
3. Results and discussion
Table 1
presents the plant species (synonyms given in brackets) used for
various reproductive problems, as well as their vernacular names (in
Sesotho), the main therapeutic uses, dosage forms as well as their
active chemical compounds as reported in the literature. In cases where
there is no information available, compounds recorded for other species
in the same genus are indicated in brackets. Available information on
pharmacological activity (antioxidant and anti-inflammatory) as well as
the toxicology of the plants is recorded in Table 2.
The review has revealed that 87 plant species are used for various
reproductive ailments as follows (it should be noted that many of these
plants are used in more than one category): infertility/ sterility (31),
menstrual problems and other uterine disorders (28), complications
associated with pregnancy (15), breast cancer (13), cleansing and toning
of uterus (11), childbirth (11), cervical cancer (7), virility (4),
fibroids and cysts (3), prostatitis and testicular tumours (2),
contraceptive (1). The plants include three pteridophyte, 66 dicot, and
18 monocot species across 41 families, with the majority of them
belonging to Asteraceae (18), followed by Rubiaceae (6), and Lamiaceae
(5). Most medicines are administered orally as decoctions, less commonly
as infusions, and rarely as a douche. Interestingly, unlike in many
ethnobotanical studies in which the family Fabaceae usually features
with a high number of species used traditionally for medicinal purposes
(e.g. Afolayan et al., 2014 ; Aremu et al., 2012; Moteetee and Van Wyk, 2011; Seleteng Kose et al., 2015; Steenkamp, 2003),
in the current study, only three species of the family are used for
reproductive problems. The reason for this is unknown since many members
of the family Fabaceae are known to possess a number of phytochemicals
which have proven medicinal properties, most species are used as
sedatives/adaptogens in Lesotho (Moteetee and Van Wyk, 2007).
It is also observed that several species are used for the treatment of
more than one illness, in this regard the species with the most uses are
G. perpensa with eight uses and Scabiosa columbaria with six uses. The different categories are discussed in the paragraphs that follow.
- Table 1. List of Lesotho medicinal plants, their vernacular names in Sesotho, parts used, the main uses, major chemical compounds, and references (synonyms are given in brackets).
Species (naturalised alien species are marked with an asterisk*) Vernacular names (in Sesotho) Parts used Dosage form Main uses Major phytochemicals Pteridophytes Equisetaceae Equisetum ramosissimum Desf. (Equisetum ramosissimum subsp. ramosissimum) Mohlaka-photoane Rhizome Decoction taken orally Infertility in women (Hutchings et al., 1996 ; Jacot Guillarmod, 1971; Phillips, 1917;Watt and Breyer-Brandwijk, 1962) Alkaloids, flavonoids (Saleh and Abdalla, 1980;Steenkamp, 2003) Pteridaceae Adiantum capillus-veneris L. (Adiantum capillus-veneris var. capillus-veneris) Lehōrōmetso Unspecified Decoction taken orally Difficult confinements (Hutchings et al., 1996 ; Jacot Guillarmod, 1971) Alkaloids, flavonoids, glycosides, saponins, steroids, tannins, triterpenoids (Ibraheim et al., 2011;Ishaq et al., 2014) Selaginenellaceae Selaginella caffrorum (Milde) Hieron. Moriri-oa-matlapa Whole plant Decoction taken orally Breast cancer (Jacot Guillarmod, 1971 ; Moteetee and Van Wyk, 2011) No records (alkaloids, flavonoids, coumarins, steroids) (Almeida et al., 2013) Dicotyledons Apocynaceae Xysmalobium undulatum (L.) W.T.Aiton (Asclepias undulata L.) Poho-tšehla/ leshokhoa Roots Powdered root is boiled and drunk Cervical cancer; eases pregnancy; afterbirth cramps, uterine disorders (Jacot Guillarmod, 1971 ; Maliehe, 1997; Phillips, 1917;Van Wyk et al., 2009;Watt and Brandwijk, 1927) Glucosides (xysmalobinum), cardiac glycosides (uzarin, xysmalorin) (Van Wyk et al., 2009) Araliaceae Cussonia paniculata Eckl. & Zeyh. ssp. sinuata (Reyneke & Kok) De Winter Motšetše Leaves Decoction taken orally, sometimes as an enema Breast cancer; mixed with Searsia divaricata and Scabiosa columbaria for period pains; cervical cancer (Seleteng Kose et al., 2015; Phillips, 1917) Flavonoids, triterpene glycosides (Adedapo et al., 2008) Asteraceae Aster bakerianus Burtt Davy ex C.A.Sm. Phōa Roots Decoction taken orally, powdered plant applied on syphilitic sores Sterility in women, tonic for pregnant women (Shale et al., 1999 ; Seleteng Kose et al., 2015) Terpenoids (Tsankova and Bohlmann, 1983) Artemisia afra Jacq. ex. Willd. Lengana Leaves Drunk as infusion Prostatitis (Seleteng Kose et al., 2015 ; Van Wyk and Wink, 2004) Coumarins, flavonoids, monoterpenoids (1,8-cineole, thujone, camphor, etc.), sesquiterpenoid lactones (Van Wyk and Wink, 2004) Berkheya cirsiifolia (DC.) Roessler mohatollo-o-mosoeu roots, leaves decoction taken orally virility in men (Maliehe, 1997) No records (alkaloids, cardiac glycosides, flavonoids, saponins, steroids, terpenoids) (Odeleye et al., 2011) B. setifera DC. Leleme-la-khomo Roots, leaves Decoction taken orally Complications associated with pregnancy; uterine disorders; mixed with Rumex lanceolatus for sterility (Seleteng Kose et al., 2015;Watt and Brandwijk, 1927) No records (see above) *Crepis hypochaeridea (DC.) Thell. Lematla-la-maqeba Not specified Decoction taken orally sterility (Watt and Breyer-Brandwijk, 1962) No records Dicoma anomala Sond. Hloenya Roots, leaves Decoction taken orally Breast cancer; uterine disorders; painful menstruation; labour pains; infertility (Jacot Guillarmod, 1971; Mugomeri et al., 2016; Van Wyk et al., 2009 ; Watt and Breyer-Brandwijk, 1962) Alkaloids, glucosides, phytosterols, sesquiterpene lactones (Becker et al., 2011 ; Van Wyk et al., 2009) Gazania krebsiana Less. Tsikitlane Roots Decoction taken orally Sterility in women (Seleteng Kose et al., 2015) Terpenoids (Bohlmann and Zdero, 1979) G. linearis (Thunb.) Druce Tsikitlane Roots Decoction taken orally Purgative for pregnant women; mixed with other plants for infertility in women (Jacot Guillarmod, 1971; Moffett, 2010;Watt and Brandwijk, 1927) No records (see above) Gerbera ambigua (Cass.) Sch. Bip. Seboka Whole plant Taken as an infusion Given to pregnant women (Seleteng Kose et al., 2015) Terpenoids (Bohlmann and Wallmeyer,1982) G. piloselloides (L.) Cass. Tsebe-ea-pela Roots Decoction taken orally Improves fertility; cleanses uterus (Seleteng Kose et al., 2015) Coumarins, phenols (Xao et al., 2002) Haplocarpha scaposa Harv. Khutsana / papetloana Roots, leaves Decoction taken orally Period pains; infertility in women; amenorrhoea (Schmitz, 1982; Watt and Brandwijk, 1927 ; Watt and Breyer-Brandwijk, 1962) Sesquiterpenes, sesquisabinene (Bohlmann and Wallmeyer, 1982) Helichrysum caespititium (DC.) Sond. ex Harv. (Helichrysum lineare var. caespititium DC.) Phate-ea-ngaka Whole plant Decoction taken orally Increases virility in men (Maliehe, 1997 ; Seleteng Kose et al., 2015) Phloroglucinols (Lourens et al., 2008) H. nudifolium var. pilosellum Boleba/ Whole plant Decoction taken orally Mixed with Commelina. africana and No records (L.f.) Beentje (Gnaphalium latifolium Thunb., G. pilosellum L.f., Helichrysum latifolium (Thunb.) Less.) Papetloana-ea-liliba Salvia triangularis for infertility in women (Watt and Breyer-Brandwijk, 1962) H. odoratissimum (L.) Sweet Phefo Whole plant Decoction taken orally Menstrual pains (Seleteng Kose et al., 2015) Flavonoids, phloroglucinols, pyrones, terpenoids (Lourens et al., 2008) H. platypterum DC. (Gnaphalium platypterum Sch. Bip.) Papetloana-ea-mafika Roots Decoction taken orally For virility in men (Jacot Guillarmod, 1971; Phillips, 1917) Flavonoids, phloroglucinols, terpenoids (Lourens et al., 2008) H. psilolepis Harv. tōane-khomo Roots Decoction taken orally Period pains (Jacot Guillarmod, 1971; Phillips, 1917;Watt and Breyer-Brandwijk, 1962) No records (see above) Senecio coronatus Harv. (Cineraria coronata Thunb., Senecio lachnorhizus O.Hoffm. Senecio lasiorhizoides Sch. Bip.) Motabo/ lehlomanyane Roots Decoction taken orally To ease difficult childbirth (Jacot Guillarmod, 1971 ; Maliehe, 1997; Moffett, 2010; Phillips, 1917) Sesquiterpene esters (Shakhnoza and Saidkhodzhaev, 2012) S. rhomboideus Harv. Lekoto-la-litšoene Roots Decoction taken orally Female sterility (Watt and Breyer-Brandwijk, 1962) No records (see above) Caprifoliaceae Cephalaria pungens Szabō Tšoene Whole plant Decoction taken orally Infertility; complications associated with pregnancy(Seleteng Kose et al., 2015) No records (glycosides, saponins) (Kayce et al., 2014) Scabiosa columbaria L. Selomi Roots, leaves Infusion taken orally Mixed with Searsia divaricata and Cussonia paniculata for colic in pregnant women, period pains, and Iridoid glycosides (loganin, swerodside) (Van Wyk et al., 2009) for difficult childbirth; cleanses the womb; uterine disorders; female infertility (Jacot Guillarmod, 1971 ; Moteetee and Van Wyk, 2011; Phillips, 1917;Schmitz, 1982;Seleteng Kose et al., 2015;Van Wyk et al., 2009;Watt and Brandwijk, 1927;Watt and Breyer-Brandwijk, 1962) Commelinaceae Commelina africana L. Khotsoana Whole plants Decoction taken orally Crushed and mixed with Haplocarpha scaposa for female sterility ( Watt and Brandwijk, 1927 ; Watt and Breyer-Brandwijk, 1962) Alkaloids, cardenolides, saponins, tannins (Agunbiade et al., 2012) C. benghalensis L. Khotsoana Whole plant Decoction taken orally Sterility in women (Phillips, 1917;Van Wyk and Gericke, 2000;Watt and Breyer-Brandwijk, 1962) Flavonoids, glycosides, phlobatannins, saponins, tannins (Jemilat et al., 2010) Convolvulaceae Convolvulus bidentatus Bernh Apud Krauss Moroto-oa-phooko / morarana-o- monyane Not specified Decoction taken orally Medicine to ease pregnant women (Phillips, 1917; Watt and Breyer- Brandwijk, 1962) No records (alkaloids, coumarins) (Jenett-Siems et al., 1998 ; Malik et al., 2015) C. sagittatus Thunb. Morarana-o- monyane Not specified Decoction taken orally Medicine to ease pregnant women (Jacot Guillarmod, 1971 ; Watt and Breyer-Brandwijk, 1962) No records (alkaloids, coumarins) (Malik et al., 2015) Turbina oblongata A. Meeuse Mothokho Roots Decoction taken orally Breast cancer (Seleteng Kose et al., 2015) No records (alkaloids) (Cholich et al., 2013) Crassulaceae Cotyledon orbiculata L. var. oblonga (Haw.) DC Serelile Roots Decoction taken orally Mixed with Commelina africana for female infertility; difficult confinements (Phillips, 1917) Phenols, saponins, tannins (Molefe, 2013) Kalanchoe tetraphylla H. Perrier (K. thyrsiflora) Serelile/sereleli Roots Decoction taken orally Given to pregnant women for nausea (Schmitz, 1982 ; Watt and Breyer-Brandwijk, 1962) Steroids (Singab et al., 2012) Ebenaceae Euclea crispa (Thunb.) Gürke Mohlakola Leaves Decoction taken orally Painful menstruation (Jacot Guillarmod, 1971; Phillips, 1917) Alkaloids, flavonoids, saponins, terpenoids (Pretorius et al., 2003) Searsia divaricata (Eckl. & Zeyh.) Moffett (Rhus divaricata Eckl. & Zeyh.) Kolitšane Not specified Decoction taken orally Mixed with Cussonia paniculata and S. columbaria for colic in pregnant women and period pains (Watt and Breyer-Brandwijk, 1962) No records (polyphenols, triterpenes) (Yürüker, 1998) S. erosa (Thunb.) Moffett (R. erosa Thunb.) Tšilabelo Leaves Decoction taken orally Uterine cancer(Mugomeri et al., 2016) No records (see above) Fabaceae Elephantorrhiza elephantina (Burch.) Skeels (Elephantorrhiza burchellii Benth.) Mositsana Rhizome Decoction taken orally Breast cancer; infertility (Seleteng Kose et al., 2015) Flavonoids, tannins, terpenoids (Mpofu et al., 2014) Leobordea lanceolata (E.Mey.) B.-E. van Wyk & Boatwr. (Lotononis lanceolata (E.Mey.) Benth.) Khonathi Roots Decoction taken orally Breast cancer (Jacot Guillarmod, 1971; Phillips, 1917, Watt and Breyer- Brandwijk, 1962) Alkaloids (Van Wyk and Verdoorn, 1989) Rhynchosia adenodes Eckl. & Zeyh. Monya-mali Roots Decoction taken orally Menstrual pains (Shale et al., 1999) No records (flavonoids) (Besson et al., 1977) Gentianaceae Chironia krebsii Griseb. Leptjetlane-la- liliba Not specified Decoction taken orally To ease pregnancy (Watt and Breyer-Brandwijk, 1962) Xanthone glycosides (Wolfender et al., 1991) C. palustris Burch. Leptjetlane Not specified Decoction taken orally Same as above (Watt and Breyer-Brandwijk, 1962) No records (see above) Geraniaceae Pelargonium sidoides DC. Khoara Roots Decoction taken orally Heartburn in pregnant women (Jacot Guillarmod, 1971; Maliehe, 1997 ; Moteetee and Van Wyk, 2011; Phillips, 1917;Van Wyk et al., 1997, 2009) Coumarins, flavonoids, phenolic acids, tannins (Herbert et al., 2003;Herbert, 2007;Van Wyk et al., 2009) Gunneraceae Gunnera perpensa L. Qobo Roots Decoction taken orally Breast cancer; mixed with Asclepias humilis and Scabiosa columbaria used to regulate menstrual cycle; tones the uterus; period pains; colic in pregnant women; induces labour; expulsion of placenta in both women and animals; contraceptive by women ( Jacot Guillarmod, 1971 ; Maliehe, 1997; Phillips, 1917;Schmitz, 1982;Seleteng Kose et al., 2015);Van Wyk and Gericke, 2000);Van Wyk et al., 2009; Watt and Breyer- Brandwijk, 1962) Benzoquinones, glucosides (Drewes et al., 2005 ; Khan et al., 2004) Lamiaceae Ajuga ophrydis Burch. ex Benth. Senyarela Whole plant Decoction taken orally Regulation of menstrual cycle; period pains; fibroids in womb; mixed with Berkheya setifera, Kohautia amatymbica, and Rumex lanceolatus for female infertility ( Jacot Guillarmod, 1971 ; Maliehe, 1997; Phillips, 1917;Watt and Brandwijk, 1927) No records (flavonoids) (Inomata et al., 2013) Mentha aquatica L. Koena-e- nyenyane Whole plant Infusion/ decoction taken orally For virility in men (Maliehe, 1997) Flavonoids, terpenoids (Malingré and Maarse, 1974) M. longifolia (L.) L. Koena Whole plant Infusion/ decoction taken orally Cervical cancer; dysmenorrhoea; delayed pregnancy; complications associated with pregnancy; during pregnancy to ease labour (Jacot Guillarmod, 1971 ; Maliehe, 1997; Moffett, 2010;Moteetee and Van Wyk, 2011; Phillips, 1917; Pooley, 1998;Schmitz, 1982;Seleteng Kose et al., 2015;Van Wyk et al., 1997, 2009; Watt and Breyer- Brandwijk, 1962) Flavone glycosides, monoterpenoids (Sharaf et al., 1999) Salvia runcinata L.f. Mosisili Whole plant Decoction taken orally Breast cancer; infertility (Seleteng Kose et al., 2015) Terpenoids (Kamatou et al., 2008) S. triangularis Thunb. Mosisili-oa-loti Whole plant Decoction taken orally Mixed with Helichrysum nudifolium var. pilosellum and C. africana for infertility in women (Watt and Brandwijk, 1927;Watt and Breyer-Brandwijk, 1962) No records (see above) Malvaceae Hermannia depressa N.E.Br. Seletjane Roots Decoction taken orally Abdominal pains in pregnancy, breast cancer; nausea, improves appetite in pregnant women (Moteetee and van Wyk, 2011; Phillips, 1917; Pooley, 1998;Schmitz, 1982;Seleteng Kose et al., 2015;Van Wyk and Gericke, 2000) Phenolics, saponins, tannins (Molefe et al., 2013;Reid et al., 2005) H. geniculata Eckl. &. Zeyh. (Hermannia betonicifolia Eckl. & Zeyh.. H. chrysantha E. Meyer ex Turczaninow non Harvey) Selepe Roots Decoction taken orally Used for flatulency in pregnant women (Jacot Guillarmod, 1971; Moffett, 2010; Phillips, 1917;Watt and Breyer-Brandwijk, 1962) No records (see above) *Malva parviflora L. Tika-motse Roots Douche for uterine troubles, decoction taken orally for menorrhagia Profuse menstruation, uterine problems (Jacot Guillarmod, 1971 ; Moteetee and Van Wyk, 2011; Phillips, 1917;Seleteng Kose et al., 2015;Watt and Brandwijk, 1927; Watt and Breyer- Brandwijk, 1962) Alkaloids, flavonoids, glucosides, phytosterols, saponins, total phenols, steroids, tannins (Abdel-Ghani et al., 2013;Shehata and Galal, 2014) Myricaceae Morella serrata (Lam.) Killick Malokela / maleleka Whole plant decoction taken orally Period pains (Hutchings and Van Staden, 1994; Jacot Guillarmod, 1971 ; Moteetee and Van Wyk, 2011; Phillips, 1917; Watt and Breyer- Brandwijk, 1962) Flavonoids, saponins, steroids, terpenoids (Ashafa, 2013) Oleaceae Olea europaea ssp. cuspidata (Wall. & G.Don) Cif. (Olea africana Mill., E. europaea subsp. africana (Mill.) P.S.Green) Mohloare Leaves, stem (bark) Drunk as infusion Male infertility (Maliehe, 1997 ; Van Wyk et al., 2009) Flavonoids, glucosides, steroids, tannins, terpenoids (Masoko and Makgapeetja, 2015 ; Tsukamoto et al., 1984) Orobanchaceae Sopubia cana Harv. Leilane/ pulumo- tšoeu Unspecified Decoction taken orally Decoction of this plant mixed with Salvia runcinata used for period pains (Phillips, 1917) No records (flavonoids) (Saxena, 1990) Papaveraceae *Argemone ochroleuca Sweet Hlaba-hlabane-e-putsoa Stem Decoction taken orally Period pains (Maliehe, 1997; Moffett, 2010) Alkaloids (Waksmundzka-Hajnos and Sherma, 2011) Phrymaceae Mimulus gracilis R.Br. Sehlapetso Not specified Decoction taken orally For irregular menstruation (Jacot Guillarmod, 1971; Phillips, 1917; Watt and Breyer-Brandwijk, 1962) No records (flavonoids, glycosides) (Ferro et al., 1972; Keefover-Ring et al., 2014) Phytolaccaceae Phytolacca heptandra Retz. Monatja Roots (toxic) Decoction taken orally (low dosage to avoid adverse effects) Cervical cancer, taken by pregnant women to prevent birthmarks in their unborn children (Moffett, 2010; Moteetee and Van Wyk, 2011;Seleteng Kose et al., 2015,Watt and Breyer-Brandwijk, 1962) No records (triterpenoid saponins) (Moreno and Rodriguez, 1981) Polygonaceae Rumex lanceolatus Thunb. (Rumex ecklonianus Meisn., Rumex ecklonii Meisn., Rumex linearis Campd. Rumex meyeri Meisn., Rumex meyerianus Meisn.) Khamane Rhizome Decoction taken orally Root decoction for menstrual pains, mixed with Ajuga ophrydis and Berkheya setifera for treatment of sterility ( Jacot Guillarmod, 1971; Seleteng Kose et al., 2015; Steenkamp, 2003; Watt and Brandwijk, 1927 ; Watt and Breyer-Brandwijk, 1962) Flavonoids, tannins (Jimoh et al., 2008, as R. ecklonianus) R. nepalensis Spreng Khamane-e-kholo Unspecified Decoction taken orally For newly confined women (Phillips, 1917;Watt and Breyer-Brandwijk, 1962) Anthraquinones, lignan derivatives, naphthalene glycosides, stilbenoids, tannins (Vasas et al., 2015) Rosaceae Rubus rigidus Sm. Monokotšoai-oa-banna Roots Decoction taken orally Cervical cancer, complications associated with pregnancy (Seleteng Kose et al., 2015) Flavonoids, glycosides, phytosterols (Nguelefack et al., 2011) Rubiaceae Anthospermum rigidum Eckl. & Zeyh. ssp. pumilum (Sond.) Puff (A. humile N.E.Br., A. pumilum Sond.) Phakisane Roots Decoction taken orally Menstrual pains and as purgative to pregnant women (Seleteng Kose et al., 2015; Watt and Brandwijk, 1927 ; Watt and Breyer-Brandwijk, 1962) No records (terpenoids) (Rosoarivelo et al., 2011) Galium capense Thunb. subsp. garipense (Sond.) Puff (Galium garipense Sond., G. wittbergense Sond.) Seharane Roots Decoction taken orally Purgative for pregnant women (Watt and Breyer-Brandwijk, 1962) No records (anthraquinones, triterpene saponins, iridoid glucosides) (De Rosa et al., 2000) G. mucroniferum Sond. var. dregeanum (Sond.) Puff (G. dregeanum Sond.) Mohlatsoa-meno/ seharane Roots Decoction taken orally Sterility in females (Jacot Guillarmod, 1971; Moffett, 2010) No records (see above) G. undulatum Puff Morara-o- mofubelu Roots Decoction taken orally Taken by women in the latter part of their pregnancy, said to have purgative effects No records (see above) Kohautia amatymbica Eckl. & Zeyh. (Hedyotis amatymbica (Eckl. & Zeyh.) Steud.), Oldenlandia amatymbica (Eckl. & Zeyh.) Kuntze) Morokolo-oa-poli Unspecified Decoction taken orally Mixed with Ajuga ophrydis, Berkheya setifera, and Rumex lanceolatus for sterility (Moffett, 2010;Steenkamp, 2003; Watt and Brandwijk, 1927 ; Watt and Breyer-Brandwijk, 1962 No records Pentanisia prunelloides (Klotzsch) Walp. Setima-mollo Roots, leaves Decoction taken orally Breast cancer; eases childbirth, expulsion of retained placenta (Jacot Guillarmod, 1971 ; Moteetee and Van Wyk, 2011; Phillips, 1917; Pooley, 1998;Schmitz, 1982;Van Wyk et al., 1997, 2009, Watt and Breyer- Brandwijk, 1962) Flavonoids, tannins, terpenoids (Mpofu et al., 2014) Scrophulariaceae Buddleja salviifolia (L.) Lam. (Lantana salviifolia L.) Lelothoane Leaves Complications associated with pregnancy; cervical cancer (Maliehe, 1997 ; Seleteng Kose et al., 2015) Flavonoids (Pendota et al., 2013) Solanaceae *Solanum aculeatissimum Jacq. (S. cavaleriei H. Lév. & Vaniot, S. khasianum C.B. Clarke) Thola/ thola-e- meutloa Whole plant Decoction taken orally Decoction used to cleanse uterus after miscarriage (Moffett, 2010) Alkaloids, glycosides, saponins, steroids, (Shale et al., 1999) Withania somnifera (L.) Dunal Mofera-ngope Roots Decoction taken orally Breast cancer; infertility; menorrhagia; toning of the uterus; removes retained conception products (Jacot Guillarmod, 1971 ; Moteetee and Van Wyk, 2011; Phillips, 1917;Schmitz, 1982; Van Wyk et al., 1997;Watt and Brandwijk, 1927; Watt and Breyer- Brandwijk, 1962) Alkaloids, glucosides, steroids, with anolides (Jain et al., 2012) Vitaceae Rhoicissus tridentata (L.f.) Wild & R.B. Drumm. Morara Not specified Decoction taken orally Sterility in women (Jacot Guillarmod, 1971; Phillips, 1917) Alkaloids, flavonoids, saponins, tannins (Mukundi et al., 2015) Monocotyledons Amaryllidaceae Agapanthus campanulatus F.M.Leight. ssp. patens (F.M.Leight.) F.M.Leight. (A. patens F.M.Leight.) Leta-la-phofu Roots Decoction taken orally Mixed with other plants for period pains (Maliehe, 1997; Moteetee and Van Wyk, 2011) Alkaloids, flavonoids, phytoecdysteroids, saponins, sapogenins (Fawole et al., 2009;Savchenko et al., 1997) Brunsvigia radulosa Herb. (B. cooperi Baker, B. burchelliana Herb.) Lematla Bulb Decoction taken orally Individually or mixed with other plants is used for infertility in women (Jacot Guillarmod, 1971; Phillips, 1917; Watt and Breyer- Brandwijk, 1962) Alkaloids (Campbell et al., 2000 ; Harborne et al., 1999) Araceae Zantedeschia albomaculata (Hook.) Baill. Mohalalitoe Rhizome Decoction taken orally Mixed with Eucomis autumnalis to cure cysts in the uterus (Maliehe, 1997; Moffett, 2010;Moteetee and Van Wyk, 2011;Mugomeri et al., 2016) Flavonoids (Greca et al., 1998) Asparagaceae Asparagus microraphis (Kunth) Baker (Asparagopsis microrhaphis Kunth, Protasparagus microraphis (Kunth) Oberm.) Lerara-tau/ lehonyeli Roots Decoction taken orally Period pains (Shale et al., 1999) No records (alkaloids, flavonoids, steroidal glycosides) (Vlase et al., 2014) Eriospermum ornithogaloides Baker (E.coerulescens Poelln., E. haygarthii Baker, E. microphyllum Baker Khongoana- tšingoana/ tsebe- ea-pela Not specified Decoction taken orally Mixed with Gunnera perpensa and Scabiosa columbaria to cleanse the uterus and improve fertility (Maliehe, 1997; Moffett, 2010) No records Eucomis autumnalis (Mill) Chitt. ssp. clavata (Baker) Reyneke Khapumpu Bulbs, roots Decoction taken orally For difficult childbirth (Jacot Guillarmod, 1971; Maliehe, 1997; Schmitz, 1982 ; Van Wyk et al., 2009) Flavonoids, terpenoids (Mulholland et al., 2013) E. regia (L.) Aiton Khapumpu Root Decoction taken orally To prevent premature childbirth (Watt and Breyer-Brandwijk, 1962) No records (see above) Fusifilum depressum (Baker) U.Müll.-Doblies, J.S.Tang & D.Müll.-Doblies (Drimia depressa (Baker) Jessop, Urginea depressa Baker, U. ecklonii Baker & Adamson Moretele Whole plant Breast cancer (Jacot Guillarmod, 1971;Moteetee and Van Wyk, 2011; Phillips, 1917; Pooley, 2003; Watt and Breyer- Brandwijk, 1962) Glycosides (Crouch et al., 2007) Ledebouria cooperi (Hook.f.) Jessop (Scilla cooperi Hook.f., S. rehmannii Baker, S. sphaerocephala Baker, etc.) Leptjetlane Bulb Decoction taken orally Soothing medicine to ease pregnancy (Hutchings et al., 1996; Phillips, 1917;Seleteng Kose et al., 2015;Watt and Breyer-Brandwiijk, 1962) Flavonoids, terpenoids (Mulholland et al., 2013) Cyperaceae Scirpus falsus C.B.Clarke Loli Rhizome Infertility (Seleteng Kose et al., 2015) No records Hypoxidaceae Hypoxis hemerocallidea Fisch. Moli Corms Decoction taken orally Infertility in men, testicular tumours, swollen testicles (Seleteng Kose et al., 2015 ; Van Wyk et al., 2009) Phytosterol glycosides (Ncube et al., 2013) Poaceae Cynodon incompletus Nees. (Cynodon hirsutus Stent) Mohloa Leaves and roots Decoction taken orally Labour pains (Watt and Brandwijk, 1927) No records (flavones) (Murali et al., 2015) Typhaceae Typha capensis (Rohrb.) N.E.Br. (Typha latifolia subsp. capensis Rohrb.) Motsitla Rhizome Decoction taken orally Given during parturition to strengthen contractions (Watt and Breyer-Brandwijk, 1962) Phenolic compounds (Shode et al., 2002) Xanthorrhoeaceae Aloe ecklonis Salm-Dyck (Aloe agrophila Reynolds) Lekhalana Roots Decoction taken orally Infertility in women (Jacot Guillarmod, 1971;Schmitz,1982) No records A. maculata All. Lekhala-la-bafu Leaves Breast cancer (Pooley, 2003; Watt and Breyer- Brandwijk, 1962) Aloin, anthraquinones, saponins (Schmelzer et al., 2008) Bulbine narcissifolia Salm.-Dyck (B. densiflora Baker, B. latibracteata Poelln. Phalangium narcissifolium (Salm-Dyck) Kuntze) Khomo-ea-balisa Roots Decoction taken orally Uterine cysts, fibroids; infertility in women (Maliehe, 1997; Watt and Breyer- Brandwijk, 1962) Anthraquinones, glycosides (Qhotsokoane-Lusunzi and Karuso, 2001) Kniphofia caulescens Baker Leloele Bulbs Decoction taken orally Infertility in women; mixed with Gunnera perpensa to cleanse uterus; regulates menstrual cycle (Maliehe, 1997) Anthraquinones (Dai et al., 2013) K. northiae Baker Lelutla Stems Decoction taken orally Period pains; menorrhagia (Mugomeri et al., 2016) Anthraquinones (Van Wyk et al., 1995)
- Table 2. List of Lesotho medicinal plants, their anti-oxidant and anti-inflammatory activities, toxicology, and references.
Species (naturalised alien species are marked with an asterisk*) Anti-oxidant activity Anti-inflammatory activity Toxicology Pteridophytes Equisetaceae Equisetum ramosissimum Desf. FRAP assay: FRAP units = 5.44×100 µm Fe2+; ESR = 97.8% (Štajner, et al., 2009). Not yet evaluated No severe discernible toxic effects (Li et al., 2016) DPPH assay: 43.41 ± 7.68% (Li et al., 2016) Pteridaceae Adiantum capillus-veneris L. H2O2 assay: Glutathione peroxidase recovery= 6.40 (H2O2 only), 7.60 (H2O2 + 5 μl leaf extract), 8.62 (H2O2 + 10 μl leaf extract), 10·20H2O2 + 20 μl leaf extract)(Kumar, 2009) Carrageenan induced oedema assay: 67.27% inhibition at 300 mg/kg (3 h) (Haider et al., 2011) Chorioallantoic membrane bioassay: weak irritation in the hen’s egg test (Nilforoushzadeh et al., 2014) Selaginenellaceae Selaginella caffrorum (Milde) Hieron. Not yet evaluated Not yet evaluated Not yet evaluated Dicotyledons Apocynaceae Xysmalobium undulatum (L). Aiton f. var. undulatum ABTS assay: methanol extract of aerial part, 50% inhibition at 0.125 mg/ml (Steenkamp et al., 2004) Cyclooxygenase assay: 96% COX inhibition (Jäger et al., 1996) Dry, alcoholic extract of the root is very toxic to animals (Watt and Breyer-Brandwijk, 1962) Araliaceae Cussonia paniculata Eckl. & Zeyh. ssp. sinuata (Reyneke & Kok) De Winter Not yet evaluated *Carrageenan-induced oedema assay: 96.6% inhibition at 50 mg/kg (2hrs); histamine-induced oedema assay: 92.4% at 200 mg/kg (3 h) (Adedapo et al., 2008) Not yet evaluated Asteraceae Afroaster hispida (Thunb.) J.C.Manning & Goldblatt Not yet evaluated Not yet evaluated Not yet evaluated Artemisia afra Jacq. ex. Willd. DPPH & ABTS assays: Crude extract: IC50=2.113 μg/ml against DPPH, 6.44 μg/ml against ABTS (Muleya et al., 2014a) Lipoxygenase assay: EC50 = 21.8 in 25 μg/ml of crude extract 15 LOX inhibitory activity (Muleya et al., 2014a) MTT toxicity assay: IC50 16.95 μg/ml on McCoy fibroblast cell line (More et al., 2012) Berkheya cirsiifolia (DC.) Roessler Not yet evaluated Not yet evaluated Not yet evaluated B. setifera DC. DPPH & ABTS assays: EC50 = 2.471 μg/ml against DPPH, 1.967 μg/ml against ABTS (Muleya et al., 2014b) Lipoxygenase assay: 80% 15-LOX inhibition at 25 μg/ml (Muleya et al., 2014b) Extracts showed no toxicity on human red blood cells and kidney epithelial cells (Sibandze and Van Zyl, 2008) *Crepis hypochaeridea (DC.) Thell. Not yet evaluated Not yet evaluated Not yet evaluated Dicoma anomala Sond. Not yet evaluated Cyclooxygenase assay: 86% COX inhibition (Shale et al., 1999) No mortalities or toxicity signs on rats (Balogun and Ashafa, 2016) Gazania krebsiana Less. DPPH & ABTS assays: IC50 3.32 µg/ml (DPPH), 5.00 µg/ml (SOD), 0.60 µg/ml (metal chelating), 0.70 µg/ml (ABTS) (Balogun and Ashafa, 2016) Not yet evaluated Not yet evaluated G. linearis (Thunb.) Druce Not yet evaluated Carrageenan-induced oedema assay: no major inhibition at 200 or 500 mg/kg; 48% inhibition at 1000 mg/kg (4hrs) (El Kady et al., 2015, as G. longiscapa Single oral administration: no significant change was observed in haematological parameters liver functions, and kidney functions (El Kady et al., 2015, as G. longiscapa) Gerbera ambigua (Cass.) Sch. Bip. Not yet evaluated Not yet evaluated Not yet evaluated G. piloselloides (L.) Cass. ABTS assay: (Wang et al., 2014) Not yet evaluated Not yet evaluated Haplocarpha scaposa Harv. Not yet evaluated Not yet evaluated Not yet evaluated Helichrysum caespititium (DC.) Sond. ex Harv. Not yet evaluated Not yet evaluated Not yet evaluated H. nudifolium var. pilosellum (L.f.) Beentje Not yet evaluated Cyclooxygenase assay: 96% COX inhibition (Jäger et al., 1996) No toxicity using sulforhodamine B assay with 73.1% T/C of Graham cells, 83.9% T/C of SF−268 glioblastoma cells, 35.3% T/C of MCF−7 breast adenocarcinoma cells (Lourens et al., 2011) H. odoratissimum (L.) Sweet 5,6-dihydroxy−3,7,8-trimethoxyflavone, 5,7-dihydroxy−3-methoxyflavone, 3′,4′,5,7- tetrahydroxy−3-methoxyflavone and 3′,4′,3,5- promising anti-inflammatory activity of 5,6-dihydroxy−3,7,8-trimethoxyflavone and 3′,4′,3,5-tetrahydroxy−7- No toxicity using sulforhodamine B assay, with 17.5% T/C of Graham cells, 48.2% T/C of SF−268 cells, 7.4% T/C of MCF−7 breast tetrahydroxy−7-methoxyflavone, have antioxidant activity by the DPPH free radical assay (Legoalea et al., 2013) methoxyflavone (Legoalea et al., 2013) cancer cells (Lourens et al., 2011) H. platypterum DC. Not yet evaluated Not yet evaluated Potential toxicity using sulforhodamine B assay, with 0.8% T/C of Graham cells, 35.1% T/C of SF−268 cells, 4.6% T/C of MCF−7 breast cancer cells (Lourens et al., 2011) H. psilolepis Harv. Not yet evaluated Not yet evaluated No toxicity using sulforhodamine B assay, with 25.9% T/C of Graham cells, 58.4% T/C of SF−268 cells, 23.1% T/C of MCF−7 breast cancer cells ((Lourens et al., 2011) Senecio coronatus Harv. Not yet evaluated Not yet evaluated Not yet evaluated S. rhomboideus Harv. Not yet evaluated Not yet evaluated Not yet evaluated Caprifoliaceae Cephalaria pungens Szabō Not yet evaluated Not yet evaluated Not yet evaluated Scabiosa columbaria L. Not yet evaluated Not yet evaluated Not yet evaluated Commelinaceae Commelina africana L. Not yet evaluated Not yet evaluated Not yet evaluated C. benghalensis L. antioxidant potency, level of GPx, CAT and SOD was significantly restored by plant extract treatment (Kokilavani et al., 2014) Carrageenan-induced oedema assay: isolated HECB showed 60.29% inhibition at 400 mg/kg (Tiwari et al., 2013) Acute and sub-acute dose toxicity tests showed no significant change in any biochemical parameters (Tiwari et al. 2013) Convolvulaceae Convolvulus bidentatus Bernh Apud Krauss Not yet evaluated Not yet evaluated Not yet evaluated C. sagittatus Thunb. Not yet evaluated Not yet evaluated Not yet evaluated Turbina oblongata A. Meeuse (Ipomoea oblongata) Not yet evaluated Not yet evaluated Not yet evaluated Crassulaceae Cotyledon orbiculata L. var. oblonga (Haw.) DC Not yet evaluated Oedema assay: 51% inhibition at 100 mg/kg; 76% inhibition at 400 mg/kg (Amabeoku and Kabatende, 2012) Negative – acute mammalian toxicity test (Amabeoku and Kabatende, 2012); acute bufadienolide cardiac glycoside toxicity in animals, with presence of histopathologically multiple foci of myocardial degeneration (Tustin et al., 1984) Kalanchoe tetraphylla H. Not yet evaluated Not yet evaluated Not yet evaluated Perrier Ebenaceae Euclea crispa (Thunb.) Gürke Not yet evaluated Not yet evaluated Toxicity against human cancer cells using the MTT test (Al-Fatim et al., 2005) Searsia divaricata (Eckl. & Zeyh.) Moffett Not yet evaluated Not yet evaluated Not yet evaluated S. erosa (Thunb.) Moffett Not yet evaluated Not yet evaluated Not yet evaluated Fabaceae Elephantorrhiza elaphantina (Burch.) Skeels Not yet evaluated Oedema assay: 93.7% inhibition at 50 mg/kg (Lall and Kishore, 2014 ; Maphosa et al., 2009) Negative – acute, sub-acute and chronic mammalian toxicity tests [low toxicity on blood parameters, however, some level of toxicity were demonstrated on organs namely kidneys, lungs, liver and spleen. Therefore the plant should be used with caution, with a maximal dose of25 mg per ml] (Maphosa et al., 2010) Leobordea lanceolata (E.Mey.) B.-E. van Wyk & Boatwr. Not yet evaluated Not yet evaluated Not yet evaluated Rhynchosia adenodes Eckl. & Zeyh. Not yet evaluated Cyclooxygenase assay: leaf extract 95% COX inhibition; root extract 93% COX inhibition (Shale et al., 1999) Not yet evaluated Gentianaceae Chironia krebsii Griseb. inhibition of two xanthones 2,3-dihydroxy−4-methoxyxanthone and the 2-formyl−3-hydroxy−4-methoxyxanthone against human cancer cells (Pedro, et al., 2002) Not yet evaluated Not yet evaluated C. palustris Burch. Not yet evaluated Not yet evaluated Not yet evaluated Geraniaceae Pelargonium sidoides DC. High levels of TDZ (2.5; 5.0 µ M) induced higher radical scavenging activity based on the DPPH assay (Kumar et al., 2015); antioxidant potential measured by DPPH radical scavenging activity (EC50 of 5.5 µm/ml) and ORAC (1000 µmolTE/g), (Moyo et al., 2013) EPsR 7630 assessed in acute bacterial bronchitis model in rats, tracheal lesions significantly reduced at doses of 30 and 60 mg/kg (Bao et al., 2015). The half maximal cytotoxic concentration of EPs 7630 (CC50) of 557 lg/ml (Theisen and Muller, 2012); EPss 7630, did not cause obvious toxic effects in mice (lungs, liver, spleen, kidneys), (Moyo and Van Staden, 2014) Gunneraceae Gunnera perpensa L. Crude extract: EC50 = 1.069 μg/ml against DPPH; 32.49 μg/ml against ABTS (Muleya et al., 2014a) Oedema assay: 59.2% inhibition at 150 mg/kg (Lall and Kishore, 2014 ; Nkomo et al., 2010); Lipoxygenase assay: EC50=81.18 μg/ml soya bean 15-LOX inhibitory activity. Lamiaceae Ajuga ophrydis Burch. ex Benth. Not yet evaluated Not yet evaluated Not yet evaluated Mentha aquatica L. Radical scavenging activity (Reduce DPPH radicals into the neutral DPPH-H form), (Mimica-Dukić et al., 2003); Anti-inflammatory effect (300 µg/cm) provoked oedema reductions ranging from 21% to 27% (Conforti et al., 2008) Acute toxicity using the Microtox acute toxicity test revealed 20% toxicity for the human health (Conforti et al., 2008) The DPPH scavenging assay of 7.50 µg/ml, (Benabdallah et al., 2016) M. longifolia (L.) L. IC50 = 57.4 µm/ml (plant extract) and 10,700 µm/ml (essential oil) against DPPH (Gulluce et al., 2007) Decreased TNFα pro-inflammatory cytokine expression (Karimian et al., 2012) Moderately toxic for oral medication in rats, with LD50 of 470 mg/kg (Jalilzadeh-Amin and Maham, 2015); Marked cytotoxic activity against MCF−7 cells using Brine shrimp cytotoxicity assay (Al-Ali et al., 2013) Salvia runcinata L.f. IC50 value of 6.09 µg/ml using a modified quantitative 2,2-diphenyl−1-picrylhydrazyl (DPPH) assay (Kamatou et al., 2005) IC50 value of > 100 µg/ml, using 5-LOX (Kamatou et al., 2005) Non-toxic, IC50 value of > 100 µg/ml, using 3-[4,5-dimethylthiazol−2-yl]−2,5-diphenyltetrazolium bromide (MTT) assay on Graham cells (Kamatou et al., 2005) S. triangularis Thunb. Not yet evaluated Not yet evaluated Not yet evaluated Malvaceae Hermannia depressa N.E.Br. Not yet evaluated COX−1 inhibition in stem (78%) and root (81%) at 0.5 mg/ml (Reid et al. 2005) Not yet evaluated H. geniculata Eckl. &. Zeyh Not yet evaluated Not yet evaluated No deleterious effect on the livers, kidneys, lungs or hearts of rats animals, but significantly reduced (p < 0.05) white blood cells and other haematological parameters (Kazeem et al., 2015) *Malva parviflora L. Strong scavenging activity with IC(50) of 89.03 µg/ml using 1,1-diphenyl−2-picryl-hydrazyl (DPPH) radical assay (Bouriche et al, 2011) Cyclooxygenase assay: 98% COX−1 inhibition at 200 μg/ml (Shale et al., 1999; Shale et al., 2005) ; inhibition of croton oil-induced ear oedema by 57% and acetic acid-induced vascular permeability by 36% and 40% (Bouriche et al, 2011) Not yet evaluated Myricaceae Morella serrata (Lam.) Killick Not yet evaluated Not yet evaluated Significant lethality against brine shrimp naupli with LC50 of 0.26 µmL−1 in ethanol extract and 0.18 µmL−1 in methanol extract of root (Ashafa, 2013) Oleaceae Olea europaea ssp. cuspidata (Wall. & G.Don) Cif. Scavenging activity of flavonol rhamnoglucoside rutin (TEAC 2.75 mM) by ABTS·+radical cation (Benavente-Garcı́áet al., 2000) Not yet evaluated No mutagenicity in a bacterial reverse mutation test and in an vitro mammalian chromosomal aberration test, and no genotoxic activity in mouse micronucleus test at concentrations of 2000 mg/kg bw/d. (Clewell et al., 2016) Orobanchaceae Sopubia cana Harv. Not yet evaluated Not yet evaluated Not yet evaluated Papaveraceae *Argemone ochroleuca Sweet Not yet evaluated Not yet evaluated Low cytotoxicity against MRC−5 cells (CC(50) of 11.6 µg/ml) (Abdel-Sattar et al, 2010) Phrymaceae Mimulus gracilis R.Br. Not yet evaluated Not yet evaluated Not yet evaluated Phytolaccaceae Phytolacca heptandra Retz. Not yet evaluated Not yet evaluated Not yet evaluated Polygonaceae Rumex lanceolatus Thunb. Not yet evaluated Not yet evaluated Not yet evaluated R. nepalensis Spreng Not yet evaluated Oedema assay: compounds 1, 7 and 16 exhibited 65.3%, 57.7% and 43.2% reduction respectively (Vasas et al., 2015) Not yet evaluated Rosaceae Rubus rigidus Sm. Free radical scavenging activity (Emaxs of 119% and 229% activity on DPPH and β-carotene test), constituent flavonoids exhibited potent antioxidant activities 66–93.56% against DPPH radical) (Nguelefack et al., 2011) Not yet evaluated Moderately toxic (LC50 of 19.8 μg/ml), (Moshi et al., 2010) Rubiaceae Anthospermum rigidum Eckl. & Zeyh. ssp. pumilum (Sond.) Puff Not yet evaluated Not yet evaluated Not yet evaluated Galium capense Thunb. subsp. garipense (Sond.) Puff Not yet evaluated Not yet evaluated Not yet evaluated G. mucroniferum Sond. var. dregeanum (Sond.) Puff Not yet evaluated Not yet evaluated Not yet evaluated G. undulatum Puff Not yet evaluated Not yet evaluated Not yet evaluated Kohautia amatymbica Not yet evaluated Not yet evaluated Not yet evaluated Eckl. & Zeyh. Pentanisia prunelloides (Klotzsch) Walp. 5-lipoxygenase inhibitory [IC50 (ppm) of 32.71] and DPPH anti-oxidant activities [IC50 (ppm) of 11.79], (Frum and Viljoen, 2006) Cyclooxygenase assay: 88% COX−1 inhibition at 0.1 mg/ml (Lall and Kishore, 2014 ; Yff et al., 2002). Lipoxygenase assay: 79% 15-LOX inhibition at 167 μg/ml (Muleya et al., 2015) Ethanol leaf extract MTT assay: No toxicity observed on monkey kidney cells up to 31.25 mg/ml (Yff et al., 2002); Nongenotoxic activity using Salmonella microsome assay (Madikizela et al., 2014) Scrophulariaceae Buddleja salviifolia (L.) Lam. IC50 of 0.23 mg/ml for DPPH and 0.14 mg/ml for ABTS radical scavenging tests (Adewusi et al., 2011) Cyclooxygenase assay: isolated compounds 1, 2, 3) exhibited high COX−2 inhibition (70%, 80%, 90% respectively) (Pendota et al., 2014) IC50 > 200 µg/ml Inhibition of cell proliferation using resazurin test (Jonville et al., 2011) Solanaceae *Solanum aculeatissimum Jacq. Not yet evaluated Not yet evaluated Not yet evaluated Withania somnifera (L.) Dunal Dose related increase in SOD, CAT and GPX enzymes activity in frontal cortex striatum of rats (Bhattacharya et al., 1997) NFkappaB-inhibitory activity, TNTα-inhibitory activity (Kaileh et al., 2007) Marked toxicity, IC50 values of 2.1 Ag/ml (PE/EtOAc) and 1.1 Ag/ml (MeOH) against ECV−304 cells (Al-Fatim et al., 2005) Vitaceae Rhoicissus tridentata (L.f.) Wild & R.B. Drumm. Inhibition of 1, 1′-diphenyl−2-picryhydrazyl free radical, xanthine oxidase, and also prevented production of thiobarbituric acid reactive substances and free radical mediated DNA sugar damage (Opoku et al., 2002) Significant inhibition of cyclooxygenase (COX−1),Lin et al., 1999) Not yet evaluated Monocotyledons Amaryllidaceae Agapanthus campanulatus F.M.Leight. ssp. patens (F.M.Leight.) F.M.Leight. Not yet evaluated Cyclooxygenase assay: ± 90% COX−1% and 70% COX−2 inhibition at 250 μg/ml (Fawole et al., 2009) Not yet evaluated Brunsvigia radulosa Herb. Not yet evaluated Not yet evaluated Cytotoxicity with BL6 mouse melanoma cells, IC50 ranging between 0.43 and 9.4 mg/ml (Campbell et al., 2000) Araceae Zantedeschia albomaculata (Hook.) Baill. Not yet evaluated Not yet evaluated Not yet evaluated Asparagaceae Asparagus microraphis (Kunth) Baker Not yet evaluated Cyclooxygenase assay: leaf extract 89% COX inhibition; root extract 97% COX inhibition (Shale et al., 1999) Not yet evaluated Eriospermum ornithogaloides Baker Not yet evaluated Not yet evaluated Not yet evaluated Eucomis autumnalis (Mill) Chitt. ssp. clavata (Baker) Reyneke DPPH assay: EC50 = 2.461 μg/ml against DPPH; ABTS assay: EC50 = 24.4 μg/ml against ABTS (Muleya et al., 2014a) 80% inhibition of COX−1% and 85% inhibition of COX−2 enzymes at 250 μg ml−1 (Taylor and Van Staden, 2002); Not yet evaluated IC50 of 72 mg/ml for the bulb, 27 mg/ml for the root extracts, and 15 mg/ml for the leaf extract (Taylor and Van Staden, 2001) E. regia (L.) Aiton Not yet evaluated Not yet evaluated Not yet evaluated Fusifilum depressum (Baker) U.Müll.-Doblies, J.S.Tang & D.Müll.-Doblies Not yet evaluated Not yet evaluated Not yet evaluated Ledebouria cooperi (Hook.f.) Jessop Not yet evaluated Not yet evaluated Not yet evaluated Cyperaceae Scirpus falsus C.B.Clarke Not yet evaluated Not yet evaluated Not yet evaluated Hypoxidaceae Hypoxis hemerocallidea Fisch. Antioxidant activity using the DPPH (1,1-diphenyl−2-picryl hydrazine) and FRAP (ferric reducing ability of plasma) tests, Inhibition of quinolinic acid (QA) induced lipid peroxidation in rat liver tissue using the thiobarbituric assay (TBA), Superoxide free radical scavenging activity using nitroblue tetrazolium assay (Nair et al., 2007); Cyclooxygenase assay: 48% COX inhibition (Jäger et al., 1996); 98%COX−1 and COX−2 74% inhibition at 250 µg/ml in corm, and 78% COX−1% and 59% COX−2 in leaf (Aremu et al., 2010) Negative toxicity using Ames test and VITOTOX (Elgorashi et al., 2003 ; Reid et al., 2006); and positive – micronucleus test (Taylor et al., 2003); No toxicity with LD50 of 1948 mg/kg in mice (Ojewole, 2006); No genotoxicity using the neutral red uptake (NRU) assay (Verschaeve et al., 2013) Poaceae Cynodon incompletes Nees Not yet evaluated Not yet evaluated Not yet evaluated Typhaceae Typha capensis (Rohrb.)N.E.Br. 2,2-diphenyl−1-picrylhydrazyl (DPPH) radical Not yet evaluated Negative effects on vitality, motility, sperm N.E.Br. scavenging activity of 12.8% (Masoko et al., 2008) production and mitochondrial membrane potential (Henkel et al., 2012) Xanthorrhoeaceae Aloe ecklonis Salm-Dyck Not yet evaluated Not yet evaluated Not yet evaluated A. maculata All. Inactive, 5-lipoxygenase inhibitory and DPPH anti-oxidant activities IC50 (ppm) > 100 (Frum and Viljoen, 2006) Not yet evaluated Not yet evaluated Bulbine narcissifolia Salm.- Dyck Not yet evaluated Not yet evaluated Not yet evaluated Kniphofia caulescens Baker Not yet evaluated Not yet evaluated Not yet evaluated K. northiae Baker Not yet evaluated Not yet evaluated Not yet evaluated
Thirty-one plants are used for the treatment of infertility, with more than half (19) used specifically by women (e.g. Ajuga ophrydis, Haplocarpha scaposa, S. columbaria, Bulbine narcissifolia) as opposed to two species that are used only by men (i.e. Hypoxis hemerocallidea and Olea europaea ssp. africana). The use of the remaining plants in this category (10) is not gender specific (e.g. Cephalaria pungens, Dicoma anomala, Elephantorrhiza elephantina, and Salvia runcinata). According to Okonufua and Obi (2009),
there is an indication that infertility is a major problem associated
with reproductive health in sub-Saharan Africa. Based on experiences
from Uganda, Cui (2010)
has argued that a couple’s failure to conceive is due to male
infertility in about 50% of cases, but indicates that according to Dr
Mahmoud Fathalla (the former director of the Special Programme of
Research, Development and Research Training in Human Reproduction based
at WHO), the social burden “falls disproportionately on women”. Cui (2010)
also points out that “in many cultures, childless women suffer
discrimination, stigma and ostracism”, and further quotes Dr Mahmoud
Fathalla saying that “when a couple is unable to reproduce, the man may
divorce his wife or take another wife if they live in a culture that
permits polygamy”. Surprisingly, only very few of the listed plants are
used for similar purposes by other cultures in southern Africa, although
none of the plants are restricted to Lesotho, this is possibly because
of the different cultural believes and practices. Elephantorrhiza elephantina is reported to be used for infertility in Zimbabwe as well, though specifically by women ( Hutchings et al., 1996). Rhoicissus tridentata is used as a cure for impotency and barrenness by the Zulu people, while Rumex
species are reported to be used by the “Nguni and the Sotho ……. as a
remedy for barrenness, infertility and sexual impotency” ( Watt and Brandwijk, 1962).
Restoration of virility in men is another aspect that is perhaps
related to infertility, for which the Basotho use four plants Berkheya setifera, Helichrysum caespititium, H. platypterum, and Mentha aquatica.
Generally,
scientific validation on the effectiveness of the species utilised for
infertility by the Basotho is very limited. Male sterility mainly
results from problems affecting spermatogenesis or sperm transport, and
less commonly from problems such as low levels of hormones produced by
the pituitary gland (https://www.andrologyaustralia.org/your-health/male-infertility/).
Several plants have been demonstrated to have in vivo and/or in vitro
androgenic activities which include: increased semen volume, sperm count
and mobility, the weights of the testis, seminal vesicles and prostate,
as well as serum testosterone levels (Nantia et al., 2009). For example, treatment of infertile men with a mixture of Tribulus terrestris, Asparagus racemosus and Withania somnifera increased semen volume, sperm count and mobility ( Devi et al., 2004).
The pharmacological properties of these plants could support their
traditional use in improving male fertility. The androgenic activity of
other plants such as Hypoxis hemerocallidea and O. europaea
has not been reported yet, however their proven pharmacological
properties could support their traditional use in improving male
fertility. Female sterility can be due to mainly anatomical defects
including “tuboperitoneal abnormalities, endometriosis, myomas
distorting the uterine cavity, congenital uterine anomalies, and other,
less frequent anomalies of the reproductive tract” ( Abrao et al., 2013). Aloe species have been reported to have oestrogenic activity ( Telefo et al., 2002), this could validate the traditional use of A. ecklonis for female sterility. Rhoicissus tridentata,
used widely by southern African women for delayed childbirth, to
facilitate childbirth, and for delayed or painful menstruation ( Hutchings et al., 1996; Roqaiya et al., 2015; Van Wyk et al., 2009 ; Watt and Breyer-Brandwijk, 1962)
is used in Lesotho only for improved fertility in females. Nonetheless,
two alkaloids sitosterol and sitosterolin isolated from this plant
demonstrated only slight oestrogenic activity (Brookes and Katsoulis, 2006). On the other hand it has been shown to exhibit antioxidant activity against radical substances such as xanthine oxidase (Opoku et al., 2002). The rootstock of R. tridentata
is reported to be toxic as it was responsible for the death of a human
due to acute paralysis of the central nervous system causing respiratory
arrest ( Watt and Breyer-Brandwijk, 1962), this could be brought about by the presence of sitosterol, sitosterolin and proanthocyanidins (Brookes and Katsoulis, 2006).
Certain phytochemicals such as flavonoids have been reported to exhibit
oestrogenic activity in both in vitro and in vivo assays, for example
coumestrol and genistein showed an increase in uterine weight in mice (Collins-Burow et al., 2015).
Forty-eight
plant species are utilised as uterotonics for the treatment of all
menstrual problems, to induce labour, ease labour pains, for difficult
childbirth, and afterbirth cramps, as well as for cleansing and toning
the uterus, with most of them (20) used for painful periods (e.g. A. ophrydis, D. anomala, Euclea crispa, G. perpensa, Rumex lanceolatus, Rhynchosia adenodes, S. columbaria and Sopubia cana). Gunnera perpensa
is one of the most renowned plants used in traditional medicines in
southern Africa for maternal reproductive ailments (such as
dysmenorrhoea) and related conditions, for example it is used by Zulu
traditional healers as a galactagogue ( Simelane et al., 2012).
Some of its other numerous uses are treatment of bladder problems,
cancer, headaches, heart diseases, hypertension, kidney complaints,
psoriasis, rheumatic fever, sores, stomach bleeding, stomach problems,
swellings, and wounds ( Brookes and Dutton, 2007; Hutchings et al., 1996; Mathibe, 2015; McGaw et al., 2005; Mugomeri et al., 2016; Seleteng Kose et al., 2015; Simelane et al., 2012 ; Van Wyk et al., 2009). Gunnera perpensa is also the only plant reported to be used as a contraceptive by the Basotho people. Scabiosa columbaria
is one of the most highly regarded plants (pers. obs.) for the
treatment of dysmenorrhoea, it therefore is no surprise that its Sesotho
name is selomi (meaning “one who bites”), which is also the
Sesotho name for period pains. Five plants are used for the treatment of
unspecified uterine disorders (i.e. B. setifera, D. anomala, Malva parviflora, S. columbaria, and Xysmalobium undulatum). According to Watt and Breyer-Brandwijk (1962), M. parviflora
is reported to have also been used in the olden days in the Western
Cape Province as a cure for conditions such as leucorrhoea. The latter,
which is an excessive mucus secretion of the cervix, may be due to a
number of reasons including hormonal disturbances, chronic inflammation
of the glands or infection ( Bourne et al., 1937). In southern Africa, the tubers of X. undulatum are generally used as uterine sedatives ( Hutchings et al., 1996).
Twelve plants are used for other uterine disorders (5), regulation of
the menstrual cycle (3), menorrhagia (3), and amenorrhoea (1). During
interviews there was no reference made to the use of plants to effect
abortion, this is most probably because abortion is illegal in Lesotho,
unless it is to save the life of a pregnant woman (http://www.un.org/esa/population/publications/abortion/doc/lesotho.doc).
Although there are several causes of amenorrhoea in females of
reproductive age, it is generally associated with pregnancy, therefore
in such cases people are likely to consult on suspicion of a pregnancy.
It is therefore not surprising that traditional practitioners will use
euphemisms such as amenorrhoea and regulation of menses instead of
abortion. It should be noted that plants used for regulation of the
menstrual cycle and amenorrhoea are often used in the same way as
abortifacients. Plants utilised to induce labour, ease labour pains, for
difficult childbirth, and afterbirth cramps include the widely
distributed Mentha longifolia, the well-known sub-Saharan African species D. anomala, and the popular southern and eastern African medicinal plants such as Eucomis autumnalis, Pentanisia prunelloides, S. columbaria, and X. undulata. Mentha longifolia, “which includes subspecies polyadena Briq. is administered by the European and the African to hasten prolonged confinements and to induce labour pains” ( Watt and Breyer-Brandwijk, 1962).
The species has numerous traditional uses elsewhere within its
distribution range, e.g. as an anthelmintic, and for treatment of
anorexia, coughs, digestive problems, kidney stones, headache, liver
complaints, toothache, etc. ( Gulluce et al., 2007 ; Mikaili et al., 2013). Cleansing of the uterus follows after childbirth or miscarriage, for this purpose species such as Gerbera piloselloides, Kniphofia caulescens, and Solanum aculeatissimum are used. Certain plants are also used for the expulsion of retained placenta, namely G. perpensa and P. prunelloides. Both plants are used for similar purposes by other cultures as well, Watt and Breyer-Brandwijk (1962) has reported that a decoction of roots of G. perpensa
“is given by the European and the Zulu to animals to assist the
expulsion of the placenta. It is sometimes given to a woman for the same
purpose”, while a decoction of the roots of P. prunelloides is used by the Xhosa people. It appears that the uterus is also cleansed to improve fertility, e.g. a decoction consisting of Eriospermum ornithogaloides, G. perpensa, and S. columbaria is used. A number of plants are used for toning the uterus, especially during pregnancy, either individually (e.g. Gerbera piloselloides, G. perpensa, or W. somnifera) or as a mixture of several plants referred to as ‘pitsa’ (meaning pot) or ‘sehlapetso’ in the local language. The latter is an equivalent of ‘isihlambezo’, a herbal medicine “used by many Zulu women in South Africa as a preventative health tonic during pregnancy” ( Varga and Veale, 1997) and ‘kgaba’, a medicine taken in the third trimester by pregnant Tswana women ( Van der Kooi and Theobald, 2006). Solanum aculeatissimum,
reported here as being used for cleansing the uterus after a
miscarriage is also used in West Africa for dysmenorrhoea and in Uganda
to induce labour ( Kamatenesi-Mugisha and Oryem-Origa, 2007).
Inflammatory
conditions such as primary dysmenorrhoea are caused by excessive
amounts of prostaglandins which are the hormones responsible for uterine
contractions, therefore treatment involves suppressing the production
of these hormones (Steward and Deb, 2014). Extracts from some plants such as Agapanthus campanulatus ( Fawole et al., 2009), Argemone ochroleuca ( Niu et al., 2012), Dicoma anomala ( Shale et al., 1999), Gunnera perpensa ( Lall and Kishore, 2014), Mentha longifolia ( Karimian et al,. 2012), Rhynchosia adenodes ( Shale et al., 1999), and Rumex nepalensis ( Vasas et al., 2015)
have been reported to exhibit anti-inflammatory activity, due to their
ability to inhibit enzymes responsible for the synthesis of
prostaglandins, such as cyclooxygenase isoenzymes (COX-1 and COX 2).
This property could be used to support the traditional use of the plants
as uterotonics. For centuries uterotonic plants have been used to
induce and ease labour, and also as abortifacients (Roqaiya, et al., 2015). Gunnera perpensa not only has antispasmodic effects, it has also been proven to have uterotonic effects. In a study by Dube (2014), application of methanolic root extracts of the plant increased the contractility of isolated rat uterus muscle strips. Kaido et al. (1997) has shown that G. perpensa
exhibits direct smooth muscle activity on isolated rat uterus, however
the plant is potentially toxic if used consecutively for a long period (
Mwale and Masika, 2011). Pentanisia prunelloides
has also shown uterotonic activity and direct effects on smooth muscle,
an in vivo study has shown significant anti-inflammatory, antibacterial
and antiviral activity ( Van Wyk et al., 2009). Biological activity of S. coronatus used by the Basotho people to ease childbirth is not yet known, but several Senecio
alkaloids are regarded as uterine stimulants. However, many of them
have been found to be toxic to test mice, causing hepatic necrosis ( Watt and Breyer-Brandwijk, 1962). The Southern Sotho use the root (not the bulb) of E. regia as a remedy to prevent premature childbirth, the bulb is regarded as being highly toxic ( Watt and Breyer-Brandwijk, 1962).
Several
plants (15 in total) are also utilised to relieve uneasiness during
pregnancy and deal with the various conditions associated with
pregnancy, i.e. abdominal pain (e.g. Hermannia depressa), colic (e.g. S. columbaia, Searsia divaricata), constipation (e.g. Anthospermum rigidum ssp. pumilum), flatulency (Hermannia geniculata), heartburn (Pelargonium sidoides), lack of appetite (H. depressa), nausea (e.g. Kalanchoe tetraphylla), and other unnamed complications (e.g. Buddleja salviifolia, Cephalaria pungens, Rubus rigidus). Rubus rigidus is also reportedly used to facilitate childbirth by the Manyika women in Southern Zimbabwe ( Watt and Breyer-Brandwijk, 1962).
Some of the plants listed in this category have been shown to have
pharmacological activities which could be directly linked to their
therapeutic uses, for example relief from abdominal pain when using H. depressa could be due to its anti-inflammatory activity as evidenced by the significant levels of COX-1 inhibition ( Reid et al., 2005), the plant also appears to be safe as it has been found not to display any toxicity (Essop, 2005). The use of B. salviifolia
could also be pain related, in which case three compounds isolated from
this plant exhibited high COX-2 inhibition (Pendota et al., 2014).
Pharmacological effects of other plants on the other, have no obvious
connection with their traditional use, it is however worth mentioning
that some of these uses appear to be only restricted to Lesotho. Pelargonium sidoides
for instance, is better known for its medicinal uses in the treatment
of ailments related to the digestive (especially diarrhoea and
dysentery) and respiratory tracts, these pharmacological effects have
been attributed to the presence of coumarins, especially umckalin ( Van Wyk et al., 2009). Root extracts have demonstrated significant activity against a number of bacteria (Kayser and Kolodziej, 1997; Mativandlela et al., 2006), but showed no inhibition of Mycobacterium tuberculosis and weak activity against the tested fungal species ( Mativandlela et al., 2006). The plant has also shown scavenging activity on a number of free radicals (Nair et al., 2007). None of these results link these pharmacological effects directly to its use for heartburn, however P. sidoides is rich in terpenoids ( Linhares et al., 2010), especially sesquieterpenes, sesquiterpene hydrocarbons, monoterpenes, and phenylpropanoids (Kayser et al., 1998). Terpenes such as D-limonene have been used for heartburn due to their gastric acid neutralizing effects (Sun, 2007), it is therefore hypothesized that the terpenoids in P. sidoides could have similar effects on heartburn. The only available pharmacological activity of Kalanchoe tetraphylla (as K. thyrsiflora) is its proven moderate anti-cancer activity against human cell lines ( Fouche et al., 2008), however the plant is known to possess bufadienolides which are toxic to livestock (Van Wyk et al., 2002).
A
number of plants are used to treat several types of cancer and other
growths including female breast cancer (13), cervical cancer (7),
fibroids and cysts (4), as well as prostate problems and testicular
tumours (2). Female breast cancer is reported to be the most frequently
diagnosed cancer worldwide, it is however generally low in sub-Saharan
Africa and Asia when compared to the rest of the world, especially
Western and Northern Europe, Australia/New Zealand, and North America
where the incidence rates are high and South America, the Caribbean, and
Northern Africa where they intermediate (Jemal et al., 2011). Plants prescribed for the treatment of breast cancer include Leobordea lanceolata, Selaginella caffrorum, Turbina oblongata (Ipomoea oblongata), and some of the well-known southern African species namely D. anomala, G. perpensa, and the widely distributed Withania somnifera ( Seleteng Kose et al., 2015). Interestingly, no reports of similar use by other southern African cultures could be found, however G. perpensa is used for other forms of cancer (as reported earlier). Aloe maculata
is a well-known southern Africa plant used for numerous medical
conditions including circulatory problems, diabetes, digestive problems,
respiratory ailments (coughs, colds, fever), and skin conditions (e.g.
boils, injuries, sores, promotion of hair growth) (Grace et al., 2009). Cussonia paniculata
is used traditionally as an analgesic, anti-inflammatory, and wound
healing plant in southern Africa, it is also used for gynaecological
problems, malaria, and mental illness (De Villiers et al., 2010 and the
cited references thereof). Dicoma anomala has a great
reputation especially in the treatment of digestive (e.g. colic,
constipation, diarrhoea, dysentery) and respiratory (colds, coughs, sore
throat, etc.) ailments, as well as STIs such as gonorrhoea ( Van Wyk and Gericke, 2000). Elephantorrhiza elephantina
is used for wide range of ailments including circulatory (anaemia,
hypertension), gastro-intestinal, gynaecological (e.g. dysmenorrhoea,
infertility), respiratory, and skin ( Hutchings et al., 1996; Mpofu et al., 2014; Van Wyk et al., 2009). Although F. depressum
occurs widely in southern Africa, no medicinal use has been reported
other than in Lesotho. In this country it is a renowned magic plant used
as a good luck and protective charm, as well as a means of causing harm
to enemies ( Moteetee and Van Wyk, 2011). Hermannia depressa
is better known for its use as a protective charm especially by the
Basotho and Zulus, medicinally it is used for digestive and respiratory
ailments in southern Africa ( Hutchings et al., 1996 ; Watt and Breyer-Brandwijk, 1962). There are no reports of medicinal use of the species L. lanceolata anywhere else outside Lesotho where it is used to treat diarrhoea ( Watt and Breyer-Brandwijk, 1962) and mixed with Aster bakerianus for fever ( Moteetee and Van Wyk, 2011). The only other use of S. runcinata
in Lesotho is as a charm to drive away bugs after an illness, it is
also reported that “a decoction of root, stem and leaf has been used by
the European for the relief of urticaria” ( Watt and Breyer-Brandwijk, 1962), it is also used by the Zulu as a purgative (Hutchings et al., 1996). Withania somnifera
is also one of the most popular medicinal plants used in Ayurvedic
medicine as a sedative and hypnotic and is regarded to be effective
against numerous ailments in southern Africa ( Van Wyk et al., 2009). Traditional healers reported to use several plants including B. salviifolia, C. paniculata ssp. sinuata, M. longiflora, and Phytolacca heptandra
for the treatment of cervical cancer including other growths within the
female reproductive system such as fibroids and cysts are also treated.
It is however not clear how this particular cancer and the other benign
growths are diagnosed, one possibility could be that the diagnosis
would have already been done in a western medicine setting. Root
decoction of B. narcissifolia is used for both fibroids and cysts, while Ajuga ophrydis is used for fibroids and Zantedeschia albomaculata ssp. albomaculata (mixed with Eucomis autumnalis)
for cysts. Apart from the medicinal plants used for the male
reproductive healthcare (i.e. improvement of fertility and virility)
mentioned earlier, one plant is used for the treatment of prostate
problems (Artemisia afra) and another for testicular tumours and swollen testicles (H. hemerocallidea). Artemisia afra is “one of the oldest and best known of all the indigenous medicines in southern Africa” ( Van Wyk and Gericke, 2000)
with a wide variety of traditional medicinal uses including cancer,
diabetes, respiratory tract problems, gastro-intestinal disorders, skin
afflictions, gynaecological problems, and cardiovascular diseases ( Hutchings et al., 1996 ; Patil et al., 2011). Hypoxis hemerocallidea
(incorrectly referred to as African potato) is another famous southern
African medicinal plant with a variety of traditional uses including
treatment of burns, cancer, cardiac disease, dizziness, respiratory
problems, testicular tumours, prostate hypertrophy, ulcers, wounds, and
as an emetic, tonic, and immune system booster ( Drewes et al., 2008; Katerere and Eloff, 2008 ; Van Wyk et al., 2009).
The common name ‘African potato’ is said to be incorrect because the
plants do not produce tubers but rather corms, it has been argued that
the name must have been incorrectly translated from the Afrikaans name
‘Afrika-patat’ (http://www.plantzafrica.com/planthij/hypoxishemero.htm). Of the breast cancer plants, W. somnifera
has been reported to reduce tumour cell proliferation and the side
effects of chemotherapeutic agents cyclophosphamide and paclitaxel ( Winters, 2006). None of the seven plants used for the treatment of cervical cancer has been tested for their anti-cancer activity. Artemisia afra,
used by the Basotho for the treatment of prostatitis has been shown to
have numerous biological activities including anti-bacterial,
anti-fungal, anti-trypanosomal, antidiabetic, anti-cancer and
anti-malarial ( Patil et al., 2011).
However, the plant contains the monoterpenoid thujone which if taken in
excessive amounts can cause vomiting, diarrhoea, dizziness, headache,
cramps, hallucinations, comma, deliriums, and seizures (Ndhlala et al., 2013), as well as addiction and cerebral dysfunction (Van Wyk and Wink, 2004). Watt and Breyer-Brandwijk (1962)
have reported that ingestion of the oil from this plant produces a
haemorrhagic nephritis, non-fatty degeneration of the liver and
pulmonary oedema and sometimes abortion in rabbit and the guinea-pig.
Furthermore, ethanol extracts have also been shown to exhibit
cytotoxicity (Venables et al., 2016). Phytosterol glycosides from H. hemerocallidea have shown activity on benign prostate hypertrophy ( Hutchings et al., 1996), with anti-cancer and anti-inflammatory activity being attributed to rooperol (Van Wyk et al., 2009). Phytolacca heptandra
is used for cervical cancer and “African women who are pregnant make
periodic prophylactic use of the strong purging action of the root in
order to prevent their children being born with birth marks” however the
plant is known to be poisonous ( Watt and Breyer-Brandwijk, 1962).
4. Conclusions
A
total of 87 plant species are used for the treatment of various
reproductive problems with most of them used for the treatment of
sterility (31), followed by menstrual problems and uterine disorder (28)
and complications associated with pregnancy (15). Curiously, most of
the plants used for infertility are gender specific, with most of these
(19) being used specifically by females and only two used by males. Gunnera perpensa,
the most used plant to combat a number of reproductive problems, has
been proven to have several pharmacological activities such as
analgesic, anti-inflammatory, anti-spasmodic and uterotonic, which could
explain its use for period pains, toning of the uterus, labour
induction, as well as expulsion of retained placenta. Several other
plants have also shown biological activities that could validate their
traditional medical uses, e.g. P. prunelloides (uterotonic), A. campanulatus, A. ochroleuca, D. anomala, R. adenodes, and R. nepalensis (anti-inflammatory), A. afra and H. hemerocallidea (anti-prostatitis), and W. somnifera
(androgenic). It should however be pointed out that many of these
biological activities have been assessed using in vitro assays only,
even those that have been tested in vivo have been done so mostly in
lower mammals such as mice. Extracts from a number of plants such as A.
campanulatus, Berkeya setifera, D. anomala, E. autumnalis, H.
odoratissimum, H. hemerocallidea, M. parviflora, Salvia runcinata,
and others, have demonstrated anti-inflammatory and/or antioxidant
activities with no toxicity exhibited, these are the plants that could
be recommended for prescription by traditional healers. Conversely,
several others have been reported to exhibit varying degrees of toxicity
(e.g. Cotyledon orbiculata, G. perpensa, Helichrysum platypterum, Mentha aquatica, R. tridentata) and should therefore not be used, particularly in large quantities, without consultation. Scabiosa columbaria
(the second most used plant) on the other hand, has no proven
pharmacological activities that could be linked to its medicinal uses
although it contains iridoid glycosides which are reported to have
anti-inflammatory effects ( Viljoen et al., 2012). In addition, extracts of this plant have shown no antimicrobial activity against a number of pathogens (Van Vuuren & Naidoo, 2010).
With regards to the evaluation of the biological activities and safety
of these plants, a number of gaps have been identified. For example, a
total of 43 plants including A. ophrydis, Commelina africana, E. ornithogalloides, S. aculeatissimum, Sopubia cana, Turbina oblongata, and Z. albomaculata
used for various reproductive problems have not been assessed for any
pharmacological activity nor for their toxicity. Certain plants such as Brunsvigia radulata, Morella serrata, and Phytolacca heptandra
have no pharmacological data, but have been found to be toxic. It is
therefore recommended that all these plants should be subjected to the
appropriate assays to evaluate both their efficacy and toxicity.
Acknowledgements
This
work is based on the research supported in part by the National
Research Foundation of South Africa for the Grant number 93625. The
University of Johannesburg (UJ) is gratefully acknowledged for financial
support. The National University of Lesotho (NUL) together with the
Lesotho Government (National Manpower Development Secretariat) are also
acknowledged for financial assistance to the second author.
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