Research ArticleTraditional Therapies Used to ManageDiabetes and Related Complications in MauritiusA Comparative Ethnoreligious Study

M Fawzi Mahomoodally1 A Mootoosamy1 and S Wambugu2

1Department of Health Sciences Faculty of Science University of Mauritius 230 Reduit Mauritius2Department of Veterinary Anatomy and Physiology University of Nairobi Nairobi 30197 00100 Kenya

Correspondence should be addressed to M Fawzi Mahomoodally fmahomoodallyuomacmu

Received 29 December 2015 Revised 11 February 2016 Accepted 14 February 2016

Academic Editor Andrea Pieroni

Copyright copy 2016 M Fawzi Mahomoodally et al This is an open access article distributed under the Creative CommonsAttribution License which permits unrestricted use distribution and reproduction in any medium provided the original work isproperly cited

Religious communities from Mauritius still rely on traditional therapies (TT) for primary healthcare Nonetheless there is still adearth of scientific information on TT used by the different religious groups to manage diabetes and related complications (DRC)This study aimed to gather ethnomedicinal knowledge on TT used by the different religious groups against DRC Diabetic patients(119899 = 95) and traditional healers (119899 = 5) were interviewed Fifty-two plant species belonging to 33 families and 26 polyherbalformulations were documented to manage DRC The most reported DRC was hypertension (119899 = 36) Leaves (452) and juice(36) were themost citedmode of preparation of herbal recipes Plants which scored high relative frequency of citation wereCitrusaurantifolia (055) andMorinda citrifolia (054) The cultural importance index showed that Ocimum tenuiflorum Cardiospermumhalicacabum Camellia sinensis and Ophiopogon japonicas were the most culturally important plants among Hindu MuslimChristian and Buddhist community respectively Hindu andMuslim community showed the highest similarity of medicinal plantsusage (Jaccard index = 958) Seven animal species distributed over 4 classes were recorded for the management of DRC Plants andanimals recorded as TT should be submitted to scientific studies to confirm safety and efficacy in clinical practice and to identifypharmacologically active metabolites

1 Background

Diabetes mellitus generally termed as diabetes is a chronicmetabolic disorder of the endocrine system characterised byabnormalities in carbohydrates protein and fat metabolism[1ndash3] The incidence of diabetes mellitus continues to soarexponentially in both developed and developing countriesleading to an increase in the cost of managementtreatmentof the disease and its related complications Diabetes mellitusis a global epidemic currently affecting more than 371 millionpeople and the death toll from the disease rose to 15 millionin 2012 [4 5]TheWorldHealth Organisation has argued thatdiabetes will be the 7th leading cause of death in 2030 [6]

Diabetes mellitus is one of the most important healthissues inMauritius with a prevalence of 245 in 2015 [7]TheInternational Diabetes Federation reported that in 2015 there

were 220000 cases of diabetes in Mauritius and the numberof cases of diabetes in adults that are undiagnosed was foundto be 113100 [7] Alterations in carbohydrates protein and fatmetabolism entail an increase in blood glucose level whichcauses long-term devastating complications in many organsof the body [8] Prolonged uncontrolled hyperglycemic levelleads to macrovascular complications (coronary artery dis-ease peripheral arterial disease and stroke) and to microvas-cular complications (diabetic nephropathy neuropathy andretinopathy) [9] Complications related to diabetes are themajor cause of disability and mortality among the Mauritiandiabetic population

Nowadays diabetes is managed with oral hypoglycemicagents and insulin Though the efficacy of these treat-ments is irrefutable they have to be given throughoutthe lifetime of the patient and entail numerous potential

Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2016 Article ID 4523828 25 pageshttpdxdoiorg10115520164523828

2 Evidence-Based Complementary and Alternative Medicine

Republic of Mauritius

Agalega Islands

Cargados Carajos

Rodrigues

Mauritius

Mauritius

Rivi ere duRempart

Pamplemousses

Port Louis

Ile drsquoAmbre

Ile de lrsquoEst

Ile aux Cerfs

Ilot Flamants

Ile MarianneIle aux Fouquets

Ile aux Aigrettes

FlacqMoka

Rivi ereNoire

PlainesWilhems

Grand PortIle aux Benitiers

Ilot Fourneau

Savanne

Figure 1 Map of Mauritius indicting the study area (spread over 9 main districts)

side effects namely hypoglycemic coma and hepatorenaldisturbances [10 11] Hence there is a growing interest intraditional therapies mostly because of the less frequent sideeffects associated with them as compared to conventionalmedicines

Mauritius is a tropical island located in the southernhemisphere in the middle of the Indian Ocean Mauritius isbestowed with a rich variety of medicinal flora fauna andcultural diversity The volcanic island of Mauritius lies in themiddle of the IndianOcean (Figure 1) with coordinates 57∘301015840east and 20∘201015840 south Mauritius has an area of 1865 km2 and

about 43 of the area is allocated to agriculture Mauritiusenjoys a mild tropical climate characterised by a warmhumid summer between November and April and a cool drywinter between June and September whereby October andMay are the transition months Mean summer temperatureis 247∘C and mean winter temperature is 204∘C [12]Mauritius has a rich heritage of indigenous and endemicplants During the past allopathic medicine was not easilyavailable for the local population and the use of traditionalmedicine was therefore necessary in order to alleviate signsand symptoms of diseases Nowadays healthcare facilities

Evidence-Based Complementary and Alternative Medicine 3

are within the reach of everybody nonetheless traditionalmedicine continues to remain active in the lives of the localpopulation

The multicultural society of Mauritius encompassesdescendants of Indian indentured labourers Chinese shop-keepers African slaves and British and French colonisersThe Indo-Mauritians community (Hindus and Muslims)represents the majority of the population followed by theChristian community and the Sino-Mauritians communityThe Hindu community is subdivided into several distinctreligious and sociocultural groupsThemain religious groupsare theHindi or Bhojpuri speaking people constituting 402of the total population and 765of allHindusTheTamils arethe second largest ethnic community (139) while Telugus(56) andMarathis (4) represent smallerminoritieswithinthe overall Hindu community The Hindus have a commonlanguage (Bhojpuri) the same regional origin (Uttar PradeshandBihar) and religious practices and rituals [13]The officiallanguage in Mauritius is the English language but ldquoCreolerdquo isthe native language of the island and is mostly used in infor-mal settings Mauritius is reputed worldwide for the peacefulharmony which prevails in the island among the differentgreat religions of the world namely Hinduism ChristianityIslam and Buddhism In Mauritius traditional therapies areparamount to panoply of ailments treatmentmanagementoffering profound therapeutic benefits and the indigenouscommunities rely heavily on them to meet their medicalneeds Though allopathic medicine is the primary form ofhealthcare in Mauritius some patients prefer traditionalmedicine for the treatmentmanagement of a number ofhuman diseases The rising costs of synthetic drugs havefueled the interest of the local population in traditionalmedicine usage thereby reintroducing such therapies as anovel emerging formof health aidMauritius is endowedwitha number of tropical rainforests which are rich repositoriesof a diverse range of invaluable medicinal plants and animalspecies Recently Mauritius has become the arena of anumber of ethnopharmacological field studies conducted byvarious workers which have emphasised mostly medicinalplants and animals among the Mauritian population andhave led to several publications [14 15] Nonetheless noneof these studies have addressed the patterns of similarityand dissimilarity of medicinal plants and animals usageamong the different religious communities present in theisland Heinrich et al [16] reported that most studies onmedicinal plants focus on the role of these plants withinone particular ethnic group and little emphasis has beengiven to the comparison of medicinal plant species amongvarious cultures Moreover an analysis of medicinal plantsusage must be carried out in order to understand thepatterns of use intra- and interculturally However studieson cross-cultural analysis of medicinal plants usage arelacking inMauritiusTherefore the current study specificallyseeks to bring in the limelight of the scientific communitythe documentation of traditional remedies used amongthe diabetic patients in Mauritius We also attempted toidentify the most culturally important medicinal plants andanimals in each religious group compare the use of plantand animal species interculturally and examine how the

different religious groups present in the island value tradi-tional remedies in their daily lives in their quest for soundhealth

2 Methods

21 Data Collection The project was approved by the Facultyof Science University of Mauritius Mauritius A total of100 key informants (27 Hindus 24 Muslims 26 Christiansand 23 Buddhists) were interviewed from June to August2015 Data was collected from key informants throughface-to-face interviews using a semistructured questionnaire(supplementary file in Supplementary Material availableonline at httpdxdoiorg10115520164523828) Traditionalinformation was sought from diabetic patients older than 30years based on the assumption that the mature populationis better versed in traditional knowledge Moreover partic-ipants should be users of traditional medicine and formallydiagnosed to be diabetic by their treating physician Duringthe course of the study 12 field trips were carried out indifferent regions of the island The interview was performedin ldquoCreolerdquo the native language of the Mauritian populationThe questionnaire developed for the survey consisted of bothclose- and open-ended questions Participants were informedabout the purpose of the survey and a prior informed consentformwas dully signed by the participants before the interviewwas carried out The traditional healers were interviewedusing the same questionnaireThe interviewswere performedin health centers home visits markets and Chinese shops(Figure 2) Figure 1 illustrates the different regions where thesurvey was carried out

The questionnaire comprised three main parts PartsA B and C Part A consisted of demographic data whichincluded age gender level of education occupation incomeand religious belief Part B of the questionnaire consistedof information about the herbal remedies used to managediabetes and related complications the local vernacular nameof the plant the method of preparation the dosage theroute of administration and the duration of treatmentPart C was based on animal-based remedy used to man-age diabetes and related complications the local vernac-ular name of the animal the method of preparation thedosage the route of administration and the duration oftreatment

22 Collection and Identification of Medicinal Plants Duringthe field visits when a remedy was mentioned by thetraditional healer or diabetic patient where possible theparticipant was encouraged to show us a sample of theremedy which was collected in situ and photographed Thecollected sample was then identified by local botanist Ourlocal repository database was updated whereby plant sampleswere assigned a collection number for future reference anddata mining Data obtained during the survey was cross-checked (local namesscientific names) according to a locallypublished book by Gurib-Fakim and Brendler [17] Scientificnames of plant species were identified according to the Inter-national Plant Name Index (IPNI httpwwwipniorg)

4 Evidence-Based Complementary and Alternative Medicine

Figure 2 Interview with traditional healers

23 Ailments Categories Based on the information obtainedfrom the key informants in the study area all the reportedailments were classified into 9 categories based on publishedscientific literature fromRiaz [18] ADA [19] Yadav et al [20]Ginsberg et al [21] and Bodansky et al [22] The categorieswere diabetic angiopathy diabetic nephropathy eye diseasesdiabetic neuropathy infections and wounds hypertensionskin complications diabetic dyslipidemia and diabetes

24 Data Analysis and Ethnobotanical Indexes The indige-nous medicinal information of plant and animal species wasanalyzed using different quantitative indexes

241 Relative Frequency of Citation Relative frequency ofcitation is calculated as follows relative frequency of citation= FCN where FC is the number of informants mentioningthe use of the species and 119873 is the number of informantsparticipating in the survey This index theoretically variesfrom 0 to 1 According to Sharma et al [23] when relativefrequency of citation is 0 it means that nobody refers tothe plantanimal as useful and when relative frequency ofcitation is 1 it means that all informants in the survey referto the plantanimal as useful

242 Cultural Importance Index Culturally importantspecies as medicines are identified by the cultural importanceindex (CII) [24] The CII was used to determine the most

culturally important plantanimal species in each religiousgroup It can be calculated by the following formula

CII =119906NC

sum

119906=1199061

119894119899

sum

119894=1198941

UR119906119894

119873

(1)

where NC is the total number of different illness categories(of each 119894 species) UR is the total number of use reportsfor each species and 119873 is the total number of informantsin each religious group The cultural importance index is thesum of the proportion of informants that mention each ofthe use-categories for a given species Themaximum value ofthe index equals the total number of different use-categories(NC) whichwould occur if all informants in a religious groupwould mention the use of a species in all use-categories Thisindex was used to estimate the cultural significance of eachplantanimal species [24] and to determine to what extenteach plantanimal species is present in the memory of theinformants belonging to each religious group

243 Jaccard Similarity Index The Jaccard similarity indexadapted from Guzel et al [25] was used to determine thedegree of similarity of medicinal plantsrsquo use among thedifferent religious groups The Jaccard similarity index iscalculated as follows Jaccard similarity index = 119862 times 100119860 +119861 minus 119862 where 119860 is the number of plant species reported byreligious group A 119861 is the number of plant species reportedby the religious group B and119862 is the number of plant speciesreported by both A and B [25]

Evidence-Based Complementary and Alternative Medicine 5

Table 1 Demographic data of the informants (119873 = 100)

Variable Categories Frequency (119899 = 100)

Age (years)

30ndash39 240ndash49 1750ndash59 2760ndash69 4170ndash79 8ge80 5

Sex Male 38Female 62

Level of education

No formal education 7Primary 64Secondary 20Tertiary 9

Occupation

Retired 36Nongovernment officer 25Housewife 18Government officer 16Traditional healer 2Ayurvedic medicine practitioner 2Traditional Chinese medicine practitioner 1

Monthly household income

ltRs 5000 2Rs 5001ndash10000 48Rs 10001ndash20000 40Rs 20001ndash30000 8gtRs 30001 2

Religion

Hindu 27Muslim 24Christian 26Buddhist 23

Diabetes related complications

Hypertension 36High level of cholesterol 27Neuropathic pain 25Cardiovascular diseases 12Cataracts 9Urinary tract infections 7Renal failure 5Foot ulcers 4Gangrene 3Infected wounds 3Stress 2Dry skin 2Erectile dysfunction 1Hearing loss 1Memory loss 1Depression 1

3 Results and Discussion

31 Demographic Profile of the Participants The demo-graphic characteristics of the participants were determinedand documented through face-to-face interviews usingsemistructured questionnaire (Tables 1 and 2) A total of 100

randomly selected informants (38males and 62 females) wereinterviewed as summarized in Tables 1 and 2 Our findingresembled the study of Ishola et al [26] where the majorityof traditional medicine users were female since they weretypically in charge of preparing herbal preparations in thedomestic setting According to Hardy [27] women are the

6 Evidence-Based Complementary and Alternative Medicine

Table 2 Age and gender distribution within each religious commu-nity

Religiouscommunity Age Number of

participants Gender Number ofparticipants

Hindu

30ndash39 1 Male 1240ndash49 3 Female 1550ndash59 860ndash69 770ndash79 6ge80 2

Muslim

30ndash39 0 Male 1140ndash49 4 Female 1350ndash59 360ndash69 1470ndash79 2ge80 1

Christian

30ndash39 1 Male 1040ndash49 4 Female 1650ndash59 760ndash69 1370ndash79 0ge80 1

Buddhist

30ndash39 0 Male 540ndash49 6 Female 1850ndash59 960ndash69 770ndash79 0ge80 1

main source of conservation and dissemination of traditionalknowledge Ethnographic investigations revealed that thegreatest contribution in terms of traditional information wasprovided by interviewees belonging to the age group 60ndash69 years old (119873 = 41) They were followed by informantsbelonging to the age category 50ndash59 years old (119873 = 27)This information implies that the young generation neglectstraditional medicine practice which might lead to the rapidloss of valuable traditional knowledge regarding the useof medicinal plants [28] There exist several reasons whichmight account for the loss of traditional knowledge in thestudy area (1) holders of empirical knowledge have diedbefore passing on this knowledge to the younger generation(2) the younger generation believes more in the efficacy ofallopathic medicine and (3) given the free cost of healthcarefacilities provided by the Mauritian government in publichospitals allopathic medicine is more accessible to thepopulation

Moreover the results revealed that the majority of theparticipants studied till the primary level only (119873 = 64) Ourfinding is in accordance with the work of Gakuya et al [29]where elder people with little formal education possess moreknowledge concerning the use of medicinal plants It wasalso noted that the majority of the informants were retired

(119873 = 36) and had a monthly household income of Rs 5001ndash10000 (1 US$ asymp Rs 3600) (119873 = 48) The retirement agein Mauritius is 60 years and above Nonetheless some ofthe participants were found to continue working thoughthey reached the retirement age The traditional healthpractitioners (119873 = 5) were found to play vital roles in thestudy area whereby the indigenous communities rely on themfor the provision of herbal medicines The traditional healthpractitioners were found to be key custodians of traditionalinformation on themedicinal use of plant and animal speciesTheir practice of healing involved panoply of methodologieswhich are considered trustworthy among the indigenouscommunity in the study area Traditional health practitionersin Mauritius were willing to share their valuable traditionalknowledge in order to prevent extinction of this culturalheritage

In order to allow better comparison of medicinal plantsand animals use among the four religious groups presentin the study area the number of participants surveyed ineach religious group was approximately equal 27 24 26and 23 for the Hindu Muslim Christian and Buddhistreligious group respectively The most common diabetesrelated complications reported by the informants were hyper-tension (119873 = 36) followed by high level of cholesterol (27)neuropathic pain (119873 = 25) and cardiovascular diseases(119873 = 12) According to the American Diabetes Associationin type 2 diabetes hypertension is often present as part ofthe metabolic syndrome of insulin resistance while in type1 diabetes hypertension may reflect the onset of diabeticnephropathy [30]

32 Herbal Remedies Used to Manage Diabetes and RelatedComplications The present research revealed the ethnob-otanical use of 52 plant species belonging to 33 familiesused to manage diabetes and related complications Infor-mation on medicinal plants obtained from the four religiousgroups namelyHinduMuslimChristian andBuddhist wasarranged alphabetically according to their botanical familiesalong with their ethnomedicinal uses (Table 3)

33 Source of Medicinal Plants Informants obtained themedicinal plants from three main sources gathering fromthe wild (39) harvesting from home gardens (37) andpurchasing from the herbalistsrsquo store (24) Our result isin agreement with the work of Singh et al [31] where themajority ofmedicinal plants used in the preparation of herbalremedies are obtained from the wild Indigenous people alsocultivate medicinal plants in home garden where medicinalplants are grown in small areas surrounding the houseMoreover medicinal plants are also grown in clay potsOne informant reported that effective medicinal plants arecultivated close to the house to allow easy accessibility On theother handmedicinal plants which are considered rare by theinformants and which are not easily available are purchasedfrom the herbalistsrsquo store

34 Forms of Medicinal Plants It was found that the infor-mants showed no particular preference for using either fresh

Evidence-Based Complementary and Alternative Medicine 7

Table3Listof

medicinalplantsandpo

lyherbalform

ulations

with

theirrelated

inform

ationused

againstd

iabetesa

ndrelated

complications

repo

rtedby

theinformants

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Acanthaceae

Graptophyllum

pictum

(L)Griff

(A

M15)

Laitde

vierge

Type

2diabetes

LPreparea

decoctionwith

3leaves

anddrink2cups

daily

for1

week

016

002

004

010

000

Alismataceae

Alism

aplantago-aquatica

subsp

orientale(Sam)S

am

(AM09)

mdashHighlevelofcho

leste

rol

mdash

Sold

asaC

hinese

teaa

gainstcholesterolPreparea

ninfusio

nwith

the

teabagsw

hich

containAlism

aorien

talis

(Rhizomaalism

atis)R

adix

angelicae

sinensisH

erba

artemisiae

capillarisH

awthornberryRh

izom

aatractylodismacrocephalaeSem

enzizip

hispinosaeand

ChineseteaD

rink

1cup

daily

012

000

000

003

009

Type

1diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Highlevelofcho

leste

rol

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Renalfailure

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Alliu

mcepa

L(A

M04)

Zoiyon

oigno

nHearin

gloss

BCr

ushandpressthe

bulbto

obtain

thejuice

andmix30

gof

thejuice

with

30gof

waterH

eatand

instill3-4drop

sinthea

ffected

ear

048

028

012

017

003

Amaryllid

aceae

Erectiled

ysfunctio

nB

Preparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Cataract

BPreparea

decoctionwith

theb

ulbandadd2teaspo

onso

fhon

eyA

llowitto

coolanduseitasa

neyebathdaily

Type

2diabetes

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Cataract

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Renalfailure

BCon

sume2

-3rawclo

vesd

ailyfor1

week

Alliu

msativ

umL

(AM39)

Lrsquoail

Hypertension

BSw

allow2sm

allclovesw

ithac

upof

water

thric

eper

week

042

024

009

022

006

Wou

ndB

Crushandpressthe

bulbto

obtain

juicea

ndapplythejuice

onthew

ound

daily

tillh

ealin

g

Ulcer

BCr

ushandpressthe

bulbto

obtain

juicea

ndapplythejuice

ontheu

lcer

daily

tillh

ealin

g

Anacardiaceae

Mangifer

aindica

L(A

M20)

Mangue

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

031

017

003

010

001

Ann

onaceae

Annona

murica

taL

(AM29)

Coron

sol

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

016

007

003

006

000

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

2 Evidence-Based Complementary and Alternative Medicine

Republic of Mauritius

Agalega Islands

Cargados Carajos

Rodrigues

Mauritius

Mauritius

Rivi ere duRempart

Pamplemousses

Port Louis

Ile drsquoAmbre

Ile de lrsquoEst

Ile aux Cerfs

Ilot Flamants

Ile MarianneIle aux Fouquets

Ile aux Aigrettes

FlacqMoka

Rivi ereNoire

PlainesWilhems

Grand PortIle aux Benitiers

Ilot Fourneau

Savanne

Figure 1 Map of Mauritius indicting the study area (spread over 9 main districts)

side effects namely hypoglycemic coma and hepatorenaldisturbances [10 11] Hence there is a growing interest intraditional therapies mostly because of the less frequent sideeffects associated with them as compared to conventionalmedicines

Mauritius is a tropical island located in the southernhemisphere in the middle of the Indian Ocean Mauritius isbestowed with a rich variety of medicinal flora fauna andcultural diversity The volcanic island of Mauritius lies in themiddle of the IndianOcean (Figure 1) with coordinates 57∘301015840east and 20∘201015840 south Mauritius has an area of 1865 km2 and

about 43 of the area is allocated to agriculture Mauritiusenjoys a mild tropical climate characterised by a warmhumid summer between November and April and a cool drywinter between June and September whereby October andMay are the transition months Mean summer temperatureis 247∘C and mean winter temperature is 204∘C [12]Mauritius has a rich heritage of indigenous and endemicplants During the past allopathic medicine was not easilyavailable for the local population and the use of traditionalmedicine was therefore necessary in order to alleviate signsand symptoms of diseases Nowadays healthcare facilities

Evidence-Based Complementary and Alternative Medicine 3

are within the reach of everybody nonetheless traditionalmedicine continues to remain active in the lives of the localpopulation

The multicultural society of Mauritius encompassesdescendants of Indian indentured labourers Chinese shop-keepers African slaves and British and French colonisersThe Indo-Mauritians community (Hindus and Muslims)represents the majority of the population followed by theChristian community and the Sino-Mauritians communityThe Hindu community is subdivided into several distinctreligious and sociocultural groupsThemain religious groupsare theHindi or Bhojpuri speaking people constituting 402of the total population and 765of allHindusTheTamils arethe second largest ethnic community (139) while Telugus(56) andMarathis (4) represent smallerminoritieswithinthe overall Hindu community The Hindus have a commonlanguage (Bhojpuri) the same regional origin (Uttar PradeshandBihar) and religious practices and rituals [13]The officiallanguage in Mauritius is the English language but ldquoCreolerdquo isthe native language of the island and is mostly used in infor-mal settings Mauritius is reputed worldwide for the peacefulharmony which prevails in the island among the differentgreat religions of the world namely Hinduism ChristianityIslam and Buddhism In Mauritius traditional therapies areparamount to panoply of ailments treatmentmanagementoffering profound therapeutic benefits and the indigenouscommunities rely heavily on them to meet their medicalneeds Though allopathic medicine is the primary form ofhealthcare in Mauritius some patients prefer traditionalmedicine for the treatmentmanagement of a number ofhuman diseases The rising costs of synthetic drugs havefueled the interest of the local population in traditionalmedicine usage thereby reintroducing such therapies as anovel emerging formof health aidMauritius is endowedwitha number of tropical rainforests which are rich repositoriesof a diverse range of invaluable medicinal plants and animalspecies Recently Mauritius has become the arena of anumber of ethnopharmacological field studies conducted byvarious workers which have emphasised mostly medicinalplants and animals among the Mauritian population andhave led to several publications [14 15] Nonetheless noneof these studies have addressed the patterns of similarityand dissimilarity of medicinal plants and animals usageamong the different religious communities present in theisland Heinrich et al [16] reported that most studies onmedicinal plants focus on the role of these plants withinone particular ethnic group and little emphasis has beengiven to the comparison of medicinal plant species amongvarious cultures Moreover an analysis of medicinal plantsusage must be carried out in order to understand thepatterns of use intra- and interculturally However studieson cross-cultural analysis of medicinal plants usage arelacking inMauritiusTherefore the current study specificallyseeks to bring in the limelight of the scientific communitythe documentation of traditional remedies used amongthe diabetic patients in Mauritius We also attempted toidentify the most culturally important medicinal plants andanimals in each religious group compare the use of plantand animal species interculturally and examine how the

different religious groups present in the island value tradi-tional remedies in their daily lives in their quest for soundhealth

2 Methods

21 Data Collection The project was approved by the Facultyof Science University of Mauritius Mauritius A total of100 key informants (27 Hindus 24 Muslims 26 Christiansand 23 Buddhists) were interviewed from June to August2015 Data was collected from key informants throughface-to-face interviews using a semistructured questionnaire(supplementary file in Supplementary Material availableonline at httpdxdoiorg10115520164523828) Traditionalinformation was sought from diabetic patients older than 30years based on the assumption that the mature populationis better versed in traditional knowledge Moreover partic-ipants should be users of traditional medicine and formallydiagnosed to be diabetic by their treating physician Duringthe course of the study 12 field trips were carried out indifferent regions of the island The interview was performedin ldquoCreolerdquo the native language of the Mauritian populationThe questionnaire developed for the survey consisted of bothclose- and open-ended questions Participants were informedabout the purpose of the survey and a prior informed consentformwas dully signed by the participants before the interviewwas carried out The traditional healers were interviewedusing the same questionnaireThe interviewswere performedin health centers home visits markets and Chinese shops(Figure 2) Figure 1 illustrates the different regions where thesurvey was carried out

The questionnaire comprised three main parts PartsA B and C Part A consisted of demographic data whichincluded age gender level of education occupation incomeand religious belief Part B of the questionnaire consistedof information about the herbal remedies used to managediabetes and related complications the local vernacular nameof the plant the method of preparation the dosage theroute of administration and the duration of treatmentPart C was based on animal-based remedy used to man-age diabetes and related complications the local vernac-ular name of the animal the method of preparation thedosage the route of administration and the duration oftreatment

22 Collection and Identification of Medicinal Plants Duringthe field visits when a remedy was mentioned by thetraditional healer or diabetic patient where possible theparticipant was encouraged to show us a sample of theremedy which was collected in situ and photographed Thecollected sample was then identified by local botanist Ourlocal repository database was updated whereby plant sampleswere assigned a collection number for future reference anddata mining Data obtained during the survey was cross-checked (local namesscientific names) according to a locallypublished book by Gurib-Fakim and Brendler [17] Scientificnames of plant species were identified according to the Inter-national Plant Name Index (IPNI httpwwwipniorg)

4 Evidence-Based Complementary and Alternative Medicine

Figure 2 Interview with traditional healers

23 Ailments Categories Based on the information obtainedfrom the key informants in the study area all the reportedailments were classified into 9 categories based on publishedscientific literature fromRiaz [18] ADA [19] Yadav et al [20]Ginsberg et al [21] and Bodansky et al [22] The categorieswere diabetic angiopathy diabetic nephropathy eye diseasesdiabetic neuropathy infections and wounds hypertensionskin complications diabetic dyslipidemia and diabetes

24 Data Analysis and Ethnobotanical Indexes The indige-nous medicinal information of plant and animal species wasanalyzed using different quantitative indexes

241 Relative Frequency of Citation Relative frequency ofcitation is calculated as follows relative frequency of citation= FCN where FC is the number of informants mentioningthe use of the species and 119873 is the number of informantsparticipating in the survey This index theoretically variesfrom 0 to 1 According to Sharma et al [23] when relativefrequency of citation is 0 it means that nobody refers tothe plantanimal as useful and when relative frequency ofcitation is 1 it means that all informants in the survey referto the plantanimal as useful

242 Cultural Importance Index Culturally importantspecies as medicines are identified by the cultural importanceindex (CII) [24] The CII was used to determine the most

culturally important plantanimal species in each religiousgroup It can be calculated by the following formula

CII =119906NC

sum

119906=1199061

119894119899

sum

119894=1198941

UR119906119894

119873

(1)

where NC is the total number of different illness categories(of each 119894 species) UR is the total number of use reportsfor each species and 119873 is the total number of informantsin each religious group The cultural importance index is thesum of the proportion of informants that mention each ofthe use-categories for a given species Themaximum value ofthe index equals the total number of different use-categories(NC) whichwould occur if all informants in a religious groupwould mention the use of a species in all use-categories Thisindex was used to estimate the cultural significance of eachplantanimal species [24] and to determine to what extenteach plantanimal species is present in the memory of theinformants belonging to each religious group

243 Jaccard Similarity Index The Jaccard similarity indexadapted from Guzel et al [25] was used to determine thedegree of similarity of medicinal plantsrsquo use among thedifferent religious groups The Jaccard similarity index iscalculated as follows Jaccard similarity index = 119862 times 100119860 +119861 minus 119862 where 119860 is the number of plant species reported byreligious group A 119861 is the number of plant species reportedby the religious group B and119862 is the number of plant speciesreported by both A and B [25]

Evidence-Based Complementary and Alternative Medicine 5

Table 1 Demographic data of the informants (119873 = 100)

Variable Categories Frequency (119899 = 100)

Age (years)

30ndash39 240ndash49 1750ndash59 2760ndash69 4170ndash79 8ge80 5

Sex Male 38Female 62

Level of education

No formal education 7Primary 64Secondary 20Tertiary 9

Occupation

Retired 36Nongovernment officer 25Housewife 18Government officer 16Traditional healer 2Ayurvedic medicine practitioner 2Traditional Chinese medicine practitioner 1

Monthly household income

ltRs 5000 2Rs 5001ndash10000 48Rs 10001ndash20000 40Rs 20001ndash30000 8gtRs 30001 2

Religion

Hindu 27Muslim 24Christian 26Buddhist 23

Diabetes related complications

Hypertension 36High level of cholesterol 27Neuropathic pain 25Cardiovascular diseases 12Cataracts 9Urinary tract infections 7Renal failure 5Foot ulcers 4Gangrene 3Infected wounds 3Stress 2Dry skin 2Erectile dysfunction 1Hearing loss 1Memory loss 1Depression 1

3 Results and Discussion

31 Demographic Profile of the Participants The demo-graphic characteristics of the participants were determinedand documented through face-to-face interviews usingsemistructured questionnaire (Tables 1 and 2) A total of 100

randomly selected informants (38males and 62 females) wereinterviewed as summarized in Tables 1 and 2 Our findingresembled the study of Ishola et al [26] where the majorityof traditional medicine users were female since they weretypically in charge of preparing herbal preparations in thedomestic setting According to Hardy [27] women are the

6 Evidence-Based Complementary and Alternative Medicine

Table 2 Age and gender distribution within each religious commu-nity

Religiouscommunity Age Number of

participants Gender Number ofparticipants

Hindu

30ndash39 1 Male 1240ndash49 3 Female 1550ndash59 860ndash69 770ndash79 6ge80 2

Muslim

30ndash39 0 Male 1140ndash49 4 Female 1350ndash59 360ndash69 1470ndash79 2ge80 1

Christian

30ndash39 1 Male 1040ndash49 4 Female 1650ndash59 760ndash69 1370ndash79 0ge80 1

Buddhist

30ndash39 0 Male 540ndash49 6 Female 1850ndash59 960ndash69 770ndash79 0ge80 1

main source of conservation and dissemination of traditionalknowledge Ethnographic investigations revealed that thegreatest contribution in terms of traditional information wasprovided by interviewees belonging to the age group 60ndash69 years old (119873 = 41) They were followed by informantsbelonging to the age category 50ndash59 years old (119873 = 27)This information implies that the young generation neglectstraditional medicine practice which might lead to the rapidloss of valuable traditional knowledge regarding the useof medicinal plants [28] There exist several reasons whichmight account for the loss of traditional knowledge in thestudy area (1) holders of empirical knowledge have diedbefore passing on this knowledge to the younger generation(2) the younger generation believes more in the efficacy ofallopathic medicine and (3) given the free cost of healthcarefacilities provided by the Mauritian government in publichospitals allopathic medicine is more accessible to thepopulation

Moreover the results revealed that the majority of theparticipants studied till the primary level only (119873 = 64) Ourfinding is in accordance with the work of Gakuya et al [29]where elder people with little formal education possess moreknowledge concerning the use of medicinal plants It wasalso noted that the majority of the informants were retired

(119873 = 36) and had a monthly household income of Rs 5001ndash10000 (1 US$ asymp Rs 3600) (119873 = 48) The retirement agein Mauritius is 60 years and above Nonetheless some ofthe participants were found to continue working thoughthey reached the retirement age The traditional healthpractitioners (119873 = 5) were found to play vital roles in thestudy area whereby the indigenous communities rely on themfor the provision of herbal medicines The traditional healthpractitioners were found to be key custodians of traditionalinformation on themedicinal use of plant and animal speciesTheir practice of healing involved panoply of methodologieswhich are considered trustworthy among the indigenouscommunity in the study area Traditional health practitionersin Mauritius were willing to share their valuable traditionalknowledge in order to prevent extinction of this culturalheritage

In order to allow better comparison of medicinal plantsand animals use among the four religious groups presentin the study area the number of participants surveyed ineach religious group was approximately equal 27 24 26and 23 for the Hindu Muslim Christian and Buddhistreligious group respectively The most common diabetesrelated complications reported by the informants were hyper-tension (119873 = 36) followed by high level of cholesterol (27)neuropathic pain (119873 = 25) and cardiovascular diseases(119873 = 12) According to the American Diabetes Associationin type 2 diabetes hypertension is often present as part ofthe metabolic syndrome of insulin resistance while in type1 diabetes hypertension may reflect the onset of diabeticnephropathy [30]

32 Herbal Remedies Used to Manage Diabetes and RelatedComplications The present research revealed the ethnob-otanical use of 52 plant species belonging to 33 familiesused to manage diabetes and related complications Infor-mation on medicinal plants obtained from the four religiousgroups namelyHinduMuslimChristian andBuddhist wasarranged alphabetically according to their botanical familiesalong with their ethnomedicinal uses (Table 3)

33 Source of Medicinal Plants Informants obtained themedicinal plants from three main sources gathering fromthe wild (39) harvesting from home gardens (37) andpurchasing from the herbalistsrsquo store (24) Our result isin agreement with the work of Singh et al [31] where themajority ofmedicinal plants used in the preparation of herbalremedies are obtained from the wild Indigenous people alsocultivate medicinal plants in home garden where medicinalplants are grown in small areas surrounding the houseMoreover medicinal plants are also grown in clay potsOne informant reported that effective medicinal plants arecultivated close to the house to allow easy accessibility On theother handmedicinal plants which are considered rare by theinformants and which are not easily available are purchasedfrom the herbalistsrsquo store

34 Forms of Medicinal Plants It was found that the infor-mants showed no particular preference for using either fresh

Evidence-Based Complementary and Alternative Medicine 7

Table3Listof

medicinalplantsandpo

lyherbalform

ulations

with

theirrelated

inform

ationused

againstd

iabetesa

ndrelated

complications

repo

rtedby

theinformants

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Acanthaceae

Graptophyllum

pictum

(L)Griff

(A

M15)

Laitde

vierge

Type

2diabetes

LPreparea

decoctionwith

3leaves

anddrink2cups

daily

for1

week

016

002

004

010

000

Alismataceae

Alism

aplantago-aquatica

subsp

orientale(Sam)S

am

(AM09)

mdashHighlevelofcho

leste

rol

mdash

Sold

asaC

hinese

teaa

gainstcholesterolPreparea

ninfusio

nwith

the

teabagsw

hich

containAlism

aorien

talis

(Rhizomaalism

atis)R

adix

angelicae

sinensisH

erba

artemisiae

capillarisH

awthornberryRh

izom

aatractylodismacrocephalaeSem

enzizip

hispinosaeand

ChineseteaD

rink

1cup

daily

012

000

000

003

009

Type

1diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Highlevelofcho

leste

rol

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Renalfailure

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Alliu

mcepa

L(A

M04)

Zoiyon

oigno

nHearin

gloss

BCr

ushandpressthe

bulbto

obtain

thejuice

andmix30

gof

thejuice

with

30gof

waterH

eatand

instill3-4drop

sinthea

ffected

ear

048

028

012

017

003

Amaryllid

aceae

Erectiled

ysfunctio

nB

Preparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Cataract

BPreparea

decoctionwith

theb

ulbandadd2teaspo

onso

fhon

eyA

llowitto

coolanduseitasa

neyebathdaily

Type

2diabetes

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Cataract

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Renalfailure

BCon

sume2

-3rawclo

vesd

ailyfor1

week

Alliu

msativ

umL

(AM39)

Lrsquoail

Hypertension

BSw

allow2sm

allclovesw

ithac

upof

water

thric

eper

week

042

024

009

022

006

Wou

ndB

Crushandpressthe

bulbto

obtain

juicea

ndapplythejuice

onthew

ound

daily

tillh

ealin

g

Ulcer

BCr

ushandpressthe

bulbto

obtain

juicea

ndapplythejuice

ontheu

lcer

daily

tillh

ealin

g

Anacardiaceae

Mangifer

aindica

L(A

M20)

Mangue

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

031

017

003

010

001

Ann

onaceae

Annona

murica

taL

(AM29)

Coron

sol

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

016

007

003

006

000

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Disease Markers

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OncologyJournal of

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Oxidative Medicine and Cellular Longevity

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PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

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Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 3

are within the reach of everybody nonetheless traditionalmedicine continues to remain active in the lives of the localpopulation

The multicultural society of Mauritius encompassesdescendants of Indian indentured labourers Chinese shop-keepers African slaves and British and French colonisersThe Indo-Mauritians community (Hindus and Muslims)represents the majority of the population followed by theChristian community and the Sino-Mauritians communityThe Hindu community is subdivided into several distinctreligious and sociocultural groupsThemain religious groupsare theHindi or Bhojpuri speaking people constituting 402of the total population and 765of allHindusTheTamils arethe second largest ethnic community (139) while Telugus(56) andMarathis (4) represent smallerminoritieswithinthe overall Hindu community The Hindus have a commonlanguage (Bhojpuri) the same regional origin (Uttar PradeshandBihar) and religious practices and rituals [13]The officiallanguage in Mauritius is the English language but ldquoCreolerdquo isthe native language of the island and is mostly used in infor-mal settings Mauritius is reputed worldwide for the peacefulharmony which prevails in the island among the differentgreat religions of the world namely Hinduism ChristianityIslam and Buddhism In Mauritius traditional therapies areparamount to panoply of ailments treatmentmanagementoffering profound therapeutic benefits and the indigenouscommunities rely heavily on them to meet their medicalneeds Though allopathic medicine is the primary form ofhealthcare in Mauritius some patients prefer traditionalmedicine for the treatmentmanagement of a number ofhuman diseases The rising costs of synthetic drugs havefueled the interest of the local population in traditionalmedicine usage thereby reintroducing such therapies as anovel emerging formof health aidMauritius is endowedwitha number of tropical rainforests which are rich repositoriesof a diverse range of invaluable medicinal plants and animalspecies Recently Mauritius has become the arena of anumber of ethnopharmacological field studies conducted byvarious workers which have emphasised mostly medicinalplants and animals among the Mauritian population andhave led to several publications [14 15] Nonetheless noneof these studies have addressed the patterns of similarityand dissimilarity of medicinal plants and animals usageamong the different religious communities present in theisland Heinrich et al [16] reported that most studies onmedicinal plants focus on the role of these plants withinone particular ethnic group and little emphasis has beengiven to the comparison of medicinal plant species amongvarious cultures Moreover an analysis of medicinal plantsusage must be carried out in order to understand thepatterns of use intra- and interculturally However studieson cross-cultural analysis of medicinal plants usage arelacking inMauritiusTherefore the current study specificallyseeks to bring in the limelight of the scientific communitythe documentation of traditional remedies used amongthe diabetic patients in Mauritius We also attempted toidentify the most culturally important medicinal plants andanimals in each religious group compare the use of plantand animal species interculturally and examine how the

different religious groups present in the island value tradi-tional remedies in their daily lives in their quest for soundhealth

2 Methods

21 Data Collection The project was approved by the Facultyof Science University of Mauritius Mauritius A total of100 key informants (27 Hindus 24 Muslims 26 Christiansand 23 Buddhists) were interviewed from June to August2015 Data was collected from key informants throughface-to-face interviews using a semistructured questionnaire(supplementary file in Supplementary Material availableonline at httpdxdoiorg10115520164523828) Traditionalinformation was sought from diabetic patients older than 30years based on the assumption that the mature populationis better versed in traditional knowledge Moreover partic-ipants should be users of traditional medicine and formallydiagnosed to be diabetic by their treating physician Duringthe course of the study 12 field trips were carried out indifferent regions of the island The interview was performedin ldquoCreolerdquo the native language of the Mauritian populationThe questionnaire developed for the survey consisted of bothclose- and open-ended questions Participants were informedabout the purpose of the survey and a prior informed consentformwas dully signed by the participants before the interviewwas carried out The traditional healers were interviewedusing the same questionnaireThe interviewswere performedin health centers home visits markets and Chinese shops(Figure 2) Figure 1 illustrates the different regions where thesurvey was carried out

The questionnaire comprised three main parts PartsA B and C Part A consisted of demographic data whichincluded age gender level of education occupation incomeand religious belief Part B of the questionnaire consistedof information about the herbal remedies used to managediabetes and related complications the local vernacular nameof the plant the method of preparation the dosage theroute of administration and the duration of treatmentPart C was based on animal-based remedy used to man-age diabetes and related complications the local vernac-ular name of the animal the method of preparation thedosage the route of administration and the duration oftreatment

22 Collection and Identification of Medicinal Plants Duringthe field visits when a remedy was mentioned by thetraditional healer or diabetic patient where possible theparticipant was encouraged to show us a sample of theremedy which was collected in situ and photographed Thecollected sample was then identified by local botanist Ourlocal repository database was updated whereby plant sampleswere assigned a collection number for future reference anddata mining Data obtained during the survey was cross-checked (local namesscientific names) according to a locallypublished book by Gurib-Fakim and Brendler [17] Scientificnames of plant species were identified according to the Inter-national Plant Name Index (IPNI httpwwwipniorg)

4 Evidence-Based Complementary and Alternative Medicine

Figure 2 Interview with traditional healers

23 Ailments Categories Based on the information obtainedfrom the key informants in the study area all the reportedailments were classified into 9 categories based on publishedscientific literature fromRiaz [18] ADA [19] Yadav et al [20]Ginsberg et al [21] and Bodansky et al [22] The categorieswere diabetic angiopathy diabetic nephropathy eye diseasesdiabetic neuropathy infections and wounds hypertensionskin complications diabetic dyslipidemia and diabetes

24 Data Analysis and Ethnobotanical Indexes The indige-nous medicinal information of plant and animal species wasanalyzed using different quantitative indexes

241 Relative Frequency of Citation Relative frequency ofcitation is calculated as follows relative frequency of citation= FCN where FC is the number of informants mentioningthe use of the species and 119873 is the number of informantsparticipating in the survey This index theoretically variesfrom 0 to 1 According to Sharma et al [23] when relativefrequency of citation is 0 it means that nobody refers tothe plantanimal as useful and when relative frequency ofcitation is 1 it means that all informants in the survey referto the plantanimal as useful

242 Cultural Importance Index Culturally importantspecies as medicines are identified by the cultural importanceindex (CII) [24] The CII was used to determine the most

culturally important plantanimal species in each religiousgroup It can be calculated by the following formula

CII =119906NC

sum

119906=1199061

119894119899

sum

119894=1198941

UR119906119894

119873

(1)

where NC is the total number of different illness categories(of each 119894 species) UR is the total number of use reportsfor each species and 119873 is the total number of informantsin each religious group The cultural importance index is thesum of the proportion of informants that mention each ofthe use-categories for a given species Themaximum value ofthe index equals the total number of different use-categories(NC) whichwould occur if all informants in a religious groupwould mention the use of a species in all use-categories Thisindex was used to estimate the cultural significance of eachplantanimal species [24] and to determine to what extenteach plantanimal species is present in the memory of theinformants belonging to each religious group

243 Jaccard Similarity Index The Jaccard similarity indexadapted from Guzel et al [25] was used to determine thedegree of similarity of medicinal plantsrsquo use among thedifferent religious groups The Jaccard similarity index iscalculated as follows Jaccard similarity index = 119862 times 100119860 +119861 minus 119862 where 119860 is the number of plant species reported byreligious group A 119861 is the number of plant species reportedby the religious group B and119862 is the number of plant speciesreported by both A and B [25]

Evidence-Based Complementary and Alternative Medicine 5

Table 1 Demographic data of the informants (119873 = 100)

Variable Categories Frequency (119899 = 100)

Age (years)

30ndash39 240ndash49 1750ndash59 2760ndash69 4170ndash79 8ge80 5

Sex Male 38Female 62

Level of education

No formal education 7Primary 64Secondary 20Tertiary 9

Occupation

Retired 36Nongovernment officer 25Housewife 18Government officer 16Traditional healer 2Ayurvedic medicine practitioner 2Traditional Chinese medicine practitioner 1

Monthly household income

ltRs 5000 2Rs 5001ndash10000 48Rs 10001ndash20000 40Rs 20001ndash30000 8gtRs 30001 2

Religion

Hindu 27Muslim 24Christian 26Buddhist 23

Diabetes related complications

Hypertension 36High level of cholesterol 27Neuropathic pain 25Cardiovascular diseases 12Cataracts 9Urinary tract infections 7Renal failure 5Foot ulcers 4Gangrene 3Infected wounds 3Stress 2Dry skin 2Erectile dysfunction 1Hearing loss 1Memory loss 1Depression 1

3 Results and Discussion

31 Demographic Profile of the Participants The demo-graphic characteristics of the participants were determinedand documented through face-to-face interviews usingsemistructured questionnaire (Tables 1 and 2) A total of 100

randomly selected informants (38males and 62 females) wereinterviewed as summarized in Tables 1 and 2 Our findingresembled the study of Ishola et al [26] where the majorityof traditional medicine users were female since they weretypically in charge of preparing herbal preparations in thedomestic setting According to Hardy [27] women are the

6 Evidence-Based Complementary and Alternative Medicine

Table 2 Age and gender distribution within each religious commu-nity

Religiouscommunity Age Number of

participants Gender Number ofparticipants

Hindu

30ndash39 1 Male 1240ndash49 3 Female 1550ndash59 860ndash69 770ndash79 6ge80 2

Muslim

30ndash39 0 Male 1140ndash49 4 Female 1350ndash59 360ndash69 1470ndash79 2ge80 1

Christian

30ndash39 1 Male 1040ndash49 4 Female 1650ndash59 760ndash69 1370ndash79 0ge80 1

Buddhist

30ndash39 0 Male 540ndash49 6 Female 1850ndash59 960ndash69 770ndash79 0ge80 1

main source of conservation and dissemination of traditionalknowledge Ethnographic investigations revealed that thegreatest contribution in terms of traditional information wasprovided by interviewees belonging to the age group 60ndash69 years old (119873 = 41) They were followed by informantsbelonging to the age category 50ndash59 years old (119873 = 27)This information implies that the young generation neglectstraditional medicine practice which might lead to the rapidloss of valuable traditional knowledge regarding the useof medicinal plants [28] There exist several reasons whichmight account for the loss of traditional knowledge in thestudy area (1) holders of empirical knowledge have diedbefore passing on this knowledge to the younger generation(2) the younger generation believes more in the efficacy ofallopathic medicine and (3) given the free cost of healthcarefacilities provided by the Mauritian government in publichospitals allopathic medicine is more accessible to thepopulation

Moreover the results revealed that the majority of theparticipants studied till the primary level only (119873 = 64) Ourfinding is in accordance with the work of Gakuya et al [29]where elder people with little formal education possess moreknowledge concerning the use of medicinal plants It wasalso noted that the majority of the informants were retired

(119873 = 36) and had a monthly household income of Rs 5001ndash10000 (1 US$ asymp Rs 3600) (119873 = 48) The retirement agein Mauritius is 60 years and above Nonetheless some ofthe participants were found to continue working thoughthey reached the retirement age The traditional healthpractitioners (119873 = 5) were found to play vital roles in thestudy area whereby the indigenous communities rely on themfor the provision of herbal medicines The traditional healthpractitioners were found to be key custodians of traditionalinformation on themedicinal use of plant and animal speciesTheir practice of healing involved panoply of methodologieswhich are considered trustworthy among the indigenouscommunity in the study area Traditional health practitionersin Mauritius were willing to share their valuable traditionalknowledge in order to prevent extinction of this culturalheritage

In order to allow better comparison of medicinal plantsand animals use among the four religious groups presentin the study area the number of participants surveyed ineach religious group was approximately equal 27 24 26and 23 for the Hindu Muslim Christian and Buddhistreligious group respectively The most common diabetesrelated complications reported by the informants were hyper-tension (119873 = 36) followed by high level of cholesterol (27)neuropathic pain (119873 = 25) and cardiovascular diseases(119873 = 12) According to the American Diabetes Associationin type 2 diabetes hypertension is often present as part ofthe metabolic syndrome of insulin resistance while in type1 diabetes hypertension may reflect the onset of diabeticnephropathy [30]

32 Herbal Remedies Used to Manage Diabetes and RelatedComplications The present research revealed the ethnob-otanical use of 52 plant species belonging to 33 familiesused to manage diabetes and related complications Infor-mation on medicinal plants obtained from the four religiousgroups namelyHinduMuslimChristian andBuddhist wasarranged alphabetically according to their botanical familiesalong with their ethnomedicinal uses (Table 3)

33 Source of Medicinal Plants Informants obtained themedicinal plants from three main sources gathering fromthe wild (39) harvesting from home gardens (37) andpurchasing from the herbalistsrsquo store (24) Our result isin agreement with the work of Singh et al [31] where themajority ofmedicinal plants used in the preparation of herbalremedies are obtained from the wild Indigenous people alsocultivate medicinal plants in home garden where medicinalplants are grown in small areas surrounding the houseMoreover medicinal plants are also grown in clay potsOne informant reported that effective medicinal plants arecultivated close to the house to allow easy accessibility On theother handmedicinal plants which are considered rare by theinformants and which are not easily available are purchasedfrom the herbalistsrsquo store

34 Forms of Medicinal Plants It was found that the infor-mants showed no particular preference for using either fresh

Evidence-Based Complementary and Alternative Medicine 7

Table3Listof

medicinalplantsandpo

lyherbalform

ulations

with

theirrelated

inform

ationused

againstd

iabetesa

ndrelated

complications

repo

rtedby

theinformants

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Acanthaceae

Graptophyllum

pictum

(L)Griff

(A

M15)

Laitde

vierge

Type

2diabetes

LPreparea

decoctionwith

3leaves

anddrink2cups

daily

for1

week

016

002

004

010

000

Alismataceae

Alism

aplantago-aquatica

subsp

orientale(Sam)S

am

(AM09)

mdashHighlevelofcho

leste

rol

mdash

Sold

asaC

hinese

teaa

gainstcholesterolPreparea

ninfusio

nwith

the

teabagsw

hich

containAlism

aorien

talis

(Rhizomaalism

atis)R

adix

angelicae

sinensisH

erba

artemisiae

capillarisH

awthornberryRh

izom

aatractylodismacrocephalaeSem

enzizip

hispinosaeand

ChineseteaD

rink

1cup

daily

012

000

000

003

009

Type

1diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Highlevelofcho

leste

rol

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Renalfailure

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Alliu

mcepa

L(A

M04)

Zoiyon

oigno

nHearin

gloss

BCr

ushandpressthe

bulbto

obtain

thejuice

andmix30

gof

thejuice

with

30gof

waterH

eatand

instill3-4drop

sinthea

ffected

ear

048

028

012

017

003

Amaryllid

aceae

Erectiled

ysfunctio

nB

Preparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Cataract

BPreparea

decoctionwith

theb

ulbandadd2teaspo

onso

fhon

eyA

llowitto

coolanduseitasa

neyebathdaily

Type

2diabetes

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Cataract

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Renalfailure

BCon

sume2

-3rawclo

vesd

ailyfor1

week

Alliu

msativ

umL

(AM39)

Lrsquoail

Hypertension

BSw

allow2sm

allclovesw

ithac

upof

water

thric

eper

week

042

024

009

022

006

Wou

ndB

Crushandpressthe

bulbto

obtain

juicea

ndapplythejuice

onthew

ound

daily

tillh

ealin

g

Ulcer

BCr

ushandpressthe

bulbto

obtain

juicea

ndapplythejuice

ontheu

lcer

daily

tillh

ealin

g

Anacardiaceae

Mangifer

aindica

L(A

M20)

Mangue

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

031

017

003

010

001

Ann

onaceae

Annona

murica

taL

(AM29)

Coron

sol

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

016

007

003

006

000

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

4 Evidence-Based Complementary and Alternative Medicine

Figure 2 Interview with traditional healers

23 Ailments Categories Based on the information obtainedfrom the key informants in the study area all the reportedailments were classified into 9 categories based on publishedscientific literature fromRiaz [18] ADA [19] Yadav et al [20]Ginsberg et al [21] and Bodansky et al [22] The categorieswere diabetic angiopathy diabetic nephropathy eye diseasesdiabetic neuropathy infections and wounds hypertensionskin complications diabetic dyslipidemia and diabetes

24 Data Analysis and Ethnobotanical Indexes The indige-nous medicinal information of plant and animal species wasanalyzed using different quantitative indexes

241 Relative Frequency of Citation Relative frequency ofcitation is calculated as follows relative frequency of citation= FCN where FC is the number of informants mentioningthe use of the species and 119873 is the number of informantsparticipating in the survey This index theoretically variesfrom 0 to 1 According to Sharma et al [23] when relativefrequency of citation is 0 it means that nobody refers tothe plantanimal as useful and when relative frequency ofcitation is 1 it means that all informants in the survey referto the plantanimal as useful

242 Cultural Importance Index Culturally importantspecies as medicines are identified by the cultural importanceindex (CII) [24] The CII was used to determine the most

culturally important plantanimal species in each religiousgroup It can be calculated by the following formula

CII =119906NC

sum

119906=1199061

119894119899

sum

119894=1198941

UR119906119894

119873

(1)

where NC is the total number of different illness categories(of each 119894 species) UR is the total number of use reportsfor each species and 119873 is the total number of informantsin each religious group The cultural importance index is thesum of the proportion of informants that mention each ofthe use-categories for a given species Themaximum value ofthe index equals the total number of different use-categories(NC) whichwould occur if all informants in a religious groupwould mention the use of a species in all use-categories Thisindex was used to estimate the cultural significance of eachplantanimal species [24] and to determine to what extenteach plantanimal species is present in the memory of theinformants belonging to each religious group

243 Jaccard Similarity Index The Jaccard similarity indexadapted from Guzel et al [25] was used to determine thedegree of similarity of medicinal plantsrsquo use among thedifferent religious groups The Jaccard similarity index iscalculated as follows Jaccard similarity index = 119862 times 100119860 +119861 minus 119862 where 119860 is the number of plant species reported byreligious group A 119861 is the number of plant species reportedby the religious group B and119862 is the number of plant speciesreported by both A and B [25]

Evidence-Based Complementary and Alternative Medicine 5

Table 1 Demographic data of the informants (119873 = 100)

Variable Categories Frequency (119899 = 100)

Age (years)

30ndash39 240ndash49 1750ndash59 2760ndash69 4170ndash79 8ge80 5

Sex Male 38Female 62

Level of education

No formal education 7Primary 64Secondary 20Tertiary 9

Occupation

Retired 36Nongovernment officer 25Housewife 18Government officer 16Traditional healer 2Ayurvedic medicine practitioner 2Traditional Chinese medicine practitioner 1

Monthly household income

ltRs 5000 2Rs 5001ndash10000 48Rs 10001ndash20000 40Rs 20001ndash30000 8gtRs 30001 2

Religion

Hindu 27Muslim 24Christian 26Buddhist 23

Diabetes related complications

Hypertension 36High level of cholesterol 27Neuropathic pain 25Cardiovascular diseases 12Cataracts 9Urinary tract infections 7Renal failure 5Foot ulcers 4Gangrene 3Infected wounds 3Stress 2Dry skin 2Erectile dysfunction 1Hearing loss 1Memory loss 1Depression 1

3 Results and Discussion

31 Demographic Profile of the Participants The demo-graphic characteristics of the participants were determinedand documented through face-to-face interviews usingsemistructured questionnaire (Tables 1 and 2) A total of 100

randomly selected informants (38males and 62 females) wereinterviewed as summarized in Tables 1 and 2 Our findingresembled the study of Ishola et al [26] where the majorityof traditional medicine users were female since they weretypically in charge of preparing herbal preparations in thedomestic setting According to Hardy [27] women are the

6 Evidence-Based Complementary and Alternative Medicine

Table 2 Age and gender distribution within each religious commu-nity

Religiouscommunity Age Number of

participants Gender Number ofparticipants

Hindu

30ndash39 1 Male 1240ndash49 3 Female 1550ndash59 860ndash69 770ndash79 6ge80 2

Muslim

30ndash39 0 Male 1140ndash49 4 Female 1350ndash59 360ndash69 1470ndash79 2ge80 1

Christian

30ndash39 1 Male 1040ndash49 4 Female 1650ndash59 760ndash69 1370ndash79 0ge80 1

Buddhist

30ndash39 0 Male 540ndash49 6 Female 1850ndash59 960ndash69 770ndash79 0ge80 1

main source of conservation and dissemination of traditionalknowledge Ethnographic investigations revealed that thegreatest contribution in terms of traditional information wasprovided by interviewees belonging to the age group 60ndash69 years old (119873 = 41) They were followed by informantsbelonging to the age category 50ndash59 years old (119873 = 27)This information implies that the young generation neglectstraditional medicine practice which might lead to the rapidloss of valuable traditional knowledge regarding the useof medicinal plants [28] There exist several reasons whichmight account for the loss of traditional knowledge in thestudy area (1) holders of empirical knowledge have diedbefore passing on this knowledge to the younger generation(2) the younger generation believes more in the efficacy ofallopathic medicine and (3) given the free cost of healthcarefacilities provided by the Mauritian government in publichospitals allopathic medicine is more accessible to thepopulation

Moreover the results revealed that the majority of theparticipants studied till the primary level only (119873 = 64) Ourfinding is in accordance with the work of Gakuya et al [29]where elder people with little formal education possess moreknowledge concerning the use of medicinal plants It wasalso noted that the majority of the informants were retired

(119873 = 36) and had a monthly household income of Rs 5001ndash10000 (1 US$ asymp Rs 3600) (119873 = 48) The retirement agein Mauritius is 60 years and above Nonetheless some ofthe participants were found to continue working thoughthey reached the retirement age The traditional healthpractitioners (119873 = 5) were found to play vital roles in thestudy area whereby the indigenous communities rely on themfor the provision of herbal medicines The traditional healthpractitioners were found to be key custodians of traditionalinformation on themedicinal use of plant and animal speciesTheir practice of healing involved panoply of methodologieswhich are considered trustworthy among the indigenouscommunity in the study area Traditional health practitionersin Mauritius were willing to share their valuable traditionalknowledge in order to prevent extinction of this culturalheritage

In order to allow better comparison of medicinal plantsand animals use among the four religious groups presentin the study area the number of participants surveyed ineach religious group was approximately equal 27 24 26and 23 for the Hindu Muslim Christian and Buddhistreligious group respectively The most common diabetesrelated complications reported by the informants were hyper-tension (119873 = 36) followed by high level of cholesterol (27)neuropathic pain (119873 = 25) and cardiovascular diseases(119873 = 12) According to the American Diabetes Associationin type 2 diabetes hypertension is often present as part ofthe metabolic syndrome of insulin resistance while in type1 diabetes hypertension may reflect the onset of diabeticnephropathy [30]

32 Herbal Remedies Used to Manage Diabetes and RelatedComplications The present research revealed the ethnob-otanical use of 52 plant species belonging to 33 familiesused to manage diabetes and related complications Infor-mation on medicinal plants obtained from the four religiousgroups namelyHinduMuslimChristian andBuddhist wasarranged alphabetically according to their botanical familiesalong with their ethnomedicinal uses (Table 3)

33 Source of Medicinal Plants Informants obtained themedicinal plants from three main sources gathering fromthe wild (39) harvesting from home gardens (37) andpurchasing from the herbalistsrsquo store (24) Our result isin agreement with the work of Singh et al [31] where themajority ofmedicinal plants used in the preparation of herbalremedies are obtained from the wild Indigenous people alsocultivate medicinal plants in home garden where medicinalplants are grown in small areas surrounding the houseMoreover medicinal plants are also grown in clay potsOne informant reported that effective medicinal plants arecultivated close to the house to allow easy accessibility On theother handmedicinal plants which are considered rare by theinformants and which are not easily available are purchasedfrom the herbalistsrsquo store

34 Forms of Medicinal Plants It was found that the infor-mants showed no particular preference for using either fresh

Evidence-Based Complementary and Alternative Medicine 7

Table3Listof

medicinalplantsandpo

lyherbalform

ulations

with

theirrelated

inform

ationused

againstd

iabetesa

ndrelated

complications

repo

rtedby

theinformants

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Acanthaceae

Graptophyllum

pictum

(L)Griff

(A

M15)

Laitde

vierge

Type

2diabetes

LPreparea

decoctionwith

3leaves

anddrink2cups

daily

for1

week

016

002

004

010

000

Alismataceae

Alism

aplantago-aquatica

subsp

orientale(Sam)S

am

(AM09)

mdashHighlevelofcho

leste

rol

mdash

Sold

asaC

hinese

teaa

gainstcholesterolPreparea

ninfusio

nwith

the

teabagsw

hich

containAlism

aorien

talis

(Rhizomaalism

atis)R

adix

angelicae

sinensisH

erba

artemisiae

capillarisH

awthornberryRh

izom

aatractylodismacrocephalaeSem

enzizip

hispinosaeand

ChineseteaD

rink

1cup

daily

012

000

000

003

009

Type

1diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Highlevelofcho

leste

rol

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Renalfailure

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Alliu

mcepa

L(A

M04)

Zoiyon

oigno

nHearin

gloss

BCr

ushandpressthe

bulbto

obtain

thejuice

andmix30

gof

thejuice

with

30gof

waterH

eatand

instill3-4drop

sinthea

ffected

ear

048

028

012

017

003

Amaryllid

aceae

Erectiled

ysfunctio

nB

Preparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Cataract

BPreparea

decoctionwith

theb

ulbandadd2teaspo

onso

fhon

eyA

llowitto

coolanduseitasa

neyebathdaily

Type

2diabetes

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Cataract

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Renalfailure

BCon

sume2

-3rawclo

vesd

ailyfor1

week

Alliu

msativ

umL

(AM39)

Lrsquoail

Hypertension

BSw

allow2sm

allclovesw

ithac

upof

water

thric

eper

week

042

024

009

022

006

Wou

ndB

Crushandpressthe

bulbto

obtain

juicea

ndapplythejuice

onthew

ound

daily

tillh

ealin

g

Ulcer

BCr

ushandpressthe

bulbto

obtain

juicea

ndapplythejuice

ontheu

lcer

daily

tillh

ealin

g

Anacardiaceae

Mangifer

aindica

L(A

M20)

Mangue

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

031

017

003

010

001

Ann

onaceae

Annona

murica

taL

(AM29)

Coron

sol

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

016

007

003

006

000

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

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Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 5

Table 1 Demographic data of the informants (119873 = 100)

Variable Categories Frequency (119899 = 100)

Age (years)

30ndash39 240ndash49 1750ndash59 2760ndash69 4170ndash79 8ge80 5

Sex Male 38Female 62

Level of education

No formal education 7Primary 64Secondary 20Tertiary 9

Occupation

Retired 36Nongovernment officer 25Housewife 18Government officer 16Traditional healer 2Ayurvedic medicine practitioner 2Traditional Chinese medicine practitioner 1

Monthly household income

ltRs 5000 2Rs 5001ndash10000 48Rs 10001ndash20000 40Rs 20001ndash30000 8gtRs 30001 2

Religion

Hindu 27Muslim 24Christian 26Buddhist 23

Diabetes related complications

Hypertension 36High level of cholesterol 27Neuropathic pain 25Cardiovascular diseases 12Cataracts 9Urinary tract infections 7Renal failure 5Foot ulcers 4Gangrene 3Infected wounds 3Stress 2Dry skin 2Erectile dysfunction 1Hearing loss 1Memory loss 1Depression 1

3 Results and Discussion

31 Demographic Profile of the Participants The demo-graphic characteristics of the participants were determinedand documented through face-to-face interviews usingsemistructured questionnaire (Tables 1 and 2) A total of 100

randomly selected informants (38males and 62 females) wereinterviewed as summarized in Tables 1 and 2 Our findingresembled the study of Ishola et al [26] where the majorityof traditional medicine users were female since they weretypically in charge of preparing herbal preparations in thedomestic setting According to Hardy [27] women are the

6 Evidence-Based Complementary and Alternative Medicine

Table 2 Age and gender distribution within each religious commu-nity

Religiouscommunity Age Number of

participants Gender Number ofparticipants

Hindu

30ndash39 1 Male 1240ndash49 3 Female 1550ndash59 860ndash69 770ndash79 6ge80 2

Muslim

30ndash39 0 Male 1140ndash49 4 Female 1350ndash59 360ndash69 1470ndash79 2ge80 1

Christian

30ndash39 1 Male 1040ndash49 4 Female 1650ndash59 760ndash69 1370ndash79 0ge80 1

Buddhist

30ndash39 0 Male 540ndash49 6 Female 1850ndash59 960ndash69 770ndash79 0ge80 1

main source of conservation and dissemination of traditionalknowledge Ethnographic investigations revealed that thegreatest contribution in terms of traditional information wasprovided by interviewees belonging to the age group 60ndash69 years old (119873 = 41) They were followed by informantsbelonging to the age category 50ndash59 years old (119873 = 27)This information implies that the young generation neglectstraditional medicine practice which might lead to the rapidloss of valuable traditional knowledge regarding the useof medicinal plants [28] There exist several reasons whichmight account for the loss of traditional knowledge in thestudy area (1) holders of empirical knowledge have diedbefore passing on this knowledge to the younger generation(2) the younger generation believes more in the efficacy ofallopathic medicine and (3) given the free cost of healthcarefacilities provided by the Mauritian government in publichospitals allopathic medicine is more accessible to thepopulation

Moreover the results revealed that the majority of theparticipants studied till the primary level only (119873 = 64) Ourfinding is in accordance with the work of Gakuya et al [29]where elder people with little formal education possess moreknowledge concerning the use of medicinal plants It wasalso noted that the majority of the informants were retired

(119873 = 36) and had a monthly household income of Rs 5001ndash10000 (1 US$ asymp Rs 3600) (119873 = 48) The retirement agein Mauritius is 60 years and above Nonetheless some ofthe participants were found to continue working thoughthey reached the retirement age The traditional healthpractitioners (119873 = 5) were found to play vital roles in thestudy area whereby the indigenous communities rely on themfor the provision of herbal medicines The traditional healthpractitioners were found to be key custodians of traditionalinformation on themedicinal use of plant and animal speciesTheir practice of healing involved panoply of methodologieswhich are considered trustworthy among the indigenouscommunity in the study area Traditional health practitionersin Mauritius were willing to share their valuable traditionalknowledge in order to prevent extinction of this culturalheritage

In order to allow better comparison of medicinal plantsand animals use among the four religious groups presentin the study area the number of participants surveyed ineach religious group was approximately equal 27 24 26and 23 for the Hindu Muslim Christian and Buddhistreligious group respectively The most common diabetesrelated complications reported by the informants were hyper-tension (119873 = 36) followed by high level of cholesterol (27)neuropathic pain (119873 = 25) and cardiovascular diseases(119873 = 12) According to the American Diabetes Associationin type 2 diabetes hypertension is often present as part ofthe metabolic syndrome of insulin resistance while in type1 diabetes hypertension may reflect the onset of diabeticnephropathy [30]

32 Herbal Remedies Used to Manage Diabetes and RelatedComplications The present research revealed the ethnob-otanical use of 52 plant species belonging to 33 familiesused to manage diabetes and related complications Infor-mation on medicinal plants obtained from the four religiousgroups namelyHinduMuslimChristian andBuddhist wasarranged alphabetically according to their botanical familiesalong with their ethnomedicinal uses (Table 3)

33 Source of Medicinal Plants Informants obtained themedicinal plants from three main sources gathering fromthe wild (39) harvesting from home gardens (37) andpurchasing from the herbalistsrsquo store (24) Our result isin agreement with the work of Singh et al [31] where themajority ofmedicinal plants used in the preparation of herbalremedies are obtained from the wild Indigenous people alsocultivate medicinal plants in home garden where medicinalplants are grown in small areas surrounding the houseMoreover medicinal plants are also grown in clay potsOne informant reported that effective medicinal plants arecultivated close to the house to allow easy accessibility On theother handmedicinal plants which are considered rare by theinformants and which are not easily available are purchasedfrom the herbalistsrsquo store

34 Forms of Medicinal Plants It was found that the infor-mants showed no particular preference for using either fresh

Evidence-Based Complementary and Alternative Medicine 7

Table3Listof

medicinalplantsandpo

lyherbalform

ulations

with

theirrelated

inform

ationused

againstd

iabetesa

ndrelated

complications

repo

rtedby

theinformants

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Acanthaceae

Graptophyllum

pictum

(L)Griff

(A

M15)

Laitde

vierge

Type

2diabetes

LPreparea

decoctionwith

3leaves

anddrink2cups

daily

for1

week

016

002

004

010

000

Alismataceae

Alism

aplantago-aquatica

subsp

orientale(Sam)S

am

(AM09)

mdashHighlevelofcho

leste

rol

mdash

Sold

asaC

hinese

teaa

gainstcholesterolPreparea

ninfusio

nwith

the

teabagsw

hich

containAlism

aorien

talis

(Rhizomaalism

atis)R

adix

angelicae

sinensisH

erba

artemisiae

capillarisH

awthornberryRh

izom

aatractylodismacrocephalaeSem

enzizip

hispinosaeand

ChineseteaD

rink

1cup

daily

012

000

000

003

009

Type

1diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Highlevelofcho

leste

rol

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Renalfailure

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Alliu

mcepa

L(A

M04)

Zoiyon

oigno

nHearin

gloss

BCr

ushandpressthe

bulbto

obtain

thejuice

andmix30

gof

thejuice

with

30gof

waterH

eatand

instill3-4drop

sinthea

ffected

ear

048

028

012

017

003

Amaryllid

aceae

Erectiled

ysfunctio

nB

Preparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Cataract

BPreparea

decoctionwith

theb

ulbandadd2teaspo

onso

fhon

eyA

llowitto

coolanduseitasa

neyebathdaily

Type

2diabetes

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Cataract

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Renalfailure

BCon

sume2

-3rawclo

vesd

ailyfor1

week

Alliu

msativ

umL

(AM39)

Lrsquoail

Hypertension

BSw

allow2sm

allclovesw

ithac

upof

water

thric

eper

week

042

024

009

022

006

Wou

ndB

Crushandpressthe

bulbto

obtain

juicea

ndapplythejuice

onthew

ound

daily

tillh

ealin

g

Ulcer

BCr

ushandpressthe

bulbto

obtain

juicea

ndapplythejuice

ontheu

lcer

daily

tillh

ealin

g

Anacardiaceae

Mangifer

aindica

L(A

M20)

Mangue

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

031

017

003

010

001

Ann

onaceae

Annona

murica

taL

(AM29)

Coron

sol

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

016

007

003

006

000

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

6 Evidence-Based Complementary and Alternative Medicine

Table 2 Age and gender distribution within each religious commu-nity

Religiouscommunity Age Number of

participants Gender Number ofparticipants

Hindu

30ndash39 1 Male 1240ndash49 3 Female 1550ndash59 860ndash69 770ndash79 6ge80 2

Muslim

30ndash39 0 Male 1140ndash49 4 Female 1350ndash59 360ndash69 1470ndash79 2ge80 1

Christian

30ndash39 1 Male 1040ndash49 4 Female 1650ndash59 760ndash69 1370ndash79 0ge80 1

Buddhist

30ndash39 0 Male 540ndash49 6 Female 1850ndash59 960ndash69 770ndash79 0ge80 1

main source of conservation and dissemination of traditionalknowledge Ethnographic investigations revealed that thegreatest contribution in terms of traditional information wasprovided by interviewees belonging to the age group 60ndash69 years old (119873 = 41) They were followed by informantsbelonging to the age category 50ndash59 years old (119873 = 27)This information implies that the young generation neglectstraditional medicine practice which might lead to the rapidloss of valuable traditional knowledge regarding the useof medicinal plants [28] There exist several reasons whichmight account for the loss of traditional knowledge in thestudy area (1) holders of empirical knowledge have diedbefore passing on this knowledge to the younger generation(2) the younger generation believes more in the efficacy ofallopathic medicine and (3) given the free cost of healthcarefacilities provided by the Mauritian government in publichospitals allopathic medicine is more accessible to thepopulation

Moreover the results revealed that the majority of theparticipants studied till the primary level only (119873 = 64) Ourfinding is in accordance with the work of Gakuya et al [29]where elder people with little formal education possess moreknowledge concerning the use of medicinal plants It wasalso noted that the majority of the informants were retired

(119873 = 36) and had a monthly household income of Rs 5001ndash10000 (1 US$ asymp Rs 3600) (119873 = 48) The retirement agein Mauritius is 60 years and above Nonetheless some ofthe participants were found to continue working thoughthey reached the retirement age The traditional healthpractitioners (119873 = 5) were found to play vital roles in thestudy area whereby the indigenous communities rely on themfor the provision of herbal medicines The traditional healthpractitioners were found to be key custodians of traditionalinformation on themedicinal use of plant and animal speciesTheir practice of healing involved panoply of methodologieswhich are considered trustworthy among the indigenouscommunity in the study area Traditional health practitionersin Mauritius were willing to share their valuable traditionalknowledge in order to prevent extinction of this culturalheritage

In order to allow better comparison of medicinal plantsand animals use among the four religious groups presentin the study area the number of participants surveyed ineach religious group was approximately equal 27 24 26and 23 for the Hindu Muslim Christian and Buddhistreligious group respectively The most common diabetesrelated complications reported by the informants were hyper-tension (119873 = 36) followed by high level of cholesterol (27)neuropathic pain (119873 = 25) and cardiovascular diseases(119873 = 12) According to the American Diabetes Associationin type 2 diabetes hypertension is often present as part ofthe metabolic syndrome of insulin resistance while in type1 diabetes hypertension may reflect the onset of diabeticnephropathy [30]

32 Herbal Remedies Used to Manage Diabetes and RelatedComplications The present research revealed the ethnob-otanical use of 52 plant species belonging to 33 familiesused to manage diabetes and related complications Infor-mation on medicinal plants obtained from the four religiousgroups namelyHinduMuslimChristian andBuddhist wasarranged alphabetically according to their botanical familiesalong with their ethnomedicinal uses (Table 3)

33 Source of Medicinal Plants Informants obtained themedicinal plants from three main sources gathering fromthe wild (39) harvesting from home gardens (37) andpurchasing from the herbalistsrsquo store (24) Our result isin agreement with the work of Singh et al [31] where themajority ofmedicinal plants used in the preparation of herbalremedies are obtained from the wild Indigenous people alsocultivate medicinal plants in home garden where medicinalplants are grown in small areas surrounding the houseMoreover medicinal plants are also grown in clay potsOne informant reported that effective medicinal plants arecultivated close to the house to allow easy accessibility On theother handmedicinal plants which are considered rare by theinformants and which are not easily available are purchasedfrom the herbalistsrsquo store

34 Forms of Medicinal Plants It was found that the infor-mants showed no particular preference for using either fresh

Evidence-Based Complementary and Alternative Medicine 7

Table3Listof

medicinalplantsandpo

lyherbalform

ulations

with

theirrelated

inform

ationused

againstd

iabetesa

ndrelated

complications

repo

rtedby

theinformants

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Acanthaceae

Graptophyllum

pictum

(L)Griff

(A

M15)

Laitde

vierge

Type

2diabetes

LPreparea

decoctionwith

3leaves

anddrink2cups

daily

for1

week

016

002

004

010

000

Alismataceae

Alism

aplantago-aquatica

subsp

orientale(Sam)S

am

(AM09)

mdashHighlevelofcho

leste

rol

mdash

Sold

asaC

hinese

teaa

gainstcholesterolPreparea

ninfusio

nwith

the

teabagsw

hich

containAlism

aorien

talis

(Rhizomaalism

atis)R

adix

angelicae

sinensisH

erba

artemisiae

capillarisH

awthornberryRh

izom

aatractylodismacrocephalaeSem

enzizip

hispinosaeand

ChineseteaD

rink

1cup

daily

012

000

000

003

009

Type

1diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Highlevelofcho

leste

rol

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Renalfailure

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Alliu

mcepa

L(A

M04)

Zoiyon

oigno

nHearin

gloss

BCr

ushandpressthe

bulbto

obtain

thejuice

andmix30

gof

thejuice

with

30gof

waterH

eatand

instill3-4drop

sinthea

ffected

ear

048

028

012

017

003

Amaryllid

aceae

Erectiled

ysfunctio

nB

Preparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Cataract

BPreparea

decoctionwith

theb

ulbandadd2teaspo

onso

fhon

eyA

llowitto

coolanduseitasa

neyebathdaily

Type

2diabetes

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Cataract

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Renalfailure

BCon

sume2

-3rawclo

vesd

ailyfor1

week

Alliu

msativ

umL

(AM39)

Lrsquoail

Hypertension

BSw

allow2sm

allclovesw

ithac

upof

water

thric

eper

week

042

024

009

022

006

Wou

ndB

Crushandpressthe

bulbto

obtain

juicea

ndapplythejuice

onthew

ound

daily

tillh

ealin

g

Ulcer

BCr

ushandpressthe

bulbto

obtain

juicea

ndapplythejuice

ontheu

lcer

daily

tillh

ealin

g

Anacardiaceae

Mangifer

aindica

L(A

M20)

Mangue

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

031

017

003

010

001

Ann

onaceae

Annona

murica

taL

(AM29)

Coron

sol

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

016

007

003

006

000

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 7

Table3Listof

medicinalplantsandpo

lyherbalform

ulations

with

theirrelated

inform

ationused

againstd

iabetesa

ndrelated

complications

repo

rtedby

theinformants

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Acanthaceae

Graptophyllum

pictum

(L)Griff

(A

M15)

Laitde

vierge

Type

2diabetes

LPreparea

decoctionwith

3leaves

anddrink2cups

daily

for1

week

016

002

004

010

000

Alismataceae

Alism

aplantago-aquatica

subsp

orientale(Sam)S

am

(AM09)

mdashHighlevelofcho

leste

rol

mdash

Sold

asaC

hinese

teaa

gainstcholesterolPreparea

ninfusio

nwith

the

teabagsw

hich

containAlism

aorien

talis

(Rhizomaalism

atis)R

adix

angelicae

sinensisH

erba

artemisiae

capillarisH

awthornberryRh

izom

aatractylodismacrocephalaeSem

enzizip

hispinosaeand

ChineseteaD

rink

1cup

daily

012

000

000

003

009

Type

1diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Type

2diabetes

BPreparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Highlevelofcho

leste

rol

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Renalfailure

BPreparea

decoctionwith

theb

ulbanddrink1cup

daily

for1

week

Alliu

mcepa

L(A

M04)

Zoiyon

oigno

nHearin

gloss

BCr

ushandpressthe

bulbto

obtain

thejuice

andmix30

gof

thejuice

with

30gof

waterH

eatand

instill3-4drop

sinthea

ffected

ear

048

028

012

017

003

Amaryllid

aceae

Erectiled

ysfunctio

nB

Preparejuice

with

theb

ulbandadd1teaspoo

nof

honeyDrin

k1cup

daily

for3

mon

ths

Cataract

BPreparea

decoctionwith

theb

ulbandadd2teaspo

onso

fhon

eyA

llowitto

coolanduseitasa

neyebathdaily

Type

2diabetes

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Cataract

BPreparea

decoctionwith

2-3clo

vesa

nddrink1cup

thric

eper

week

Renalfailure

BCon

sume2

-3rawclo

vesd

ailyfor1

week

Alliu

msativ

umL

(AM39)

Lrsquoail

Hypertension

BSw

allow2sm

allclovesw

ithac

upof

water

thric

eper

week

042

024

009

022

006

Wou

ndB

Crushandpressthe

bulbto

obtain

juicea

ndapplythejuice

onthew

ound

daily

tillh

ealin

g

Ulcer

BCr

ushandpressthe

bulbto

obtain

juicea

ndapplythejuice

ontheu

lcer

daily

tillh

ealin

g

Anacardiaceae

Mangifer

aindica

L(A

M20)

Mangue

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

031

017

003

010

001

Ann

onaceae

Annona

murica

taL

(AM29)

Coron

sol

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

016

007

003

006

000

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

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Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

8 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aphloiaceae

Aphloiatheiformislowast

(Vahl)Be

nn

(AM51)

Fand

amane

Cataract

LPreparea

ninfusio

nwith

theleavesa

ndwashthee

yesw

ithitdaily

018

008

002

010

000

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Apiaceae

Apium

graveolen

sL

(AM07)

Celeri

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

003

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Coria

ndrum

sativ

umL

(AM11)

Cotom

iliTy

pe2diabetes

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

018

005

002

011

000

Petro

selin

umcrisp

um(M

ill)

Nym

anexAWH

ill

(AM52)

Persil

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

027

012

007

016

001

Highlevelofcho

leste

rol

LPreparea

soup

with

theleavestogetherw

ithAp

ium

graveolen

sLand

Alliu

mam

peloprasum

varporrum

Con

sumeittwicep

erweek

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Renalfailure

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparejuice

with

theleavestogetherw

ithDau

cuscarotaandAp

ium

graveolen

sLD

rink1cup

twicep

erweek

Apocyn

aceae

Catharanthus

roseus

LGDon

(AM17)

Sapo

nnaire

(blanc)

Type

2diabetes

LPreparea

ninfusio

nwith

7leaves

in2cups

ofho

twaterD

rink1cup

thric

eperw

eek

018

004

005

008

001

Arecaceae

Cocosn

ucifera

L(A

M21)

Coco

Cataract

FrInstill2drop

sofo

ilin

thee

yetw

icep

erday

023

008

002

012

000

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

thric

eper

week

Renalfailure

FrDrin

k1cup

ofthefruitwater

four

times

perw

eek

Renalfailure

RPreparea

decoctionof

ther

ootand

drink1cup

twicep

erweek

Asparagaceae

Ophiopogonjaponicus(Th

unb)K

erGrawl

(AM22)

mdashTy

pe2diabetes

mdash

Sold

asCh

inesea

ntidiabetic

teaPreparea

ninfusio

nwith

thetea

bags

which

containOphiopogonjaponicas(Ra

dixop

hiop

ogon

is)fragrant

solomon

sealrhizom

eCh

inesey

amH

awthornberryRa

dixpu

erariaeand

whiteteaDrin

k1cup

daily

013

000

000

002

011

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

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Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 9

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Aste

raceae

Bidens

pilosa

L(A

M31)

Lavilbag

Type

2diabetes

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

028

014

007

010

004

Hypertension

LPreparea

decoctionof

3leaves

anddrink1cup

twicep

erweek

Type

2diabetes

LPreparea

ninfusio

nwith

10gof

leaves

in1L

ofwater

anddrink1cup

twicethric

eper

week

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Cyna

racardun

culusL

(A

M24)

Artichaut

Highlevelofcho

leste

rol

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

031

010

006

015

007

Atherosclerosis

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erdayfor1

week

Atherosclerosis

LPreparejuice

with

theleavesa

nddrink1cup

twicep

erdayfor1

week

Sigesbeckiaorien

talis

L(A

M05)

Herbe

deflacq

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

034

017

009

008

000

Type

2diabetes

LPreparea

decoctionof

theleavestogetherw

ithAp

hloiatheiformis

Faujasiopsisflexu

osaRu

busa

lceifoliu

sRa

vena

lamadagascarie

nsis

and

Rhizophora

mucronataD

rink1cup

twicep

erweek

Brassic

aceae

Brassicaoleracea

L(A

M33)

Lichou

Cardiovascular

disease

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

037

013

011

017

002

Type

2diabetes

LPreparejuice

with

theleavesa

nddrink1cup

daily

for1

week

Wou

ndL

Applytheleavesa

sacataplasm

onthew

ound

Cataract

LCr

ushandpressthe

leaves

toob

tain

juicea

ndinstill3-4drop

sineach

eye2

hoursd

ailytillh

ealin

g

Hearin

gloss

LPreparejuice

with

theleavesa

ndmixequalamou

ntof

thejuice

with

equal

amou

ntof

thejuice

ofCitru

smedica

LfruitInstill2drop

sinthee

arsd

aily

before

goingto

bed

Brom

eliaceae

Anan

ascomosus

(L)Merr

(AM30)

Anana

Renalfailure

FrCon

sumer

ipefruittwicep

erweek

015

003

001

013

000

Cardiovascular

disease

FrPreparejuice

with

thefruitandwater

anddrink1cup

twicep

erweek

Caric

aceae

Caric

apapaya

L(A

M45)

Papaya

Hypertension

FrCon

sumer

ipefruithalfan

hour

before

breakfastthricep

erweek

021

007

008

005

002

Highlevelofcho

leste

rol

FrCr

ushandpressthe

rawfruittoob

tain

milk

yliq

uidanddrink1teaspoo

ntwicep

erweek

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaDrin

k1cup

thric

eperw

eek

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

10 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Cucurbita

ceae

Cucumissativ

usL

(AM10)

Con

combre

Type

1diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

014

002

001

012

001

Type

2diabetes

FrPreparejuice

with

thefruitandwater

anddrink1cup

onalternatived

ays

Cucurbita

maxim

aDuchesne

(AM01)

Giro

mon

Type

2diabetes

FrPreparea

decoctionwith

thep

eelsin

water

anddrink1cup

daily

for1

week

023

002

007

014

001

Cataract

FlCr

ushandpressthe

flower

toob

tain

juiceAp

plyjuicea

scom

press

externallyon

thee

yes

Renalfailure

SeSeedsa

redriedin

bright

sunlight

for1

dayandeatenrawthefollowingday

Seedssho

uldbe

consum

edthric

eper

week

Wou

ndFr

Preparejuice

with

thefruitandapplyiton

wou

ndtillh

ealin

g

Lagena

riasiceraria(M

olina)

Standl

(AM41)

Calebasse

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

byallowingitto

boilfor2

0minutesD

rink1cup

for3

days

032

014

009

009

007

Highlevelofcho

leste

rol

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Hypertension

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

Luffa

acutangula(L)Ro

xb

(AM08)

Patole

Hypertension

LCr

ushandpress3

ndash5leaves

toob

tain

juicea

nddrinkittwicep

erweek

017

003

005

011

000

Cardiovascular

disease

LPreparejuice

with

theleavestogetherw

ithSw

ertia

chira

yita

andho

ney

Drin

k1cup

twicep

erweek

Type

2diabetes

LEa

t2-3

leaves

twicep

erweek

Type

2diabetes

LEx

tractthe

liquidby

crushing

theleavesa

nddrink1teaspoo

ntwicep

erweek

Type

2diabetes

FrEx

tractthe

liquidby

crushing

thefruitanddrink1-2

teaspo

onstwicep

erweek

Type

2diabetes

SeDry

thes

eeds

inbright

sunlight

durin

gthed

ayandatnightallo

wthem

tosoak

inac

upof

water

anddrinkitthen

extm

orning

onan

emptysto

mach

Type

2diabetes

LPreparejuice

with

3leaves

andaddPipern

igrumD

rinkiton

ceperw

eek

Mom

ordica

charantia

L(A

M03)

Margose

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

LM

alus

domesticaandAloe

barbadensisD

rink1cup

once

perw

eek

046

023

009

011

005

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Phaseolusv

ulgaris

Landdrink1

cuptwicep

erweek

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

Cucumissativ

usanddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

thefruitof

Phyllanthus

emblica

andthefruitof

Syzygium

cuminiDrin

k1cup

twicep

erweek

Fabaceae

Tamarindu

sind

icaL

(AM37)

Tamarin

Hypertension

FrPreparejuice

with

thep

ulpandwater

anddrink1cup

twicep

erdayfor1

day

039

012

009

018

002

Pain

LPreparea

foot

bath

with

adecoctio

nof

theleavesm

ixed

with

1teaspoo

nof

salt

Type

2diabetes

SePreparea

decoctionwith

thes

eeds

anddrink1cup

thric

eper

week

Trigo

nella

foenum

-graecum

L(A

M18)

Methi

Highlevelofcho

leste

rol

SeSo

akthes

eeds

in1g

lassof

water

for1

nightand

drinkitthen

extm

orning

onan

emptysto

mach

043

023

006

022

001

Erectiled

ysfunctio

nSe

Preparea

decoctionwith

1teaspoo

nof

seedsa

nd2cups

ofwaterD

rink1

cupon

anem

ptysto

machin

them

orning

daily

for1

week

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 11

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Type

2diabetes

LCon

sume2

rawleaves

twicep

erweek

Hypertension

LCr

ushandpressthe

leaves

toob

tain

juicea

nddrink2teaspo

onstwicep

erweek

Cataract

LCr

ush2leaves

andpresstoob

tain

juicea

ndtake

1dropof

thejuice

inthe

eyed

aily

Ocim

umtenu

iflorum

L(A

M26)

Tulsi

Cataract

LCr

ushandpress3

-4leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

ey

Instill

2drop

softhe

mixture

inthee

yeeach

nightfor

5days

048

039

015

016

002

Lamiaceae

Erectiled

ysfunctio

nL

Preparea

decoctionwith

3leaves

together

with

3leaves

ofPiperb

etleand

drink1cup

twicep

erweek

Wou

ndL

Crushandpressthe

leaves

toob

tain

juicea

ndmixthejuice

with

theo

ilof

Cocosn

ucifera

thathasp

reviou

slybeen

heated

andapplyiton

thew

ound

Highlevelofcho

leste

rol

LCr

ushandpress3

leaves

toob

tain

juicea

ndadd2teaspo

onso

fhon

eyand

drinktwicep

erweek

Prun

ellavulga

risL

(AM28)

mdashHypertension

mdashSold

asCh

inesea

ntihypertensiveteaP

repare

aninfusio

nwith

thetea

bags

which

containPrun

ellavulga

risL(Selfhealspike)Ra

mulus

uncaria

ecumun

cisFructus

leonu

riandCh

ineseo

olon

gteaDrin

k1cup

daily

009

000

000

001

008

Lauraceae

Persea

america

naMill

(AM34)

Avocat

Cataract

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

021

008

004

011

000

Highlevelofcho

leste

rol

FrPreparejuice

with

2cups

ofyoghurt12

acup

ofthefruit

and12

acup

ofwater

anddrink1cup

once

perw

eek

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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Behavioural Neurology

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Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

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Oxidative Medicine and Cellular Longevity

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The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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ObesityJournal of

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Computational and Mathematical Methods in Medicine

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Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

12 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Linaceae

Linu

musita

tissim

umLinn

aeus

(AM40

)Grain

delin

Type

2diabetes

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

034

016

013

008

001

Renalfailure

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Highlevelofcho

leste

rol

SeSo

akthes

eeds

inac

upof

water

atnightand

drinkitthen

extm

orning

onan

emptysto

machDrin

kitthric

eper

week

Meliaceae

Azadira

chta

indica

AJuss

(AM16)

Neemlila

perche

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

046

021

012

009

004

Type

2diabetes

LCr

ushtheleavesa

ndmakes

mallballswith

them

andallowthem

todryin

thes

unTh

efollowingdaysw

allow2balls

with

1glassof

water

twicep

erweek

Moraceae

Artocarpus

heterophyllus

Lam

(AM36)

Zack

Type

2diabetes

FrPreparea

decoctionwith

they

oung

fruitsanddrink1cup

daily

for1

week

019

007

002

008

002

Moringaceae

Moringa

oleiferaLam

(AM42)

Brede

mou

roun

gue

Type

2diabetes

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

026

012

006

016

000

Highlevelofcho

leste

rol

LCr

ushandpressthe

leaves

toob

tain

juiceMixitwith

milk

anddrink1cup

twicep

erweek

Hypertension

RPreparea

decoctionwith

ther

ootand

drink1cup

twicep

erweek

Hypertension

StPreparea

decoctionwith

thes

tem

anddrink1cup

twicep

erweek

Myrtaceae

Eucalyptus

globu

lusL

abill

(AM32)

Eucalyptus

Type

2diabetes

LPreparea

ninfusio

nwith

2-3leaves

anddrink1cup

twicep

erweek

013

005

000

008

000

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

daily

for1

week

Psidium

guajavaL

(AM50)

Goyave

Type

2diabetes

FrCon

sumer

ipfruitthricep

erweek

038

017

004

015

002

FrPreparea

juiceo

fthe

fruitand

drink1cup

daily

for1

week

Syzygium

cuminiL

Skeels

(AM06)

Jamblon

Type

2

LPreparea

decoctionwith

theleavesa

nddrink1cup

daily

for1

week

049

019

014

013

003

FrCon

sume10rip

efruits

thric

eper

week

FrPreparejuice

with

1cup

ofthefruits

and2cups

ofwaterD

rink1cup

twice

perw

eek

SePreparea

decoctionwith

thes

eeds

anddrink1cup

twicep

erweek

FrSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoKarela

jamun

rdquowhich

contains

Syzygium

cuminiand

Mom

ordica

charantia

Drin

k5ndash10mlofthe

preparationwith

12ag

lassof

water

twicep

erday

Fr

Sold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoYesakardquo

which

contains

Phyllanthus

emblica

TerminaliachebulaTerm

inaliabelleric

aSyzygium

cuminiPicrorhiza

kurroaSwe

rtiachira

taT

inospora

cordifoliaG

ymnema

sylve

streMom

ordica

charantia

CuraumalongaSalacia

chinensis

Linn

and

Meliaazadira

chtaD

rink1tablespoo

ntwicep

erday

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 13

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Oleaceae

Olea

europaea

L(A

M02)

Zolive

Hypertension

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

024

010

004

013

002

Cardiovascular

disease

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Type

2diabetes

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

daily

for1

week

Phyllanthaceae

Phyllanthus

emblica

L(A

M13)

Amla

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

ncalledldquoTrip

halardquoc

ontainingPh

yllanthu

sem

blica

Bellirica

myrobalan

and

Chebulicmyrobalan

Drin

k1tablespoo

ndaily

052

025

014

016

006

Type

2diabetes

mdashSold

asan

Ayurvedicp

reparatio

nkn

ownas

ldquoAmlakarelardquow

hich

contains

Phyllanthus

emblica

andMom

ordica

charantia

Drin

k10ndash30m

lofthe

preparationdaily

in100m

lofw

ater

Type

2diabetes

FrCon

sumer

awfruitsthric

eper

week

Type

2diabetes

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

andadd1teaspoo

nof

honeyto

thejuice

(optional)

Drin

k1cup

thric

eper

week

Highlevelofcho

leste

rol

FrPreparejuice

with

1cup

offruitsand1cup

ofwater

anddrink1cup

thric

eperw

eek

Poaceae

AvenasativaL

(AM35)

Oatmeal

Type

2diabetes

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

032

019

008

013

002

Highlevelofcho

leste

rol

Gr

Theg

rainsa

resoaked

in1cup

ofwater

durin

gthen

ight

anddrun

kin

the

morning

onan

emptysto

mach

Dry

skin

Gr

Theg

rainsa

recrushedinto

fined

powdersandmixed

with

1tablespoo

nof

almon

doiltoform

apasteandappliedon

wetskin

after

bathLeave

itfor10

minutes

then

rinse

itwith

water

Prim

ulaceae

Lysim

achiachristin

aeHance

(AM19)

mdashUrin

arytractinfectio

nL

Preparea

decoctionof

theleavesa

nddrink1cup

daily

for1

week

005

000

000

000

005

Rhizop

horaceae

Rhizophora

mucronatalowastLam

(AM25)

Manglier

Type

2diabetes

RPreparea

ninfusio

nof

ther

ootsanddrink1cup

twicep

erweek

039

016

004

019

000

Rosaceae

Crataeguslaevigata

Poir

DC

(AM38)

Aubepine

Cataract

LPreparea

ninfusio

nof

theleavesa

ndwashthee

yewith

it

032

014

006

017

000

Highlevelofcho

leste

rol

LPreparea

ninfusio

nof

theleavesa

nddrink1cup

twicep

erweek

Hypertension

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Atherosclerosis

FlPreparea

ninfusio

nwith

1teaspoo

nof

flower

anddrink2cups

perd

aytwicep

erweek

Rubu

salce

ifoliu

sPoir

(AM14)

Piqu

antlou

lou

Type

2diabetes

LPreparea

decoctionwith

theleavesa

nddrink1cup

twicep

erweek

036

011

009

014

002

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

14 Evidence-Based Complementary and Alternative Medicine

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Rubiaceae

Morinda

citrifoliaL

(AM12)

Non

i

Type

2diabetes

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

054

024

019

025

007

Highlevelofcho

leste

rol

FrTh

efruitispeele

dcrushedandpressedto

obtain

thejuiceD

rink1cup

thric

eper

week

Hypertension

LPreparea

ninfusio

nwith

theleavesa

nddrink1cup

twicep

erweek

Pain

LAp

plywarm

oilonthep

ainful

area

andbind

itwith

theleaves

Vangueria

madagascarie

nsis

JFGmel

(AM27)

Vavang

ueTy

pe2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

037

012

008

019

002

Hypertension

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Rutaceae

Hypertension

FrPeelandpressthe

fruittoob

tain

thejuice

anddrink1cup

Type

2diabetes

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

um1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Renalfailure

LPeelandpressthe

fruittoob

tain

juicea

nddrink1cup

twicep

erweek

Citru

saurantifolia(C

hristm)

Swingle

(AM49)

Limon

Renalfailure

FrPeelandpreparejuice

with

thep

ulpandadd1teaspoo

nof

honeyDrin

kthric

eper

weekin

them

orning

055

024

010

023

005

Cardiovascular

disease

LPreparea

ninfusio

nwith

4leaves

anddrink1cup

thric

eper

week

Cardiovascular

disease

FrPreparejuice

with

thefruittogether

with

1clove

ofAlliu

msativ

umL1

teaspo

onof

honeyand1cup

ofwaterD

rink1cup

twicep

erweek

Cataract

FrPreparejuice

with

thep

ulpandadd2teaspo

onso

fhon

eyanduseitasa

neyebathdaily

Type

2diabetes

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

Citru

smaxim

a(Burm)Osbeck

(AM47)

Pamplem

ousse

Highlevelofcho

leste

rol

FrPreparea

decoctionof

thep

eelsin

water

anddrink1cup

thric

eper

week

048

020

018

019

002

Highlevelofcho

leste

rol

FrPreparejuice

with

thefruittogether

with

Dau

cuscarotaand2c

mof

Zingiberoffi

cinaleroo

tDrin

k1cup

once

perw

eek

Murraya

koenigii(L)Spreng

(AM44

)Ca

rripou

let

Hypertension

LPreparea

ninfusio

nwith

3leaves

anddrink1cup

twicep

erweek

018

009

003

005

001

Sapind

aceae

Cardiospermum

halicacabum

L(A

M23)

Pocpoc

Gangrene

LPreparea

ninfusio

nof

theleavestogetherw

ithSenn

aalexan

drinaMilland

Senn

aalataLDrin

k1cup

twicep

erweek

021

008

009

005

000

Wou

ndL

Crushtheleavesa

ndapplythem

onthew

ound

asap

oultice

Type

2diabetes

LPreparea

decoctionof

theleavesa

nddrink1cup

twicep

erweek

Theaceae

Camelliasin

ensis

LKu

ntze

(AM48)

Thev

ert

Cataract

LPreparea

ninfusio

nwith

thetea

bags

andwashthee

yewith

it

045

026

012

027

008

Type

2diabetes

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Hypertension

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

thetea

bags

anddrink1cup

twicep

erweek

Highlevelofcho

leste

rol

LPreparea

ninfusio

nwith

theteabags

together

with

Cinn

amom

umverum

Drin

k1cup

twicep

erweekatnight

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 15

Table3Con

tinued

Family

Scientificn

ameo

fplant

(identifi

catio

nnu

mber)

Localn

ame

ofplant

Indicatio

nPartof

plantu

sed

Metho

dof

preparationandadministratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Verbenaceae

Aloysia

citrio

dora

Palau

(AM45)

Verveine

Cardiovascular

disease

WPreparea

ninfusio

nwith

1teaspoo

nof

thep

lant

in1cup

ofho

twaterA

llow

itto

infuse

for10minutes

anddrink1cup

thric

eper

week

009

002

000

007

000

Xantho

rrho

eaceae

Aloe

vera

(L)Bu

rmf

(AM46

)Aloev

era

Type

2diabetes

LGelisremoved

from

theleafp

ulpand2tablespo

onsa

reeatendaily

inthe

morning

for1

week

053

017

015

023

006

Type

2diabetes

LSold

asan

Ayurvedicjuice10m

ltaken

twiced

ailyaft

ermeal

Highlevelofcho

leste

rol

LPreparea

mixture

with

2tablespo

onso

fthe

gelrem

oved

from

theleafp

ulp

1cup

ofyoghurtand12

acup

ofwaterM

ixallinajuicera

nddrink1cup

ofthejuice

obtained

twicep

erweek

Gangrene

LPreparea

footbath

with

thed

ecoctio

nof

theleafm

ixed

with

1teaspoo

nof

saltand1teaspoo

nof

vinegarSo

akfoot

for3

0ndash45

minutes

daily

for1

week

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexa

mon

gthe

Budd

histcommun

ityPlant

partusedR

roo

tLleafFrfruitSeseedsW

who

leplantBbu

lbStste

mFlfl

owerG

rgrainlowast

Listofendemic

plants

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

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Diabetes ResearchJournal of

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Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

16 Evidence-Based Complementary and Alternative Medicine

452

1300

2810

210 210620

070 210 0700050

100150200250300350400450500

Leaves Bulb Fruit Root Flower Seed Stem Grain Wholeplant

Plan

t par

ts us

ed (

)

Part of the plant used

Figure 3 Plant parts employed in herbal remedies by the partici-pants

or dried plants in the preparation of herbal remedies Theyreported that the use of either fresh or dried plants in herbalrecipes did not make any difference in the efficacy of theherbal remedies However the traditional healers reportedthat they preferred dried plants which should be kept inopen air and not in closed container Furthermore dryingenabled indigenous people to use medicinal plants duringoff season This is supported by the work of Tahraoui et al[32] whereby plant parts are dried in shade and stored in ahouse room free of humidity and sunlight for their use duringunavailability Similarly Lingaraju et al [33] reported that inthe absence of freshmaterials the dried ones were prescribedin the preparation of herbal remedies Previous studies hadshown that there were quantitative and qualitative differencesin the essential oil contents of fresh and dry plant materials[34 35] Ishola et al [26] reported that dry plant materialsmight not be as potent as freshly collected herbs since someof their enzymes may have been denatured or the heat labilecompounds could have been destroyed

35 Parts of Medicinal Plants Used in the Preparation ofHerbal Remedies In the current investigation different partsof medicinal plants were documented in the preparationof indigenous herbal medicines to manage diabetes andrelated complications Whole plant in addition to differentparts of the same plant including leaf bulb fruit rootflower seed stem and grain was used in the preparation ofherbal remedies for the management of diabetes and relatedcomplications (Figure 3) Leaf was the most frequently usedplant parts (452) followed by fruit (281) bulb (13)seed (62) root (21) flower (21) grain (21) stem(07) and whole plant (07) These observations resonatewith finding obtained by Sadeghia and Mahmood [36] inwhich the part of the plant most commonly used was leavesAccording to Tuttolomondo et al [37] greater accessibility ofthe aboveground parts of the plants in natural ecosystems andthe greater abundance of leaves compared to other plant partsmay explain the higher use-frequency of these plant partsin traditional medicine Leaves are the most favored partsin the preparation of herbal medicines since they contain

Decoction26

Infusion20Juice

36

Soup06 Crude form

17

Paste06

Figure 4 Forms of herbal preparations

a high concentration of pharmacologically active secondarymetabolites which are valuable in phytotherapy [38 39]The result of the present study showed that whole plant isnot commonly used in the preparation of herbal remediesbecause its removal will threaten the conservation of theplant species and hence impair sustainability of indigenousflora in the study area The result of the study deviates fromthe work of Cheikhyoussef et al [40] who observed thatroots are mostly used in the preparation of herbal remediesFrom the current study the root of Rhizophora mucronataan endemic plant was reported to be used against type2 diabetes According to Flatie et al [41] roots containhigh concentration of bioactive substances Nonethelessfrequent harvesting of roots has a negative influence on thesurvival of the plant species and is therefore discouragedDifferent parts of a plant species may contain different typesand concentrations of pharmacologically active constituentsresulting in distinct pharmacological activities In the presentwork the fruit of Cucurbita maxima was reported to be usedagainst type 2 diabetes and in wound healing its leaves wereused against cataract while its seeds were used against renalfailure The phytochemical analysis of an ethanolic extract ofCucurbita maxima seeds revealed the presence of tanninscarbohydrates glycosides alkaloids volatile oils saponinsproteins and flavonoids [42]

36 Method of Preparation of Herbal Remedies Variouspreparation modes of herbal medicines like juice decoctioninfusion crude form paste and soup were used by theindigenous community in Mauritius (Figure 4) The mostcommon modes of preparation were juice (36) followedby decoction (26) and infusion (20) Similar findingwas reported by Malla et al [43] in western Nepal wherejuice was the most commonly used preparation method foradministering medicinal plants Most of the reported herbalpreparations are made with water as dilution media Thisfinding is in line with previous work [44] where waterwas mostly used as solvent medium in the preparation ofherbal remedies Decoctions are usually prepared by boilingplant parts in water until the amount of water is reducedto half its original amount According to a study conductedby Zhang et al [45] on heating various biological reactions

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Behavioural Neurology

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Disease Markers

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OncologyJournal of

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Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 17

0 1 2 3 4 5 6Acanthaceae

AlismataceaeAmaryllidaceaeAnacardiaceae

AnnonaceaeAphloiaceae

ApiaceaeApocynaceae

ArecaceaeAsparagaceae

AsteraceaeBrassicaceae

BromeliaceaeCaricaceae

CucurbitaceaeFabaceae

LamiaceaeLauraceae

LinaceaeMeliaceaeMoraceae

MoringaceaeMyrtaceae

OleaceaePhyllanthaceae

PoaceaePrimulaceae

RhizophoraceaeRosaceae

RubiaceaeRutaceae

SapindaceaeTheaceae

VerbenaceaeXanthorrhoeaceae

Number of plant species

Fam

ilies

Figure 5 Representative botanical families

are accelerated resulting in many active compounds henceaccounting for the effectiveness of herbal remedies preparedby decoction

37 Administration of Herbal Remedies Regarding themeansof administration oral ingestion (871) was the preferredmode of administration of herbal remedies followed byexternal use (129) This is in agreement with the findingof Sadeghia and Mahmood [36] where herbal remedies aremostly administered orally It was reported that the predom-inance of oral route for administration of herbal remediescan be attributed to the ease of administration without usingcostly and complex accessories [46]

38 Botanical Families Thepredominantly quotedmedicinalplant families were Cucurbitaceae with five species followedby Apiaceae Asteraceae Myrtaceae and Rutaceae withthree species each and Amaryllidaceae Fabaceae LamiaceaeRosaceae and Rubiaceae with two species each The remain-ing 23 families were each represented by one species (Fig-ure 5) The Cucurbitaceae family encompasses 800 speciesdistributed mainly in tropical and subtropical regions of theworld [47] The most plausible reason for the predominanceof the Cucurbitaceae family in the study area could be dueto the large group of plant species belonging to this familywhich are medicinally valuable due to their phytochemicalprofile Moreover the high citations of the Cucurbitaceaefamily may be because of the high availability of plant speciesbelonging to this family in the study area Further plantsbelonging to the Cucurbitaceae family contain a group ofactive secondary metabolites namely triterpenoid which

are well known for their bitterness [47] hence justifyingtheir use in the management of diabetes in the presentstudy It was noted from the current investigation that someof the informants believed that type 2 diabetes is causedby excess sugar in the blood hence bitter plants are usedto neutralise the excess sugar In an ethnopharmacologicalsurvey conducted in Congo by Katemo et al [48] it wasreported that bitter plants are prescribed to control bloodsugar level Some of the bitter plants recorded from thepresent study used to manage diabetes with high relativefrequency of citation include Aloe vera (053) Phyllanthusemblica (052) Azadirachta indica (046) and Momordicacharantia (046) Phyllanthus emblica has been shown tocontain an array of bioactive components like quercetinphyllaemblic compounds gallic acid tannins flavonoidspectin vitamin C terpenoids and alkaloids which possessesuseful biological activities [49ndash51] According to Walia andBoolchandani [52] Phyllanthus emblica contain high vitaminC content which is effective in controlling diabetes andtanninswhich has the capacity to enhance glucose uptake andinhibit adipogenesis The majority of the informants (92)responded that after consumption of the herbal remedy theyfelt an improvement in their health state

39 Relative Frequency of Citation Relative frequency ofcitation was calculated to ascertain the most commonlyoccurring medicinal plants used for the management of dia-betes and related complications and thus aids in the selectionof plants for further phytochemical and pharmacologicalstudies Citrus aurantifolia (055) was the predominant plantspecies which exhibited the highest relative frequency ofcitation demonstrating its importance in indigenous phy-totherapy It is followed by Morinda citrifolia (054) Aloevera (053) Phyllanthus emblica (052) and Syzygium cumini(049) Plant species with high relative frequency of citationreflected their popularity due to their strong healing powerand they were easily available and affordable in the studyarea According to Kpodar et al [46] other reasons why plantspecies are cited frequently might be (1) the trust that theindigenous community have in these plants as medicine and(2) the relatively high cost of synthetic drugs Based on theseresults such plants should be focused on for the investigationof bioactive phytochemical constituents and other pharma-cological activities It is important to note that the plantswith high relative frequency of citation have been previouslyscreened for their pharmacological activities Unripen juicesof Citrus aurantifolia showed antioxidant activities in vitro[53] Moorthy and Reddy [54] reported that the ethanolicextract of the roots ofMorinda citrifolia lowered blood pres-sure in an anesthetized dog An experimental investigationcarried out by Alam et al [55] demonstrated that leaves ofSyzygium cumini contain the bioactive compounds lupeol 12-oleanen-3-ol-3120573-acetate stigmasterol and 120573-sitosterol whichpossess potential antidiabetic activities hence supportingthe traditional use of the leaves for treating diabetes Someof the plant species reported namely Lysimachia christinae(005) Prunella vulgaris (009) and Aloysia citriodora (009)scored low relative frequency of citation since they have

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

18 Evidence-Based Complementary and Alternative Medicine

Table 4 Culturally most important plant and animal species used against diabetes and related complications

Religiousgroups Hindu Muslim Christian Buddhist

Plantspecies

Ocimum tenuiflorum (039) Cardiospermum halicacabum (009) Camellia sinensis (027) Ophiopogon japonicas (011)

Allium cepa (028) Carica papaya (008) Morinda citrifolia (025) Alisma plantago-aquatica(009)

Phyllanthus emblica (025) Aloe vera (023) Prunella vulgaris (008)Allium sativum (024) Apium graveolens (019) Lysimachia christinae (005)Citrus aurantifolia (024) Rhizophora mucronata (019)

Momordica charantia (023) Vangueria madagascariensis(019)

Trigonella foenum-graecum(023) Tamarindus indica (018)

Azadirachta indica (021) Brassica oleracea (017)Citrus maxima (020) Crataegus laevigata (017)Avena sativa (019) Moringa oleifera (016)Syzygium cumini (019) Petroselinum crispum (016)Mangifera indica (017) Cynara cardunculus (015)Psidium guajava (017) Cucurbita maxima (014)Sigesbeckia orientalis (017) Rubus alceifolius (014)Linum usitatissimum (016) Ananas comosus (013)Bidens pilosa (014) Olea europaea (013)Lagenaria siceraria (014) Cocos nucifera (012)Murraya koenigii (009) Cucumis sativus (012)Annona muricata (007) Coriandrum sativum (011)

Luffa acutangula (011)Persea americana (011)Aphloia theiformis (010)Graptophyllum pictum (010)Artocarpus heterophyllus(008)Catharanthus roseus (008)Eucalyptus globules (008)Aloysia citriodora (007)

Animalspecies

Anguilla japonica (002) Salmo salar (008) Rattus rattus (002)Apis mellifera (003)Tenrec ecaudatus (003)Helix aspersa (002)Periplaneta americana (002)

been reported by few informants only Low relative frequencyof citation values of these plants imply that traditionalknowledge about their use is on the verge of extinctionFurthermore they were found to be scarce in the studyarea due to deforestation and urbanization Since Lysimachiachristinae is not native to Mauritius many informants wereunaware of this medicinal plant The traditional Chinesemedicine practitioner reported that this plant is importedin its dried form from China Lysimachia christinae containsflavonoid and phenolic compounds which possess promisingpharmacological activities in vivo [56]

310 Cultural Importance Index The cultural importanceindex showed that Ocimum tenuiflorum (039) Cardiosper-mumhalicacabum (009)Camellia sinensis (027) andOphio-pogon japonicas (011) are the most culturally important plantspecies among the Hindu Muslim Christian and Buddhistcommunity respectively (Table 4) The high cultural impor-tance index of these plants indicates their importance in theirrespective culture because of their medicinal properties andversatility These plant species have been used since timeimmemorial and themedicinal knowledge of these plants hasbeen transmitted from one generation to the next within the

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Behavioural Neurology

EndocrinologyInternational Journal of

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Disease Markers

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OncologyJournal of

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ObesityJournal of

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Research and TreatmentAIDS

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Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 19

Table 5 Jaccard similarity index for the different religious groups ofMauritius regarding the number of medicinal plants used tomanagediabetes and related complications

Hindu Muslim Christian BuddhistHindu mdash 958 941 635Muslim 958 mdash 902 660Christian 941 902 mdash 692Buddhist 635 660 692 mdash

specific religious group According to Tardıo and Pardo-de-Santayana [57] the cultural importance index is an efficienttool for highlighting those species with a high agreementfor the culture of the study area and hence recognises theshared knowledge of these people From Table 4 it is evidentthat plant species which scored very low cultural importanceindex value in a particular religious group imply that little cul-tural importance is given to these plant species in traditionalmedicine in that particular religious group Tuttolomondoet al [37] reported that plants with low cultural importanceindex value indicate that the local populations had little trustin them concerning their use in the treatment of certainpathologies or indicate a fall in traditional plant knowledgeregarding medicinal uses of these plants which is an evidenceof an ongoing process of cultural erosion Cultural andreligious preferences also influence the use of medicinalplants [58] Some of the documented medicinal plants werefound to play important roles in religious ceremonies amongthe Hindu community Ocimum sanctum is considered assacred by the Hindu community The holy basil worship isdone every morning in every Hindu community householdin order to keep the family members healthy MoreoverAzadirachta indica and Mangifera indica were reported toplay fundamental role in ldquoDurga poojardquo a prayer dedicatedto goddess ldquoDurgardquo

311 Jaccard Similarity Index In the current investigation theChristian community provided us with the highest numberof medicinal plants (51) followed by the Hindu (48) Muslim(46) and the Buddhist (37) community As depicted inTable 5 the Hindu community and the Muslim communityshowed the highest similarity of medicinal plants usage withJaccard similarity index value of 958 The Hindu and Mus-lim community are both descendants of Indian indenturedlabourers who were recruited by the British Empire to workon sugar cane banana tea and coffee plantationsThey camefrom the same village in eastern Uttar Pradesh and westernBihar in northern India and arrived to Mauritius in thesame ships [59] It was observed that the Hindu and Muslimcommunity in Mauritius commonly spoke the ldquoBhojpurirdquodialect which is an amalgam of Creole and Hindi languageMoreover certain traditions were found to be similar amongthese two religious groups For instance the use of hennato decorate womenrsquos hands during weddings was found tobe similar among both religious groups The high degreeof similarity of medicinal plants usage between these two

communities implies that there has been an exchange oftraditional information between these two cultures on theuse of medicinal plant species to manage diabetes and relatedcomplications The Hindu community and the Buddhistcommunity showed the least similarity of medicinal plantsusage with Jaccard similarity index value of 635 The reasonfor this least similarity is most likely because the Buddhistcommunity have their own systemof healingwhich is distinctto that of the Hindu community Moreover the Buddhistcommunity commonly purchased medicinal plants fromherbal stores which are imported from China and some ofplants employed by the Buddhist community are unknownby the other three religious communities Moreover theBuddhist community was observed to be quite reticent toshare their traditional knowledge with people not belongingto their cultural group According toGuzel et al [25] detailedanthropological studies should be carried out in order toidentify factors affecting ethnomedicinal similarities anddifferences amongst different cultural groups

312 Ailment Categories The reported ailments weregrouped into 9 broad categories of diseases (Table 6)The ailment categories treated by the greatest number ofmedicinal plants were diabetes with 40 listed plant speciesfollowed by diabetic dyslipidemia and hypertension with 19plant species each The reasons for this may be due to highprevalence of diabetes in the study area as reported earlierhence the need to search for more hypoglycemic plants Theefficacy demonstrated by some of the antidiabetic plantsidentified in this study has previously been documentedin either in vivo or in vitro studies Ethanolic leaf extractof Azadirachta indica was found to normalize bloodglucose level in streptozotocin-induced diabetic rats [60]Syzygium cumini bark extract lowered blood glucose levelin streptozotocin-induced diabetic albino Wistar rats [61]Aqueous leaf extract of Graptophyllum pictum was found tohave hypoglycemic effect which is comparable to metforminin alloxan-induced diabetic Wistar rats [62] Aqueousalcohol extract of the aerial parts of Bidens pilosa loweredblood glucose in dbdb mice a type 2 diabetes mouse model[63] However herbal medicinal practices may vary amongdifferent groups of people in different parts of the worldFor example Trigonella foenum-graecum was reported tobe used against diabetes high level of cholesterol anderectile dysfunction in Mauritius but in Iran it is usedagainst gynaecological problems [36] The result revealedthat 635 of the plant species enlisted were employed for themanagement of more than one kind of disease This findingis in agreement with previous result described by Yousuf etal [64] and Gupta et al [65] where most plant species usedby indigenous people have multiple uses

313 Cross-Cultural Comparison of Medicinal Plants amongthe Different Religious Groups Though the four religiousgroups in Mauritius possess different cultures and traditionsit was observed that they have common knowledge about themajority of the reportedmedicinal plant speciesThirty-threeplants species were used commonly among the four religious

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

20 Evidence-Based Complementary and Alternative Medicine

Table6Th

euse

ofplant-b

ased

remediesa

ndanim

al-based

remediesb

yillnesscategorie

s

Illnesscategorie

sEthn

omedicinal

applications

Plantspecies

Animalspecies

Diabetic

angiop

athy

Atherosclerosis

cardiovascular

disease

Cynara

cardun

culusBrassicaoleraceaA

nana

scom

osusC

arica

papayaLuff

aacutangulaO

leaeuropaeaC

rataegus

laevigataCitru

saurantifoliaand

Aloysia

citrio

dora

mdash

Diabetic

neph

ropathy

Renalfailure

Alliu

mcepaA

llium

sativ

umPetroselin

umcrisp

umC

ocos

nuciferaAn

anas

comosus

Cucurbita

maxim

aLinu

musita

tissim

umand

Citru

saurantifolia

Tenrec

ecau

datus

Diabetic

neurop

athy

Painerectile

dysfu

nctio

nandhearingloss

Alliu

mcepaB

rassica

oleraceaTam

arindu

sind

icaTrig

onellafoenum

-graecum

Ocim

umtenu

iflorum

and

Morinda

citrifolia

Anguillajaponica

Eyed

iseases

Cataracts

Alliu

mcepaA

llium

sativ

umA

phloiatheiformis

Cocosn

uciferaB

rassica

oleracea

Cucurbita

maxim

aOcim

umtenu

iflorum

Perseaam

erica

naC

rataegus

laevigata

Citru

saurantifoliaand

Camelliasin

ensis

Helixaspersa

Apismellifera

Diabetic

dyslipidemia

Highlevelofcho

lesterol

Alism

aplantago-aquatica

Allium

cepaPetroselin

umcrisp

umC

ynaracardun

culus

Caric

apapayaL

agenariasicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Perseaam

erica

naLinum

usita

tissim

um

Moringa

oleiferaPh

yllanthu

semblica

Avena

sativaCrataeguslaevigata

Morinda

citrifoliaC

itrus

maxim

aCa

melliasin

ensisand

Aloe

vera

mdash

Hypertension

Hypertension

Alliu

msativ

umA

nnonamurica

taA

pium

graveolen

sPetro

selin

umcrisp

umB

idens

pilosaC

arica

papayaL

agenariasicerariaLuff

aacutangulaTam

arindu

sind

ica

Ocim

umtenu

iflorum

Prunella

vulga

risM

oringa

oleiferaOlea

europaeaC

rataegus

laevigataMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifolia

Murraya

koenigiiandCa

melliasin

ensis

mdash

Infections

andwou

nds

Ulce

rsgangreneurinary

tractinfectio

nandwou

ndhealing

Alliu

msativ

umB

rassica

oleraceaC

ucurbita

maxim

aOcim

umtenu

iflorum

Lysim

achiachristin

aeC

ardiosperm

umhalicacabum

and

Aloe

vera

Perip

laneta

america

naRa

ttusrattus

Diabetes

Type

1diabetestype

2diabetes

Graptophyllum

pictum

Allium

cepaA

llium

sativ

umM

angifer

aindicaA

phloia

theiformis

Apium

graveolen

sCo

riand

rum

sativ

umPetroselin

umcrisp

um

Catharanthus

roseusC

ocos

nuciferaOphiopogonjaponicasBidens

pilosaC

ynara

cardun

culusSigesbeckiaorien

talisB

rassica

oleraceaC

ucum

issativ

us

Cucurbita

maxim

aLa

genaria

sicerariaM

omordica

charantia

Trig

onella

foenum

-graecum

Ocim

umtenu

iflorum

Linum

usita

tissim

umA

zadirachta

indica

Artocarpus

heterophyllusMoringa

oleiferaEu

calyptus

globu

lesPsid

ium

guajava

Syzygium

cuminiOlea

europaeaP

hyllanthu

semblica

Avena

sativaRh

izophora

mucronataR

ubus

alceifoliu

sMorinda

citrifoliaV

angueriamadagascarie

nsis

Citru

saurantifoliaC

itrus

maxim

aCa

rdiospermum

halicacabum

Cam

elliasin

ensisand

Aloe

vera

Salm

osalar

Skin

complications

Dry

skin

Avenasativa

mdash

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 21

(A)

Hindu

Christian

Buddhist

Muslim

(B)

(C)

(E)(n = 1)

(D)(n = 3)

(n = 2)

(n = 13)

(n = 33)

Figure 6 Venn diagram representing the overlap of plant speciescited by participants from Hindu Muslim Christian and Chinesecommunities in Mauritius (A) Plant species common to HinduMuslim Christian and Buddhist religious group (Allium cepaAllium sativum Mangifera indica Apium graveolens Petroselinumcrispum Catharanthus roseus Bidens pilosa Cynara carduncu-lus Brassica oleracea Carica papaya Cucumis sativus Cucurbitamaxima Lagenaria siceraria Momordica charantia Tamarindusindica Trigonella foenum-graecum Ocimum tenuiflorum Linumusitatissimum Azadirachta indica Artocarpus heterophyllus Psid-ium guajava Syzygium cumini Olea europaea Phyllanthus emblicaAvena sativa Rubus alceifolius Morinda citrifolia Vangueria mada-gascariensis Citrus aurantifolia Citrus maxima Murraya koenigiiCamellia sinensis and Aloe vera) (B) Plant species common toHindu Muslim and Christian religious group only (Graptophyllumpictum Annona muricata Aphloia theiformis Coriandrum sativumCocos nucifera Sigesbeckia orientalis Ananas comosus Luffa acu-tangula Persea americana Moringa oleifera Rhizophora mucronataCrataegus laevigata and Cardiospermum halicacabum) (C) Plantspecies common to Hindu and Christian religious group only(Eucalyptus globules Aloysia citriodora) (D) Plant species commonto Christian and Buddhist religious group only (Alisma plantago-aquatica Ophiopogon japonicas and Prunella vulgaris) (E) Plantspecies common to Buddhist religious group only (Lysimachiachristinae)

groups whereas 13 plant species were common among theHindu Muslim and Christian religious groups only 2 plantswere common between Hindu and Christian communitiesonly 3 plants were common between the Christian andBuddhist communities only and 1 plant was used exclusivelyby the Buddhist community (Figure 6) A high correspon-dence between the uses of the same medicinal plant speciesamong the four religious groups was surprising The possiblereason accounting for the high similarity of plant speciesused to manage diabetes and related complications amongthe four religious groups might be due to the frequent cross-cultural exchange of traditional knowledge on medicinalplants between them tomanage these ailmentsMoreover thefour religious groups live in close proximity to each other andshare similar flora Lingaraju et al [33] reported that differentethnic groups influence each other in the adoption and usageof certain medicinal plant species According to Masevheet al [66] the use of plant species by different cultural

groups may also indicate their potential pharmacologicalefficacy Medicinal plants are not selected at random butexhibit a considerable degree of patterning within one culture[16] Moreover plants are selected and used in a consistentmanner because of their culturally perceived effectiveness[67 68] According to Heinrich et al [16] the parallel useof plant taxa among different ethnic groups may be due to(1) coincidence (a random selection of similar species) (2)similar criteria for selecting plants and (3) shared infor-mation on the potential usefulness of a plant Thereforemedicinal plant species which are used in parallel amongthe four religious groups require further pharmacologicaltoxicological and phytochemical analysis for the discoveryof potential novel drugs to manage diabetes and relatedcomplications

314 Animal-Based Remedies Used to Manage Diabetes andRelated Complications In this study a total of 7 medicinalanimal species distributed over 4 classeswere recorded for themanagement of diabetes and related complications (Table 7)Among them Actinopterygii Insecta and Mammalia occu-pied themost cited classes with two species each Our presentanalysis reveals that various parts of animal species wereselected as medicinal materials Whole animal (714) wasmostly recorded in the preparation of animal-based remediesfollowed by honey (143) and skin (143) The resultdepicts that animal-based remedies were mainly taken inthe raw form (571) Our finding is comparable to that ofVijayakumar et al [69] where medicinal animal species aremostly taken as raw for the treatment of ailments Basedon relative frequency of citation the most frequently citedmedicinal animal species was Salmo salar (012) Salmo salarwas found to be commonly used against diabetes in thestudy area since it contains a polyunsaturated compoundnamely omega-3Malasanos and Stacpoole [70] reported thatomega-3 fatty acids reduce serum lipids and lipoproteinsimpair platelet aggregation increase cell membrane fluidityand lower blood pressure in diabetic subjects Further studiesare required to confirm the presence of bioactive compoundsin these animal remedies reported in the current studyWith regard to the administration routes of the animal-based remedies external application (571) was the mostcommonly used route of administration It was observed thatcertain animal species were used exclusively in a specificreligious group For instance Tenrec ecaudatus was reportedto be used against renal failure by the Christian communityonly This can be explained by the fact that Tenrec ecaudatusis regarded as impure by the Hindu and Muslim communityand their religious values forbid them from consuming themeat of this animal In addition animal-based remedieswere found to be more prominent among the Christiancommunity as compared to the other three religious groupsIt is fundamental to carry out studies to evaluate the safetyefficacy and optimal dosage of the reported animal-basedremedies in order to validate their traditional use and ensureproper treatment outcomes

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

22 Evidence-Based Complementary and Alternative Medicine

Table7Inventoryof

anim

alspeciesu

sedto

managed

iabetesa

ndrelated

complications

Class

Scientificn

ame

Localn

ame

Indicatio

nPartused

Metho

dof

preparationand

administratio

nRF

CCI

I HCI

I MCI

I CCI

I B

Actin

opterygii

Salm

osalar

Saum

onTy

pe2diabetes

Who

lebo

dyAdish

ofthew

holebo

dyisprepared

and

itistakenon

ceperw

eek

012

004

000

008

000

Anguillajaponica

Ang

uille

Neuropathic

pain

Skin

Thes

kinispeeled

anddriedin

bright

sunlightTh

edrie

dskin

isthen

placed

inab

ottle

ofoilMassage

thep

ainful

area

daily

usingthisoil

003

002

000

001

000

Gastro

poda

Helixaspersa

Cou

rpa

Cataract

Who

lebo

dyTh

ewho

lebo

dyiscrushedto

obtain

whiteliq

uidand2drop

softhe

liquidare

instilled

inthee

ye

002

000

000

002

000

Insecta

Apismellifera

Mou

ched

imiel

Cataract

Hon

eyAsm

allamou

ntisinstilledin

thee

yedaily

004

001

000

003

000

Perip

laneta

america

naCa

ncrela

Gangrene

Who

lebo

dyPreparea

ninfusio

nwith

4cockroaches

and1h

andful

ofPetro

selin

umcrisp

um

Filterinac

loth

anddrink1cup

daily

003

000

000

002

001

Mam

malia

Tenrec

ecau

datus

Tang

Renalfailure

Who

lebo

dy

Adish

oftheb

odyisprepared

using

Cinn

amom

umverumSyzygium

arom

aticu

mM

urraya

koenigiiLand

1cupof

whitewineTh

edish

istakenon

ceperw

eek

003

000

000

003

000

Rattu

srattus

Lerat

Wou

ndWho

lebo

dyTh

eanimalisplaced

inab

ottle

ofcoconu

toilfor1-2

days

andtheo

ilisthen

appliedon

thew

ound

002

000

000

000

002

RFC

relativefre

quency

ofcitatio

nCI

I Hculturalimpo

rtance

indexam

ongtheHindu

commun

ityC

IIMculturalimpo

rtance

indexam

ongtheMuslim

commun

ityC

IICculturalimpo

rtance

indexam

ongthe

Chris

tiancommun

ityand

CII Bculturalimpo

rtance

indexam

ongtheB

uddh

istcommun

ity

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 23

4 Conclusion

To the best of our knowledge this is the first cross-culturalinvestigation on traditional therapies used to manage dia-betes and related complications in Mauritius The panoplyof information gathered in the present study demonstratesthe important recognition of herbal and animal-based reme-dies among diabetic patients and traditional healers for themanagement of diabetes and related complications The highpopularity of Citrus aurantifolia demonstrates its importancein the study area for the management of diabetes andrelated complications However there is a tendency of usingparticular types of plants excessively in traditional medicinefor its therapeutic effects without concerning its vulner-ability to extinction Hence appropriate measures shouldbe taken in order to preserve important plant species andemphasis should be placed on the judicious use of medicinalplants Interviews with individuals from different religiousbackground revealed intra- and interculturally importantmedicinal plants Though cultural divergence exists amongthe 4 religious groups of the island a high degree ofsimilarity of medicinal plants usage among them has beenobserved The possible reason for the high correspondenceof the use of the same medicinal plant species is due to thefrequent cross-cultural exchange of traditional knowledge onmedicinal plants Nonetheless the use of certain medicinalplants and animal species has been found to be confinedin only a particular religious group According to Mustafaet al [71] cross-cultural studies could be important forproposing culturally sensitive ways of using plant naturalresources in future sustainable economic development ini-tiatives Culturally important plant species such as Ocimumtenuiflorum Cardiospermum halicacabum Camellia sinensisand Ophiopogon japonicas should be subjected to detailedscreenings for pharmacologically active metabolites for thediscovery of new therapeutic agents As a concluding notethe present study reflects the rich cultural heritage in termsof ethnomedicinal knowledge possessed by the differentreligious groups in Mauritius However this knowledge is injeopardy due to the lack of interest shown by the youngergeneration Therefore we keenly emphasise the importanceof transmitting this precious knowledge which is vanishing atan alarming rate in order to safeguard our cultural heritage

Competing Interests

The authors declare that they have no competing interests

Authorsrsquo Contributions

M Fawzi Mahomoodally A Mootoosamy and S Wambugudesigned the study and contributed to discussion regardingthe study and to the preparation of the paper AMootoosamyconducted the field work All authors read and approved thefinal paper

Acknowledgments

The authors express their gratefulness to all the participantswho were willing to share their precious knowledge duringthe course of field study and the University of Mauritius forfinancial support

References

[1] M Jung M Park H C Lee Y-H Kan E S Kang and SK Kim ldquoAntidiabetic agents from medicinal plantsrdquo CurrentMedicinal Chemistry vol 13 no 10 pp 1203ndash1218 2006

[2] R M OrsquoBrien and D K Granner ldquoRegulation of gene expres-sion by insulinrdquo Physiological Reviews vol 76 no 4 pp 1109ndash1161 1996

[3] International Diabetes Federation Types of Diabetes Interna-tional Diabetes Federation Brussels Belgium 2011

[4] International Diabetes Federation IDF Diabetes Atlas Update2012 International Diabetes Federation Brussels Belgium2012

[5] World Health Organization Global Health Estimates Deathsby Cause Age Sex and Country 2000ndash2012 World HealthOrganization Geneva Switzerland 2014

[6] C D Mathers and D Loncar ldquoProjections of global mortalityand burden of disease from 2002 to 2030rdquo PLoS Medicine vol3 no 11 pp 2011ndash2030 2006

[7] International Diabetes Federation Mauritius InternationalDiabetes Federation Brussels Belgium 2015

[8] F Qamar S Afroz Z Feroz S Siddiqui andA Ara ldquoEvaluationof hypoglycemic effect of Cassia italicrdquo Journal of Basic andApplied Sciences vol 7 no 1 pp 61ndash64 2011

[9] M J Fowler ldquoMicrovascular and macrovascular complicationsof diabetesrdquo Clinical Diabetes vol 26 no 2 pp 77ndash82 2008

[10] MH Eshrat ldquoEffect ofCoccinia indica (L) andAbroma augusta(L) on glycemia lipid profile and on indicators of end -organdamage in streptozotocin induced diabetic ratsrdquo Indian Journalof Clinical Biochemistry vol 18 no 2 pp 54ndash63 2003

[11] FMustaffa J Indurkar N IM Ali et al ldquoA review ofMalaysianmedicinal plants with potential antidiabetic activityrdquo Journal ofPharmacy Research vol 4 no 11 pp 4217ndash4224 2011

[12] Mauritius Meteorological Services ldquoClimate of MauritiusrdquoMarch 2016 httpmetserviceintnetmuclimate-servicesclimate-of-mauritiusphp

[13] O Hollup ldquoThe disintegration of caste and changing conceptsof Indian ethnic identity in Mauritiusrdquo Ethnology vol 33 no 4pp 297ndash316 1994

[14] V Chintamunnee and M F Mahomoodally ldquoHerbal medicinecommonly used against non-communicable diseases in thetropical island of Mauritiusrdquo Journal of Herbal Medicine vol 2no 4 pp 113ndash125 2012

[15] M FMahomoodally and Z D Hossain ldquoTraditional medicinesfor commondermatological disorders inMauritiusrdquoTANG vol3 no 4 pp 311ndash318 2013

[16] M Heinrich A Ankli B Frei C Weimann and O SticherldquoMedicinal plants in Mexico Healersrsquo consensus and culturalimportancerdquo Social Science and Medicine vol 47 no 11 pp1859ndash1871 1998

[17] A Gurib-Fakim and T Brendler Medicinal and AromaticPlants of Indian Ocean Islands Medpharm Scientific StuttgartGermany 2004

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

24 Evidence-Based Complementary and Alternative Medicine

[18] S Riaz ldquoDiabetes mellitusrdquo Scientific Research and Essays vol4 no 5 pp 367ndash373 2009

[19] American Diabetes Association (ADA) ComplicationsJanuary 2014 httpwwwdiabetesorgliving-with-diabetescomplications

[20] R Yadav P Tiwari and E Dhanaraj ldquoRisk factors and compli-cations of type 2 diabetes in Asiansrdquo CRIPS vol 9 no 2 pp8ndash12 2008

[21] H N Ginsberg Y-L Zhang and A Hernandez-Ono ldquoRegula-tion of plasma triglycerides in insulin resistance and diabetesrdquoArchives of Medical Research vol 36 no 3 pp 232ndash240 2005

[22] H J Bodansky A G Cudworth R A F Whitelocke and JH Dobree ldquoDiabetic retinopathy and its relation to type ofdiabetes review of a retinal clinic populationrdquo British Journalof Ophthalmology vol 66 no 8 pp 496ndash499 1982

[23] U K Sharma S Pegu D Hazarika and A Das ldquoMedico-religious plants used by the Hajong community of AssamIndiardquo Journal of Ethnopharmacology vol 143 no 3 pp 787ndash800 2012

[24] C Leto T Tuttolomondo S La Bella and M Licata ldquoEth-nobotanical study in the Madonie Regional Park (CentralSicily Italy) Medicinal use of wild shrub and herbaceous plantspeciesrdquo Journal of Ethnopharmacology vol 146 no 1 pp 90ndash112 2013

[25] Y Guzel M Guzelsemme and M Miski ldquoEthnobotany ofmedicinal plants used in Antakya a multicultural district inHatay Province of Turkeyrdquo Journal of Ethnopharmacology vol174 article 9657 pp 118ndash152 2015

[26] I O Ishola I A Oreagba A A Adeneye C Adirije K AOshikoya and O O Ogunleye ldquoEthnopharmacological surveyof herbal treatment of malaria in Lagos Southwest NigeriardquoJournal of Herbal Medicine vol 4 no 4 pp 224ndash234 2014

[27] M L Hardy ldquoHerbs of special interest to womenrdquo Journal of theAmerican Pharmaceutical Association vol 40 no 2 pp 234ndash242 2000

[28] M F Kadir M S Bin Sayeed N I Setu A Mostafa and MM K Mia ldquoEthnopharmacological survey of medicinal plantsused by traditional health practitioners in Thanchi BandarbanHill Tracts Bangladeshrdquo Journal of Ethnopharmacology vol 155no 1 pp 495ndash508 2014

[29] D W Gakuya S M Itonga J M Mbaria J K Muthee and JK Musau ldquoEthnobotanical survey of biopesticides and othermedicinal plants traditionally used in Meru central district ofKenyardquo Journal of Ethnopharmacology vol 145 no 2 pp 547ndash553 2013

[30] AmericanDiabetesAssociation ldquoHypertensionmanagement inadults with diabetesrdquo Diabetes Care vol 27 supplement 1 ppS65ndashS67 2004

[31] A G Singh A Kumar and D Tewari ldquoAn ethnobotanicalsurvey of medicinal plants used in Terai forest of westernNepalrdquo Journal of Ethnobiology and Ethnomedicine vol 8article 19 2012

[32] A Tahraoui J El-Hilaly Z H Israili and B LyoussildquoEthnopharmacological survey of plants used in the tradi-tional treatment of hypertension and diabetes in south-easternMorocco (Errachidia province)rdquo Journal of Ethnopharmacologyvol 110 no 1 pp 105ndash117 2007

[33] D P Lingaraju M S Sudarshana and N RajashekarldquoEthnopharmacological survey of traditional medicinal plantsin tribal areas of Kodagu district Karnataka Indiardquo Journal ofPharmacy Research vol 6 no 2 pp 284ndash297 2013

[34] F Sefidkon K Abbasi and G B Khaniki ldquoInfluence of dryingand extraction methods on yield and chemical composition ofthe essential oil of Satureja hortensisrdquo Food Chemistry vol 99no 1 pp 19ndash23 2006

[35] O O Okoh A P Sadimenko O T Asekun and A J AfolayanldquoThe effects of drying on the chemical components of essentialoils of Calendula officinalis LrdquoAfrican Journal of Biotechnologyvol 7 no 10 pp 1500ndash1502 2008

[36] Z Sadeghia and A Mahmood ldquoEthno-gynecological knowl-edge of medicinal plants used by Baluch tribes southeast ofBaluchistan Iranrdquo Revista Brasileira de Farmacognosia vol 24no 6 pp 706ndash715 2014

[37] T Tuttolomondo M Licata C Leto et al ldquoPopular uses of wildplant species for medicinal purposes in the Nebrodi RegionalPark (North-Eastern Sicily Italy)rdquo Journal of Ethnopharmacol-ogy vol 157 no 18 pp 21ndash37 2014

[38] A Ghorbani ldquoStudies on pharmaceutical ethnobotany in theregion of Turkmen Sahra north of Iran (part 1) general resultsrdquoJournal of Ethnopharmacology vol 102 no 1 pp 58ndash68 2005

[39] S K Ghimire O Gimenez R Pradel D McKey and YAumeeruddy-Thomas ldquoDemographic variation and populationviability in a threatened Himalayan medicinal and aromaticherb Nardostachys grandiflora matrix modelling of harvestingeffects in two contrasting habitatsrdquo Journal of Applied Ecologyvol 45 no 1 pp 41ndash51 2008

[40] A Cheikhyoussef M Shapi K Matengu and H M AshekeleldquoEthnobotanical study of indigenous knowledge on medicinalplant use by traditional healers in Oshikoto region NamibiardquoJournal of Ethnobiology and Ethnomedicine vol 7 no 10 2011

[41] T Flatie T Gedif K Asres and T Gebre-Mariam ldquoEthnomed-ical survey of Berta ethnic group Assosa Zone Benishangul-Gumuz regional state mid-west Ethiopiardquo Journal of Ethnobi-ology and Ethnomedicine vol 5 article 14 2009

[42] R Bajpai N Jain and A K Pathak ldquoStandardization ofethanolic extract of Cucurbita maxima seedrdquo Journal of AppliedPharmaceutical Science vol 2 no 8 pp 92ndash95 2012

[43] B Malla D P Gauchan and R B Chhetri ldquoAn ethnobotanicalstudy of medicinal plants used by ethnic people in Parbatdistrict of western Nepalrdquo Journal of Ethnopharmacology vol165 pp 103ndash117 2015

[44] M Y Paksoy S Selvi and A Savran ldquoEthnopharmacologicalsurvey of medicinal plants in Ulukisla (Nigde-Turkey)rdquo Journalof Herbal Medicine 2014

[45] J-L Zhang M Cui Y He H-L Yu and D-A Guo ldquoChemicalfingerprint and metabolic fingerprint analysis of Dansheninjection by HPLC-UV and HPLC-MS methodsrdquo Journal ofPharmaceutical and Biomedical Analysis vol 36 no 5 pp 1029ndash1035 2005

[46] M S Kpodar P Lawson-Evi B Bakoma et al ldquoEthnophar-macological survey of plants used in the treatment of diabetesmellitus in south of Togo (Maritime Region)rdquo Journal of HerbalMedicine vol 5 no 3 pp 147ndash152 2015

[47] K Dhiman A Gupta D K Sharma N S Gill and A GoyalldquoA review on the medicinally important plants of the familyCucurbitaceaerdquo Asian Journal of Clinical Nutrition vol 4 no1 pp 16ndash26 2012

[48] M Katemo P T Mpiana B M Mbala et al ldquoEthnopharmaco-logical survey of plants used against diabetes in Kisangani city(DR Congo)rdquo Journal of Ethnopharmacology vol 144 no 1 pp39ndash43 2012

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Evidence-Based Complementary and Alternative Medicine 25

[49] E Singh S Sharma A Pareek J Dwivedi S Yadav and SSharma ldquoPhytochemistry traditional uses and cancer chemo-preventive activity of Amla (Phyllanthus emblica) the Sus-tainerrdquo Journal of Applied Pharmaceutical Science vol 2 no 1pp 176ndash183 2012

[50] H J Kim T Yokozawa H Y Kim C Tohda T P Rao and LR Juneja ldquoInfluence of amla (Emblica officinales Gaertn) onhypercholesterolemia and lipid peroxidation in cholesterol-fedratsrdquo Journal of Nutritional Science andVitaminology vol 51 no6 pp 413ndash418 2005

[51] S Arora K Kaur and S Kaur ldquoIndian medicinal plants as areservoir of protective phytochemicalsrdquo Teratogenesis Carcino-genesis and Mutagenesis vol 23 no 1 pp 295ndash300 2003

[52] K Walia and R Boolchandani ldquoRole of amla in type 2 diabetesmellitusmdasha reviewrdquo Research Journal of Recent Sciences vol 4pp 31ndash35 2015

[53] S Kumari N Sarmah and K Handique ldquoAntioxidant activitiesof the unripen and ripen Citrus aurantifolia of Assamrdquo Interna-tional Journal of Innovative Research in Science Engineering andTechnology vol 2 no 9 pp 4811ndash4816 2013

[54] N K Moorthy and G S Reddy ldquoPreliminary phytochemicaland pharmacological study ofMorinda citrifolia LinnrdquoAntisep-tic vol 67 pp 167ndash171 1970

[55] M R Alam A B Rahman M Moniruzzaman et al ldquoEvalu-ation of antidiabetic phytochemicals in Syzygium cumini (L)skeels (Family Myrtaceae)rdquo Journal of Applied PharmaceuticalScience vol 2 no 10 pp 94ndash98 2012

[56] X Yang B-C Wang X Zhang et al ldquoEvaluation of Lysimachiachristinae Hance extracts as anticholecystitis and cholagogicagents in animalsrdquo Journal of Ethnopharmacology vol 137 no1 pp 57ndash63 2011

[57] J Tardıo and M Pardo-de-Santayana ldquoCultural importanceindices a comparative analysis based on the useful wild plantsof southern Cantabria (Northern Spain)rdquo Economic Botany vol62 no 1 pp 24ndash39 2008

[58] A Jusu and A C Sanchez ldquoEconomic Importance of themedicinal plant trade in Sierra Leone1rdquo Economic Botany vol67 no 4 pp 299ndash312 2013

[59] O Hollup ldquoIslamic revivalism and political opposition amongminority Muslims in Mauritiusrdquo 1996 httpsunnirazvinetsocietymauritiushtm

[60] S Bisht and S S Sisodia ldquoAnti-hyperglycemic and antidys-lipidemic potential of Azadirachta indica leaf extract in STZ-induced diabetes mellitusrdquo Journal of Pharmaceutical Sciencesamp Research vol 2 no 10 pp 622ndash627 2010

[61] G Saravanan and P Leelavinothan ldquoEffects of Syzygium cuminibark on blood glucose plasma insulin and C-peptide instreptozotocin -induced diabetic ratsrdquo International Journal ofEndocrinology and Metabolism vol 4 pp 96ndash105 2006

[62] S O Olagbende-Dada S O Ogbonnia H A B Coker andG E Ukpo ldquoBlood Glucose lowering effect of Aqueous extractof Graptophyllum pictum (Linn) Griff on Alloxan-inducedDiabetic Rats and its acute toxicity in Micerdquo African Journal ofBiotechnology vol 10 no 6 pp 1039ndash1043 2011

[63] R PUbillas CDMendez S D Jolad et al ldquoAntihyperglycemicacetylenic glucosides from Bidens pilosardquo Planta Medica vol66 no 1 pp 82ndash83 2000

[64] J Yousuf R K Verma and H Dar ldquoTraditional plant basedtherapy among rural communities of some villages of Baramulladistrict (Jammu and Kashmir)rdquo Journal of Phytology vol 4 no5 pp 46ndash49 2013

[65] S K Gupta O P Sharma N S Raina and S Sehgal ldquoEth-nobotanical study of medicinal plants of Paddar Valley ofJammu and Kashmir Indiardquo African Journal of TraditionalComplementary and Alternative Medicine vol 10 no 4 pp 59ndash65 2013

[66] N AMasevhe L J McGaw and J N Eloff ldquoThe traditional useof plants to manage candidiasis and related infections in VendaSouth Africardquo Journal of Ethnopharmacology vol 168 pp 364ndash372 2015

[67] R T Trotter II ldquoRemedios caseros Mexican American homeremedies and community health problemsrdquo Social Science andMedicine B vol 15 no 2 pp 107ndash114 1981

[68] R Trotter andM Logan ldquoInformant consensus a new approachfor identifying potentially effective medicinal plantsrdquo in Plantsin Indigenous Medicine and Diet Bio-Behavioural ApproachesN L Etkin Ed pp 91ndash112 Redgrave Publishers Bedford HillsNY USA 1986

[69] S Vijayakumar J E M Yabesh S Prabhu M Ayyanar andR Damodaran ldquoEthnozoological study of animals used bytraditional healers in Silent Valley of Kerala Indiardquo Journal ofEthnopharmacology vol 162 pp 296ndash305 2015

[70] T H Malasanos and P W Stacpoole ldquoBiological effects of 120596-3fatty acids in diabetes mellitusrdquoDiabetes Care vol 14 no 12 pp1160ndash1179 1991

[71] B Mustafa A Hajdari A Pieroni B Pulaj X Koro and C LQuave ldquoA cross-cultural comparison of folk plant uses amongAlbanians Bosniaks Gorani and Turks living in south KosovordquoJournal of Ethnobiology and Ethnomedicine vol 11 article 392015

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom

Submit your manuscripts athttpwwwhindawicom

Stem CellsInternational

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

MEDIATORSINFLAMMATION

of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Behavioural Neurology

EndocrinologyInternational Journal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Disease Markers

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

BioMed Research International

OncologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Oxidative Medicine and Cellular Longevity

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

PPAR Research

The Scientific World JournalHindawi Publishing Corporation httpwwwhindawicom Volume 2014

Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Journal of

ObesityJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Computational and Mathematical Methods in Medicine

OphthalmologyJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Diabetes ResearchJournal of

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Research and TreatmentAIDS

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Gastroenterology Research and Practice

Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom