International Journal of Ayurveda (A Monthly Scientific Journal of Kiban Research Publications)

ISSN: 2456-6640 International Journal of Ayurveda (A Monthly Scientific Journal of Kiban Research Publications) www.kibanresearchpublications.com

RESEARCH ARTICLE

The Use of Hypoxis Hemerocallidea and H. Obtusa in Bapedi Phytomedicine in the Limpopo Province, South Africa

MJ Potgieter1*, LJC Erasmus2, SS Semenya1, SA Rankoana3 and A Potgieter4

Departments of Biodiversity1, Physiology2 and Environmental Health, Sociology and Anthropology3 and Science Centre4, University of Limpopo, Private Bag X1106, Sovenga 0727, South Africa.

*Corresponding Author: Email: [email protected]

Abstract: Objective: Hypoxis species play an important role in the traditional health care of the Bapedi in the Limpopo Province of South Africa. This study investigated the use of Hypoxis hemerocallidea Fisch., C.A. Mey. & Avé-Lall. (H. rooperi T. Moore) and H. obtusa Ker Gawl. by Bapedi traditional healers. Methods: We investigated the use of H. hemerocallidea and H. obtusa in traditional medicine in 17 municipalities in the Capricorn, Greater Sekhukhune and Waterberg Districts of Limpopo Province, via a semi-structured questionnaire. Results: Corms of both species were used in the preparation of herbal remedies among the Bapedi people, with most traditional healers producing decoctions by cooking the corms for 20 minutes in water. Most of the medicinal preparations were taken orally for a period of one week. Preparations contained only Hypoxis, or Hypoxis in combination with various other species. Among the Bapedi, H. hemerocaliidea is used primarily to treat sexual health aspects whereas H. obtusa is more generally used to treat general health issues. Conclusion: Because of its multitude of uses we conclude that Hypoxis should be seriously considered for conservation measures.

Keywords: Bapedi, Hypoxis hemerocallidea, Hypoxis obtusa, Limpopo Province, phytomedicine. Article Received: 09 May 2017 Revised: 17 May 2017 Accepted: 27 May 2017

Introduction

Hypoxis L. (African potato), the largest genus weakness, internal tumours and nervous of Hypoxidaceae, is widespread south of the disorders [4]. Sahara, with a concentration of 28 species in southern Africa [1]. It is primarily a summer In addition, the rhizomes of these species are rainfall genus, with most species distributed used as an emetic against fearful dreams [5]. in the eastern region of South Africa [2]. The species has been reported to be used for centuries in African traditional medicine to The rootstock of Hypoxis is traditionally used treat a variety of ailments such as testicular in various ways in South Africa, with the two tumours [6], prostrate hypertrophy [4] and species H. hemerocallidea Fisch., C.A. Mey. & urinary infections [2]. Avé-Lall. (H. rooperi T. Moore) and H. colchicifolia Baker, the most sought after for Hypoxis hemerocallidea is viewed by their use in African traditional remedies, entrepreneurs as a 'wonder herb' and 'miracle including the preparation of herbal teas and cure', and dominates the South African tinctures [3]. herbal trade based on this genus. Corms of this species are commercially marketed for Rootstocks of H. hemerocallidea and H. the alleviation of countless immune-related colchicifolia have been used by Zulu ailments, including the common cold, flu, traditional healers for centuries in the arthritis, tumours, cancer and HIV/AIDS. treatment of urinary infections, heart

Sections of the southern African public, such in the Limpopo province. This might shed as the rural poor and their urban light on the medicinal value of this genus counterparts, have resorted to self- within Hypoxis hemerocallidea is a geophyte, medication with various kinds of up to 500 mm tall with 3-ranked, falcate, preparations from its rhizomes, which have pubescent leaves. It is widespread in the become available over the counter in selected summer rainfall grassland regions of South health stores [7]. Africa [13].

The genus has great potential as a source of Hypoxis obtusa is very similar to H. new drugs with immuno-modulatory hemerocallidea in appearance but differs in properties. For example in health care, the its stiff leaves, twisting with age, and with therapeutic value of this species is associated white margins due to overlapping hairs. Very with its content of a sterol called hypoxoside little is known about the traditional use of [8], which once in the human gut, readily this species. converts to rooperol, a biologically active compound that boosts the immune system In the Limpopo Province, the Bapedi is the [9]. dominant ethnic group utilise both H. hemerocallidea and H. obtusa to treat a Clinical trials on mammalian laboratory number of ailments. Information on the plant animal models confirmed the anti- parts utilised, the diversity of ailments inflammatory and immuno-modulatory treated, the application of preparations based properties of H. hemerocallidea [10]. These on the species as a single component or in findings support the probability that combination with other species, and the hypoxoside can be effectively used in primary modes of preparation and administration has health care in South Africa to boost immuno- not yet been reviewed. compromised HIV/AIDS patients [7]. Materials and Methods

Of the eight species of Hypoxis occurring in Study Area and Study Population the Limpopo Province, only H. The study area is situated in the Limpopo hemerocallidea and H. obtusa Ker Gawl. are Province, in the far north of South Africa. documented in traditional medicinal use by Data were collected from three districts two of the more prominent indigenous tribes (Capricorn, Greater Sekhukhune and of the Province, namely; VhaVenda ([11] and Waterberg), covering 17 local municipalities Bapedi [12]. (Table 1).

The question could be asked why these two These districts were selected due to their particular species are exclusively used in sizable population of Bapedi. A total of 34 traditional medicine. Possible reasons could traditional healers (2 per local municipality) include abundance and distribution amongst were selected using the snow-balling others. Furthermore, with respect to its sampling method, which includes word-of- cultural use there is a definite need to mouth. investigate the use of this genus by other ethnic groups residing

Table 1: Districts and local municipalities included in study Capricorn District Greater Sekhukhune Waterberg District District

Aganang Elias Motsoaledi Bela Bela (Greater Groblersdal) Blouberg Ephram Mogale (Greater Lephalale Marble Hall) Lepelle-Nkumpi Fetakgomo Modimolle Molemole Groblersdal Mogalakwena Polokwane Makhuduthamaga Mookgophong Tubatse Thabzimbi

Figure1: Study area: Capricorn, Waterberg and Sekhukhune Districts, Limpopo Province, South Africa (Map adopted from Dept. of Agriculture, Forestry and Fisheries, 2010)

Ethnobotanical Survey Hypoxis Obtusa This ethnobotanical study on Bapedi Traditional healers in all three districts phytomedicine was conducted from August (Capricorn, Greater Sekhukhune and 2015 to March 2016. Prior informed consent Waterberg) utilise H. obtusa. The species is was obtained from all participating used in only one municipality, (Blouberg) in traditional healers via a semi-structured the Capricorn District, in five municipalities questionnaire. in the Greater Sekhukhune, and in three municipalities in Waterberg. Results

Utilisation of Plant Material The most frequently-mentioned ailments treated with H. obtusa were diabetes mellitus Various plant parts are utilised by Bapedi (Greater Sekhukhune and Waterberg traditional healers (Table 2). These include Districts) and non-specified STIs (all leaves (Musa sapientum L.), roots (Burkea districts). Blouberg (Capricorn District) and africana Hook., Catharanthus roseus (L) G. Ephriam Mogale (Greater Marble Hall) Don., Cinnamomum verum J. Presl., (Greater Sekhukhune District) were the only Dombeya rotundifolia (Hochst.) Planchon and municipalities where traditional healers use Senna italica (Miller) F.W. Andrews, H. obtusa to treat more than one ailment. rhizomes (H. hemerocallidea and H. obtusa), bulbs (Eucomis pallidiflora Baker) and the In Blouberg, the species is a remedy for entire plant (Geigeria aspera Harv.). During hypertension and STIs, while in Ephriam collection species such as the herbaceous G. Mogale (Greater Marble Hall) it is used for aspera and perennial geophyte Hypoxis HIV/AIDS related symptoms and impotence. species were uprooted. Ailments associated with the reproductive, Ailments Treated per District cardio-vascular and endocrine systems were Hypoxis species were used for medicinal the most commonly (30% each) treated with purposes in 12 out of 17 municipalities H. obtusa, followed by abnormal functioning surveyed. Ten ailments, namely; of the renal system (10%). tuberculosis, gonorrhoea, HIV/AIDS, Single and Multi-Species Decoctions hypertension, kidney problems, impotence, In all three districts of the Limpopo Province, blood clotting, contaminated blood (STI’s), both single and multiple species decoctions diabetes mellitus and injury bleeding, related were documented, with single plant to the functioning of six physiological systems decoctions (involving only Hypoxis rhizomes) (respiratory, reproductive, renal, cardio- constituting 57% of the remedies and vascular, immunological and endocrine) were multiple plant decoctions (involving Hypoxis treated by traditional healers. rhizomes and other species) 43%.

Hypoxis was not used in medicinal In the Capricorn District equal use of single preparations in the municipalities of and multiple species decoctions were found to Aganang, Molemole, Polokwane, Elias be practised, while in the Greater Motsoaledi and Thabazimbi [Table 1, Figure Sekhukhune District single species 1]. preparations and in the Waterberg District Hypoxis Hemerocallidea multiple species decoctions are respectively In our pilot survey the species was used to dominant. treat patients in Lepelle-Nkumpi (Capricorn District) and Bela Bela, Lephalale and Hypoxis hemerocallidea is used in three Modimolle (Waterberg District). Three instances in combination with other species ailments or related symptoms were treated for the treatment of ailments. These include with H. hemerocallidea, including the roots of Burkea africana and tuberculosis (TB), HIV/AIDS and gonorrhoea. Cinnamomum verum, and the entire plant of Treatment involving the reproductive and Geigeria aspera to treat HIV/AIDS patients, immune systems was the most prevalent and in conjunction with either Senna italica (HIV/AIDS and gonorrhoea, 80%), followed or Catharanthus roseus to treat gonorrhoea by the respiratory system (TB, 20%). (drop).

In contrast H. obtusa is used predominantly The species is combined with Dombeya (67% of cases) as a single species decoction, rotundifolia to treat hypertension or Musa and the frequency of its use as a multi sapientum to treat general injuries or species decoction mirrors that of H. Eucomis pallidiflora to treat impotence hemerocallidea. When used as part of a (Table 2). multi-species preparation the approach is to combine it with an additional species.

Table 2: Preparation of Hypoxis and ailments treated by traditional healers in 12 local municipalities in the Limpopo Province. (A cup = ±300 ml, extracts are normally supplied in 2 L plastic bottles). Municipality Mode of preparation and administration Ailment treated Capricorn District Equal amounts of combined H. obtusa and Dombeya Hypertension Blouberg rotundifolia cooked for 5 minutes. A cup of the extract taken orally three times a day for a week. H. hemerocallidea cooked for 20 minutes. A cup of the Tuberculosis Lepelle-Nkumpi extract taken orally three times a day for a week. Sekhukhune District Elias Motsoaledi (Greater H. obtusa cooked for an undisclosed time. Warm extract Blood clotting Groblersdal) administered rectally twice a day for a week. H. obtusa and E. pallidiflora. Five teaspoons of pounded HIV/AIDS material in a cup of warm water, administered rectally once a Ephram Mogale (Greater Marble day for a week. Hall) H. obtusa cooked for 20 minutes. A cup of the extract taken orally three times a day. Impotence H. obtusa and Eucomis pallidiflora. Five teaspoons of Impotence Fetakgomo pounded material administered rectally twice a day for a week. H. obtusa cooked for 20 minutes. A cup of the extract taken Diabetes mellitus Makhuduthamaga orally three times a day for a week. Waterberg District Equal amounts of combined H. hemerocallidea, HIV/AIDS Cinnamomum vernum, Burkea africana) and Geigeria aspera Bela Bela cooked for 20 minutes. A cup of the extract taken orally three times a day for a week. Equal amounts of H. hemerocallidea and Senna italica. Five Gonorrhoea (Drop) teaspoons of pounded material in a cup of warm water, Lephalale administered orally three times a day. H. hemerocallidea, five teaspoons of pounded material, administered orally with soft porridge, three times a day.

Equal amounts of H. hemerocallidea and Catharanthus Gonorrhoea (Drop) roseus cooked for 20 minutes. A cup of the extract taken orally three times a day for a week. Modimolle Equal amounts of H. obtusa, and Musa sapientum, and a scale of an ostrich egg burned. Three teaspoons of ashes General injury topically applied on wound, after a bath H. obtusa macerated in water for 24 hours. A cup of the Diabetes mellitus Mogalakwena decoction taken orally three times a day for a week. H. obtusa cooked for 20 minutes. A cup of the extract taken Contaminated blood (STI’s) Mookgophong orally three times a day for a week.

Mode of Preparation and traditional healers via a bulb syringe, Administration whereas oral applications were taken either Cooking plant material to produce a as a liquid by the patients themselves, via a decoction is preferred (86 %), followed by tin cup, or as solids mixed with soft porridge. maceration (7 %) and pounding (7 %) to Decoctions and infusions were generally prepare herbal remedies. Boiling times in taken three times a day from a tin cup for a water range from 5 to 20 minutes. period of one week. The use of a tin cup was Maceration in water is done for 24 hours significant because of the traditional belief without exception to produce an infusion. that it increases the potency of the extracts.

Discussion Oral administrations of Hypoxis extracts were by far the most popular choice, The widespread use of Hypoxis accounting for 79 % of reported cases, hemerocallidea and H. obtusa within the followed by enemas (11 %). Enemas were Greater Sekhukhune and Waterberg without exception administered by Districts, and very limited utilization in the

Capricorn District could possibly be A possible explanation for this phenomenon attributed to either its distribution, or is the fact that the widespread availability of abundance in these areas. However, this transport eliminates the notion that natural aspect needs further elucidation via a more distribution limits medicinal use. Traditional comprehensive investigation, as the current healers can now easily travel large distances observations are preliminary at best and to collect their medicinal plants. This further might not be an accurate reflection on the supports the observation that the absence of widespread use of these two species. this particular species from the Waterberg District [17], did not exclude its medicinal Detailed research is thus urgently needed use in that area. into the distribution and abundance of these two species in the Limpopo. The fact that H. However, in the Sekhukhune District, an obtusa is sold by Muthi stores (shops trading area where H. hemerocallidea occurs in medicinal plants) in the Limpopo Province naturally, this species were not used, thereby for only R 10.00 per rhizome [14] shows that illustrating that many factors can interplay this species must still be fairly common in in the use or non-use of a plant species. The the province, more so than H. hemerocallidea disjunction between distribution and use which was not available in any Muthi store could be the result of factors such as or street vendor visited by Moeng and cultivation in home gardens, plant trading Potgieter [14]. and medicinal preferences.

Utilisation of Plant Material In the districts included in the present study The existing literature [15] supports the fact it was noted that a vast array of ailments that any part of a plant can be used for was treated using these species. However, medicinal purposes. This is in agreement their medicinal use across these districts with findings from our study, where it was differed significantly. For example, in the observed that various parts of different Capricorn District Hypoxis species were used species are used; thus supporting the fact exclusively for cardiovascular (hypertension) that plant parts used are species dependant. and respiratory (tuberculosis) ailments. In Hypoxis, only the rhizomes are used. In contrast to this, only Hypoxis obtusa was This focus could be the result of a dual used for the treatment of ailments in the interplay between seasonality, where the Greater Sekhukhune District, focusing leaves are lost during winter, and cultural mainly on the treatment of disorders related perceptions that the rhizome is more potent to sexual health (impotence and sexually than the leaves. To a large extent this transmitted infections, STIs) and endocrine emphasis influenced ethnopharmacological dysfunction (diabetes mellitus). Similarly in investigations into the medicinal use of this the Waterberg District, H. obtusa was used to species. Katerere and Eloff [16], in an effort treat diabetes mellitus and STIs. It is to promote the use of aerial parts as a noteworthy that H. hemerocallidea is used substitute for subterranean parts, compared exclusively for the treatment of gonorrhoea these plant parts using TLC, followed by and HIV/AIDS in the Waterberg District. In further antimicrobial assessment. the light of the number ailments, being treated using the two Hypoxis species, it is Their study illustrated definite differences clear that they play an integral role in the regarding the chemistry and biological Bapedi phytomedicine. activity of these parts. Based on these Single and Multi-species Preparations findings they recommended that the lack of similarity between aerial and subterranean The similar application of single versus parts illustrated that leaves could not be multiple species decoctions is an indication of used as substitutes for corms. the wide use of Hypoxis hemerocallidea and H. obtusa species in the treatment of Ailments Treated Per District ailments. However, there is a marked It is reasonable to argue in favour of a difference in the utilisation of these two correlation between distribution and use of species in the construction of decoctions. For medicinal plants; however this study could example, H. obtusa is being used primarily as not confirm this with regards to H. a single species preparation as opposed to a hemerocallidea. multi-species preparation.

The preference of a single species preparation current study found that H. obtusa was over a multi-species preparation could be macerated in water. linked to the perception that the species is potent enough, and the availability of Similar to the Xhosa traditional healers [20], associated species. the Bapedi traditional healers preferred water as the vehicle for administration; and Logic dictates that the severity of an ailment most of the medicinal preparations were would necessitate the use of a multi-species taken orally. The preparations were taken preparation rather than a single species thrice daily, after a meal, for a period of one preparation, as traditional medicine is week. This preference for one week is in overwhelmingly based on the treatment of contrast to the Xhosa custom to prescribe symptoms, which according to Semenya et al. medicine for periods of between six and 12 [18] include symptoms such as weight loss months [20]. It is notable that three and prolonged flu-like symptoms, amongst municipalities in the Greater Sekhukhune other. However, the only indication of this District, in addition to oral administration of trend, in the current study, was the complex remedies, also used rectal administration to nature of the multi-species preparation used treat ailments. to treat HIV/AIDS, which necessitated the Validation from the Literature application of three additional species together with H. hemerocallidea, as observed Folkloric and anecdotal reports regarding the in the Waterberg District. efficacy of Hypoxis hemerocallidea and H. obtusa, in the treatment of various ailments In contrast to this, the use of H. obtusa is well-documented. The genus is used to decoction only to treat diabetes mellitus, a treat a number of ailments, such as urinary metabolic disorder of multiple etiologies [19] infections [21], hypertension, HIV-AIDS [22], is traditionally diagnosed via the presence of impotency [23], bacterial infections [24], glucose in the urine. Thus the lack of diabetes mellitus [10], and sores and wounds multiple symptoms, as observed in [25]. The literature validates the utilization HIV/AIDs, might result in the perception of the two Hypoxis species for the above that this ailment is less severe and therefore mentioned ailments as used by the Bapedi require less aggressive treatment. traditional healers. Mode of Preparation and Conservation Administration Although many publications give the Most traditional healers preferred to cook the distribution of H. hemerocallidea and H. plant parts for 20 minutes. However, an obtusa as widespread in the Limpopo exception was recorded in the Blouberg Province of South Africa, the conservation of Municipality (Capricorn District); where a these two species must be a concern for the multi-species decoction prepared from H. future as the harvesting generally involves obtusa and Dombeya rotundifolia was cooked the removal of the whole plant. Dold and for only five minutes. Currently, it is Cocks [26] noted that H. hemerocallidea is unknown why this large time discrepancy heavily traded with a high price and is exists when decoctions are prepared. It is unsustainably harvested in the Eastern Cape postulated that perhaps longer boiling times Province. will make the extract too strong, or even reduce its efficacy. This aspect is currently Similar findings are echoed by Moeng and the subject of an investigation by the authors Potgieter [15] for H. obtusa. In fact they of this paper. found that H. obtusa was one of the eight most heavily traded species in the Limpopo It was previously reported [12] that the Province, being traded by all interviewed Bapedi use the process of maceration when traders across the province. preparing herbal remedies. This is a time consuming process, lasting 24 hours and The sudden awareness of the medicinal value probably also the reason why it is less often by the general public has no doubt been fired used. Even though Erasmus et al. [12] by press statements [27, 28] and TV indicated that the Bapedi used either water programmes, but there have also been other or milk as their maceration medium, the developments [29], which includes the

appearance of patented preparations such as It is therefore vital that this species, with its Harzol® , Moducare® and Hypo-Plus® [23]. multitude of uses, be managed effectively to ensure sustainability for future use. Moeng and Potgieter [14] noted that H. Conservation efforts thus need to be in line obtusa has the potential for commercial with people’s willingness to cultivate species cultivation via home gardens. However, of concern, either via home gardens or Wiersum et al. [30] noted that in the case of community nurseries. This can only be H. hemerocallidea, the interest of the Xhosa achieved when conservation is seen by the of the Amatola region of the Eastern Cape community as a tool for poverty alleviation. Province of South Africa to cultivate this Conclusion species in home gardens, was based primarily on their ideas regarding the The findings support the reports on the use of commercial/financial values of the plants, Hypoxis by Bapedi traditional healers. The while ideas on scarcity of species or cultural use of Hypoxis by the Bapedi indicates that issues played only a minor role. Similar H. hemerocaliidea is primarily used to treat motives were found regarding the selection of sexual health aspects, while H. obtusa is used species for cultivation. more to treat general health issues. Widespread utilization of this genus by In addition, availability of propagation Bapedi traditional healers residing in various material, ease of cultivation and drought geographical locations is an indication that it resistance played a role, while hardly might contain properties of medicinal value. mention was made to the need to conserve Acknowledgements rare or endangered species. We are very grateful to traditional healers in As Drewes et al. [23] so eloquently stated, it the various districts and municipalities who is important to realise that the incidence of participated in this study, and generously diseases are ever increasing, and as such it is shared their valuable knowledge of medicinal foreseen that the utilisation of this genus will plants with us. increase.

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