Plants Used As Anticancer Agents in the Ethiopian Traditional Medical Practices: a Systematic Review

Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2018, Article ID 6274021, 28 pages https://doi.org/10.1155/2018/6274021

Review Article Plants Used as Anticancer Agents in the Ethiopian Traditional Medical Practices: A Systematic Review

Nigatu Tuasha ,1,2 Beyene Petros,2 and Zemede Asfaw3

1 College of Natural and Computational Sciences, Mizan-Tepi University, P.O. Box 121, Tepi, Ethiopia 2Addis Ababa University, Department of Microbial, Cellular and Molecular Biology, P.O. Box 1176, Addis Ababa, Ethiopia 3Addis Ababa University, Department of Plant Biology and Biodiversity Management, P.O. Box 3434, Addis Ababa, Ethiopia

Correspondence should be addressed to Nigatu Tuasha; [email protected]

Received 13 March 2018; Revised 12 July 2018; Accepted 18 September 2018; Published 3 October 2018

Academic Editor: Chong-Zhi Wang

Copyright © 2018 Nigatu Tuasha et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background. Tis systematic review aimed at examining the use patterns of Ethiopian anticancer traditional medicinal plants (MPs) in view of recommending further validation studies. Methods. Te information was retrieved from PubMed according to the PRISMA guideline. Te electronic library of Addis Ababa University and relevant church-based religious books were also inspected for additional data. Results. From 34 studies meeting specifc inclusion/exclusion criteria, 119 anticancer MP species distributed in 98 genera and 57 families were recorded. Fabaceae (10.92 %) and Euphorbiaceae (10.08 %) were the most widely used families. Plumbago zeylanica (Plumbaginaceae) was the most frequently used anticancer MP species. Shrubs (42.02 %) and herbs (35.29 %) were dominant growth forms. About 89.08 % of the MPs were collected from wild habitats. Leaves (33.73 %) and roots (27.11 %) were the most frequently harvested parts. Te most favored routes were dermal (33.33 %) and oral (29.25 %). About 87.07 % preparations were made from fresh plant materials. Breast cancer and skin cancer were treated with 14 % and 10.76 % of anticancer MPs, respectively. Conclusion. Te review showed that anticancer MPs are widely used across the regions of Ethiopia. Most of the MPs are not scientifcally experimented and yet are at a higher vulnerability to loss mainly by human activities. Calling for conservation measures, we recommend experimental validation of the frequently used anticancer MPs. Tis augments global anticancer drug researches.

1. Background existandthemostcommoncausesofcancerdeathsinclude cancer of the lung (1.69 million), liver (788, 000), colorectal 1.1. Cancer. Cancer is the name given to a group of diseases (774, 000), stomach (754, 000), and breast (571, 000) [4]. Te comprising a combination of genetic, metabolic, and sig- prevalence of cancer is increasing because of the growth and naling pathway aberrations [1]. It is usually a fatal disease, agingofthepopulation,aswellasanincreasingprevalenceof which constitutes an enormous burden on society in both established risk factors such as smoking, overweight, physical economically developed and underdeveloped nations alike inactivity, and changing reproductive patterns associated [2]. It is the second leading cause of death globally next to car- with urbanization and economic development [3, 5]. diovascular diseases; and available estimates by GLOBOCAN (an International Agency for Research on Cancer-IARC) In Africa, cancer is alarmingly becoming a critical public show that about 14.1 million new cancer cases and 8.8 million health problem, with cancer forms attributed to infectious deaths occurred in 2012 worldwide. Furthermore, by 2012 agents (e.g., cervical cancer, liver cancer, Kaposi sarcoma, 32.6 million people were living with cancer, within 5 years and urinary bladder cancer) being the dominant types [6]. of diagnosis [3, 4]. Overall, 57 % of new cancer cases, 65 % According to the IARC, about 715,000 new cancer cases of the cancer deaths, and 48 % of the 5-year prevalent cancer and 542,000 cancer deaths occurred in 2008 in Africa [6, cases occurred in the less developed regions [3]. According 7].Tenumbersareprojectedtodoubleby2030dueto to WHO estimates in 2015, about 200 known types of cancer the aging and fast growth of the population. Te potential 2 Evidence-Based Complementary and Alternative Medicine of being even higher has been imagined because of the 1.3. Ethiopian Flora and Medicinal Plants. Historical accounts adoption of behaviors and lifestyles associated with economic substantiate age-long usage of traditional medicines (TMs) development [6–9]. Tus, prostate cancer in men and breast in Ethiopia. For instance, collections of medicoreligious cancer in women have now become the most commonly manuscripts of the Axumite kingdom, medical textbooks that diagnosed cancers in some parts of Africa [3, 10]. have been written in Ge’ez and Arabic languages between th th Reports on the prevalence of cancer in Ethiopia are mid-17 and beginning of the 18 century are few among scanty and difcult to verify because oncology services long-standing sources [28, 29]. It is widely reported that are inadequate and national registry centers do not exist; over seventy percent of the Ethiopian people depend on TM there are no control and prevention programmes against the for their healthcare, where more than 95 % of traditional disease; diagnosis and treatment services are very limited [11– medicines are sourced from plants [30, 31]. Ethiopia’s location 13]. However, the limited reports show that Kaposi sarcoma, in a tropical area, its huge landmass, and incredible variation liver, prostate, cervical, and breast cancer are the most in altitude ranging from about 120 meters below sea level common cancers [14] in Ethiopia. According to the cancer to 4,543 meters above sea level have strongly infuenced the country profles of WHO, most prevalent forms among range of its ecosystem and have contributed to the high males are colorectal, Kaposi sarcoma, leukemia, lymphomas diversity and rate of endemism in the fora [32–34]. Tus, the (non-Hodgkin), and prostate cancers in the order of listing, fora of Ethiopia has about 6,027 species of vascular plants whereas cancer of the breast, cervix-uteri, ovary, colorectal, with 10 % endemism [35–38]. According to recent reports, andleukemia,intheordergiven,aretoppingthelistamong over 1000 species are used as traditional medicinal plants females [15]. A study at the radiotherapy center of Tikur (MPs) of which about 33 species are endemic to Ethiopia Anbessa specialized hospital (currently the only one in the [39, 40]. country) showed that breast cancer had a high prevalence (27.8 %) [16]. On the scale of mortality leukemia (12.7 %) in 2. The Rationale for the Systematic Review on males and breast cancer (24.4 %) in females were reported to be the highest in 2014 [15]. the Anticancer MPs of Ethiopia It is evident that the incidence of cancer is on the rise 1.2. Traditional Medicines and Cancer. Herbal medicine (phy- globally. Te disparity in cancer survival between high and tomedicine, phytotherapy, or botanical medicine) is the low economic settings mainly lies on two factors: the stage oldest system of complementary and alternative medicine of its diagnosis and availability and access to treatments [6, (CAM) in the world with a history of more than 2,000 81, 82]. Although surgery is the existing standard curative years [17]. It is made exclusively from plants and is used therapy for most cancer forms, its therapeutic efcacy is by all societies and are common to numerous cultures compromised as most tumors are ofen diagnosed at an [18]. Tere are, however, variations in the preparation and advanced stage, particularly in the underdeveloped part of treatment procedures throughout the world [19]. Certain the world [83, 84]. Terefore, treatments such as radiotherapy herbal medicines defend the body from malignancy by and chemotherapy are next ladder therapies although they augmenting detoxifcation or cleaning the body. Some bio- achieve only very modest results [85]. Te everincreasing logical response modifers derived from herbs are known to occurrence of cancer and the severe side efects and limited hinder the growth of cancer by modifying the activities of efcacy of current cancer chemotherapy based on synthetic hormones and enzymes, while others diminish lethal side drugs shif the attention toward drugs of plant origin [86, efects and complications of chemotherapy and radiotherapy 87]. [20]. Te use of CAM is common among cancer patients in In Ethiopia, environmental degradation, deforestation, general and breast cancer patients, in particular [21]. Tey intermittent drought, high rate of cultural and habitat loss, are perceived by the general public to be safe, cause less com- and various anthropogenic activities are threatening the MPs. plications, and are less likely to cause dependency [19]. Most However, recent ethnobotanical studies from diferent parts cancer patients combine herbal remedies with conventional of the country have shown that TM is widely practiced in therapy in the hope of boosting the efect of conventional the country. It is also claimed that cancer patients prefer medicine [22]. Nevertheless, cancer patients who use CAM TMs to conventional therapeutic approaches mainly due report outcomes including improvement of clinical symptom, to its cultural acceptance and ease of access [37, 39, 51, quality of life, reduction of chemo/radiotherapy induced side 52, 56, 59, 72, 73, 76, 77, 88–99]. Te Ethiopian fora efects, and reduced tumor size [23–25]. Supporting conven- largely remained untouched with tremendous potential that tional cancer treatment, preventing recurrence and eventual could ofer a lot in the fght against cancer. Terefore, it prolonging of survival were also reported [26]. In addition is believed that the systematic review of ethnobotanical to these claims, anticancer agents derived from plants were studies reported from Ethiopia would help identify potential shown to inhibit angiogenesis, suppress cell proliferation, anticancer MPs. Tis will serve as a basis for initiating inhibit or reverse tumor development, and show general rigorous scientifc investigations for the chemopreventive antioncogenic efects [27]. A number of phytoconstituents and anticancer attributes of the MP species most frequently resulting from the herbs were also reported to assist the used across the regions of Ethiopia. Such investigation body’s immune system to combat cancer more efciently would contribute to the global anticancer drug discovery [20]. efort. Evidence-Based Complementary and Alternative Medicine 3

Records identiﬁed through database Additional records identiﬁed from  local repositories and religion-based searching [n = ] sources [n = ]

Records aer duplicates removed [n = ]

Records screened Records excluded due to irrelevant data [n = ] & lack of full text [n = ]

Full-text articles assessed for Full-text articles excluded, due to eligibility [n = ] inclusion/exclusion criteria [n = ]

Studies included in qualitative synthesis [n = ]

Figure 1: Flow of information retrieving strategy during identifcation, screening, and scrutinizing eligibility of the documents for the systematic review according to PRISMA suggestions.

3. Methods English; (v) lacking clear objectives and methodologies; (vi) abstract only or without full text access; (vii) experimental 3.1. Literature Search Strategy. Ethnobotanical studies from studies; (viii) articles lacking scientifc plant names; (ix) Ethiopia were systematically reviewed. Information included research reports without voucher numbers of the specimens; in this review spans from mid-1970s to 2017, which was the and (x) ethnobotanical information with no reports of MP period when valid documentation on the Ethiopian TMs was use for the treatment of malignancies/cancer and/or any undertaken. Knowledge of CAM for the treatment of various neoplasm were excluded. forms of cancer/malignancies in Ethiopia was retrieved from PubMed database (https://www.ncbi.nlm.nih.gov/pubmed- 3.3. Data Extraction and Review Process. Afer the retrieval accessed on 25.09.2017) following “Preferred Reporting from the electronic databases, the research articles were Items for Systematic Reviews and Meta-Analyses (PRISMA)” imported to the ENDNOTE sofware version X7 (Tomson guidelines [100]. Electronic repository of the Addis Ababa Reuters, USA) and the duplicates were removed. Afer the University (AAU) (http://etd.aau.edu.et) and sources that removal of the duplicates, all the imported articles and the make references to the TM knowledge of church-based additional fles were checked against the inclusion/exclusion religious teachers (‘debteras’) were examined as addi- criteria. Following the confrmation of the eligibility for the tional sources (Figure 1). In the search process, keywords systematic review, each document was carefully examined at including, “ethnobiology”, “ethnobotany”, “ethnobotanical” a time. We extracted the following data from each eligible “ethnomedicine”, “ethnomedicinal”, “medicinal plants”, “tra- document: (i) taxonomic diversity (the scientifc name of ditional healer”, “traditional medicine practitioner”, “tra- the species and family name), (ii) vernacular/local name ditional medicine”, “traditional herbal medicine “herbal of the plant, (iii) habitat of the plant, (iv) the growth medicine”, “food supplements” and “medico-cultural”, all form(habitoftheMP),(v)partsoftheMPsusedfor with the term “Ethiopia” were used. Afer completing iden- the remedy preparation and routes of administration, (vi) tifcation, screening and checking the eligibility of the liter- the forms of malignancies treated, and (vii) reports on ature for the systematic review, only those reporting forms the adverse efect(s); contraindications and antidotes were of malignancies/cancer, neoplasms, ‘nekersa’, tumor and carefully extracted and analyzed. Te citation frequency and swelling due to ‘nekersa’ were analyzed. Troughout the mapping of their geospatial distribution were done. Data on review paper the term “cancer” or ‘nekersa’ or “malignancy” the distribution of MPs in the Ethiopian fora region and is used to defne a condition where cells of neoplastic features the altitudinal range the plants grow was generated. Data divide without control and can invade nearby tissues. extraction was carried out twice independently and the data sheet was further checked for methodological conformity and 3.2. Inclusion and Exclusion Criteria. Information obtained correction of any discordance. Descriptive statistics was used from the database and other sources were scrutinized based to summarize the fndings. on the following conditions. Published articles and unpub- lished thesis/dissertation on ethnomedicinal/ethnobotanical 4. Results surveys reporting MPs used in Ethiopia to treat various forms of malignancies/cancer were included. 4.1. Taxonomic Diversity and Growth form and Distribution Researches reporting (i) CAM used for the treatment of the Anticancer MPs of Ethiopia. One hundred nineteen of single etiology; (ii) ethnoveterinary research reports; (119) species of anticancer MPs distributed in 98 genera and (iii) review articles; (iv) published in languages other than 57 families were retrieved from thirty-four (34) reports that 4 Evidence-Based Complementary and Alternative Medicine

Table 1: Te taxonomic distribution of anticancer MPs of Ethiopian fora.

Family (N=) Genera N (%) Species N (%) Fabaceae 9 (9.18) 13 (10.92) Euphorbiaceae 7 (7.14) 12 (10.08) Asteraceae 4 (4.08) 6 (5.04) Lamiaceae 5 (5.10) 6 (5.04) Ranunculaceae 3 (3.06) 5 (4.2) Cucurbitaceae 3 (3.06) 3 (2.52) Rosaceae 3 (3.06) 3(2.52) Solanaceae 3 (3.06) 3(2.52) Other 49 families 61 (62.24) 68(57.14) Total (%) (%)

Table 2: Frequently cited anticancer MPs from diferent parts of Ethiopia.

Areas/regions the Part(s) of the MP(s) Scientiﬁc Name [Family] Total reports MP(s) are used as References used anticancer agent Jeldesa Cluster (Dire Dawa) Plumbago zeylanica Mecha District, Zegie Lf, Rt and Sh 5 [41–45] [Plumbaginaceae] Peninsula, Ghimbi District and across the regions Jimma Zone, Bale Zone Brucea antidysenterica Lf, St and Br 3 and [46–48] [Simaroubaceae] Fiche District Clematis hirsuta var. hirsute Wondo Genet; Dega [49–51] Lf, St and Br 3 [Ranunculaceae] Damot and Blue Hora Croton macrostachyus Wondo Genet, Hawassa Lf 3 [37, 51, 52] [Euphorbiaceae] city, and Dalle District Dalle District (diferent Dodonaea angustirolia Lf 3 sites) and Debre Libanos [45, 52, 53] [Sapindaceae] monastery Fiche District, Dalle Dovyalis abyssinica [Flacourtiaceae] Fr, Br and WP 3 District and across the [45, 54, 55] regions Vernonia leopoldi (bitter leaf) Jimma area, Bale Zone, Lf 3 [44, 47, 48] [Asteraceae] and Zegie Peninsula Hawassa city and Dalle Zanthoxylum chalybeum [Rutaceae] Lf and Rt 3 [52, 55, 56] District (diferent sites) Note: Parts Used: Lf=Leaf; Rt=Root; Fr=Fruit; Br=Bark; Sh=Shoot; St=Stem.

fulflled the inclusion/exclusion criteria (Table 1). Twenty-fve including Jeldesa Cluster (Dire Dawa city administration), (25) families were represented by two or more anticancer MechaandGhimbiDistrictsofOromiaRegionalStateand MPs, whereas 32 families were represented by a single Zegie Peninsula, Amhara regional state (Table 2). Te life species each (Appendix). Te families Fabaceae (10.92 %) forms of the anticancer MPs are constituted shrubs (42.02 and Euphorbiaceae (10.08 %) were represented by the highest %), herbs (35.29 %), trees (18.49 %), and climber/liana (4.2 number of anticancer MP species followed by the families %). A total of 89.08 % of the MPs are found in the wild Asteraceae and Lamiaceae (5.04 % each). Eight (8) anticancer habitats; home gardens make up 9.24 % and the remaining MP species were found to be widely used in diferent regions 1.68 % are found, both in the wild and home gardens. of the country, where the species Plumbago zeylanica (family About 8.4 % of anticancer MP species are endemic, 86.56 % Plumbaginaceae) being the most frequently used in areas are indigenous, and 5.04 % are introduced from elsewhere. Evidence-Based Complementary and Alternative Medicine 5

Table 3: Geospatial distribution of the ethnobotanical studies that reported the use of CAM for the treatment of any form of malignancies/cancer atregional/city administration level.

Region/city administration of the Federal Democratic Republic of Ethiopia Frequency (%) Oromia Regional State 10 (37.04) Amhara Regional State 9(33.33) SNNPR State 5(18.52) Tigray Regional State 1(3.70) Dire Dawa City Administration 1(3.70) Afar Regional State 1(3.70) Total reports ()

∘   14 0 0 N

N ∘   13 0 0 N

∘   12 0 0 N

∘   11 0 0 N

∘   10 0 0 N

∘   9 0 0 N

∘   8 0 0 N

∘   7 0 0 N

∘   6 0 0 N

∘   5 0 0 N

∘   4 0 0 N

∘   Study areas AMHARA HARARI 1.5 0.75 0 1.5 Decimal Degrees 3 0 0 N Afar OROMIA REGION BENISHANGUL-GUM SOUTHERN REGION ∘   DIRE DAWA Somali Region 2 0 0 N ADDIS ABEBA GAMBELLA TIGRAY E E E E E E E E E E E E E E E E                 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0                 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ ∘ 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 33

Figure 2: Te geographical distribution of the Ethiopian anticancer traditional MPs.

Bidens macroptera (Sch Bip.) ex Chiov. Mesfn, Erythrina bru- Regional State (37.04 %), Amhara Regional State (33.33 %), cei Schweinf., Euphorbia heterochroma Pax., Galium boreo- and Southern Nations, Nationalities and Peoples Regional aethiopicum Puf., Lobelia rhynchopetalum (Hochst.) Hemsl, (SNNPR) State (18.52 %) (Table 3). Te frequency of reports Millettia ferruginea (Hochst.) Baker, Pittosporum abyssinicum across the regions and distribution in the Ethiopian Flora Del., Plectocephalus varians (A. Rich) Jefrey ex Cufod., Region are shown in Figure 2 and Appendix. Sideroxylon oxyacanthum Baill, and Vernonia leopoldi (Sch. Bip. ex Walp.) Vatke are endemic to Ethiopia [39, 101, 102]. 4.3. Forms of Malignancies Most Frequently Treated by Tradi- tional MPs. A variety of malignancies or cancer forms were 4.2. Geospatial Distribution of the Anticancer MPs. According reported to be treated with traditional MPs in Ethiopia. In to the present systematic review, the eligible studies on the higher number of the reports (43.33 %), it was reported anticancer MPs were reported mainly from the Oromia as “cancer/ ‘nekersa’” nonspecifcally. Specifc forms of 6 Evidence-Based Complementary and Alternative Medicine

Swelling by Bone cancer, 1.33 'NEKERSA', 2.00 Brain cancer, 0.67

Neck cancer/ulcer, 2.67 Tumors (in Stomach tumor, 0.67 general), 6.67

Rectal & anal cancer/ Breast cancer, 14.00 'FISTULA NEKERSA', 2.67

Skin cancer/“MINSHIRO NEKERSA” , 10.67

Prostatic hyperplasia (benign), 0.67 Lung cancer, 3.33 Prostate gland hypertrophy, 0.67

Leukemia, 1.33 Cancer/'NEKERSA', in general, 43.33 Wound cancer, 0.67 Swelling with wound/ 'KEMENZINA NEKERSA', 2.00 Invasive cancer /'KAYSI NEKERSA', 3.33 Internal cancer, 2.00

Cervical cancer, 1.33 Figure 3: Types and frequency of cancer forms treated by traditional MPs in Ethiopia (%).

cancer reported include breast cancer (14.0 %) and skin from fresh plant materials and water is the solvent that is cancer/‘Minshironekersa’ (10.67 %). Te remaining list mostly used to prepare anticancer TMs. About 4.76 % of includes bone cancer, brain cancer, cervical cancer, rectal preparations included honey as an additive to the remedy. cancer, anal cancer, invasive cancer/ ‘kaysi nekersa’,swelling Butter, four of ‘teff’, spicy stew, and sulfur (locally called with wound/‘kemenzina nekersa’, leukemia, and lung can- ‘digne’ in Amharic) among others were found to be mixed in cer among others (Figure 3). about 4.08 % of the remedies. Common methods of dermal application included dressing the swelling with warm plant 4.4. Parts of the MPs Used for the Remedy Preparation and material, smearing on the wound, rubbing the afected area Routes of Administration. Analysisoftheeligibleethnob- with the TM, tying the residue on the swelling, and giving a otanical fndings showed that various parts of the anticancer message with the fresh plant material preparation, as in the MPs were used for the remedy preparation. Te most fre- cases of breast and skin cancer. quently harvested parts of the anticancer MPs are leaves (33.73 %) and roots (27.11 %). Debarking constituted 10.84 4.5. Adverse Efects, Contraindications Implicated, and Anti- % whereas the whole parts of the MPs were used in as high dotes. Te present fnding revealed that nine eligible studies as 4.22 % of the preparations. Te stem and shoots were discussed the existence and management approaches used by rarely collected (only 1.81 %, each) for the remedy preparation the TM practitioners in case the anticancer remedies cause (Figure 4). any possible side efect(s). Besides, contraindications were From the various formulations and application proce- also noted, pregnant women being the most commonly at dures reported, the most preferred administration route of risk. Out of 119 MP species compiled, eleven (11) species were the TMs was dermal application (33.33 %) followed by oral found to have adverse side efects and/or contraindications. (29.25 %). About 4.08 % of the applications recommend both Te most commonly implicated species was Phytolacca dode- oral and dermal routes of applications and in 26.53 % of candra, followed by Croton macrostachyus. Two studies have the cases, the route of administration has not been specifed reported that any MP could result in mild adverse efects (Figure 5). About 12.93 % of the preparations were made especially among the risk groups or in case of overdosing from dried plant materials whereas 87.07 % were prepared of the remedy. During such circumstances, drinking cofee, Evidence-Based Complementary and Alternative Medicine 7

Not suggested 2.41

Whole part 4.22

Latex 5.42

Fruit/seed 9.04

Stem 1.81

Flower 3.61

Shoot 1.81

Bark 10.84 Part(s) of the MPs used/suggested the MPs of Part(s) Root 27.11

Leaf 33.73 Frequency of use (%)

Figure 4: Part(s) of the anticancer MPs used/suggested for the treatment of various forms of cancer.

33.33 29.25 26.53

Frequency (%) Frequency 4.08 0.68 0.68 1.36 2.04 2.04

al Nas Oral Dermal

Not suggested

Nasal and/or dermal Oral and/or dermal

Insertion into the opening

Oral and/or dermal and/or nasal ral and/or insertion into the opening O Route of administration Figure 5: Routes of anticancer TM remedy administration. local beer and fax, and eating local food like ‘SHIRO’ alle- in an alarmingly high demand for agricultural land which viatesthesymptoms[41,69].Tefndingsaresummarized in turn seriously threatens forest cover and hence the MPs. along with the recommended antidote(s) (Table 4). Tis makes designing and implementing of an insightful conservation program mandatory [29, 30, 106]. 5. Discussion Consistent with various ethnobotanical studies, shrubs made up a larger proportion of the anticancer MPs (42.02 Tese days, there is a higher level of dynamics in sociocultural %)followedbyherbs(35.29%)[31,44,97,107–109].Tis transformations in Ethiopia. It is evident, however, that the may be explained by the fact that shrubs are perennial in the communities by and large retained valuable knowledge of arid or subarid environments and may be available for use the MPs and their uses with regard to traditional health- as MPs [64]. Te dominance of certain life forms of MPs in care. In the present investigation, 119 anticancer MPs were diferent study areas might be explained by their availability documented. Tis implies a wider usage of CAM among and adaptation in the particular ecological setting and the cancer patients in Ethiopia. Tis could be related to lack dynamics involved due to bushy vegetation being lef behind of full access to healthcare facilities. In addition, CAM when the forest recedes. usage is culturally accepted among Ethiopians as an efective Dominant families from which anticancer MPs are pre- cure and safe and is afordable. It is also perceived more pared were found to be Fabaceae (13 MP species, 10.92 %), efcacious against certain types of diseases including cancer Euphorbiaceae (12 MP species, 10.08 %), and Lamiaceae and [103–105]. However, the rapid population growth has resulted Asteraceae (six MP species, 5.04 %, each). Tis could be 8 Evidence-Based Complementary and Alternative Medicine

Table 4: Adverse/side efects, contraindication implicated, and possible antidote.

Adverse eﬀect(s); [possible Family MP (s) involved Contraindication (if any) antidote recommended] (if Reference any) Asteraceae Vernonia Amygdalina, Pregnant women A headache and diarrhea [50, 57] A headache, vomiting, and Cucurbitaceae Zehneria scabra - [50, 57] diarrhea [Taking shower] A headache, vomiting, diarrhea, urination; Pregnant women [50, 57] [“Teff injera” and porridge Euphorbiaceae Croton macrostachyus are anecdotes] Any; [milk whey as an - [58] antidote] Nausea, vomiting and Pregnant women [59] diarrhea Calpurnia aurea -headache[57] Fabaceae Nausea, vomiting and Millettia ferruginea Pregnant women [59] diarrhea Vomiting and diarrhea; [“SHIRO WOT” (sauce made Lobeliaceae Lobelia rhynchopetalum - of pulse grains) and powder [60] of Linum usitatissimum infusion in water] Any; [milk whey as an Menispermaceae Stephania abyssinica - [58] antidote] Overdosage would result in Pregnant women [53] death Women at a child-bearing Could result in sterility in [46] Phytolaccaceae Phytolacca dodecandra age women Vomiting and diarrhea; [“SHIRO WOT” (sauce made - of pulse grains) and powder [60] of Linum usitatissimum infusion in water] Children and pregnant Vomiting and diarrhea; [milk [50, 57] women and red “TEFF” porridge] Nausea, vomiting and Pregnant women [59] diarrhea Vomiting and diarrhea; [red Polygonaceae Rumex nervosus Children [50, 57] “Teff’ porridge] Clematis hirsuta var. A headache, Sweating, and Ranunculaceae - [50, 57] hirsuta diarrhea A headache, vomiting, and [50, 57] Rosaceae Hagenia abyssinica - diarrhea [“SHIRO WOT” (sauce made of pulse grains) and powder [60] of Linum usitatissimum infusion in water]

attributed to the fact that these families are among the most Te present review also revealed that roots (27.11 %), bark widely distributed ones in the Ethiopian Flora Regions [31, (10.84 %), and the whole part of the MPs (4.22 %) accounted 67, 110]. Since Plumbago zeylanica (Plumbaginaceae) is the for about 42.17 % usage in TM. Tis will signifcantly afect anticancer MP species most widely used across the country, the sustainability of the MPs unlike use of aerial parts, such it may have a better healing potential over other anticancer as leaves [91, 106, 111]. It was revealed that most remedies are MPs. Tis fnding would make it a prime candidate for further prepared from fresh plant materials (87.07 %). Tis would in-depth experimental investigations. result in the extensive exploitation of the MPs and in a long Evidence-Based Complementary and Alternative Medicine 9 run and will compromise the sustainability of the MPs [55, that most MPs are vulnerable to destructive anthropogenic 58, 111]. activities directed against forests and other environmental Te fnding that a signifcant proportion of the remedies factors including climate variability. Tus, due attention were given orally (29.25 %) implies that the remedies are should be given to conserving these valuable resources in safe for systemic applications. However, in the present report addition to raising awareness of the community on how to over ten MP species used as anticancer agents across the use these plants sustainably. country had contraindications and/or adverse efects calls We also call for the proper enforcement of the Nagoya for cautionary usage. In addition, there are experimental Protocol with all its international recommendations and in evidences on the toxicity of some anticancer MPs (e.g., accordance with the national setups in order to protect the Hagenia abyssinica and the species from genus Vernonia) TM knowledge and associated rights of indigenous commu- reported in the present study [112–114]. Tis indicates the nities. Tis will further not only grant an opportunity to need for acute and chronic toxicity investigations on the most salvage the indigenous knowledge held by the communities, commonly used traditional anticancer MPs. but also help the scientifc endeavor in plant-based anticancer Te majority of anticancer MPs reported in the present and other diseases drug discoveries. study were from wild habitats (89.08 %). Tese habitats are Te efcacies of most Ethiopian traditional anticancer vulnerable to demise by anthropogenic activities [57, 115]. treatment claims with the MPs are not validated scientifcally. As intermittent drought and wide spreading climatic changes Besides, only a small proportion of the MPs were reported are posing additional threats to the anticancer MPs of the to have side efects and/or contraindications. To avoid such country, they are limited to inaccessible areas. Terefore, as overlooked health risks, we recommend further assessment d’Avigdor and the coworkers suggested, the community must on the safety of the anticancer MPs. Scientifc investigation be encouraged to grow them in and around home gardens on the MP’s potential toxicity and anticancer efcacy must and backyard [46]. also be made. Tis would possibly provide a lead material to One of the greatest challenges in ethnomedicinal a more thorough anticancer drug development researches. researches is the issue of access and beneft sharing (ABS) and that of intellectual property rights. WHO states that Appendix “agreements on the return of immediate and/or long-term benefts and compensation for the use of MP materials See Table 5. and associated community knowledge must be discussed and concluded” [116]. In the year 1986, there were over Abbreviations 6,000 TM practitioners in the country registered with the Ethiopian Ministry of Health [117]. However, there is no AAU: Addis Ababa University national guideline to address the regulatory situation [118]. ABS: Access and beneft sharing Te proclamation, which was issued based on the National CAM: Complementary and alternative medicine Drug Policy in 1999 in Article 6, Sub-Article 8 states, “the IARC: International Agency for Research on Cancer Drug Administration and Control Authority shall prepare MP/MPs: Medicinal plant(s) standards of safety, efcacy, and quality of TMs and shall SNNP: Southern Nations, Nationalities and Peoples evaluate laboratory and clinical studies in order to ensure TM/TMs: Traditional medicine(s) that these standards are met”. It states that the authority WHO: World Health Organization. shall also issue licenses for the use of TMs in the ofcial health services. However, there were no ofcial education Disclosure and training systems to strengthen the TM practitioners in addition to the lack of regulation to address the issue of Tis work did not receive any specifc grant from funding property rights and beneft sharing [117]. agencies in the public, commercial, or not-for-proft sectors. In Ethiopia, there have been attempts to implement ABS system of the Convention on Biological Diversity (CBD) Conflicts of Interest according to the provisions in the Nagoya Protocol and other international agreements [119–121]. Te country has acceded Te authors declare that they have no conficts of interest. to it and developed a code of conduct to administer the ABS regime. However, there are several unmet issues requiring Authors’ Contributions resolution [119, 120]. Nigatu Tuasha has incepted and designed this systematic 6. Conclusion review, searched the literature, screened the literature for eligibility against inclusion/exclusion criteria, extracted the From the present study, it can be concluded that CAM data, carried out the analysis of the results, and prepared practice is an integral part of the primary healthcare system the draf manuscript. Beyene Petros and Zemede Asfaw of Ethiopians, where the traditional anticancer MPs are independently checked for the methodological conformity, reported from diferent corners of the country. Te majority corrected the discordance, provided consistent comments of anticancer MPs are found in wild habitats. Tis shows during the analysis and write-up, and rigorously reviewed the 10 Evidence-Based Complementary and Alternative Medicine [63] [68] [66] KF, GG, SD SD, BA, HA ﬂora region (500-1900) [61] (550-2600) [61] (300-1300) [65] HA (1400-3250) (1300-1820) [63] ?HA (300-2200) KF, GG, SD, BA, GG, SD, BA, HA (1600-2350) [68] EW, TU, GD, GJ, EW, TU, GD, GJ, (1300-3000) [63] EW, TU, GD, GJ, EW, TU, GD, GJ, EW, TU, GD, GJ, WU, SU, SD, BA, EW,WU,SU,KF, EW,GD,SU,AR, WU,SU,KF,GG, WU,SU,WG,IL, GG, SD, BA, HA, (m)) [Reference] EW,TU,GD,WU WU,SU,WG,SD, WU,SU,AR,WG, WU,SU,AR,WG, (altitudinal range Distribution in the BA (1250-3400) [63] KF, GG, SD, BA, HA BA, HA (1000-3000) EW,AF,TU,GD,GJ, WG,KF,IL,GG,SD, hiopia [45] t reported E Region [67] Region [62] [Reference] Oromia [54] Fiche District, Libo Kemkem e study area of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of District, Amhara of reporting, and forms of cancer treated Across the regions Across the regions Across the regions Across the regions Across the regions Across the regions Across the regions Yalo Distric t, Z one 4, Afar Region [64] Sidama Zone, SNNP ’ ’ ’ / ’ /skin ’ cancer Tumor Cancer described ‘Nekersa ‘Nekersa ‘Nekersa nekersa Lung cancer Lung cancer ‘Minshiro Cancer form Breast cancer ‘Kemenzina Internal cancer nekersa swelling with wound part water drunk surface Used in Used in procedure Te fruit is taken orally Application is given orally pounded, cold macerated and with honey and and drunk with other herbs and other herbs and Creamed on the is applied orally, applied topically eaten twice a day combination with combination with One tablespoon of powder with water nasally or topically Dried or fresh root Te root is crushed pulp (leaf) is mixed Te leaf of the plant Tied on the afected ‡ AR &De Or, Ns § Rt NA NA PU Ψ GF WHFrOr WHRtOr W H Lf Habitat

NA (Amh) Iret (Amh) W Sb Lf Or Doge (Amh) Bilinjii (Oro) W Sb Rt Or Ensilal (Amh) HG H Rt Or Duduna (Age) W T Br De Ye- Eregna kolo WotetAshir(Age) W H Rt De Bala noranti (Oro) W H Rt NA NA Dem asteft (Amh) W H Rt De Vernacular name Etse-Tekhino (Ge’ez) R. Br. (L.f) Berger Mill. (aloe) Baker Towns. Barleria the plant Lannea sp. Anthericum S.M Almeida angustifolium (Forssk.) C.C. (Martyn) Raf. ex C.B. Clarke Chlorophytum (Hamilt.) MR. & tetraphyllum Hygrophila schulli Hochst. ex A.Rich Celosia polystachia Scientiﬁc name of Foeniculum vulgare Ferula communis L. Aloe pirottae eranthemoides Scadoxus multiforus Family Acanthaceae Apiaceae Amaranthaceae Aloaceae Amaryllidaceae Anacardiaceae Anthericaceae and distribution in the Ethiopian Flora Region. Table 5: Families of anticancer MPs with their scientifc and local names, habitats, growth forms, parts used, application route and procedures, area Evidence-Based Complementary and Alternative Medicine 11 [70] [68] WG, HA SD, BA, HA ﬂora region GG, BA, HA WU, SU, AR, EW, TU, WU SU, AR, IL, KF, (700-3800) [63] (600-2500) [68] (1750-3600) [71] (1700-2440) [71] (1900-3600) [71] EW, TU, GD, GJ, EW, TU, GD, GJ, (1600-2400) [68] EW,TU,GD,SU, GG, SD, BA, HA, (m)) [Reference] WG,.KF, GG, SD, AR, WG, KF, GG, EW, SU (NA) [68] WU,SU,AR,WG, (altitudinal range BA, HA (550-2500) Distribution in the BA, SU and possibly WU,SU,AR,IL,KF, other regions (2900) KF, GG, SD, BA, HA AF, EW, TU, GD, GJ, EW,TU,GD,GJ,SU, AF, EW, TU, GD, GJ, reported Region [52] Region [58] Region [59] Region [67] [Reference] Dale District, bosa Districts Fiche District, Libo Kemkem e study area Mecha District, Mecha District, of Ethiopia [45] of Ethiopia [45] Loma and Gena District, Amhara (KT) Zone, SNNP Across the regions Across the regions Gubalafo District, North Wello Zone, Kembatta Tembaro West Gojjam Zone, West Gojjam Zone, North Shewa Zone, Dawro zone, SNNP Oromia Region [46] Amhara Region [69] Amhara Region [42] Amhara Region [42] Sidama Zone, SNNP ’ ’ nekersa’ ’ Breast Tumor Tumor Cancer Cancer described ‘Nekersa ‘Nekersa Skin cancer Brain cancer Cancer form pain/ ’ nd a Ruta ), Zingiber )madeinto is used applied and drunk procedure Mixed with part is used Application squeezed and ingibil ( Tenadam ( chalepensis Powdered fower with ‘sumanfar andinsertedinto Z the cancer wound Te latex is mixed latex is given orally or applied topically an infusion, fltered Fresh leaf juice with Whole fresh plant is Te whole areal part ofcinale ‡ De AR Or & § WP De NA PU Table 5: Continued. Ψ GF WSbRtOrNA WSbLf&Lx WHWPNA SFNN Cancer WSbFrNANA WHLxIn Habitat

Sid) ( NA HG Sb WP NA (Amh) (Amh) (Amh) Otila Ariti (Amh) HG H Lf Or Serati (Kam) Agam (Amh) Este-Yohannes Arust /tifrinde Yemidir kulkual Yesetkest(Amh) Vernacular name Adey Abeba (Amh) W H Fl Or Etse-Anbessa (Ge’ez) W Sb Rt Or NA L. L. L. L. (A. Rich) Lam. Mesfn the plant Artemisia Asplenium absinthium Plectocephalus trichomanes Vinca major (Forssk.) R. Br. Jefrey ex Cufod. varians Kanahia Lanifora (A.Rich) Sprenger Bidens macroptera Scientiﬁc name of (Sch Bip.) ex Chiov. Carissa spinarum Asparagus africanus Huernia macrocarpa Asteraceae Aspleniaceae Asparagaceae Family Apocynaceae Asclepiadaceae 12 Evidence-Based Complementary and Alternative Medicine GJ, WU, TU, AF, GG, SD ﬂora region (900-2350) [61] (650-3000) [71] (700-1800) [66] (300-1500) [66] (1200-3000) [71] GG, SD, BA, HA GG, SD, BA, HA EW, TU, GD, GJ, (2406-3200) [65] EW, TU, WU, SU SU,WG,KF,HA, EW, (m)) [Reference] TU,GD,GJ,WU, EW,TU,WU,SU, EW TU, WU, GD WU,SU,AR,WG, (altitudinal range GJ,SU,WG,IL,KF, IL,KF,GG,SD,BA, Distribution in the GJ, SU, AR, WG, IL, HA (700-2550) [61] AR, HA, IL, GG, SD GG (1850-2850) [71] SU, AR, WG, IL, KF, KF, GG, SD, BA, HA trict, Dis rk reported Region [52] Region [72] Region [62] [Reference] Dale District, Northwestern North Gondar Zone, Amhara e study area Region [47, 48] of Ethiopia [45] of Ethiopia [45] Deba Zegie Peninsula, Jimma Zone and Jimma Zone and Ethiopia, Amhara Across the regions Across the regions Yalo Distric t, Z one Yalo Distric t, Z one Region [44, 47, 48] Bale Zone, Oromia 4, Afar Region [64] 4, Afar Region [64] Bale Zone, Oromia; Sidama Zone, SNNP Sidama Zone, SNNP Tumor Tumor Cancer Tumors described Cancer (as (‘nekerse’) Cancer form Breast cancer Breast cancer chemoprevention) ‘Fistula nekersa’ rectal & anal cancer ‘Fistula nekersa’/ is Cordia with the Plumbago NA NA topically topically recovery procedure zeylanica and applied and applied Application with butter and creamed on the Bark of the root; with other herbs with other herbs africana pounded and the root of the pulp is drunk powdered, mixed Tender shoots are afected part until Bark of the root is Te bark of juice squeezed from used in combination used in combination ‡ De AR &De OR & Or, Ns § Br NA NA PU Table 5: Continued. Ψ GF WSbBrDe W T Lf WSbShOr W Sb Lf Habitat

NA NA (Amh) Hecho (Sid) Qilxuu (Oro) W Sb Lf NA NA Grawa (Amh) Wanza (Amh) W/HG T Br De Mukerba (Amh) W/HG Sb Br Yes et af / Z inkila Vernacular name Merara kitel (Amh) W Sb Lf NA NA A. Engl. Del. (van GB Lam. Rich. Tonn. (L.) Del. Balanites Vernonia Vernonia the plant hymenolepis Ehretia cymosa Cordia africana amygdalina rotundifolia Tieghem) Blatter Vernonia leopoldi Vatke (bitter leaf ) Scientiﬁc name of (Sch. Bip. ex Walp.) Balanites aegyptiaca Berberis holstii Boraginaceae Family Balanitaceae Berberidaceae Evidence-Based Complementary and Alternative Medicine 13 [65] J,TU,SU,AR, ﬂora region GJ, SU, (Gibe ,G AR SD BA, HA (450-1950) [74] (300-2800) [74] (1350-3850) [65] GG, SD, BA, HA EW, TU, GD, GJ, SU, AR, GG, BA, D GJ, WG, SU, HA, (m)) [Reference] (1900-3600 ) [65] TU,GD,WU,SU, (sea level to 2000) EW,TU,WU,GD, WU,SU,AR,WG, WU,SU,AR,WG, (altitudinal range IL KF GG, SD, BA, IL,KF,GG,SD,BA SD (380-2440) [66] Gorge),WG, IL, KF, Distribution in the IL, KF, GG, BA, HA EW, GD, SU, IL, HA AR, BA, IL, KF, GG, HA (1180-2800) [74] G HA (1200-3580) [74] AF, EW, TU, GD, GJ, reported Region [73] Region [72] Region [72] Region [56] Region [50] [Reference] Dega Damot Hawassa city, Gondar Zuria North Gondar North Gondar Zone, Amhara Zone, Amhara e study area of Ethiopia [45] of Ethiopia [45] Debark District, Debark District, District, Amhara District, Amhara Across the regions Across the regions 4, Afar Region[64] Yalo Distric t, Z one Yalo Distric t, Z one 4, Afar Region [64] Sidama Zone, SNNP ) ’ / ’ ’ ’ Cancer Cancer described ‘Nekersa Skin cancer Wound and Cancer form Breast cancer Breast cancer invasive cancer ‘Kaysi nekersa Tumors (‘nekersa B. are (galo – Tarenna with seed wound Used in crushed, procedure Dry root is Combretum Application afected part afected area Te leaves of Collinum Te leaves are Te seed of squeezed, and applied on the and applied on creamed on the with honey and other herbs and applied topically wound or tumor and drunk orally Amh) is crushed, powdered, mixed graveolens It is pasted on the combination with carinata and leaf of pounded, powdered pounded, powdered ‡ AR § Lf De Rt Or PU Table 5: Continued. Ψ GF W H Lf Or NA WHLf&RtNANA‘Nekersa HG H Habitat

NA Atat (Amh) W Sb Lf De Abalo (Amh) W T Lf De Wof tech (Amh) W H Rt De Areg resa (Amh) Qalaanqaal (Som) W Sb Lf Or NA Etse-Sabek (Ge’ez) Gomen zer (Amh) HG H Sd De Basu baaqula (Sid) Vernacular name A. A. (L.F. (Lam.) Fresen. (Harms) Br. Rich Exell Sond) Forssk. C. Jefrey the plant Maytenus Momordica Combretum (Molina) Standl Cadaba farinosa Collinum Scientiﬁc name of Lagenaria siceraria senegalensis friesiorum Brassica carinata Silene macrosolen Zehneria scabra Caryophyllaceae Capparidaceae Family Brassicaceae Combretaceae Celastraceae Cucurbitaceae 14 Evidence-Based Complementary and Alternative Medicine 2000) [74] c [74] ﬂora region HA (1200) [74] (500-2350) [74] GD, GJ, SU, AR, (1200-2700) [74] EW, TU, GD, GJ, TU,GD,WU,GJ, TU,GD,GJ,WU, (m)) [Reference] EW, WU, SU, GG, IL, KF, SD BA HA WU,SU,AR,WG, (altitudinal range SU, IL, KF, SD, HA SD, HA (435-1800) Distribution in the SU,AR,KF,SD,BA, BA (1050-2200) [74] HA (1450-2950) [74] WG, IL, KF, GG, SD, SU, HA ( Oromia [51] reported Region [37] Region [52] Region [75] Region [72] [Reference] Hawassa city, Dale District, Wondo Genet North Gondar Zone, Amhara e study area Shewa, of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] District, Sidama Debark District, Across the regions Across the regions Across the regions Across the regions Yalo Distric t, Z one 4, Afar Region [64] Zone, SNNP Region Chelya District, West Sidama Zone, SNNP Sidama Zone, SNNP ’ ’ ) ’ Cancer described (‘lemtse ‘Nekersa’ ‘Nekersa ‘Nekersa Skin cancer Skin cancer Breast ulcer Cancer form Breast cancer Wound cancer and is used together Euphorbia uphorbia is chopped E wound topically h to cancer or topical Euphorbia Euphorbia t procedure Kotschy and crushed and Application afected part Crushed and Te fower of ampliphylla and put on the Te whole part wi Fresh leaves are and mixed with C. robusta; inserted into the caandelabrum & Root and latex of and fumigated to lathris applied oral, nasal Stem of C. richardiana ofen together with on the afected part abyssinica, honey and creamed Dry/fresh leaves are ulcerated breast due pounded, powdered pounded, powdered Euphorbit oboalifolia ‡ AR &De Or, Ns § Lf In Lf NA NA PU Table 5: Continued. Rt & Lx NA Ψ GF WSbLfDe WHWPDe W Sb Lf Habitat

NA Masina (Sid) Bisana (Amh) Kelekol (Amh) W Sb Rt & Lx NA NA Invasive’ ‘nekersa Fiyele-fej (Amh) Qulquale (Amh) W T Fl De Vernacular name Este-mefrih (Ge’ez) eeitf(m)WYenebirtifr(Amh) Sb Rt NA NA L. Hadaamii (Oro) HG H St De Del. M Pax. . Forssk Croton Gilbert the plant Euphorbia Euphorbia dalettiensis (Hochst.) Baill. ampliphylla Jaub. and Spach. Clutia abyssinica Acalypha fruticosa Bridelia micrantha Scientiﬁc name of macrostachyus Euphorbia lathyris Family Euphorbiaceae Evidence-Based Complementary and Alternative Medicine 15 AR, WU, , , 2500) [74] GJ, SU, AR SU, BA, HA SD, BA, HA ﬂora region BA, HA (400- (100-1600) [66] (900-2750) [74] (600-1900) [66] SU,BA,HA,SD (450-2000) [66] SU, AR, HA, BA HA, KF, GG, SD (1200-2250) [74] (1300-2000) [74] (1650-3000) [66] (2000-3200) [74] GJ, WG, SU (1600-4000) [66] EW,TU,WU,GJ, (m)) [Reference] WG,SU,AR,BA, EW,TU,WU,SU, AF, EW, TU, WU, EE, EW, TU, WU, TU,GD,WU,SU, GD,GJ,WU,WG AF, EW, TU EW, TU, GD, WU, EW, TU, GD, WU, (altitudinal range Distribution in the SU,AR,IL,KF,GG, IL, GG, SD, BA, HA SU, AR, BA, HA, SD BA,HA,KF,GG,SD WG, IL, KF, GG, SD, , Zone , Zone [51] reported Region [60] [Reference] Shewa Shewa Hawassa city, Northwestern Wondo Genet Debre Libanos Debre Libanos e study area Wello, Amhara Region [55, 56] Mecha District, of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] District, Sidama Delanta District, monastery, North monastery, North Across the regions Across the regions Across the regions Yalo Distric t, Z one Yalo Distric t, Z one Yalo Distric t, Z one West Gojjam Zone, 4, Afar Region [64] 4, Afar Region [64] 4, Afar Region [64] Oromia Region [53] Oromia Region [53] Zone, SNNP Region Amhara Region [42] Sidama Zone, SNNP ’ cancer Tumor Cancer (cancer) described ‘Nekersa’ ‘Nekersa Skin cancer Unidentifed Unidentifed Cancer form Breast cancer Breast cancer Breast cancer Skin bleaching swellings/ Neck swellings/ Cancer Cervical and rectal Skin cancer (tumor) orally lied nasally Used in p procedure with root of Application afected area p Fresh latex is Crushed and Crushed and applied on the and swallowed applied nasally a tumor topically other herbs and and/or topically and/or topically and given orally the afected part applied topically Cucumis fcifolius is cold macerated Latex dropped on combination with Te powdered leaf crushed and taken (Yemidir Embuay) Root of the plant is Its latex is squeezed and creamed on the of the plant is mixed Fresh root is chewed ‡ De De AR Ns & Ns & § Lx NA NA NA NA NA PU Table 5: Continued. Ψ GF WTLxDe HG H Rt Or Habitat

(Sid) Seraw (Tig)Seraw W (Tig) Sb W Lf T Lf Ader (Amh) W Sb Rt Or Gulo (Amh) Digita (Amh) W Sb Lf Or Sosiye (Amh) W Sb Rt NA NA Carricho (Sid) W Sb Lx De Anitrfa (Amh) W H Lx De Qonbo”o (Sid) Kinchib (Amh) Shuraamo carre Duaduate (Amh) W Sb Rt & Sd De Vernacular name L. e L. Boiss. L. Am. (L.) Wight et the plant Euphorbia Euphorbia Phyllanthus (Alt.) Benth. Dichrostachys Acacia tortilis platyphyllos Acacia oerfota Calpurnia aurea (Forssk.) Hayne. Kunth & Bouch´ ovalifolius Forssk. Colutea abyssinica polyacantha Euphorbia tirucalli Scientiﬁc name of (Forssk.) Schweinf. Ricinus communis cinerea Family 16 Evidence-Based Complementary and Alternative Medicine GD , GD, WU, , [65] [66] [66] 1200) [66] 2500) [66] GJ, SU, SD ﬂora region (0-1850) [66] (Sudan border), AR,SD,BA,HA (1450-2250) [63] AF, EW, TU, GD SU, AR, GG, SD, AF, EW, TU AF, EW (0-1400) (1500-2400) [66] AF, EW, HA, BA, IL, KF, SD (1600- (m)) [Reference] TU,GD,GJ,WU, WU, WG, GJ, SU, WU,GJ,WG,SU, WG, SU, HA, BA, KF, GG, SD (up to (altitudinal range EW, TU SD (300-2000) [66] Distribution in the SU,AR,HA,IL,KF, BA, HA, IL, KF, GD, SD (1700-2400) [66] GG, SD (1400-2600) BA, HA (1700-3000) AR, HA, IL, KF, GG, [45, 50] reported region [52] region [52] Region [55] [Reference] Oromia [54] Dale District, Dale District, Dale District, Fiche District, e study area of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] Damot District, Amhara Region of Ethiopia; Dega Across the regions Across the regions Across the regions Across the regions Across the regions Gubalafo District, Gubalafo District, North Wello Zone, North Wello Zone, Yalo Distric t, Z one 4, Afar Region [64] Sidama Zone, SNNP Sidama Zone, SNNP Amhara Region [69] Sidama Zone, SNNP Amhara Region [69] ’ ’ (cancer) ’ /Lymphatic tumor ’ Cancer Cancer Cancer Nekersa nekersa’ described ‘Nekersa ‘Nekersa ‘Minshiro Lung cancer Cancer form Breast cancer Breast cancer ‘Muje ‘Nekersa eaten orally drunk swelling swallowed Te root is procedure body wash body wash Application afected part wound, or the is chewed and powdered and applied on the with water and fltrate is drunk Te raw bark of NA/ Te bark is Creamed on the in water and the powder is mixed fltered and given washed, pounded, Leaf of the plant is Leaf of the plant is Dovyalis abyssinica Six to ten fruits are Te Leaf is crushed used orally and as a used orally and as a and creamed on the Te bark is pounded ‡ De De De AR Or & Or & Or & § Fr Or Br Or WP De PU Table 5: Continued. Ψ GF WHRt WTBrOr W T Br NA NA W Sb Lf W H Lf Or W Sb Lf & Br De Applied topically W H Lf Habitat

) Sid ( NA NA (Amh) Busha (Age) Kuara /Korch Bofefe – Amh W Sb Rt NA NA Welekko (Sid) Birbira (Amh) Koshim (Amh) W Sb Mekerbaa (Oro) W Sb Br De Hanxxaye (Oro) Hengedicho Key enchet (Amh) Vernacular name Milas Golgul (Amh) Mill. NA Forsk. r. r e Mill. Senna L.M Barneby the plant Schweinf. Indigofera (Del.) Lock (Viv.) Irwin & septemtrionalis Sesbania sesban (A. Rich.) Warb (Hochst.) Baker Erythrina brucei Senna singueana Senna italica oblongifolia Senna alexandrina Scientiﬁc name of Gladiolus candidus Millettia ferruginea (Rendle), Goldblatt Dovyalis abyssinic a Family Iridaceae Flacourtiaceae Evidence-Based Complementary and Alternative Medicine 17 GD, SU, , [61] [61] [63] highlands except AF 2600) [61] ﬂora region (500-3700) [61] (500-3700) [61] Troughout the (900–2700) [61] AR, WG, IL, KF, All Flora region, (1300-3800) [61] HA (3000-4350) GG, SD, BA, HA EW, TU, GD, GJ, EW, TU, GD, GJ, (1600-3800) [65] WU,SU,AR,KF, EW, TU (m)) [Reference] TU,GD,WU,SU, GG, SD, HA (700- EW, TU, GD, WU, EW, TU, GD, WU, (altitudinal range Distribution in the AR, BA (2400-3120) GJ, SU, AR, WG, IL, GJ, SU, AR, WG, IL, KF, GG, SD, SA, HA KF, GG, SD, SA, HA HA, BA (1700-2800) GD, GJ, SU, AR, BA, HA (1500-3400) [61] WU, SU, KF, SD, BA, WG, IL, KF, GG, SD, reported Region [55] Region [58] [Reference] Jimma Zone, Dale District, Fiche District, e study area of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] (KT) Zone, SNNP Across the regions Across the regions Across the regions Across the regions Across the regions Across the regions Kembatta Tembaro North Shewa Zone, Oromia Region [47] Oromia Region [46] Sidama Zone, SNNP ’ ’ ) ’ ’ ’ ’ ’ nekersa ’ Breast massage nekersa nekersa described ‘Nekersa ‘Nekersa ‘Minshiro (‘nekersa ‘Minshiro Cancer form Breast cancer Internal cancer pain/ ‘Kaysi nekersa Ulcer of the neck Cancer (Leukemia) breast Used in Used in Used in bination with not given anthoxylum chalybeum procedure other herbs for 24 hours Application m Z with honey and o other herbs and other herbs and Ofen used with pounded, mixed applied topically applied topically with the shoot of drunk; or its root Leonotis Africana combination with combination with c boiled ofen mixed applied to the ulcer Chopped leaves are Applied on afected Te leaf part will be andapplied topically and an application is ‡ AR § PU Table 5: Continued. Ψ GF WHLfOr WHbLfDe Habitat

(Oro) Telba (Amh) HG H Sd Or NA Jibira (Amh) W T Lx NA NA Ma’niisa (Sid) Harma guusaa Hulegeb (Amh) W H Rt NA NA Misrichi (Amh) Ras kimir (Amh) W Sb Rt NA Este meaza (Amh) W Sb Lf De Vernacular name Etse-libawit (Ge’ez) Mardhisiisaa (Oro) Etse-kemun (Ge’ez) W T Rt De Yefereszeng(Amh) W Sb Lf De . L. Etse felatsut (Amh) W H Rt De L. Jacq (Hochst.) Don Vatke Linum Hemsl. Hemsl. Lobelia the plant De FC (Vis.) (Benth.) Briq. Clerodendrum Lobelia giberroa rhynchopetalum usitatissimum Juncus efusus Ajuga integrifolia Buch.-Ham. ex D. Scientiﬁc name of Satureja abyssinica (Burm.f.) Iwarsson Leonotis ocymifolia Leonotis raineriana Salvia nilotica myricoides Lamiaceae Family Juncaceae Linaceae Lobeliaceae 18 Evidence-Based Complementary and Alternative Medicine [74] BA, IL, GG SD, BA, HA HA, BA, SD ﬂora region WU, SU, AR KF,SD,BA,HA (700-3300) [68] (500-2450) [66] AF, TU, GD, GJ, HA (l600-4000) (1700-2715) [66] WG, SD, BA HA (1450-3400) [65] EW, TU, GD, GJ, EW, TU, GD, GJ, GD,SU,HA,SD, WG,KF,SD,BA, (1500-2600) [74] (m)) [Reference] TU, WU, GD, GJ, (1680-3000) [66] WU,SU,AR,WG, WU,SU,AR,WG, (altitudinal range GJ,SU,IL,KF,AR, TU,GD,WU,WG, KF,IL,GG,SD,HA Distribution in the WG,SU,AR,IL,KF, EW,TU,GD,GJ,SU, , Zone [51] reported Region [55] Region [55] Region [55] Region [72] Region [76] Region [44] Region [31] [Reference] Shewa Dale District, Dale District, Dale District, Northwestern Wondo Genet ama Zone, SNNP North Gondar Zone, Amhara Debre Libanos e study area of Ethiopia [45] District, Sidama Debark District, of Ethiopia [45] Zegie Peninsula, Wellega, Oromia d monastery, North Ethiopia, Amhara i Across the regions Across the regions Ada’a District, East Oromia Region [53] Zone, SNNP Region Nekemte Town, East Sidama Zone, SNNP Sidama Zone, SNNP Shewa Zone Oromia S ) ’ ’ ’ ’ Cancer Cancer Cancer Cancer Cancer Tumors nekersa described ‘nekersa ‘Nekersa Swelling by Skin cancer Wound and ‘Minshiro (‘nekersa Unidentifed Cancer form Breast cancer swellings/ Neck is inserted pounded, applied on procedure on the skin taken orally Application afected part amount of the Pounded, cold plant pounded macerated and Te fruit of the Te bark of the Fresh leaves are squeezed root is Sida schimperi Small opening is plant is pounded, mixed with honey boiled and a small fltered and drunk Te juice of freshly Te leaf is crushed, area and the root is powdered and then tied on the swelling Te leaf and root of warmed on fre and droplets are applied rubbed by hand and made in the afected preparation is drunk ‡ AR § Lf NA NA Lf De Rt Or Fr Or NA NA NA PU Table 5: Continued. Lf & Rt De Rt & Br NA NA Ψ GF WHLfDe WTBrOr WHRtIn WSbLfOr WSb Habitat

(Amh) Kalaala (Sid) Anfar (Amh) Simboo (Oro) Work Bemeda Azamir (Amh) Chefreg (Amh) W Sb Duduna (Amh) Goddiicho (Sid) Engochit (Amh) Bullaancho (Sid) Etse Eyesus (Ge’ez) Xeweerrakko (Sid) Vernacular name L. Lut (Amh) W H Fresen . Walp. Sparm Fresen. Buddleja the plant Dorstenia Schwienf. barnimiana Sida schimperiana Ekebergia capensis polystachya Scientiﬁc name of Bersama abyssinica (Dillon & A. Rich.) Malva verticillata Hochst. ex. A. Rich. Stephania abyssinica Moraceae Family Loganiaceae Menispermaceae Melianthaceae Malvaceae Meliaceae Evidence-Based Complementary and Alternative Medicine 19 [65] [66] 3200) [68] SD, BA, HA ﬂora region SD, BA, HA, WG, GG, BA SD, BA (1350- AR,IL,KF,SD KF (1000-2400 ) EW, TU, GD, GJ, EW, TU, GD, GJ, (1250-3000) [68] HA (1500-3000 ) (1900-3800) [68] (2500-3750) [68] (1400-2500) [66] EW, TU, BA,GG, WU,SU,AR,KF, GJ, WG, SU, HA, AF, EW, TU, GD, WU,SU,KF,GG, (m)) [Reference] EW, TU,WU, GD, WU,SU,HA,AR, GD, WU, GJ, WG, (altitudinal range SU, IL, KF, AR, SD, Distribution in the GD, SU, AR, IL, KF, TU,GD,GJ,SU,AR, reported region [59] Region [55] Region [55] [Reference] Shewa Zone, Dale District, Dale District, bosa Districts Fiche District, District, North e study area Mecha District, of Ethiopia [45] of Ethiopia [45] Loma and Gena Minjar-Shenkora Across the regions Across the regions West Gojjam Zone, North Shewa Zone, Dawro zone, SNNP Oromia Region [54] Amhara Region [77] Sidama Zone, SNNP Sidama Zone, SNNP Amhara Region [42] ’ ) ’ ’ gland Tumor Cancer Cancer nekersa described (‘lemtse Skin cancer Cancer form ‘Kemenzina Cancer (leukemia) Cancer/swelling of , Olea Osyris Allium )is are ofen ,fruitsof drunk Shoot of pounding; procedure capensis given orally Application Zanthoxylum water is given chopping and quadripartita Clerodendrum Te leaf (ofen pounded, cold macerated and chalybeum and of tef and then boiled together plant is used by Dried fruit with mixed with Te shoot part is crushed together, powdered, mixed sativium fruit powder with with little water is honey and drunk; Embelia schimperi Its root and leaves dried leaf of boiled, mixed with Lagenaria siceraria applied on wounds Te dried fruit and nasally before food with bulb of Rootandleafofthe myricoides backed with powder ‡ NA NA AR § Fr Br NA NA ‘Kaysi nekersa PU Table 5: Continued. Lf & Rt De Rt, Br & Ψ GF Habitat

Beles (Amh) W Sb Woira (Amh) W T Fr Ns Endod (Amh) W Sb Lf & Rt NA Morocho (Sid) W T Lf Or Vernacular name L. Quechemo (Amh) W Sb Fr Or L.f. Seettaame (Sid) W T Sh Or L'Herit. opaea Forssk. Shola (Amh) W T (Wall. ex. r eu subsp. Forssk. Myrsine the plant (L.) R. Br. Phytolacca G. Don) Cif. Ficus palmata Olea Melanophloeos Ficus sur Olea capensis Scientiﬁc name of Myrsine africana Cuspidate dodecandra Oleaceae Myrsinaceae Family Phytolaccaceae 20 Evidence-Based Complementary and Alternative Medicine [65] ﬂora region (700-2200) [61] KF, GG, SD, BA (600-2500) [65] EW, TU,GD, GJ, (1200-3200) [61] AR,WG,KF,IL, GD, SU, BA, HA (1350-2900) [78] AF, EW, TU, GD GG, SD, BA, HA GG, SD, BA, HA (1200-3300) [65] EW, TU, GD, GJ, (2300-3200) [66] WG, SD, BA, HA WU,SU,WG,IL, EW, TU, GD,, GJ, TU,GD,GJ,WU, (m)) [Reference] WU, SU, AR, GG, (altitudinal range SD, HA (400-3300) Distribution in the SU,AR,IL,KF,GG, GJ,WU,SU,AR,IL, SU, GG, SD, BA, HA EW,TU,GD,GJ,SU, reported Dawa city region [52] region [52] Region [56] Region [44] [Reference] Hawassa city, Dale District, Dale District, Northwestern Seharti Samre Seharti Samre e study area Mecha District, of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] Zegie Peninsula, Ghimbi District, Ethiopia, Amhara District, Southern District, Southern Across the regions Across the regions Across the regions Tigray Region [57] Tigray Region [57] West Gojjam Zone, Administration [41] West Wollega Zone, Jeldesa Cluster, Dire Oromia Region [43] Sidama Zone, SNNP Sidama Zone, SNNP Sidama Zone, SNNP Amhara Region [42] ’ ’ ’ Cancer Cancer Cancer Cancer Cancer described ‘Nekersa ‘Nekersa Bone cancer Cancer form Breast cancer Stomach tumor ed part t P. z e y l a ni c a paste c orally orally swelling topically boiled and procedure Application afe afected area with “digne” Whole part is cancer wound Root powder is Te root part is Dried seeds are creamed on the and also applied consumed orally dressed with root andpastedonthe and applied to the Fresh shoot boiled (sulfur) is applied/ Leaf of with water is given Leaves are crushed crushed, powdered juice is taken orally is squeezed and the of curing and taken mixed in spicy stew and creamed on the Root powder mixed Te root is pounded to increase its power ‡ De AR Or & § Lf Or Rt De Rt NARt NA ‘Kaysi nekersa Rt De Rt Or Sh Or PU Table 5: Continued. Ψ GF SBNN Cancer WSbBrNANA WH WSbLfDe HG H Habitat

(Oro) Afuh (Tig) Lola (Amh) Zigba (Amh) W T Lf NA NA Boncho (Sid) Mexres (Som) Amera (Amh) Qorxobi (Oro) W H Sd De Kurnchit (Amh) W H WP De Shiishoone (Sid) Mekmeko (Amh) Huhot/Embuacho Vernacular name Este-berhan (Ge’ez) (Amh) Dhangaggoo Del. (Meisn.) L. L. Jacq. Vahl. Dammer the plant Oxygonum Pittosporum Rumex nervosus abyssinicum sinuatum Rumex abyssinicus (Tunb.) C.N.Page Scientiﬁc name of Afrocarpus falcatus Plantago lanceolata Plumbago zeylanica Polygonaceae Plantaginaceae Plumbaginaceae Podocarpaceae Family Pittosporaceae Evidence-Based Complementary and Alternative Medicine 21 3200) [65] ﬂora region WG,KF,IL,SD WG, IL, KF, HA (1200-3800)[65] EW, SU, KF, and GG, SD, BA, HA (1000-2450) [65] (1600-3050) [65] EW, TU, GD, GJ, EW, TU, GD, GJ, (1350-3300 ) [65] SU, AR, WG, KF, (1500-3350) [65] (m)) [Reference] GD,TU,WU,GJ, SD, BA, HA (850- WU,SU,AR,WG, (altitudinal range IL, KF, SD, BA, HA probably elsewhere Distribution in the GD, GD/GJ, GJ, SU, WU,SU,AR,IL,KF, TU,GD,GJ,SU,AR, , Zone on [55] [51] i g reported Re Region [79] Region [50] Region [67] Region [67] [Reference] Shewa Dega Damot Dale District, Borana Zone, Wondo Genet Libo Kemkem Libo Kemkem Debre Libanos e study area of Ethiopia [45] District, Sidama District, Amhara District, Amhara District, Amhara Ethiopia, Oromia monastery, North Across the regions Blue Hora District, Bale area, Southeast Oromia Region [53] Zone, SNNP Region Oromia Region [49] Sidama Zone, SNNP ’ (Cancer) ’ Cancer Cancer Cancer Cancer 'nekersa’ described ‘Nekersa Swelling by Bone cancer Cancer form Breast cancer ‘Kemenzina ‘Nekersa then wound. Used in bandage Plectranthus and eaten externally and drunk and drunk procedure and dressed Application Te leaves are Te leaves are ingiarius Te leaves are the solution is of and mixed with other herbs and syringe or other applied topically pounded, fltered will be macerated on the swelling as combination with certain amount of and then creamed butter and applied the opening of the domestic material; Leaves of the plant crushed, powdered pounded to make a of the wound using solution and half of Te fruit is crushed are mixed with leafs Te plant is crushed crushed and applied small glass is drunk; the residue is put on Leafs/stem and bark Te leaf is powdered applied into the hole ‡ Or AR § Lf De Lf Or & In Lf Or Br PU Table 5: Continued. Lf, St & Ψ GF WHLfDe Habitat

(Amh) W Cl Etse Siol Fiide (Sid) W Cl Lf De (Amh/Ge’ez) Sire bizu (Amh) W H Rt De Nech yeazo Areg YeazoAreg(Amh) W Cl WP De Vernacular name L. Roman (Amh) HG Sb Fr Or Dill. Forssk. Perr. and Guill. Fresen. the plant &A.Rich. Talictrum Ranunculus (Roxb.) Kurz Clematis simensis hirsuta./ multifdus Clematis bracteata Scientiﬁc name of Punica granatum Clematis hirsuta var. rhynchocarpum Family Punicaceae Ranunculaceae 22 Evidence-Based Complementary and Alternative Medicine ﬂora region SD, BA, HA, BA, HA, KF, SD (1900-3300) [66] EW, TU, GD, GJ, GJ, WG, SU, AR, (2450-3250) [66] WU,SU,AR,KF, AF, EW, TU, GD, GD, GJ, WG, SU, (1000-2850) [68] (m)) [Reference] WU, SU, GG, BA, HA (0-2400) [66] EW, TU, GD, WU, EW, TU, GD, WU, (altitudinal range Distribution in the IL, GG, SD, SD-BA, GJ, SU, AR, HA, BA HA (400-1600) [66] AR, BA, HA, IL, KF, SD (1700-2500) [66] reported [Reference] e study area of Ethiopia [45] of Ethiopia [45] of Ethiopia [45] Ghimbi District, Across the regions Across the regions Across the regions Across the regions Gubalafo District, North Wello Zone, Yalo Distric t, Z one of Ethiopia [45, 80] 4, Afar Region [64] West Wollega Zone, Oromia Region [43] Amhara Region [69] ’ ’ ;Tumors ’ nekersa described ‘Nekersa ‘Minshiro ‘Minshiro hyperplasia, Lung cancer hypertrophy Cancer form Breast cancer prostate gland Internal cancer Benign prostatic Nekersa bark is orally Used in procedure honey, then taken orally Application afected part Te root part is creamed on the and mixed with other herbs and applied topically 3daysandtaken combination with P. Af r i c a na crushed in water for Te root is pounded pounded, juiced and Liquid extracts from ‡ AR § Rt De Rt Or PU Table 5: Continued. Ψ GF W Sb Lf Or NA WTRt&FrNANA WH Habitat

NA Kega (Amh) W Sb Rt & Fl NA NA Kosso (Amh) W T Rt De Qurqura (Oro) Geba (Amh/Age) Vernacular name Tikur Enchet (Amh) W T Br Or L. Enchibir (Amh) L. Desf. Lam. Lindley Ziziphus the plant Rosa abyssinica Prunus Africana (Bruce) J.F.Gmel. (Hook. f.) Kalkm Rubia cordifolia Scientiﬁc name of Hagenia abyssinica Ziziphus mauritiana spina-christi Family Rhamnaceae Rosaceae Rubiaceae Evidence-Based Complementary and Alternative Medicine 23 1550) [66] SD, BA, HA AR, BA, HA ﬂora region TU, GD, SU, (800-1650) [61] (1300-3100) [61] GJ, WG, SU, KF, GG, SD, BA, HA (500-2900) [66] BA,WU,GJ,TU GD,GJ,WG,KF (1250-2800) [68] (1680-3000) [66] GD, EW, SU, HA, TU, WU, GD, GJ, (m)) [Reference] GG, AR, HA, BA, EW, TU, GD, WU, EW, TU, GD, WU, (altitudinal range GG, BA, HA (900- Distribution in the WG,SU,AR,IL,KF, SD (1600-2900) [66] SU,AR,GJ,WG,KF, , Zone [45, 52] reported region [52] Region [55] [Reference] Shewa Dale District, Dale District, Dale District, Dalle District, Fiche District, Debre Libanos e study area of Ethiopia [45] of Ethiopia [45] monastery, North Across the regions Across the regions Region [52, 55, 56] Region; Across the regions of Ethiopia Oromia Region [53] Oromia Region [54] Sidama Zone, SNNP Sidama Zone, SNNP Sidama Zone, SNNP Sidama Zone, SNNP cancer Cancer Cancer Cancer Cancer Cancer Cancer described Lung cancer Unidentifed Cancer form Breast cancer Hawassa city and swellings/ Neck Cervical and rectal is drunk Used in Used in procedure given orally given orally taken orally Application Te leaf part dried fruit of macerated and macerated and with water and Dried leaf with powdered, cold other herbs and other herbs and applied topically powdered, mixed combination with combination with Myrsine africana, Te leaves are dried, ‡ AR § Lf NA NA Rt NA NA NA NA NA PU Table 5: Continued. Ψ GF WSb Habitat

Ittancha (Sid) Oloncho (Sid) W Sb Fr NA NA Kitkita (Amh) Queret (Amh) W T Lf Or Yes et lib (A mh) W H F l Or Bunguude (Sid) W Sb Lf Or Delashut (Amh) W H Lf & Fl De Gadda (Sid/O ro) W T Lf Or Vernacular name Baill. Engl. (Engl.) Hochst. hicarpa (Hochst.) Dale Decn. Benth. amp the plant Dodonaea Fagaropsis Sideroxylon h Zanthoxylum Craterostigma R angustirolia L. f. chalybeum pumilum angolensis fstulosa Scientiﬁc name of oxyacanthum Osyris quadripartita Sapindaceae Sapotaceae Santalaceae Scrophulariaceae Family Rutaceae 24 Evidence-Based Complementary and Alternative Medicine = Ψ GF [61] [61] [66] ﬂora region to 2300) [65] EW, TU, GD, KF,SD,BA,HA WG,SU,AR,IL, EW,TU,GD,SU, EW, TU, GD, GJ, GD-GJ, WU, SU, AF, EW, TU, GD, WU,SU,KF,GG, (1650-2800) [66] (m)) [Reference] WG, KF, GG, SD, EW, WU, SU, AR, WG, GG, SD, BA, (altitudinal range SD, BA (1100-2300) SD, HA (600-2700) BA, HA (600-2650) HA (300-2400) [61] Distribution in the HA (250-2800) [66] AF, EW, TU,GD, GJ, GD, GJ, WG, IL, KF, SD, HA (sea level up WU, SU, SU-AR, GJ, WG, IL, KF, GG, SD, [31, 45] ss the regions reported o Region [58] [Reference] r Fiche District, Fiche District, e study area Region [47, 48] of Ethiopia [45] of Ethiopia [45] of Ethiopia [80] Jimma Zone and (KT) Zone, SNNP Across the regions Across the regions Ac Region; Across the Ada’a District, East regions of Ethiopia Bale Zone, Oromia Kembatta Tembaro North Shewa Zone, North Shewa Zone, Oromia Region [46] Oromia Region [46] Shewa Zone Oromia n above 1000 m contour; GD: Gondar region; WG: rerge region. ’ ’ ’ (Or=oral; De=dermal; In=insertion; Ns=nasal); Cancer Cancer Cancer described ‘nekersa ‘Nekersa ‘Nekersa Swelling by Cancer form , font 10, within single inverted commas throughout the document. Italic =application route ‡ AR swelling procedure Application afected area pasted on the Te leaves are Te leaf part is warmed up and applied to the skin the powder is then Te leaf is pounded collected and dried, and creamed on the ‡ local names: Ge’ez: Ge’ezinga; Amh: Amharic; Tig: Tigrigna; Oro: Afaan Oromoo; Sid: Sidamu-afoo; Age: AR

: Key § Lf De PU Table 5: Continued. Ψ GF egion; IL: I1ubabor region; GG: Gamo Gofa region; SD: Sidamo region; HA: Ha SLDN Breastpain WSbLfDeNA W Sb St & Br Or Decoction is drunk Cancer W Cl Rt & Fl NA NA Habitat

(Amh) (Amh) Ziza (Kam) Yedega Abalo Kelkalo (Oro) Tikur Embuay Gizawa (Ama) W Sb NA NA NA Waginos (Ge’ez) Gindosh (Amh) Timbaho (Amh) HG H Lf De Asserkush (Amh) W Cl Lf De Vernacular name L. Ch’amare (Oro) W H Fr NA NA J.F. (Steud. L. ex Jacq. Mill. Brucea the plant Drummond ex. A. Rich.) cyphopetalum Cyphostemma Cyphostemma (L.) Dunal in DC. antidysenterica Wild&Drummond Solanum gigantum adenocaule Scientiﬁc name of Nicotiana tabacum (Fresen.) Descoings (Lf-leaf; Rt=root; Br=bark; Fl; fower; Fr=fruit; Sd=seed; Lx=latex; Sh=shoot; St=stem; WP=whole part); Withania somnifera Descoings exWild & (T=tree; Sb=shrub; H=herb; Cl=climber/liana); habitat (W=wild; HG=home garden); =partused § Solanaceae Vitaceae Family Simaroubaceae Zygophyllaceae Tribulus terrestris Note: PU Agewugna; Kam: Kambatissa; Som: Somali; NA= notTU: available. Tigray Note: region vernacular above names 1000 of m malignancies/cancerWelega contour; are region; AF: written KF: Afar in Kefa region small region; below caps, AR: 1000 Arsi m region; contour BA: to Bale Eritrean region; border GJ: in Gojam the r east and Harerge border in the south; WU: Welo regio growth forms Evidence-Based Complementary and Alternative Medicine 25

manuscript. All authors have read, approved, and agreed on [17]H.Ma,C.L.Carpenter,J.Sullivan-Halley,andL.Bernstein, submission of the fnal manuscript. “Te roles of herbal remedies in survival and quality of life among long-term breast cancer survivors - results of a prospec- tive study,” BMC Cancer, vol. 11, article no. 222, 2011. Acknowledgments [18] WHO, WHO traditional medicine strategy 2014–2023,World Health Organization, Geneva, 2013. Te authors would like to appreciate Mr. Girma Gudesho, lecturer at Mizan-Tepi University and a Ph.D. candidate at [19] O. Olaku and J. D. White, “Herbal therapy use by cancer patients: a literature review on case reports,” European Journal AAU, for kindly generating the map shown in Figure 2 using of Cancer,vol.47,no.4,pp.508–514,2011. ArcGIS. [20] D. Sakarkar and V. Deshmukh, “Ethnopharmacological review of traditional medicinal plants for anticancer activity,” Interna- References tional Journal of PharmTech Research,vol.3,no.1,pp.298–308, 2011. 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