oua eiia lnsi otadadKnso,Jmia Compiled and Edited by Ina Vandebroek and David Picking Popular Medicinal in Portland and Kingston, About the Editors

Ina Vandebroek, Ph.D. is a biologist and David Picking, Ph.D. came to Jamaica as a ethnobotanist. She is the Matthew Calbraith Commonwealth Scholar, completing his Popular Medicinal Plants in Perry Assistant Curator of Economic and doctorate in biochemistry at The University of the Program Director at The New York West Indies (UWI), having previously graduated Botanical Garden. Ina is the principal investigator as a medical herbalist and naturopath from the Portland and Kingston, Jamaica of the research project “Comparative Exploration University of Westminster’s School of Integrated of Plants and Local Knowledge in Portland Health, London. David is currently a Research Parish, Jamaica,” funded by the National Fellow at the Natural Products Institute, UWI, Geographic Society Committee for Research where his research focuses on the contemporary and Exploration. She studied Biology at the use of medicinal plants by Jamaicans and University of Ghent in Belgium and holds a Ph.D. screening medicinal plants for their potential in Medical Sciences from the same university. interaction with pharmaceutical drugs, a key After earning her doctorate, Ina specialized in aspect of medicinal safety. David was part , the science that investigates how of a team that successfully undertook a TRAMIL people perceive, use and manage their plant survey and completed Jamaica’s first resources in traditional, culturally appropriate contribution to the TRAMIL database and online ways. Since 2000, she has collaborated with plant pharmacopeia (www.tramil.net), adding to traditional healers from indigenous communities the body of knowledge from over 50 surveys in the mountain regions and lowland rainforest in completed across the Caribbean to date (the , and with Dominicans living in the name TRAMIL is derived from “Traditional and who in the Islands”). self-medicate with plants. Ina documents the traditional knowledge, beliefs and practices of these communities to help preserve their cultural heritage and contribute to plant conservation. She also trains medical students and healthcare providers in developing a more culturally sensitive clinical practice.

This book is for educational purposes only. Compiled and Edited by Ina Vandebroek and David Picking Contributors: The editors greatly acknowledge the valuable assistance of the following scientists in making this research project a success and would like to extend special gratitude to them for their contributions: Stacey Aiken, M.Sc. helped with ÀHOGZRUNLQ.LQJVWRQPatrick Albert Lewis, M.Sc., Andreas Oberli, B.Sc., Richard Abbott, Ph.D. and Robbin Moran, Ph.D. were always there to assist with plant LGHQWLÀFDWLRQSylvia Mitchell, Ph.D. oversaw the project in Jamaica and advised on the plant monographs together with Rupika Delgoda, PhD. Brian Boom, Ph.D. oversaw project progress at The New York Botanical Garden and advised together with Elizabeth Kiernan, B.Sc. on GIS conservation analysis of Jamaican plant .

Funding: Research activities and printing of this book were funded by Grant # 9339-  ´&RPSDUDWLYH([SORUDWLRQRI 3ODQWVDQG/RFDO.QRZOHGJHLQ3RUWODQG3DULVK Jamaica”) from the National Geographic Society Committee for Research and Exploration (CRE) to Ina Vandebroek.

Intellectual Property Rights (IPR): The information in this book pertaining to the uses of medicinal plants or bush medicines in Windsor Forest (Portland Parish) and 3D\QH/DQG .LQJVWRQ UHSUHVHQWVWKH7UDGLWLRQDO.QRZOHGJH 7. DQG,QWHOOHFWXDO Property (IP) of these communities and must be respected as such. It should not be used for the development of any commercial product without the Prior Informed Consent (PIC) of the communities and their agreement on appropriate mechanisms RI $FFHVVDQG%HQHÀW6KDULQJDVSHUWKH&RQYHQWLRQRQ%LRORJLFDO'LYHUVLW\ &%' 1992) and the Nagoya Protocol (2010). The publication of the traditional knowledge in this book establishes “prior art” and “prior knowledge” that is protected under international law from unauthorized patenting.

Disclaimer: This book is intended as a reference work, in which the information provided herein is meant only for educational purposes. This information has been recorded in an attempt to preserve and return traditional knowledge about the uses of medicinal plants, or bush medicines, to the participating communities in Windsor )RUHVW3RUWODQGDQG3D\QH/DQG.LQJVWRQ$VVXFKWKLVLQIRUPDWLRQLVQRWWREH used as a medical manual for self-treatment with plants, or as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. In matters of SHUVRQDO KHDOWKFDUH D TXDOLÀHG PHGLFDO VSHFLDOLVW VKRXOG EH FRQVXOWHG 'HOD\ LQ seeking appropriate medical care may worsen illness. The editors do not make any claims regarding the accuracy, completeness, timeliness, controversial nature, nor XVHIXOQHVVRI DQ\LQIRUPDWLRQFRQWDLQHGRUUHIHUHQFHGLQWKLVERRNVLQFHVFLHQWLÀF knowledge changes frequently.

Copyright: No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the editors.

Citation: Vandebroek I, Picking D (Eds.) (2016) Popular medicinal plants in Portland DQG.LQJVWRQ-DPDLFD.LQJVWRQ3HDU7UHH3UHVV

Popular Medicinal Plants in Portland and Kingston, Jamaica | 1 Table of Contents

Acknowledgements ...... 4 Introduction ...... 6 Geographic location of research ...... 7 Research methodology ...... 8 A) Ethnobotanical interviews ...... 8  % 3ODQWFROOHFWLRQDQGLGHQWLÀFDWLRQ C) Data entry and analysis ...... 10  ' 5HYLHZRIWKHVFLHQWLÀFOLWHUDWXUH How to use this book ...... 11 Future studies ...... 12 Selected bibliography ...... 13

Plant monographs Bitter orange: Citrus x aurantium L...... 14 Breadfruit: Artocarpus altilis (Parkinson) Fosberg ...... 21 Calabash: Crescentia cujete L...... 25 Cassava marble: Jatropha gossypiifolia L...... 31 Castor oil: Ricinus communis L...... 37 Cerasee: Momordica charantia L...... 46 Coconut: Cocos nucifera L...... 54 Dandelion: Senna occidentalis (L.) Link ...... 63 Fevergrass: Cymbopogon citratus Stapf ...... 72 Fitweed: Eryngium foetidum L...... 78 Ginger: =LQJLEHURIÀFLQDOH Roscoe ...... 84 Guinea henweed: Petiveria alliacea L...... 91

2 | Popular Medicinal Plants in Portland and Kingston, Jamaica Holy thistle: Argemone mexicana L...... 97 Jack-in-the-bush: Chromolaena odorata (L.) 50.LQJ +5RE  .LQJRIWKHIRUHVW Senna alata (L.) Roxb...... 112 of life: Bryophyllum pinnatum (Lam.) Oken ...... 117 Noni: Morinda citrifolia L...... 124 Pennyroyal: brownei 6Z .XQW]H Pimento: Pimenta dioica (L.) Merr...... 138 Ramgoat regular: Turnera ulmifolia L...... 143 Rice and peas: +RRN $UQ Semi-contract: Dysphania ambrosioides (L.) 0RV\DNLQ &OHPDQWV Sinkle bible: Aloe vera (L.) Burm.f...... 164 Soursop: Annona muricata L...... 173 Susumba: Solanum torvum Sw...... 182

Index of plant names and health conditions ...... 188

Popular Medicinal Plants in Portland and Kingston, Jamaica | 3 Acknowledgments

As humans, we excel when we put our Juney asked me “isn’t this beautiful?” I strengths together. The richest collabora- knew then and there that I wanted to tions are those that transcend boundaries. learn more about the plants growing in 5HJDUGOHVV RI  ÀHOG RI  RFFXSDWLRQ RU those mountains, and their uses. I wanted culture, they bring together like-minded to know if other people like Juney, who individuals, who are driven by a similar roamed the bush and worked the land, passion for what they do, even when they loved their hills so much. grew up on opposite sides of the planet. The wisdom that complements us is like a The National Geographic Society puzzle, one that can only be solved when supported this idea, and collaborators all the pieces, held by different individu- from Jamaica and the University of als, come together. the West Indies partnered to develop it further. Together we embraced the Wisdom of plants comes in many forms. opportunity to do research about plants The farmer, man or woman, who works DQGSHRSOHLQ.LQJVWRQDVZHOOWREHWWHU the land stands each day in a living and understand the rural-urban connections breathing laboratory. Just like the student of plant knowledge and use. Ultimately, who attends school to learn, the bush all this work has resulted in this book. is a very powerful teacher. The farmer Collaborating with the University of the observes the seasons, sky and stars, West Indies, Mona Campus, has been an phases of the moon, and the behavior incredibly rewarding experience. of the animals in the bush. Learning about plants is so much more than just So in 2016, here we are, and we could not learning about plants. It is ultimately have done this without you. Thank you, about learning how humans, plants, and Juney, for taking me up that mountain in the environment depend on each other 2010. Thank you, Calvin, for being such for survival. The farmer understands that a great cook of real Jamaican food, and humans are but a speck in the web of life. for making me laugh with your stories. (YHQZLWKRXWDQRIÀFLDOGHJUHHIDUPHUV Thank you Peter, for taking me deep into have already graduated with honors from hills to look for blossoms on way bush school, and - faced with continu- up in the , and for your incredible ous challenges brought about by climate wisdom about plants. The same goes change, drought, crop failure or illness - for Dalman and many others. Thank continue to deepen their wisdom every you, Enny Penny, for rhyming about day. the bush like no one else. Remember, Straw, that I am looking forward to your :KHQ , ÀUVW DUULYHG LQ :LQGVRU )RUHVW spoken-word performance. Thank you, in Portland parish in July 2010, I went Jason, for being the best shoulder to lean on a bush trip with Juney (Edna Pearcy). on and for watching over me in so many We climbed a hill, and there, overlook- ways. Thank you, Professor Davidson, ing a green oasis of bush in front of us, for connecting us with the community

4 | Popular Medicinal Plants in Portland and Kingston, Jamaica LQ 3D\QH /DQG WKURXJK WKH RIÀFH RI  about the bush, and its secrets, held by The Most Honorable Portia Simpson the moon and the stars. Miller, and to Mr. Monroe and Hosanna, IRU PDNLQJ RXU UHVHDUFK LQ .LQJVWRQ It is my sincere hope that this book will possible. stimulate Jamaican youth to follow in the footsteps of their farming relatives, A huge thank you goes to everybody and learn from them as much as I did. in the communities of Windsor Forest Lesson number one, always walk with a and Payne Land, for kindly sharing clean heart, watch the moon, and don’t their knowledge and stories about bush forget to drink your jelly water. The true medicines. riches of Jamaica are in the land. This land will require continued attention and We are all extremely grateful for funding protection from the government and the from the National Geographic Society community to enable it to continue to be Committee for Research and Exploration as precious as it is today. (CRE). Ina Vandebroek, 12 May 2016. My parents have instilled in me a sense of wonder for nature since I was a baby Windsor Forest, Portland Parish. who proudly posed in front of the camera holding a little daffodil, even though I could barely walk. Jos and Rosa 9DQGHEURHN9HUKRHYHQ ZHUH WKH ÀUVW organic kitchen-garden farmers in my life. They continue to be so today, at the age of seventy-six and seventy-two. Their VWUDLJKWIRUZDUGDQGÀUPSRVLWLRQLQOLIH has given me the endurance to take on any task.

Michael J. Balick, Ph.D. continues to be a great source of inspiration to me. He carries forward the legacy of the founding father of modern ethnobota- ny, Richard Evans Schultes, Ph.D. It is a SULYLOHJHWRNHHSOHDUQLQJIURPKLVÀHOG experiences and wisdom.

This book is dedicated to the people of Jamaica, their stories, their humor, their language, their creativity and skills, and last but not least, their knowledge of plants for , roots tonics and culinary delights. May you always carry forward the melodic Patois language

Popular Medicinal Plants in Portland and Kingston, Jamaica | 5 Introduction

7KH ÁRUD RI -DPDLFD LV TXLWH ULFK DQG people’s cultural knowledge about plants, diverse, with 3,218 distinct species and use this information as a tool to educate varieties of plants. The country’s the next generations, and ultimately draw ÁRUD KDV D KLJK GHJUHH  SHUFHQW  RI  attention to the importance of biologi- endemism, a term referring to plants that cal diversity in Jamaica. The information only occur in Jamaica and nowhere else JDWKHUHG LQ WKH ÀHOG WKURXJK RULJLQDO (Acevedo-Rodríguez and Strong, 2008). research was supplemented with a review Seventy-three percent of Jamaicans RI WKHVFLHQWLÀFOLWHUDWXUHFRQFHUQLQJWKH popularly use medicinal plants to treat safety of use and clinical effectiveness of illness and maintain health (Picking et al., the collected plants. 2011); and at least 334 species growing in -DPDLFDKDYHEHHQLGHQWLÀHGDVPHGLFLQDO (YHQ WKRXJK WKH VSHFLÀF IRFXV RI  WKLV plants (Mitchell and Ahmad, 2006). research project was on medicinal plants and their uses to treat health problems, Medicinal plants in Jamaica are commonly it soon became clear at the start of the called “bush medicines”, regardless of project that people possess a much their habit as , shrubs, trees, grasses broader knowledge base about plants. This or vines. This book is a compilation of knowledge transcends a narrow focus on FXOWXUDODQGVFLHQWLÀFLQIRUPDWLRQRQ medicines and health, including the use of popular medicinal plants that are used plants for spiritual purposes, as regular teas today in urban Jamaica (Payne Land, and wild foods, as utensils and tools, and .LQJVWRQ  DQG UXUDO -DPDLFD :LQGVRU to maintain healthy animals. These uses Forest, Portland parish). It is the result are listed in the book under “cultural uses of ethnobotanical research carried out and beliefs”, as they embody important in 2014 and 2015, during which we cultural dimensions of plant knowledge. interviewed 79 people in Payne Land As such, this cultural knowledge adds and 40 people in Windsor Forest about depth to medicinal plant use data for their knowledge and use of medicinal human health, and should be valued on its plants. Information from interviews was own merit. As ethnoscientists exploring entered into databases to record common the links between traditional knowledge plant names, and the medicinal uses of DQG VFLHQWLÀF NQRZOHGJH ZH ORRN DW WKHVHSODQWV6XEVHTXHQWO\ÀHOGWULSVZHUH plants as more than chemical factories made with knowledgeable people in the for which the biological activity needs to surrounding areas of the communities to be corroborated or refuted by laborato- collect plants, make herbarium specimens, ry data. Instead, we equally value the and identify the botanical names of these “emic” or insider’s perspective, an insight plants, a methodology called botanical borrowed from anthropological study. authentication. Ultimately, all knowledge is useful when considered within its own cultural context. The goal of this research was to preserve Cultural beliefs are also important agents

6 | Popular Medicinal Plants in Portland and Kingston, Jamaica of transmission, and thus preservation, of natural drugs. plant knowledge for future generations. Therefore, this book does not shy away Geographic location of research from talking about spiritual uses of bush medicines, as they not only represent the Our research efforts were focused in reality of life in contemporary rural and two communities, one in rural Jamaica urban Jamaica, but also put health in a (Windsor Forest, Portland parish), and one FRQWH[W DV GHÀQHG E\ WKH :RUOG +HDOWK in urban Jamaica (Payne Land, downtown Organization, which is “not merely the .LQJVWRQ  )LJXUH  VKRZV WKH ORFDWLRQ absence of disease, but a state of complete RI  :LQGVRU )RUHVW DQG .LQJVWRQ RQ D physical, emotional and social well-being.” map of Jamaica (map courtesy of Logan Sander, M.Sc.). Plants can heal or poison, depending on the species, its chemical components, prepara- Windsor Forest in Portland parish is a rural tion and dosage used. The consumption subsistence farming community of about of herbal remedies to treat illness is often 1000 residents. The community is located considered harmless because of their at the fringes of the John Crow Mountains, natural origin. However, worldwide, some about 2 kilometers inwards from the herbal products have been reported to coastal road between Boston Bay and induce toxicity. Many plants, including Long Bay, and about 30 kilometers from several that are listed in this book, have the town of Port Antonio. No biomedical been understudied for their biological healthcare is available in the community. activity and safety of use. For those plants, The nearest hospital is located in Port additional research is required to clarify Antonio, but for serious health problems issues of safety, toxicity, proper dosage, SHRSOH QHHG WR WUDYHO WR .LQJVWRQ WR contamination, and potential interactions receive more specialized biomedical care. with synthetic (pharmaceutical) and other Payne Land is an inner-city community in

)LJXUH/RFDWLRQRIWKHVWXG\DUHDV

Popular Medicinal Plants in Portland and Kingston, Jamaica | 7 ‹†•‘” ‘”‡•–‹‘”–Žƒ†’ƒ”‹•Š‹•ƒ”—”ƒŽ•—„•‹•–‡ ‡ˆƒ”‹‰ ‘—‹–›‘ˆ ƒ„‘—–ͳͲͲͲ”‡•‹†‡–•ǤŠ‡ ‘—‹–›‹•Ž‘ ƒ–‡†ƒ––Š‡ˆ”‹‰‡•‘ˆ–Š‡ ‘Š”‘™ ‘—–ƒ‹•ǡƒ„‘—–ʹ‹Ž‘‡–‡”•‹™ƒ”†•ˆ”‘–Š‡ ‘ƒ•–ƒŽ”‘ƒ†„‡–™‡‡‘•–‘ƒ› ƒ†‘‰ƒ›ǡƒ†ƒ„‘—–͵Ͳ‹Ž‘‡–‡”•ˆ”‘–Š‡ ‹–›‘ˆ‘”––‘‹‘Ǥ‘„‹‘‡†‹ ƒŽ Š‡ƒŽ–Š ƒ”‡‹•ƒ˜ƒ‹Žƒ„Ž‡‹–Š‡ ‘—‹–›ǤŠ‡‡ƒ”‡•–Š‘•’‹–ƒŽ‹•Ž‘ ƒ–‡†‹‘”– –‘‹‘ǡ„—–ˆ‘”•‡”‹‘—•Š‡ƒŽ–Š’”‘„Ž‡•’‡‘’Ž‡‡‡†–‘–”ƒ˜‡Ž–‘‹‰•–‘–‘ ”‡ ‡‹˜‡‘”‡•’‡ ‹ƒŽ‹œ‡†„‹‘‡†‹ ƒŽ ƒ”‡Ǥƒ›‡ƒ†‹•ƒ‹‡”Ǧ ‹–› ‘—‹–›‹ †‘™–‘™‹‰•–‘ǡ™‹–Š‹–Š‡ƒ”‹•Š‘ˆ–Ǥ†”‡™ǡ™‹–Šƒ’‘’—Žƒ–‹‘‘ˆƒ”‘—† ͵ǡͲͲͲ‹Šƒ„‹–ƒ–•Ǥ

‡•‡ƒ” Š‡–Š‘†‘Ž‘‰› –Š‘„‘–ƒ‹ ƒŽˆ‹‡Ž†™‘”–‘‘’Žƒ ‡ˆ”‘ʹͲͳͶ–‘ʹͲͳͷǤŠ‡‡–Š‘†‘Ž‘‰› ‘•‹•–‡† ‘ˆ‹–‡”˜‹‡™‹‰ƒ†—Ž–•™Š‘Šƒ˜‡’”‡˜‹‘—•Ž›—•‡†„—•Š‡†‹ ‹‡•ǡ–‘”‡ ‘”† ‘‘ ’Žƒ–ƒ‡•ƒ†‡†‹ ‹ƒŽ—•‡†ƒ–ƒǡ ‘„‹‡†™‹–Š„‘–ƒ‹ ƒŽ‡–Š‘†•–‘‹†‡–‹ˆ› ’Žƒ–•’‡ ‹‡•ƒ† ”‘••ǦŽ‹–Š‡‹” ‘‘ƒ‡•™‹–Š–Š‡‹”• ‹‡–‹ˆ‹ ƒ‡•Ǥ  ‹†•‘” ‘”‡•–ǡ ƒƒ†‡„”‘‡ ‘’Ž‡–‡†ʹͲ’Š‘–‘‹–‡”˜‹‡™•ƒ†ʹͲ•‡‹Ǧ •–”— –—”‡†‹–‡”˜‹‡™•ȋ™‹–ŠʹͲ‡ƒ†ʹͲ™‘‡ȌǤ ‹‰•–‘ǡƒ–‡ƒ‘ˆ͵’‡‘’Ž‡

͵ GRZQWRZQ.LQJVWRQZLWKLQWKHSDULVKRI  7KH PDLQ DSSURDFK WR ÀQG SHRSOH WR St. Andrew, with a population of around interview was through referrals made by 3,000 inhabitants. others who had previously completed an interview. These people were Research methodology subsequently approached in person and asked if they wanted to participate in :HFDUULHGRXWHWKQRERWDQLFDOÀHOGZRUN the study. If they agreed, details about during 2014 to 2015. The methodology the study were explained and they were consisted of interviewing adults who have asked to provide their Prior Informed previously used bush medicines, to record Consent (PIC) before the interview was common plant names and medicinal use started. data, combined with botanical methods to identify plant species and cross-link During photo interviews, the interview- WKHLUFRPPRQQDPHVZLWKWKHLUVFLHQWLÀF er showed a picture of each plant, and names. In Windsor Forest, Ina Vandebroek YHULÀHGLIWKHSODQWZDVUHFRJQL]HG,I completed 20 photo interviews and 20 DSHUVRQFRQÀUPHGNQRZLQJWKHSODQW semi-structured interviews (with 20 men information was recorded about its DQG  ZRPHQ  ,Q .LQJVWRQ D WHDP common name(s), medicinal uses, and of 3 people (Ina Vandebroek, David other cultural information about the Picking and Stacey Aiken) conducted 41 species. photo interviews and 38 semi-structured interviews (with 40 men and 39 women). During semi-structured interviews, the interviewer asked questions based on a A) Ethnobotanical interviews previously developed questionnaire, and ,Q :LQGVRU )RUHVW DQG .LQJVWRQ ZH recorded the answers in writing. The carried out two types of interviews ÀUVW TXHVWLRQ LQYROYHG IUHHOLVWLQJ DOO (Alexiades, 1996): (1) Photo interviews the plants a person knew, together with featuring 45 plant species growing their medicinal uses, preparation and in Jamaica, and; (2) semi-structured mode of administration. interviews based on a questionnaire containing 36 questions. Participants for Ethics Committee approval for this interviewing were recruited according research project was obtained from the to the following inclusion criteria: (a) University of the West Indies, Mona Residency in the community; (b) age Campus. 18 years or older; (c) having previous- ly used medicinal plants for treatment % 3ODQWFROOHFWLRQDQGLGHQWLÀFDWLRQ RI  KHDOWK SUREOHPV G  FRQÀUPLQJ D Interviews yielded extensive lists of willingness to be interviewed. We tried common plant names in both communi- to balance gender and interview equal ties. The next step was to verify the numbers of men and women. We did proper botanical identity of each bush QRW VSHFLÀFDOO\ ORRN IRU SHRSOH ZKR remedy through original botanical were plant specialists or healers; rather, ÀHOGZRUN DQG XVH RI  SODQW LGHQWLÀFD- anyone who said they had previous- tion techniques to associate a common ly used bush medicine was considered SODQWQDPHZLWKDVFLHQWLÀF ERWDQLFDO  TXDOLÀHGWRSDUWLFLSDWHLQDQLQWHUYLHZ name. Common plant names are known

8 | Popular Medicinal Plants in Portland and Kingston, Jamaica to vary considerably across countries, as and/or fruiting, as these details of the well as within different regions of the plant material are important for its same country. In popular books and on authentication by means of botanical WKHLQWHUQHWLWLVQRWXQFRPPRQWRÀQG NH\VLQVFLHQWLÀFERRNVVXFKDV$GDPV QRPHQWLRQRISODQWLGHQWLÀFDWLRQDQG (1972) for Jamaica. one is only left guessing if and how the authors were able to authenticate the In total, we collected 224 different plants for which they are describing the voucher numbers (654 plant specimens) uses. It is a common mistake to impose that were dried, pressed, and deposited VFLHQWLÀF QDPHV RQWR FRPPRQ SODQW at the herbarium of the Universi- QDPHVZLWKRXWERWDQLFDOYHULÀFDWLRQRI  ty of the West Indies (UWI) and the actual plant material. Without properly herbarium of The New York Botanical LGHQWLÀHG SODQW VSHFLHV WKH UHVXOWV RI  Garden (NYBG), and will be distribut- any study are at best dubious, and at ed to the Institute of Jamaica (IOJ) as worst useless. well. The NYBG collection duplicates will be digitized and made freely After completing the interviews, we available on-line on the C.V. Starr compiled a list of plants by common Virtual Herbarium (http://sciweb.nybg. name, and ranked them according to org/Science2/VirtualHerbarium.asp. how frequently they were mentioned html) in the near future. To date, at least by all study participants. Next, guided 90 percent of the collection has been by a knowledgeable person from LGHQWLÀHG WR ERWDQLFDO VSHFLHV QDPH the community, we set out into the This collection contains more than 145 surroundings of each community to botanical species that are cross-linked collect all the plants that were mentioned with their common names. independently by at least three people during interviews. In addition, plants A permit for plant collection was indicated as medicinal by the guide were obtained from the National Environ- collected as well, even if they were not mental Protection Agency (NEPA). previously mentioned during interviews. :KLOH LQ WKH ÀHOG FROOHFWLQJ SODQWV During plant collection, the researcher Ina Vandebroek took pictures of each prepared a voucher number consist- species to develop a comprehensive ing of 3 to 4 specimens of the same photo library (containing more than species that are pressed and stored in 2000 pictures) that serves as visual individual newspaper until transferred support material for our data in this to a herbarium where they are properly book. mounted on special paper. This voucher number is documented in a notebook $ VFLHQWLÀF ERWDQLFDO  SODQW QDPH containing descriptive data about always consists of three parts: (a) A the plant and locality information. A name (always capitalized); (b) a voucher specimen can be an entire species name (never capitalized); and, (c) (for small plant species), or a branch of an author name (from the person who a bush or . It is important to look ÀUVW GHVFULEHG WKH VSHFLHV LQ VSHFLDO- IRUIHUWLOHVSHFLPHQVWKDWDUHÁRZHULQJ L]HG VFLHQWLÀF OLWHUDWXUH  )RU H[DPSOH

Popular Medicinal Plants in Portland and Kingston, Jamaica | 9 Solanum torvum Sw., consists of the genus (PubMed, Biological Abstracts, Science name Solanum, the species name torvum, Direct, Google Scholar) for clinical and the abbreviated author name Sw. and safety information about each Note that the botanical name (minus plant species, using the following the author name) is always italicized. key-words: “adverse”, “safety”, “toxic”, The correct spelling of botanical “toxicity”, “interaction”, “clinical”, QDPHV LQ WKLV ERRN ZDV YHULÀHG ZLWK “poison”, “poisoning”, “breastfeeding”, The International Plant Names Index “pregnancy”, “medicine”, “medicinal”. (www.ipni.org). Denomination of plant Database searches with these key-words families followed the Angiosperm OHG WR LQGLYLGXDO VFLHQWLÀF DUWLFOHV WKDW 3K\ORJHQ\*URXS&ODVVLÀFDWLRQEDVHG were downloaded, read, and summarized on molecular data. Botanical names in a few sentences to be added to the can be subject to review and change. plant monographs. The bibliographic For example, Chromolaena odorata was references of these articles are available formerly known as Eupatorium odoratum, at the end of each monograph. Major the latter now being an outdated name. Caribbean reference books, such as those produced by TRAMIL (Tradition- C) Data entry and analysis al Medicine in the Islands), were also Data obtained from interviews were consulted, for example Germosén-Rob- entered into databases, yielding a ineau (2014). total of 847 and 780 distinct plant use-reports in Windsor Forest and Our criteria for inclusion of scientif- .LQJVWRQ UHVSHFWLYHO\$Q H[DPSOH RI  ic studies in the monographs were: (a) a plant use-report is: “rub the Animal studies of whole plant extracts RI .LQJRIWKH)RUHVW ERWDQLFDOQDPH that were water- or alcohol-based, Senna alata (L.) Roxb.) on the skin for and in dosages that correspond with liver spots [a fungal skin infection]”. the traditional use of these extracts; Seventeen percent of all plant (b) human case reports and clinical XVHUHSRUWVZHUHFRQÀUPHGE\DWOHDVW studies; (c) ethnobotanical studies in the three people in Windsor Forest, whereas Caribbean and worldwide, describing LQ.LQJVWRQWKLVSURSRUWLRQDPRXQWHG the traditional use of the plant species to 21 percent. in other cultural groups.

Analysis of our research data showed Articles excluded from the monographs 44 plant species with medicinal uses reported on: (a) Intravenous adminis- WKDW ZHUH FRQÀUPHG LQGHSHQGHQWO\ E\ tration of plant extracts (for example, at least 20 percent of the people (one an article that demonstrated that LQÀYHSHUVRQV ZHLQWHUYLHZHGLQHDFK soursop administered intravenously community. About half of these species had a blood pressure-lowering effect), (48%) are native to Jamaica. From this because traditional administration was list, we selected 25 plant species for the never done intravenously; (b) in vitro monographs in this book. studies (research with plant extracts in test tubes), because those are too far ' 5HYLHZRI WKHVFLHQWLÀFOLWHUDWXUH removed from human physiology; (c) :H VHDUFKHG WKH VFLHQWLÀF OLWHUDWXUH WKHHIIHFWVRI LQGLYLGXDO SXULÀHG SODQW

10 | Popular Medicinal Plants in Portland and Kingston, Jamaica compounds (chemicals); (d) extracts one can conclude that many plant species that did not correspond with traditional remain understudied for their safety, but preparations, for example n-butanolic especially from a clinical (human) perspec- extracts. An exception was made for in tive. It is our hope that this book will also vitro studies about herb-drug interac- be used by healthcare providers in their tions. We do report on those type of clinical practice to start a dialogue with in vitro studies in the plant monographs patients about medicinal plants or bush (when they are available in the literature), medicines. Especially, since the use of EHFDXVH WKH\ DUH D XVHIXO ÀUVW OLQH RI  bush medicines remains a very popular investigation to identify those plants that practice in rural and urban Jamaica today. are likely to interact with pharmaceutical In light of this popularity, in-depth products. discussion about medicinal plant safety, including potential plant-drug interac- :KHQVFLHQWLÀFLQIRUPDWLRQRQDSODQW tions, is overdue. species was scarce, we repeated literature searches with synonyms, for example in There exists the common belief that the case of Clinopodium brownei. Some bush medicines are safe because they are plants, such as guinea henweed (Petiveria natural. However, some plants can pose alliacea), are well-studied because they real toxicity issues for human health, and grow in tropical regions around the potentially lead to serious side effects if world and their use is very popular. The taken at the same time as pharmaceuti- amount of information we were able cal drugs, so it is very important to not to retrieve about this species stands in start experimenting with bush medicines contrast to many understudied plants, without supervision. One should always such as pennyroyal (Clinopodium brownei) consult with a person knowledgeable or breadfruit (Artocarpus altilis). about bush medicine, and talk openly with a physician about such use. How to use this book $SUHYLRXVVWXG\LGHQWLÀHGWKDWSHUFHQW This book is meant as an education- of Jamaicans who use medicinal plants to al resource, not as an herbal guide for treat illness and maintain health did so in self-medication. It is for this reason that combination with pharmaceutical drugs, we did not include a separate section in and that only 19 percent of physicians the plant monographs on recommend- knew about such practices (Picking et ed dose and methods of preparation. al., 2011). Extra care should be taken Our aim was to develop a reference work about dosage and possible toxicity before that provides an overview of traditional administering bush medicines to pregnant (cultural) knowledge related to the use of women and children. In most cases, it is EXVKPHGLFLQHVDVZHOODVVFLHQWLÀFVWXGLHV not advisable to give bush remedies to highlighting the clinical effectiveness and pregnant women. safety of these plants from human clinical studies and animal safety studies. These In this book, multiple types of prepara- two bodies of knowledge (traditional and tions are mentioned, including: a decoction VFLHQWLÀF NQRZOHGJH  FDQ EH FRQVLGHUHG (plant parts are boiled), an infusion (plant complementary. After reading this book, parts are steeped in hot water), a poultice

Popular Medicinal Plants in Portland and Kingston, Jamaica | 11 (a compress of plant parts is applied to studies exist. “Randomized, double blind, the skin), a maceration (plant parts are placebo controlled trials” are those in shredded in pieces, oftentimes in water, by which groups of volunteers are randomly rubbing the hands), and others. chosen to receive the medicine (either a plant extract or a pharmaceutical drug), Each plant monograph has a section and others are randomly chosen to receive on “Reported uses a placebo (dummy or inactive treatment). across the Caribbean.” In that section, No one, neither the researchers, nor the we often refer to the recommendations human volunteers, know who gets the from TRAMIL (Traditional Medicine in real treatment, and who gets the placebo. the Islands), whenever that information Both the researchers who are giving the is available. TRAMIL is a network of treatment, and the human volunteers who researchers and healthcare professionals are receiving the treatment, are “blind” to that aims to study, validate and expand the type of treatment, hence the wording medicinal plant use in primary healthcare “double blind”. Placebos are important and has completed over 50 surveys across because if researchers notice that the the Caribbean to date. TRAMIL provides “treatment group” is different from the recommendations for medicinal plant “placebo group”, they will know that the use, based on their surveys and follow-up difference is because of the treatment. research, that are generally accompanied Without a “placebo group”, research- by a number of cautions. For example, for ers cannot know if those changes would oral consumption relating to conditions have happened anyway, no matter which such as asthma and pneumonia, an medicine people had taken. “Open initial medical evaluation is recommend- randomized trials” are those studies in ed. In addition, where appropriate, the which both the researcher and volunteer use of traditional treatments should be know which treatment they are receiving. considered complementary to medical There is no “blinding” in this type of treatment. For topical applications, strict study. A “crossover study” is one in which hygiene measures should be observed in all the volunteers receive the same number order to avoid contamination or addition- of treatments, but at different times. For al infection. For all recommendations, example, Group A might initially receive should there be a notable worsening of the medicine and Group B the placebo for a patient’s condition, medical attention one week, then in week two they would should be sought without delay. swap and Group A receives the placebo and Group B the medicine. Another section in each plant monograph LV DERXW ´&OLQLFDO HIÀFDF\ HIIHFWLYHQHVV  Future studies studies in humans.” There, we report on, and summarize, information we 8SRQÀQLVKLQJWKLVERRNZHUHDOL]HWKDW encountered in the biomedical literature we have only touched the surface of about clinical studies. Clinical studies are Jamaican plant knowledge. The informa- carried out with human volunteers, to tion about medicinal uses that we have ÀUVWO\PDNHVXUHWKDWWKHPHGLFLQHEHLQJ UHFRUGHG FRPHV IURP WZR ÀHOG VLWHV LQ tested is safe, and secondly to establish 3RUWODQGDQG.LQJVWRQQDPHO\:LQGVRU whether it works. Different types of clinical Forest and Payne Land. Therefore, we do

12 | Popular Medicinal Plants in Portland and Kingston, Jamaica not claim this information to be represen- tative of the rich diversity of medicinal plant uses and preparations encountered all over Jamaica. Future studies will be conducted to add to this wealth of informa- tion. We hope to expand on this work in other parishes, using the same systemat- ic research methodology to ultimately develop a medicinal plant guidebook that covers the whole of Jamaica. Selected bibliography

Acevedo-Rodríguez P, Strong MT (2008) Floristic ULFKQHVV DQG DIÀQLWLHV LQ WKH :HVW ,QGLHV Botanical Review 74: 5-36. Adams CD (1972) 7KHÁRZHULQJSODQWVRI -DPDLFD .LQJVWRQ 8QLYHUVLW\ RI  WKH :HVW ,QGLHV  pp. Alexiades MN (1996) Selected guidelines for HWKQRERWDQLFDOUHVHDUFK$ÀHOGPDQXDO Bronx, NY: New York Botanical Garden, 306 pp. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: &HQWURGH,QYHVWLJDFLyQ&LHQWtÀFDGH

Popular Medicinal Plants in Portland and Kingston, Jamaica | 13 Bitter orange, sour orange, Seville orange 6FLHQWLÀF1DPHCitrus x aurantium L., Botanical Family: Rutaceae

rect tree that is 3 to 10 meters high with thorny branches (it has more thorns WKDQWKHVZHHWRUDQJHDQGKDVDGHQVHUFDQRS\ ZKLWHIUDJUDQWÁRZHUVDQG Erelatively large aromatic leaves with a slightly winged petiole. The leaves have diminutively toothed margins. The bitter-tasting has a fairly thick and fragrant skin. 7KHVSHFLHVLVQDWLYHWR6RXWKHDVW$VLD:KHQIDUPHUVÀQGVXFNHUVDORQJWUDLOVWKH\ often transplant them on their farm land to add to their collection of fruit trees. They also throw on their land to obtain new plants.

14 | Popular Medicinal Plants in Portland and Kingston, Jamaica :KHUHWRÀQGWKHSODQW Dragon stout.

Sour orange grows commonly on people’s Reported traditional medicine farm land. uses across the Caribbean

Part used According to the Caribbean pharmaco- peia, the plant is recommended for colic The fruit and leaf. (fresh leaf decoction or infusion), cough IUXLW MXLFH  LQÁDPPDWLRQ RI  WKH H\H Jamaican cultural uses and (conjunctivitis) (juice), diarrhea (juice), beliefs fever (fresh leaf decoction or infusion; IUXLW SHHO GHFRFWLRQ  ÁDWXOHQFH IUXLW The leaf and fruit skin are used to SHHO LQIXVLRQ  ÁX IUHVK OHDI  GHFRFWLRQ prepare a regular tea. The juice makes nice or infusion; juice), headache (fresh leaf lemonade that has vitamin C. The fruit decoction or infusion), and intestinal juice can clear rust from a utensil. Burning parasites (fresh leaf decoction). These the dry fruit skin chases away mosquitoes. recommendations are based on TRAMIL Animals are bathed with the fruit juice to VXUYH\V WR[LFLW\ VWXGLHV VFLHQWLÀF WUHDWPDQJHDQGÁHDV7KHLQQHUSDUWRI  validation and available published scientif- the fruit is roasted for the goat when “him ic information (Germosén-Robineau, hurt him foot.” 2014). Jamaican medicinal uses Reported traditional medicine uses internationally Sour orange is a popular remedy for the FRPPRQ FROG ERWK LQ .LQJVWRQ DQG In Africa, the cut-open fruit is applied Windsor Forest. directly to ulcers, yaws (a type of chronic bacterial infection), and areas of the body Major uses (mentioned by more than 20% of affected by arthritis (Morton, 2013). people): • Common cold (including cough): The In Latin America and Italy, a leaf decoction IUXLWLVURDVWHGLQWKHÀUHDIWHUZKLFK is used as an anti-spasmodic, diaphoretic the juice is squeezed, and honey is (induces sweating), stimulant, stomachic added; 2 teaspoons are taken. Or, the (improves action of the stomach and juice is drunk with salt. The roasted LQFUHDVHVDSSHWLWH DQGWRQLF7KHÁRZHUV IUXLW ÁHVK FDQ EH VFUDSHG DQG HDWHQ are prepared as a syrup with reported with sugar. Alternatively, a tea is sedative properties for nervous disorders boiled with the leaves. and to help induce sleep. Infusions of the bitter bark are prepared and taken as an Minor uses (mentioned by more than 5% of antipyretic (to reduce fever), stimulant, people, but less than 20%): tonic and vermifuge (to expel intestinal • Fever (and to keep cool): The roasted worms) (Morton, 2013). fruit is eaten, or used to bathe. The IUXLW LV URDVWHG LQ WKH ÀUH DQG WKH In China, Citrus aurantium preparations juice is drunk with salt, or mixed with have a history of use in Traditional Chinese

Popular Medicinal Plants in Portland and Kingston, Jamaica | 15 Medicine (TCM) for the treatment of a promoted as a safe alternative to ephedra number of health conditions, including (Haaz et al., 2006). constipation, diarrhea, dysentery, indiges- tion, and as an expectorant (clears mucus) A number of clinical studies are reported (Stohs and Shara, 2007). The dried fruit, in the literature, with the majority relating and, less commonly, the peel are used to to the use of Citrus aurantium extracts for treat a prolapsed uterus and anus, and weight loss and as athletic performance for blood in the stool (Leung and Foster, aids, with few studies looking into the 1996). more traditional uses listed above. In a review of the literature, up to the year In the USA, Citrus aurantium was tradition- %OXPHQWKDO  LGHQWLÀHG ally used by the Eclectic physicians (early two studies relating to weight loss, three to American herbalists) in the late 19th and increased thermogenesis ( expendi- early 20th centuries as a digestive tonic WXUH DQGRQHDVVHVVLQJWKHVDIHW\SURÀOH DQGDVDÁDYRULQJDJHQWIRURWKHUKHUEDO of Citrus aurantium extracts. medicines (Blumenthal, 2004; 2005). A more recent review of clinical studies, In Europe, the peel of Citrus aurantium is also involving Citrus aurantium extracts traditionally used to treat indigestion and DQG SV\QHSKULQH LGHQWLÀHG VL[WHHQ related conditions, and in Germany, as a published studies. Eight of the studies supportive measure in treating stomach measured the impact on metabolism and/ FRPSODLQWVVXFKDVLQVXIÀFLHQWIRUPDWLRQ or weight loss, seven studies measured of gastric juice, and as an appetite the impact on cardiovascular outcomes stimulant (Bisset and Wichtl, 1994). The (e.g. blood pressure, heart rate), and one German Commission E Monographs study measured the impact on key drug recognize the medicinal value of Citrus metabolizing enzymes (highlighting aurantium peel in the treatment of appetite potential drug-herb interactions). The loss and digestive complaints (Blumenthal authors of the review concluded that et al., 1998). Citrus aurantium extracts, used in combina- tion products, and p-synephrine used &OLQLFDOHIÀFDF\VWXGLHVLQ alone, increased energy expenditure and humans metabolic rate, with modest increases in weight loss when given for 6 to 12 weeks. The use of Citrus aurantium and its primary They recommended longer term studies phytochemical, p-synephrine, increased with larger study groups to further assess VLJQLÀFDQWO\IROORZLQJD8QLWHG6WDWHVEDQ WKHHIÀFDF\RI WKHVHSURGXFWV 6WRKVHWDO on the sale of a similar phytochemical 2012). (ephedra) due to growing concerns about adverse events about the latter, including In one of the seven safety studies, a number of fatalities of ephedra. Both a randomized, placebo controlled, ephedra and p-synephrine are thought crossover, double blind study with 25 to support weight loss by increasing the healthy volunteers, was used to investi- metabolic rate, and/or decreasing energy gate the cardiovascular effects of a dietary intake and energy absorption. Citrus supplement containing Citrus aurantium aurantium extracts and p-synephrine are extract, green tea extract and caffeine. The

16 | Popular Medicinal Plants in Portland and Kingston, Jamaica authors reported that no effects of the et al., 2016). supplement were observed on heart rate, systolic and diastolic blood pressure, or A review of 22 Food and mean arterial pressure (Seifert et al., 2011). Drug Administration (FDA) adverse event reports and ten published clinical In one of the studies on weight loss, FDVHUHSRUWVRYHUDÀYH\HDUSHULRGIURP a double blind, randomized, placebo 2004 to 2009, concluded that no serious controlled study with 23 overweight adverse events could be directly attributed healthy volunteers, in combination with a to Citrus aurantium extracts or p-syneph- prescribed diet and exercise program, was rine (Stohs, 2010). used to investigate a supplement contain- ing Citrus aurantium extract, St. John’s wort, • Toxicology: and caffeine. The authors concluded that The Caribbean pharmacopeia, based on the supplement was safe and effective, toxicity studies, has validated the safe use when combined with mild caloric restric- of several traditional preparations of Citrus tion and exercise for promoting both aurantium, namely, fresh leaf decoction weight and fat loss in healthy, overweight and infusion, fruit peel decoction and adults (Colker et al., 1999). infusion, and fresh juice (Germosén-Rob- ineau, 2014).

Safety information A review of Citrus aurantium and p-syneph- rine concluded that bitter orange extract • Side effects: is safe for human consumption, and The use of a supplement containing that there are no credible adverse effects multiple plant ingredients, including Citrus associated with oral ingestion of bitter aurantium, gave rise to two reports of mild orange or p-synephrine (Stohs and Preuss, gastric problems, in a review of adverse 2010). events from plant food supplements across six European countries (Restani et • Contraindications: al., 2016). 7KHUH DUH FRQÁLFWLQJ UHSRUWV LQ WKH literature regarding contraindications for Citrus aurantium was among the ten Citrus aurantium. According to one study, most frequently reported plant-based the blood pressure of healthy young supplements for adverse events between adults increased after taking a Citrus 2006 and 2010, documented across aurantium supplement containing 6 percent selected European and Brazilian poison p-synephrine (Bui et al., 2006). centers. However, most cases involved mild gastric symptoms that resolved However, according to an extensive without clinical intervention (Lüde et al., UHYLHZ RI  WKH VFLHQWLÀF OLWHUDWXUH WKH 2016). juice of Citrus aurantium showed no effect on blood pressure or heart rate The use of plant-based supplements with in healthy subjects (Brinker, 2010). The PXOWLSOH LQJUHGLHQWV PDNHV LW GLIÀFXOW WR author suggests the following contrain- DWWULEXWH WKH VLGH HIIHFWV VSHFLÀFDOO\ WR dications for Citrus aurantium in patients Citrus aurantium (Lüde et al., 2016; Restani ZKRVXIIHUIURPWKHIROORZLQJDIÁLFWLRQV

Popular Medicinal Plants in Portland and Kingston, Jamaica | 17 stomach or intestinal ulcers, due to bitter studies in 12 healthy human subjects, who orange’s tonic effect on the gastrointesti- were given 350 mg of Citrus aurantium nal tract; severe high blood pressure, rapid extract (standardized to 4 percent heart rate, and narrow-angle glaucoma p-synephrine) twice a day for 28 days. (a disease that damages the eye’s optic A comparison of the results before and nerve and may lead to blindness), due after supplementation demonstrated weak to its p-synephrine content (noted as inhibition of the key drug metabolizing speculative by the author). Its use is also enzymes tested, CYPs 1A2, 2D6, 2E1 and contraindicated in children due to the 3A4. The authors concluded that the Citrus presumption that excessive doses can aurantium extract tested posed minimal risk produce “toxic effects”; and in combina- for cytochrome P450-mediated drug-herb tion with ultraviolet light due to the interactions in humans. potential photosensitizing effect. However, the authors noted that Citrus • Use in pregnancy and breast- aurantium extracts are generally prepared feeding: by hot water extraction and that the key Traditional Chinese Medicine (TCM) phytochemicals, 6’-and 7’-dihydroxyber- texts advise caution in the use of Citrus gamottin and bergapten, present in the aurantium preparations during pregnancy fresh fruit juice were notably absent from (Dharmananda, nd). the tested extract (Gurley et al., 2004). Therefore, caution is advised in the use • Drug interactions: of the fresh fruit juice of Citrus aurantium The impact of crude extracts of Citrus LQFRPELQDWLRQZLWKDVLJQLÀFDQWQXPEHU aurantium were tested and found to inhibit of pharmaceutical drugs, such as the the activity of an important human immunosuppressant drug tacrolimus (Lin drug metabolizing enzyme, CYP3A4 in et al., 2011), the anti-hypertensive drug laboratory-based screens (Guo et al., 2001). felodipine (Malhotra et al., 2001), the In addition, Citrus aurantium contains two anti-retroviral drug indinavir (Penzak et phytochemicals, 6’-and 7’-dihydroxyber- al., 2002) the anti-tussive (to treat cough) gamottin and bergapten, both of which dextromethorphan (Di Marco et al., 2002), have been shown individually to potently and other drugs metabolized by CYP3A4, inhibit the same enzyme, CYP3A4 including acetaminophen, codeine, )XJK%HUPDQDQG0\HUV .QRZQ cyclosporin, diazepam, and erythromycin inhibitors of CYP3A4 include grapefruit (Edwards et al., 1999). juice which has, to date, been shown to interact with over forty pharmaceutical Recommendations drugs, giving rise to dangerous increases in drug levels and serious adverse drug The United States Food and Drug reactions (Delgoda and Picking, 2015). $GPLQLVWUDWLRQ )'$  KDV FODVVLÀHG WKH use of bitter orange in food as Generally However, tests in the laboratory, whilst Recognized as Safe (GRAS). According SURYLGLQJ D XVHIXO ÀUVW VWDJH LQGLFDWLRQ to the Natural Standard (2007), bitter of potentially harmful drug interactions, orange is probably safe when used orally UHTXLUHFRQÀUPDWLRQXVLQJKXPDQFOLQLFDO in quantities available in food. It may studies. Gurley et al. (2004) conducted be safe to use the essential oil of bitter

18 | Popular Medicinal Plants in Portland and Kingston, Jamaica orange applied topically or inhaled in Brinker F (2010) Herbal contraindications and . It may not be safe to use drug interactions plus herbal adjuncts with medicines, bitter orange in higher doses because H[SDQGHG WK HGLWLRQ Sandy: Eclectic Medical it contains the substance p-synephrine, Publications. which is a stimulant. However, this view is Bui LT, Nguyen DT, Ambrose PJ (2006) Blood controversial and not universally accepted. pressure and heart rate effects following a single Current research indicates that ingestion dose of bitter orange. The Annals of Pharmaco- of bitter orange and p-synephrine in the therapy 40: 53-57. form of supplements, fruit, juice and other &RONHU&0.DLPDQ'67RULQD*&3HUOLV7 citrus food products, are safe (Stohs et al., Street C (1999) Effects of Citrus aurantium 2011). No credible adverse events have extract, caffeine, and St. John’s Wort on body fat been directly attributed to bitter orange, loss, lipid levels, and mood states in overweight or its primary phytochemical, p-syneph- healthy adults. Current Therapeutic Research 60: rine. However, research does indicate 145-153. that caution is necessary for those people Delgoda R, Picking D (2015) Potential drug taking a number of over-the-counter and interactions for commonly used medicinal plants & foods prescription drugs with the fresh juice LQ -DPDLFD .LQJVWRQ 8QLYHUVLW\ RI  WKH :HVW (theoretical concern), and the guidance of Indies, Natural Products Institute. DTXDOLÀHGSK\VLFLDQRUSKDUPDFLVWVKRXOG Dharmananda S (nd) Synephrine: Is Chih-shih always be sought. The use of bitter orange (Zhishi) toxic? http://www.itmonline.org/arts/ during pregnancy is traditionally cautioned syneph.htm. Accessed online 5th April 2016. against in Traditional Chinese Medicine Di Marco MP, Edwards DJ, Wainer IW, Ducharme (TCM). The effects of bitter orange in MP (2002) The effect of grapefruit juice and nursing women are not known, and its use seville orange juice on the pharmacokinetics should best be avoided during pregnancy of dextromethorphan: The role of gut CYP3A or breastfeeding. and P-glyco protein. Life Sciences 71: 1149-1160. Edwards DJ, Fitzsimmons ME, Schuetz EG, Selected bibliography

Popular Medicinal Plants in Portland and Kingston, Jamaica | 19 Properties of umbelliferous or citrus crude drugs December 2007. and their relative prescriptions. Japanese Journal of Penzak SR, Acosta EP, Turner M, Edwards DJ, Pharmacology 85: 399-408. Hon YY, Desai HD, Jann MW (2002) Effect Gurley BJ, Gardner SF, Hubbard MA, Williams of seville orange juice and grapefruit juice on '.*HQWU\:%&DUULHU-.KDQ,$(GZDUGV indinavir pharmacokinetics. Journal of Clinical DJ, Shah A (2004) In vivo assessment of botanical Pharmacology 42: 1165-1170. supplementation on human cytochrome P450 Restani P, Di Lorenzo C, Garcia-Alvarez A, phenotypes: Citrus aurantium, Echinacea purpurea, Badea, M, Ceschi A, Egan B, Serra-Ma- milk thistle, and saw palmetto. Clinical Pharmacology jem L (2016) Adverse effects of plant food and Therapeutics 76: 428-440. supplements self-reported by consumers in the +DD]6)RQWDLQH.5&XWWHU*/LPGL1 PlantLIBRA Survey involving six European Perumean-Chaney S, Allison DB (2006) Citrus countries. PLoS One 11: e0150089. aurantium and synephrine alkaloids in the Seifert JG, Nelson A, Devonish J, Burke ER, Stohs treatment of overweight and obesity: an update. S J (2011) Effect of acute administration of an Obesity Reviews 7: 79-88. herbal preparation on blood pressure and heart Leung AY, Foster S (1996) Encyclopedia of natural rate in humans. International Journal of Medical ingredients used in foods, drugs, and cosmetics. New Sciences 8: 192-197. York: John Wiley. Stohs SJ, Shara M (2007) A review of the safety Lin SP, Wu PP, Hou YC, Tsai SY, Wang MJ, Fang DQGHIÀFDF\RI &LWUXVDXUDQWLXPLQZHLJKWPDQDJHPHQW 6+ &KDR 3'   'LIIHUHQW LQÁXHQFHV RQ In Obesity: Epidemiology, pathophysiology, tacrolimus pharmacokinetics by coadministra- and prevention. Bagchi D, Preuss HG (Eds). tions of zhi ke and zhi shi in rats. Evidence-Based Boca Raton: CRC Press. Complementary and , Article Stohs SJ (2010) A review and assessment of the ID 751671, 6 pages. http://www.hindawi. FDA adverse events reports and clinical case com/journals/ecam/2011/751671/. Accessed reports between April 2004 and October 2009. online 16th April 2016. Journal of Functional Foods 2: 235–238. Lüde S, Vecchio S, Sinno-Tellier S, Dopter A, Stohs SJ, Preuss HG (2010) The safety of bitter Mustonen H, Vucinic S, Jonsson B, Müller D, orange (Citrus aurantium) and p-synephrine. 9HUDV*LPHQH])UXFKWHQJDUWHQ/+UXE\.'H HerbalGram 89: 34-39. Souza Nascimento E, Di Lorenzo C, Restani P, Stohs SJ, Preuss HG, Shara M (2011) The safety .XSIHUVFKPLGW + &HVFKL $   $GYHUVH of Citrus aurantium (bitter orange) and its effects of plant food supplements and plants primary protoalkaloid p-synephrine. Phytotherapy consumed as food: Results from the poisons Research 25: 1421-1428. centres-based PlantLIBRA Study. Phytotherapy Stohs SJ, Preuss HG, Shara M (2012) A review Research [Epub ahead of print]. of the human clinical studies involving Citrus Malhotra S, Bailey DG, Paine MF, Watkins PB aurantium (bitter orange) extract and its primary (2001) Seville orange juice-felodipine interac- protoalkaloid p-synephrine. International Journal tion: Comparison with diluted grapefruit juice of Medical Sciences 9: 527-538. and involvement of furocoumarins. Clinical Pharmacology and Therapeutics 69: 14-23. Morton J (2013) )UXLWVRI ZDUPFOLPDWHV Brattleboro: Echo Point Books and Media. Natural Standard (2007). The Authority on Integrative Medicine. Citrus aurantium. http:// www.naturalstandard.com. Accessed online 31st

20 | Popular Medicinal Plants in Portland and Kingston, Jamaica Breadfruit

6FLHQWLÀF1DPHArtocarpus altilis (Parkinson) Fosberg, Botanical Family: Moraceae

n evergreen tree of up to 20 meters high with dark green, deeply lobed leaves. When a part of the tree is broken off, a white latex (called “milk”), will come Aout. The fruit is round to oval, with a smooth skin texture and a yellowish- JUHHQFRORUZKHQPDWXUH7KHIUXLWÁHVKLVFUHDP\ZKLWH)UXLWVDUHPDWXUHDQGUHDG\ to cook or roast in 15 to 19 weeks. A breadfruit tree starts bearing around 3 to 5 years of age and does so for several decades. The species is thought to be native to northern 1HZ*XLQHDEXWLWKDVEHHQZLGHO\FXOWLYDWHGLQVRXWKHDVW$VLDDQGWKH3DFLÀFUHJLRQ for thousands of years, and is now cultivated throughout the tropics. In rural Jamaica, farmers transplant suckers found underneath a breadfruit tree to other places; they also exchange suckers of much-appreciated varieties with each other, such as the “jackfruit breadfruit”, also called “maca breadfruit”, a variety that is considered “easier to roast.”

Popular Medicinal Plants in Portland and Kingston, Jamaica | 21

:KHUHWRÀQGWKHSODQW Breadfruit trees grow everywhere in the little as 2 minutes, or up to an hour, community, and on people’s farm land. in water. Some people say that when you pick a leaf from the tree for tea Part used it “cannot drop on the ground.” Breadfruit leaf is sometimes steeped The leaf is used medicinally. The fruit is or boiled together with the leaf of eaten. guinep (Melicoccus bijugatus). Jamaican cultural uses and Reported traditional medicine beliefs uses across the Caribbean

Breadfruit is considered a tonic fruit. It is All parts of Artocarpus altilis are used part of the Jamaican national dish. The PHGLFLQDOO\LQWKH&DULEEHDQDQG3DFLÀF fruit can be boiled and blended to make especially the latex, leaf tips, and inner juice and punch. The ripe fruit is also bark. In the West Indies, the yellowing used to bake pudding. There is a saying leaf is brewed into a tea and drunk to “if yuh eat too much breadfruit, it make lower high blood pressure, and to treat yuh coward.” The leaf of breadfruit is asthma. The leaf tea is also believed to appreciated as a regular tea in the morning control diabetes. The latex is massaged and evening, sometimes with sweet milk, into the skin to treat broken bones and vanilla and nutmeg added. Milk from sprains, and is bandaged on the spine to the chopped breadfruit tree can serve as relieve sciatica (pain affecting the back, chewing gum. The milk (“gum”) of the hip and outer side of the leg, caused by breadfruit tree is sometimes used to catch compression of a nerve). It is commonly birds by putting it on a bamboo stick that used to treat skin ailments and fungus is placed in an ackee tree (). diseases such as “thrush,” which are A lesser-known use is as a cosmetic: An also treated with crushed leaves. Diluted RXQFH WR D SLQW RI  OHDI  DQG ÁRZHUV RI  latex is taken internally to treat diarrhea, breadfruit is steeped and added to the stomachache, and dysentery. The sap bath water as a hydrating substance. from the crushed stems or leaves is used to treat ear infections or sore eyes. The Jamaican medicinal uses root is astringent and used as a purgative; when macerated it is used as a poultice Breadfruit leaf is applied to the head, and (compress) for skin ailments. The bark drunk as a tea, to treat high blood pressure. is also used to treat headache in several islands (Ragone, 2006). Major uses (mentioned by more than 20% of people): In Martinique, a decoction of breadfruit • %ORRGSUHVVXUH,Q.LQJVWRQSHRSOH leaf is drunk to treat high blood pressure, treat high blood pressure by tying liver disease and diabetes, while the milk a warm leaf on the head, together of the fruit is ingested for diabetes and with white or blue rubbing alcohol. applied externally for pain in the back $OWHUQDWLYHO\ LQ .LQJVWRQ DQG (Longuefosse and Nossin, 1996). Windsor Forest, people boil or draw the ripe (yellow) breadfruit leaf for as

22 | Popular Medicinal Plants in Portland and Kingston, Jamaica In Trinidad and Tobago, breadfruit leaf is • Toxicology: used to treat high blood pressure as well In an acute toxicity study of breadfruit (Lans, 2006). leaf and bark extracts in rats (2 g per kg body weight administered orally for 2 Reported traditional medicine weeks), no toxic reaction or mortality was uses internationally observed. These results suggest the safety of the extracts in therapeutic uses (Sairam In Mauritius, a leaf decoction of Artocarpus and Urooj, 2014). altilis is drunk to treat diabetes, one cup twice per week (Mootoosamy and Mahomoodally, • Contraindications: 2014). No information available.

In Indonesia, a decoction of the leaves has • Use in pregnancy and breast- been used traditionally for the treatment feeding: of liver cirrhosis, hypertension (high No information available. blood pressure), and diabetes (Wang et al., 2006). • Drug interactions: Traditionally prepared water extracts of In Taiwan, the leaves are used to treat liver the dried leaves of Artocarpus altilis were disease and fever, and an extract from the tested in the laboratory for their effect ÁRZHUV LV VDLG WR EH HIIHFWLYH LQ WUHDWLQJ on a number of key human enzymes ear swelling (edema) (Orwa et al., 2009). that are responsible for processing many pharmaceutical drugs in the body ,QWKH3DFLÀF,VODQGVODWH[DQGMXLFHIURP (cytochrome P450, CYPs 2D6, and 3A4). the crushed leaves are both traditional- The results showed moderate to weak ly used to treat ear infections. The root LPSDFWLQGLFDWLQJWKDWFOLQLFDOO\VLJQLÀFDQW is an astringent (able to tighten body interactions with drugs metabolized by the tissues), and is used as a purgative, and same enzymes are unlikely (Nwokocha when macerated it is used as a poultice et al., 2012; Murray, 2014; Delgoda and for skin ailments. The bark is used to treat Picking, 2015). headache (Orwa et al., 2009). Recommendations &OLQLFDOHIÀFDF\VWXGLHVLQ humans Absence of human (clinical) studies warrants caution for use of breadfruit leaf No information available. tea as a medicine in humans, especially in pregnant or breastfeeding women, and Safety information in children. Hypertension (high blood pressure) is a serious condition that needs • Side effects: WREHIROORZHGXSE\DTXDOLÀHGKHDOWKFDUH One respondent in the Jamaican TRAMIL provider. People who self-medicate with survey reported experiencing hypotension breadfruit leaf tea should disclose this (low blood pressure) as a result of drinking information to their physician. breadfruit leaf tea (Picking et al., 2015).

Popular Medicinal Plants in Portland and Kingston, Jamaica | 23 Selected bibliography Sairam S, Urooj A (2014) Safety evaluation of Artocarpus altilis as pharmaceutical agent in Delgoda R, Picking D (2015) Potential drug Wistar rats. Journal of Toxicology 2014: 980404. interactions for commonly used medicinal plants & foods Wang Y, Deng T, Lin L, Pan Y, Zheng X (2006) in Jamaica .LQJVWRQ 8QLYHUVLW\ RI  WKH :HVW Bioassay-guided isolation of anti-atheroscle- Indies, Natural Products Institute. rotic phytochemicals from Artocarpus altilis. Lans CA (2006) used in Phytotherapy Research 20: 1052-1055. Trinidad and Tobago for urinary problems and diabetes mellitus. Journal of and 2: 45. Longuefosse J, Nossin E (1996) Medical ethnobotany survey in Martinique. Journal of Ethnopharmacology 53: 117-142. Mootoosamy A, Mahomoodally MF (2014) Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius. Journal of Ethnopharmacology 151: 413-444. Murray J (2014) Inhibition of human cytochrome P450 enzymes by local herbs, natural and synthetic LVRODWHV.LQJVWRQ8QLYHUVLW\RI WKH:HVW,QGLHV M.Phil. Dissertation. Nwokocha CR, Owu DU, McLaren M, Murray J, 'HOJRGD 5 7KD[WHU . 0F&DOOD *

24 | Popular Medicinal Plants in Portland and Kingston, Jamaica