Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2018, Article ID 2183705, 33 pages https://doi.org/10.1155/2018/2183705

Research Article Used by Bapedi Traditional Healers to Treat Asthma and Related Symptoms in Limpopo Province, South

Sebua Silas Semenya 1,2 and Alfred Maroyi 1

1 Technology Transfer Ofce, Research Administration and Development Department, University of Limpopo, Private Bag X1106, Sovenga 0727, South Africa 2Medicinal Plants and Economic Development (MPED) Research Center, Department of Botany, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa

Correspondence should be addressed to Sebua Silas Semenya; [email protected]

Received 23 January 2018; Accepted 10 April 2018; Published 19 July 2018

Academic Editor: Dolores Garc´ıa Gimenez´

Copyright © 2018 Sebua Silas Semenya and Alfred Maroyi. 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.

To the best of our knowledge there are presently no ethnobotanical surveys focusing on the utilisation of herbal remedies for asthma in South Africa. Te present study is therefore an attempt to fll this gap in knowledge. A total of 140 Bapedi traditional healers (THs) practicing in the Capricorn, Sekhukhune, and Waterberg districts of the Limpopo Province (South Africa) were queried using semistructured questionnaires, supplemented by feld observations during face-to-face interview. A total of 104 medicinal species (92 indigenous and 12 exotics) belonging to 92 genera, distributed across 54 botanical families, mostly the and Fabaceae (18.5%, for each) as well as Malvaceae (12.9%), were used as antiasthmatics and related symptoms by these THs. Most of the plants were trees and herbs (37.5%, for each), with root (57%), leaf (15.8%), and bark (7.5%), respectively, being the saliently used parts for preparation of remedies. Clerodendrum ternatum, Cryptocarya transvaalensis, Lasiosiphon cafer, Enicostema axillare, Mimusops obovata, Sclerocarya birrea,andStylochaeton natalensis were widely used and valued by all THs across the surveyed districts. Furthermore, these taxa also scored both the highest use value and fdelity level indexes as asthma therapies. Overall, the larger number of species documented in the present study is recorded for the frst time in literature as asthma and/or related symptoms remedies. Our study fnding generally contributes towards an establishment of South African database of herbal therapies used traditionally against these conditions.

1. Introduction common in Africa, and studies conducted in Algeria [8], Nigeria [2], Uganda [9], and Zambia [10], amongst other Asthma is a chronic lung disease that infames and narrows countries, highlighted this. Asthma impact is also prevalent the airways, afecting people of all ethnic groups world- in South Africa. According to the recent report by the Global wide [1]. Its symptoms include amongst others intermittent Initiative for Asthma, this country has the world’s fourth attacks of wheeze, cough, breathlessness with variable airway highest asthma death rate amongst people aged fve to 34 obstruction, chest tightness, and cough that occurs more years [11]. Furthermore, of an estimated 3.9 million South at night and or early in the morning [2]. In 2008 at least Africans diagnosed with asthma, 1.5% die of this condition three hundred million people worldwide were diagnosed annually [12]. with asthma and over 250,000 asthma-related annual deaths Treatment of asthma is focused on ad hoc treatment of were reported [3]. acute exacerbations including lifestyle factors and prevention Despite the above statistics, asthma continues to be a of exacerbations [13]. Tere are a number of top medications major world problem afecting people in various countries such as short or long acting beta2 agonist (preferably by of the world including Australia [4], India [5], Jamaica [6], inhalation) and inhaled steroid that an asthmatic patient can and Norway [7]. Health impact of this condition is also receive during exacerbations [3]. Supplementary medications 2 Evidence-Based Complementary and Alternative Medicine

Figure 1: Map of Limpopo Province indicating the studied areas (districts and municipalities).

for asthma suferers include leukotriene receptor antagonists 2. Methodology and theophylline or slow release beta2 agonist tablets [14]. However, these therapies are ofen limited and/or not aford- 2.1. Study Area and Population. Tisstudywascarriedoutin able to a common man residing in most developing countries the three districts (Capricorn, Sekhukhune, and Waterberg) particularly in Africa [15, 16]. Consequently, asthma suferers of the Limpopo Province and associated municipalities (Fig- in these countries resort to locally available traditional healers ure 1). (THs) who prescribe afordable herbal remedies. A total of fve rural villages from each municipality Tere are extremely few ethnobotanical surveys reporting were chosen as study sites. In general, all these settlements on the use of medicinal plants by indigenous people including are economically and socially marginalized [28]. Terefore, THsastreatmentsofasthmaandrelatedsymptomsinAfrica there is inadequate infrastructure, high unemployment, and as a continent. To the best of our knowledge the only studies dependency on natural resources amongst the people to thatfocusedonthissubjectwereconductedinCameroon[17] support their livelihoods [28]. Furthermore, larger number and Nigeria [18]. However, general ethnobotanical studies of people still rely heavily on traditional methods of health carried out in other African countries, to name a few, carefortreatmentofvariousailments[29];thusTHsandtheir Uganda [19], Kenya [20], Lesotho [21], and Botswana [22], services play an important role in the wellbeing of people. highlighted that THs of other cultures do treat asthma and Te Bapedi tribe who speak Sepedi language is the dominant related conditions. South Africa is no exclusion and studies ethnic group inhabiting the studied districts, representing by Hutchings [23], Tring and Weitz [24], De Beer and Van more than 50% of the total population [30]. Wyk [25], York et al. [26], and Bhat [27] also emphasised this. Te present study therefore will be the frst in South Africa to 2.2. Ethnobotanical Survey and Data Collection. Areconnais- exclusively focus on ethnobotanical knowledge and practices sance study was frstly carried out in each selected village to of plants implicated in the treatment of these conditions. (i) request permission from local tribal leaders to conduct Evidence-Based Complementary and Alternative Medicine 3 this study within their areas of governance and (ii) ask THs was determined via UV, following Phillips and Gentry [33] who were conveniently (i.e., with the help of local leaders and index: healers) selected to participate in the survey. Both traditional � leaders and healers were enlightened about the nature of = ∑ UV � (2) the project including aim and objectives, using their mother tongue of Sepedi. Consequently, THs who agreed to take part From the above formulation, U was the number of curative in this study were requested to sign a consent form. applications of each species, where � represented the total Data was collected from May 2017 to October 2017 using number of THs. Generally plant with broad therapeutic uses a semistructured interview with 140 THs during face-to- or those that are highly accepted as cure of a particular face interviews, supplemented by feld trips for participant’s ailment will score a high UV. observation and specimen collections. Te questionnaire was designed to capture information on (i) local names of the plants used by Bapedi THs to manage asthma; (ii) plant 3. Results and Discussions parts used; (iii) state/s of used plant part; and (iv) mode/s 3.1.DiversityofUsedPlantSpecies.Tis is the frst study of preparation and administration of remedies. Overall, THs ofitskindinSouthAfricaandfewofthoseconducted were questioned independently in their consultation rooms in other African countries [17, 18] and elsewhere [34] that using Sepedi dialect. focusedontheutilisationofplantstotreatasthmaand Field excursions for medicinal plant species identifcation related symptoms. A total of 104 medicinal plant species (92 and collection were conducted with the assistance of each indigenous and 12 exotics) belonging to 92 genera, distributed questioned traditional healer. During these trips THs initially across 54 botanical families, mostly the Asteraceae and identifed the species via vernacular names. Subsequently, Fabaceae (n=10 spp., for each, 18.5%), Malvaceae (n=7 spp., voucher specimens were collected, prepared, and deposited 12.9%), Anacardiaceae, and Euphorbiaceae (n=4 spp., for at the Larry Leach Herbarium (University of Limpopo), each, 7.4%), respectively, were recorded as being used by wherein a scientifc name of plant species was established by 140 Bapedi THs to treat these conditions. Tis diversity of a trained taxonomist. plants is higher compared to 46 noted by Sonibare and Gbile [18] in Nigeria, and 29 by Noumi [17] in Cameron. Te 2.3. Data Analysis observed variation might be attributed to extremely larger sample size of THs and spatial coverage included in our 2.3.1. Microsof Excel and Statistical Package for the Social study compared to these two studies. Some of the above- Sciences (SPSS). Tedatacollectedinthisstudywereanal- mentioned botanical families documented in our study are ysed using Microsof Excel 2000 and SPSS version 14.0. repeatedly noted as predominant in various ethnobotanical Descriptive statistics using frequencies and cross-tabulations surveys focusing on asthma. For instance, the Asteraceae, were utilised in constructing tables showing the commonly Euphorbiaceae, and Fabaceae were also represented with used plant species by THs, local names of the plants used higher number of species in a study conducted in India for asthma and related conditions, plant parts used and [34]. In a similar survey carried out amongst THs in South state/s of their usage, modes of preparation, and remedy Western Nigeria, Euphorbiaceae was also dominant [18]. Te administration. widespread and higher utilisation of species from all the aforesaid botanical families is an indication that they are 2.3.2. Fidelity Level (FL). Te FL as described by Al-Quran widely distributed in various countries of the world. Overall, [31] were used to determine the uniformity of plant utilisation their high preponderance in the present study might be due amongst the questioned THs. Analysis of FL of each plant tothefactthattheycontainarelativelyhigherintegerof species mentioned by Bapedi THs as a treatment of asthma antiasthmatic taxa locally known by Bapedi THs compared and related symptom followed the formula displayed below: to the rest of plant families which had less than four taxa �� (Table 1). ( ) = × 100, FL % � (1) where �� was the number of THs who claim the use of a 3.2. Plant Habit. Plants documented in this study were particular plant species to treat asthma or related symptom mainly trees and herbs (n=39, for each) as well as shrubs and � was the total number of THs who mentioned the use (n=26). Tis fnding, however, is not surprising because of species as a medicine to treat any given ailment/s (asthma thesegrowthformsareprevailingcomponentsoflocalfora or related symptom). Fidelity level expresses the preference a distributed across the studied districts and municipalities. species is given over others in the management of a particular According to Shankar et al. [35] the more common the growth ailment [32]. formisinanarea,thegreatertheprobabilityofitspopularuse is. Terefore, Bapedi THs might prefer the aforesaid habits 2.3.3. Use Value (UV). Use values are calculated for an duetotheirlocalavailabilityandfamiliarity. individual plant, in order to objectively give a quantitative measure of its relative importance to the informants [33]. 3.3. Distribution of Used Plants within the Municipalities Terefore, the extent of utilisation of each species used ther- and Districts. Te recorded 104 plant species were not apeutically by Bapedi THs for asthma and related symptoms used by all THs who diagnosed asthma and its symptoms 4 Evidence-Based Complementary and Alternative Medicine 0.01 0.05 FL UV % =THs (140) of use; 1 0.7 100 0.00 1 0.7 100 0.00 1 0.7 100 0.00 1 0.7 14.2 10.750 10.750 3 2.1 100 0.02 2 1.4 100 0.01 2 1.4 28.5 4 2.8 57.1 6 4.2 100 0.04 n UM Frequency Nasal Fatigue Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma breathing breathing Laboured Laboured Aliment/s congestion Trice a day Trice a day Trice a day orally. Trice a day orally. Trice a day orally. Trice a day Methods of herbal preparation and administration Boiled for 5 minutes. Steam inhaled (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day Boiled for 3–5 minutes. Extract is taken Boiled for 5–6 minutes. Extract is taken Boiled for 5–7 minutes. Steam is inhaled Boiled for 4–10 minutes. Extract is taken Pounded and taken orally with warm water. Boiled for 5 minutes. Extract is taken orally. Boiled for 5 minutes. Extract is taken orally. use State of Used parts plant Herb Root Dry Maime shidi-tshwene Tree Root Dr ˇ Momenko Tree Root Fresh Setlwatlwa Shrub Root Dry Khonofolo Herb Bulb Dry Mookapitsi Shrub Root Dry Moeye-ya-naga Herb Bulb Fresh Mot Toba/Mokwepere Tree Leaf Fresh L L. Harv. L. R.A.Dyer C.B.Clarke var. violacea Schinus molle Species names Vernacular name Habit Allium sativum Bernh. ex Krauss ∗ Mangifera indica (Nees) C.B.Clarke ∗ ∗ Blepharis subvolubilis Blepharis diversispina Harpephyllum cafrum Tulbaghia violacea Clivia caulescens Table 1: Plant used to treat asthma and related symptoms in the Capricorn, Sekhukhune and Waterberg districts of Limpopo Province, South Africa. Amaryllidaceae Botanical family Acanthaceae Acanthaceae Alliaceae Amaryllidaceae Anacardiaceae Anacardiaceae Anacardiaceae Evidence-Based Complementary and Alternative Medicine 5 0.02 FL UV % 100 100 1 =THs (140) of use; 1 1 0.7 33.3 1 1 2 1.4 66.6 751000.05 11 7.8 100 0.07 15 10.7 100 0.10 n 137 140 100 100 1 UM Frequency Nasal treated Asthma Asthma Asthma Asthma Asthma Asthma Asthma Asthma Asthma Aliment/s congestion S. italica, Powered is and anddried bark cafra X . day day , B. discolor water P. af r i canum . . Taken orally with warm Trice a day Trice a day Trice a day orally. Trice a day orally. Trice a day Methods of herbal A. erioloba is taken orally. Trice a day africanum preparation and administration P . Pounded and with mixed with dried Boiled for 5–6 minutes. Extract is taken of Boiled for 6–12 minutes. Extract is taken inhaled (nasally) under blanket. Trice a inhaled (nasally) under blanket. Trice a Pounded and mixed with dried powdered poured in to the boiled water and steam is and dried bark of powdered roots of Powder is poured in the hot water. Steam is roots of Boiled (until water gain colour) and extract Pounded and taken orally with warm water. Pounded and taken orally with warm water. Boiled for 5 minutes. Extract is taken orally. Juice is squeezed (raw), dried and pounded. use State of Bark Dry Fruit Fresh Used parts plant Table 1: Continued. Herb Root Dry Herb Root Dry shete ˇ sokwane Herb Rhizome Dry ˇ Mothebe Mokunya/ Phenyokga Herb Root Dry Le Moku Morarwane Shrub Root Dry Morula/Mokano Tree (L.) Eckl. Schltr Schott Spreng. cafra (Sond.) Species names Vernacular name Habit Sclerocarya birrea Stylochaeton natalensis (Ward & Harv.) Reber Strophanthus speciosus Schizoglossum nitidum ∗ (A.Rich.) Hochst. subsp. &Zeyh.var.amatymbica Zantedeshia aethiopica Alepidea amatymbica Botanical family Anacardiaceae Apiaceae Apocynaceae Apocynaceae Araceae Araceae 6 Evidence-Based Complementary and Alternative Medicine 0.23 FL UV % 17.8 75.7 =THs (140) of use; 1 1 0.7 100 0.00 3 2.15 37.5 0.02 3.5 62.5 0.03 223.56 8 6 4.2 18.1 n 16 UM Frequency Nasal Fatigue Fatigue treated Asthma Asthma Asthma Asthma Wheezing Aliment/s congestion D. . Boiled for C. sativa . Taken orally with day 5 .Triceaday orally. Trice a day Boiled for 2 minutes. Extract is Methods of herbal Syrup P. af r i canum taken orally. Trice a day is taken orally. Trice a day preparation and administration Macerated in warm water 2–5hrs. Mixed with dried pounded leaf of (nasally) under blanket. Trice a day Decoction is taken orally. Trice a day bark of Boiled for 3–7 minutes. Extract is taken Pounded and mixed with dried powered Boiled for 4–5 minutes. Steam is inhaled 5 minutes. Extract is taken orally. Trice a senecioides. Macerated in warm for 3–24hrs. Decoction Mixed with fresh leaf of use State of Used parts plant Table 1: Continued. si Herb Leaf Dry ˇ Sekgopha Shrub Leaf Fresh Legana/Moilan Togo/Marobadibogale Shrub Leaf Fresh Jacq. ex Baker Aloe spp. Willd. var. afra Species names Vernacular name Habit Aloe falcata Artemisia afra Botanical family Asphodelaceae Asphodeloideae Asteraceae Evidence-Based Complementary and Alternative Medicine 7 0.10 FL UV % 1.4 13.3 9.2 86.6 =THs (140) of use; 1 1 0.7 100 0.00 1 1 1 1 3 2.1 100 0.02 n 10 UM Frequency Fatigue Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma Aliment/s L. leaves . Boiled for leaves of . Taken orally O. ,androotof C. edulis O. lanceolata, Or day . Boiled for 4 minutes. T. dioica and . Taken orally with warm T. dioica H. caespititium, Trice a day Trice a day Trice a day and water. Trice a day orally. Trice a day orally. Trice a day orally. Trice a day and Methods of herbal . Taken orally with warm water. L. javanica C. laureola Z. capense with warm water. Trice a day preparation and administration L. javanica javanica Boiled for 5–8 minutes. Extract is taken of Boiled for 7–9 minutes. Extract is taken Boiled for 4–6 minutes. Extract is taken root of Pounded and mixed with dried powered Pounded and mixed with dried powered Steam is inhaled (nasally) under blanket. lanceolata Pounded and mixed with dried powdered Pounded and mixed with dried powdered 5 minutes. Extract is taken orally. Trice a root of whole plants of Pounded and taken orally with warm water. roots of Mixed with fresh leaf of use Dry State of plant Used parts plant Whole Table 1: Continued. Herb Root Dry Herb Herb Root Dry swaneng ˇ Phelana/ Bokgatha Maku Phela/Hlonya/ Makuru/Pedipekanto DC. subsp. gerrardii (DC.) Harv. Species names Vernacular name Habit Callilepis laureola Dicoma anomala Helichrysum caespititium Botanical family Asteraceae Asteraceae Asteraceae 8 Evidence-Based Complementary and Alternative Medicine 0.19 0.18 0.07 FL UV % 9.2 48.1 =THs (140) of use; 1 0.7 100 0.00 1 0.7 100 0.00 1 2 1.4 100 0.01 2 1.4 100 0.01 7 5 53.8 0.05 7563.6 4 2.8 33.3 4 2.8 36.3 44 2.8 2.8 33.3 33.3 6 4.2 46.1 0.04 12 n 14 19.2 51.8 UM Frequency Nasal Nasal Nasal Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma Asthma Asthma Wheezing Wheezing Aliment/s congestion congestion congestion Powder is poured in Trice a day Trice a day Trice a day Trice a day Trice a day Trice a day orally. Trice a day orally. Trice a day Methods of herbal P. g randif ora . under blanket. Trice a day preparation and administration (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day under (nasally) blanket. Trice a day Boiled for 5 minutes. Steam is inhaled Boiled for 4–11 minutes. Extract is taken Boiled for 5–13 minutes. Extract is taken Boiled for 5–7 minutes. Steam is inhaled the boiled water. Steam inhaled (nasally) Pounded and mixed with dried powdered root of Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Boiled for 5 minutes. Extract is taken orally. Boiled for 3–8 minutes and steam is inhaled use Dry Fresh State of plant plant Used parts plant Whole Whole Table 1: Continued. Tree Root Dry Tree Bark Dry Herb Leaf Dry Herb Herb Leaf Leaf Herb Shrub Root Dry suhla sane/lesodi ˇ ˇ Molaka Motloro sane/Seralane ˇ Mpepho Mo ˇ Sathume/ Unknown Lesotlane/ sa ˇ Mo Monotlet (L.) DC. Legatuludi Shrub Leaf Dry (Lam.) (DC.) DC. Mill. Vatke (L.) Hilliard & B.L.Burtt Species names Vernacular name Habit Kuntze ex Tell. Sch.Bip. e x Walp. (G.Bertol.) Chiov. Vernonia natalensis Warburgia salutaris album Opuntia fcus-indica Pseudognaphalium luteo- pinnata Psiadia punctulata Senecio serratuloides ∗ ∗ ∗ Helichrysum gymnocomum Botanical family Asteraceae Asteraceae Asteraceae Asteraceae Asteraceae Asteraceae Cactaceae Canellaceae Evidence-Based Complementary and Alternative Medicine 9 0.13 FL UV % 2.1 50 0.02 =THs (140) of use; 1 1 0.7 100 0.00 1 0.7 100 0.00 32.1500.02 2 8 5.7 42.1 11 7.8 57.8 13 9.2 100 0.09 n UM Frequency chest Tight Nasal Fatigue Fatigue Fatigue treated Asthma Asthma Asthma Aliment/s congestion ,dried elata D . A.. afra Boiled for 5 Trice a day Trice a day Trice a day Trice a day orally. Trice a day Methods of herbal C.. abbreviata Boiled for 6 minutes. inhaled (nasally). Trice a day preparation and administration Extract is taken orally. Trice a day Mixed with fresh bulb of Boiled for 4–5 minutes. Extract is taken bark of Rubbed (raw) between hands and vapour is Pounded and taken orally with warm water. Pounded and taken orally with warm water. Boiled for 5 minutes. Extract is taken orally. Boiled for 5 minutes. Extract is taken orally. Mixed with dried leaf of minutes. Extract is taken orally. Trice a day use Dry Fresh State of Used parts plant Table 1: Continued. Tree Root Dry Shrub Leaf Fresh Shrub Root Dry se Herb Leaf ˇ sikana ˇ sope ˇ Mo Moethi/ simanewanaga/ ˇ Morit Lebake/Pat Diragadibonwe Shrub Root Dry Molomomonate Lehlatse/Lewang/ Mo (Lindl.) L. var. Pax subsp. (Vahl) Forssk. Sweet ex Endl. Species names Vernacular name Habit Welw. ex Britten crustata (Wild) Wild Kalanchoe brachyloba Cannabis sativa indica (Lam.) Wehmer Maerua juncea Ipomoea albivenia Catha edulis Botanical family Cannabaceae Capparaceae Celastraceae Convolvulaceae Crassulaceae 10 Evidence-Based Complementary and Alternative Medicine 0.17 0.46 FL UV % =THs (140) of use; 1 0.7 100 0.00 1 0.7 100 0.00 53.520 7510.7 85.732 4 2.8 100 0.02 n 12 8.5 48 19 13.5 100 0.13 10 7.1 100 0.07 58 41.4 89.2 UM Frequency Nasal Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma Asthma Wheezing Aliment/s congestion C. L. and leaf of O. lanceolata Or H. caespititium, Trice a day Trice a day Trice a day Trice a day Trice a day Trice a day orally. Trice a day Methods of herbal . Taken orally with warm water. and roots of preparation and administration (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day Boiled for 9 minutes. Steam is inhaled laureola whole plant of Boiled for 5–8 minutes. Steam is inhaled Pounded and mixed with dried powered Boiled for 6–10 minutes. Extract is taken javanica Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Boiled for 5 minutes. Extract is taken orally. use State of Used parts plant Table 1: Continued. Herb Root Dry Herb Leaf Dry Herb Tuber Dry shi ˇ sane ˇ shit ˇ Kgato T Bogopa/ Mohlahla Herb Root Dry Mabat Moolologa/Selogane Tree Root Dry Pax Ngaka-dianya Herb Root Dry Eckl. Burch. Sond. Sephapabadiya Herb Root Dry Sond. Nees gratissimus Burkill Species names Vernacular name Habit var. E.Mey. ex Naudin Tragia dioica Cucumis metuliferus Cyperus sexangularis Jatropha zeyheri Euphorbia schinzii Dioscorea sylvatica Croton gratissimus var. brevipes (Burtt Davy) Botanical family Cucurbitaceae Cyperaceae Dioscoreaceae Euphorbiaceae Euphorbiaceae Euphorbiaceae Euphorbiaceae Evidence-Based Complementary and Alternative Medicine 11 0.04 FL UV % 2.1 50 =THs (140) of use; 1 0.7 100 0.00 1 1 0.7 100 0.00 1 0.7 100 0.00 3 2.1 100 0.02 32.150 3 2.1 100 0.02 2 2 1.4 100 0.01 n UM Frequency Fatigue Fatigue Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma Aliment/s . ,androot P. af r i canum . birrea E. autumnalis S . and Or and root of Trice a day Trice a day Trice a day Trice a day orally. Trice a day orally. Trice a day orally. Trice a day orally. Trice a day Methods of herbal . Taken orally with warm water. A. spinosa P. af r i canum cafra preparation and administration X . Boiled for 5–8 minutes. Extract is taken Mixed with fresh bulb of Boiled for 5–9 minutes. Extract is taken Boiled for 6–11 minutes. Extract is taken Boiled for 5–12 minutes. Extract is taken Pounded and mixed with dried powdered Pounded and mixed with dried powdered of bark of Taken orally with warm water. Trice a day stem of Pounded and taken orally with warm water. Pounded and taken orally with warm water. Boiled for 6 minutes. Extract is taken orally. use State of Used parts plant Table 1: Continued. Tree Root Dry Tree Root Dry Tree Root Dry Shrub Root Dry sane Shrub Root Dry ˇ su su ˇ ˇ sane/ ˇ sit ˇ si ˇ Mo Mo Batswetsi Mogohlo/ Mo Mo Mokgaripe Monepenepe Tree Bark Dry Mafahla-nare Tree Root Dry Oliv. DC. var. E.Mey. (L.) Willd. Benth. goetzei Brenan Brenan adianthifolia Species names Vernacular name Habit var. rostrata Brenan Albizia adianthifolia Acacia erioloba Cassia abbreviata Elephantorrhiza burkei (Harms) Harms subsp. Elephantorrhiza goetzei Acacia senegal subsp. beareana (Holmes) Acacia sieberiana (Schumach.) var. W.Wight woodii(BurttDavy)Keay& Botanical family Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae Fabaceae 12 Evidence-Based Complementary and Alternative Medicine FL UV % 2.1 21.4 0.1 7.8 78.5 6.4 100 0.06 =THs (140) of use; 1 1 1 1 1 8 n 10 7.1 100 0.07 10 UM Frequency Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma Wheezing Aliment/s 5 . birrea E. burkei. and dried and dried bark S. italica, cafra dried bark of S. X . and a root of Powered is poured in to and , Powered is poured in to Trice a day Trice a day . Taken orally with Syrup orally. Trice a day orally. Trice a day orally. Trice a day Methods of herbal . Taken orally with warm water. afra B. discolor, A. spinosa S. birrea. A . B. discolor A. erioloba birrea preparation and administration P. af r i canum . (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day S . the boiled water and steam is inhaled the boiled water and steam is inhaled Boiled for 5–11 minutes. Extracts taken Boiled for 5–8 minutes. Extract is taken Boiled for 4–8 minutes. Extract is taken leaf of Pounded and mixed with dried powered bark of roots of stem of root of Pounded and mixed with dried powdered Pounded and mixed with dried powdered of and Taken orally with warm water. Trice a day Pounded and mixed with a dried powdered Pounded and mixed with a dried powdered roots of use Dry State of Bark Root Used parts plant Table 1: Continued. Tree Bark Dry Tree si Herb Root Dry ˇ sho ˇ Mmale Sebalo/ Mosehla Moroteladit Mill. subsp. Sond. Hutch. Species names Vernacular name Habit Erythrina lysistemon Peltophorum africanum Senna italica arachoides (Burch.) Lock Botanical family Fabaceae Fabaceae Fabaceae Evidence-Based Complementary and Alternative Medicine 13 0.15 0.12 0.08 FL UV % 10 77.7 =THs (140) of use; 1 10.78.3 1 0.7 11.1 0.00 10.74.7 32.125 8 5.7 88.8 0.05 4 2.8 22.2 44 2.8 33.3 2.8 33.3 9 6.4 42.8 11 7.8 52.2 13 n 140 100 100 1 UM Frequency Nasal Nasal Fatigue Fatigue Fatigue Fatigue Fatigue treated Asthma Asthma Asthma Asthma Wheezing Wheezing Aliment/s congestion congestion E.. goetzei S. aethiopicus. M.,dried juncea Or Trice a day Trice a day Trice a day Trice a day Trice a day orally. Trice a day orally. Trice a day orally. Trice a day Methods of herbal C.. abbreviata Boiled for 6 minutes. preparation and administration Extract is taken orally. Trice a day (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day Boiled for 5 minutes. Steam is inhaled Mixed with fresh bulb of Boiled for 5–12 minutes. Extract is taken Boiled for 5–8 minutes. Steam is inhaled Boiled for 5–14 minutes. Extract is taken Boiled for 5–10 minutes. Extract is taken Mixed with dried root dried of Mixed with dried root of bark of Pounded and taken orally with warm water. Boiled for 5 minutes. Extract is taken orally. Boiled for 5 minutes. Extract is taken orally. Boiled for 6 minutes. Extract is taken orally. Boiled for 6 minutes. Extract is taken orally. use Dry State of plant Used parts plant Whole Herb Tuber Fresh Herb Table 1: Continued. sohle/ ˇ Sekgekolwana Mathubadifala Herb Bulb Fresh Mathubadifala Herb Bulb Fresh Makgonot Vernacular name Habit Mphedu-ya-thaba Hlakudiboya/Titikwane/ ´ e- Baker (Mill.) (Lam.) Jacq. Sekanama Herb Bulb Fresh Lall Chitt. J.C.Manning Species names Drimia elata subsp. pole-evansii (N.E.Br.) Reyneke ex Hypoxis hemerocallidea Fisch., C.A.Mey. & Av A.Raynal subsp. Axillare Eucomis pallidifora Enicostema axillare Eucomis autumnalis Botanical family Gentianaceae Hyacinthaceae Hyacinthaceae Hyacinthaceae Hypoxidaceae 14 Evidence-Based Complementary and Alternative Medicine 0.02 FL UV % =THs (140) of use; 1 0.7 100 0.01 1 0.7 33.3 5 3.5 100 0.03 3 2.1 100 0.02 2 1.4 100 0.01 2 1.4 66.6 2 1.4 100 0.01 4 2.8 100 0.02 n 14 10 100 0.1 68 48.5 100 0.48 140 100 100 1 140 100 100 1 UM Frequency Nasal Fatigue Fatigue Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma Asthma Asthma Aliment/s congestion Powder is poured Trice a day Trice a day S. pinnata. orally. Trice a day orally. Trice a day orally. Trice a day orally. Trice a day orally. Trice a day orally. Trice a day Methods of herbal warm water. Trice a day under blanket. Trice a day preparation and administration Boiled for minutes. Steam is inhaled (nasally) under blanket. Trice a day Boiled for 5–7 minutes. Extract is taken Boiled for 5–8 minutes. Extract is taken Boiled for 5–8 minutes. Extract is taken Boiled for 5–9 minutes. Extract is taken Boiled for 4–7 minutes. Extract is taken Pounded and extract is taken orally with Boiled for 6–10 minutes. Extract is taken Pounded and mixed with dried powdered in the boiled water. Steam inhaled (nasally) entire plant of Pounded and taken orally with warm water. Pounded and taken orally with warm water. use Dry Dry State of leaf plant Used parts plant Whole Root or Table 1: Continued. Tree Root Dry Tree Bark Fresh Tree Root Dry Herb Shrub Shrub Root Dry Shrub Root Dry sa ˇ Bjere Lebake Mogoo mogaba Mmot Mokgoba Sebokane Kgosupsa Tree Bark Dry Modumela/ Mohlokohloko Tree Leaf Fresh Monna maledu Herb Tuber Fresh Mohuf/Mohufe Tree Root Dry (L.) Engl. A.Meeuse Burch. ex R.Br. Baill. Schinz E.Mey. Ker Gawl. Burtt Davy rotundifolia Species names Vernacular name Habit (Hochst.) Kuntze Adansonia digitata Kirkia wilmsii Cassinopsis ilicifolia Leonotis leonurus Dombeya rotundifolia (Hochst.) Planch. var. Clerodendrum glabrum Clerodendrum ternatum Pyrenacantha grandifora Hypoxis obtusa E.Mey. var. angustifolium Cryptocarya transvaalensis Abutilon galpinii Botanical family Hypoxidaceae Icacinaceae Icacinaceae Kirkiaceae Lamiaceae Lamiaceae Lamiaceae Lauraceae Malvaceae Malvaceae Malvaceae Evidence-Based Complementary and Alternative Medicine 15 FL UV % 2.8 100 0.02 =THs (140) of use; 1 0.7 100 0.00 1 3 3 2.1 100 0.02 2 1,4 100 0.01 2 1.4 100 0.01 17 12.1 100 0.12 n 70 50 100 0.5 UM Frequency Nasal Fatigue treated Asthma Asthma Asthma Asthma Asthma Asthma Aliment/s congestion .Boiled laureola C . aday aday Trice a day Trice a day Trice a day Methods of herbal swallowed. Trice a day warm water. Trice a day preparation and administration Chewed (orally) as raw and juice is (nasally) under blanket. Trice a day Boiled for 5 minutes. Steam is inhaled Pounded and extract is taken orally with Pounded and extract is taken orally. Trice for 5 minutes. Extract is taken orally. Trice Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Mixed with dried root of use State of Used parts plant Table 1: Continued. Tree Leaf Dry Herb Leaf Fresh Shrub RootShrub Dry Root Dry shipse ˇ Mo Moringka Mogwete/ Mopilikomo Tree Bark Dry Mogolori/Lefelo Katluni/Leokodi/ Mogwete/Mogoto Tree Root Dry Mohlare-wa-mawisi L. (L.) L. Mohutasela Shrub Root Dry sensu Harv. Mast. var. Dehnh sulcata Vollesen Species names Vernacular name Habit Exell & Mendon Sida cordifolia L.Bolus subsp. edulis Grewia hispida Moringa oleifera Carpobrotus edulis Eucalyptus camaldulensis ∗ subsp. africanum (Watt) Gossypium herbaceum Grewia sulcata ∗ Botanical family Malvaceae Malvaceae Malvaceae Malvaceae Mesembryanthemaceae Moringaceae Myrtaceae 16 Evidence-Based Complementary and Alternative Medicine 0.09 FL UV % 3.5 100 0.03 5.7 100 0.05 =THs (140) of use; 1 0.7 100 0.00 1 1 7 4 4 2.8 30.7 9 9.2 69.2 n UM Frequency Fatigue treated Asthma Asthma Asthma Asthma Asthma Aliment/s P . ,driedbarkof . Taken orally with S. birrea Trice a day Trice a day orally. Trice a day orally. Trice a day Methods of herbal and A. A. erioloba warm water. Trice a day topically as bath. Trice a day preparation and administration Boiled for 6 minutes. Extract is used roots of Boiled for 5–13 minutes. Extract is taken Boiled for 8 minutes and extract is taken Pounded and mixed with dried powdered africanum Pounded and taken orally with warm water. Pounded and taken orally with warm water. use Fresh Chew as raw (orally). Trice a day Asthma State of scale Fruit Used parts plant Table 1: Continued. shidi-kgomo Tree Root Dry ˇ Mopowane Shrub Root Dry Mokgarenate Tree Mot Mohlware/Mo-olive Tree Root Dry L. L. subsp. Burtt Davy Sond. var. Species names Vernacular name Habit subsp. fruticosa natalensis Sond. Panica granatum ∗ Olea europaea Ximenia cafra africana (Mill.) P.S.Green Adenia fruticosa Botanical family Olacaceae Oleaceae Punicaceae Passiforaceae Evidence-Based Complementary and Alternative Medicine 17 0.03 0.58 0.06 FL UV % 40.7 69.5 =THs (140) of use; 1 0.7 11.1 1 0.7 100 0.00 1 1 0.7 100 0.00 10.720 3 2.1 100 0.02 2 1.4 100 0.01 8 5.7 88.8 42.880 6 4.2 100 0.04 n 25 17.8 100 0.17 25 17.8 30.4 56 UM Frequency Nasal Fatigue Fatigue Fatigue Fatigue treated Asthma Asthma Asthma Asthma Asthma Asthma Asthma Asthma Aliment/s congestion 5 Aloe Taken and dried P. af r i canum . P. af r i canum , and Powder is poured in boiled and Trice a day Trice a day Trice a day Trice a day orally. Trice a day orally. Trice a day Methods of herbal blanket. Trice a day E. burkei S. birrea S. italica. preparation and administration Boiled for 2 minutes. Extract is taken drink or sof porridge. Trice a day orally with warm water. Trice a day (nasally) under blanket. Trice a day Pounded and taken orally with Mageu Boiled for 6–13 minutes. Extract is taken spp. Boiled for 5–10 minutes. Steam is inhaled roots of Pounded and mixed with powdered dried Pounded and mixed with dried powdered water and steam is inhaled (nasally) under Pounded and mixed with fresh leaf of Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. root of bark of use State of Used parts plant Table 1: Continued. Tree Root Dry Tree Root Dry Tree Root Dry Herb Root Dry Shrub Stem Dry Shrub Root Dry sumi/ ˇ simabe/ ˇ segomabe ˇ Mabele Mphesu/ Mothema Moneyee/ Momphati Herb Leaf Dry Modumela Ma Mogokgoma Ma Mabele-thoro Herb Seed Dry Mpitlamarago Monna-apare/ Pisayabat Mogabaletswana Tree Root Dry L. (L.) Fresen. Meisn. Burtt Davy subsp. mays L. Securidaca subsp. cafra Wet & Harlan Species names Vernacular name Habit Moench subsp. (Tunb.) Radlk. (Klotzsch) Abels (Klotzsch) Hemsl. Berchemia discolor Protea cafra Sorghum bicolor Ptaeroxylon obliquum Plumbago zeylanica var. longepedunculata Zea mays longepedunculata Dicerocaryum senecioides arundinaceum (Desv.) de ∗ Adenia spinosa Botanical family Passiforaceae Pedaliaceae Plumbaginaceae Poaceae Poaceae Polygalaceae Proteaceae Ptaeroxylaceae Rhamnaceae 18 Evidence-Based Complementary and Alternative Medicine 0.11 0.09 FL UV 46.1 % =THs (140) of use; 1 0.7 100 0.00 10.7 1 0.7 100 0.00 10.76.2 10.76.2 53.5 2 1.4 100 0.01 2 1.4 100 0.01 7553.8 n 14 11.4 87.5 UM Frequency chest Tight Fatigue Fatigue treated Asthma Asthma Asthma Asthma breathing breathing Laboured Laboured Wheezing Aliment/s L. ,whole and leaves of .Taken orally with O. lanceolata . Taken orally with . Taken orally is with and Trice a day Trice a day Trice a day Trice a day Trice a day T. dioica orally. Trice a day Methods of herbal and H. caespititium C. laureola W. somnifera warm water. Trice a day warm water. Trice a day warm water. Trice a day C. laureola preparation and administration root of root of plant of javanica Boiled for 4–5 minutes. Extract is taken Pounded and mixed with dried powdered Pounded and mixed with dried powdered Pounded and mixed with dried powdered root of Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. use State of Used parts plant Table 1: Continued. Tree Root Dry Tree Root Dry Tree Root Dry Tree Root Dry Tree Fruit Fresh Mphera Moswiri Mokgalo Mofentshe Pharagobe Monokwane/Moregakgaka Tree Root Dry Willd. Jacq. Hochst. I.Verd. (L.) Burm.f. Benth. refexa &Steud. (Tunb.) Harv. Species names Vernacular name Habit subsp. mucronata Vepris var. angustifolia (L.f.) Zanthoxylum capense Dodonaea viscosa Citrus limon Osyris lanceolata ∗ Ziziphus mucronata Botanical family Rhamnaceae Rutaceae Rutaceae Rutaceae Santalaceae Sapindaceae Evidence-Based Complementary and Alternative Medicine 19 1.12 FL UV % =THs (140) of use; 1 0.7 14.2 0.00 3 2.1 100 0.02 3 2.1 100 0.02 5 3.5 100 0.03 3 2.1 100 0.02 2 1.4 100 0.01 4 2.8 100 0.02 6 4.2 85.7 0.04 17 12.1 10.8 n 140 100 100 1 140 100 100 UM Frequency chest Tight Fatigue treated Asthma Asthma Asthma Asthma Asthma Asthma Asthma Asthma breathing Laboured Aliment/s . Taken orally with Trice a day Trice a day Trice a day Trice a day Trice a day Methods of herbal O. lanceolata warm water. Trice a day preparation and administration (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day Boiled for 5 minutes. Steam is inhaled root of Mixed with (spider’s web). Pounded and Boiled for 5–10 minutes. Steam is inhaled Boiled for 5–10 minutes. Steam is inhaled Pounded and mixed with dried powdered taken orally with warm water. Trice a day Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. Pounded and taken orally with warm water. use Dry State of plant Used parts plant Whole Table 1: Continued. Tree Root Dry Herb Herb Root Dry Shrub Leaf Fresh Shrub Root Dry supeng Shrub Root Dry ˇ sala ˇ Moketla Mmupudu Nkekologe Shrub Root Dry Mothola-o- Mothola-o- Mohlatshwa Tree Root Dry mokokotane Bokokotane/ moserolwane Mo momokhwibidu Peyr. (L.) Baker Tuse Herb Root Dry Nees (Sond.) Meisn. (L.) Lam Tunb. Dunal E.Mey. ex Sond. T.D.Penn. Species names Vernacular name Habit Englerophytum Solanum panduriforme Lantana rugosa Withania somnifera Mimusops obovata Lasiosiphon cafer Xerophyta retinervis magalismontanum Buddleja salvifolia Solanum catombelense Scrophulariaceae Botanical family Sapotaceae Sapotaceae Solanaceae Solanaceae Solanaceae Tymelaeacea Velloziaceae Verbenaceae 20 Evidence-Based Complementary and Alternative Medicine 0.12 FL UV % 7.1 55.5 =THs (140) of use; 1 1 0.7 100 0.00 10.75.5 10.75.5 2 1.4 11.1 4 2.8 100 0.02 4 2.8 22.2 9 n UM Frequency Nasal Fatigue treated Asthma Asthma Asthma Asthma breathing Laboured Wheezing Aliment/s congestion . . ,whole T. dioica hemerocallidea H . and leaf of O. lanceolata and . Boiled for 4 minutes and Trice a day Trice a day Trice a day open. Trice a day orally. Trice a day Methods of herbal C. laureola H. caespititium, C. laureola preparation and administration (nasally) under blanket. Trice a day (nasally) under blanket. Trice a day Boiled for 5 minutes. Steam is inhaled (nasally) under blanket, but while eyes Boiled for 5–14 minutes. Extract is taken steam is inhaled (nasally) under blanket. Boiled for 5–13 minutes. Steam is inhaled Boiled for 5–10 minutes. Steam is inhaled Pounded and mixed with dried powdered Pounded and mixed with dried powdered Taken orally with warm water. Trice a day Mixed with fresh bulb of Pounded and taken orally with warm water. Boiled for 5 minutes. Extract is taken orally. root of roots of plant of use Dry Fresh Fresh State of Used parts plant Table 1: Continued. Herb Bulb Fresh Herb Root Dry Shrub Leaf nageng sunkwane/ ˇ Serokolo Terebe-ya- Mo motlaba-dipoo (Burm.f.) Spreng ) , fdelity level; FL, use mention; UM and use value; UV. Species names Vernacular name Habit ∗ ( tomentosa (Schweinf.) B.L.Burtt Lippia javanica Siphonochilus aethiopicus (Lam.) Wild & R.B.Drumm. Exotic plant species: asterisk Botanical family Verbenaceae Zingiberaceae Key: Evidence-Based Complementary and Alternative Medicine 21 across the studied municipalities and districts. Overall the during certain season of the year and in selected geographical most widely distributed medicinal plant species (6.7%, n=7) areas. Furthermore, it is perhaps a means to allow them used in all these geographical areas were Clerodendrum to select more efective asthma remedy or it is traditional ternatum, Cryptocarya transvaalensis, Lasiosiphon cafer, Eni- practice they learned from their mentors. costema axillare, Mimusops obovata, Sclerocarya birrea,and Stylochaeton natalensis. Te widespread utilisation of these 3.4.1. Asthma Terapies. Of the 53 (50.9%) asthmatic species, species shows that they are popular, safe, and well-known as six (11.3%) comprising C. ternatum, C. transvaalensis, E. axil- asthma therapies in Bapedi traditional healing sectors. lare, M. obovata, S. birrea,andS. natalensis were appreciated An overwhelming majority (40%, n=42) of species com- by all THs (n=140) who treated asthma across the study sites. prising Abutilon galpinii, Acacia erioloba, Acacia senegal, To the best of our knowledge, with the exclusion of S. birrea Acacia sieberiana, Albizia adianthifolia, Allium sativum, Aloe which were previously highlighted by Ojewole [36] as being falcata, Berchemia discolor, Blepharis diversispina, Blepharis used for asthma in unspecifed countries, subvolubilis, Buddleja salviifolia, Cassinopsis ilicifolia, Catha all the aforesaid taxa are recorded for the frst time in our edulis, Clivia caulescens, Dicerocaryum senecioides, Dicoma study as remedy for this ailment. However, such species are anomala, Dodonaea viscosa, Dombeya rotundifolia, Elephan- well-known and widely used as traditional cure for other torrhiza goetzei, Eucalyptus camaldulensis, Grewia hispida, humandiseasesacrossAfrica.Hossanetal.[37]observedthat Grewia sulcata, Harpephyllum cafrum, Helichrysum cae- medicinal plants that are both highly and widely used for a spititium, Helichrysum gymnocomum, Hypoxis obtusa, Ipo- particular ailment are in most case new sources of medication moea albivenia, Jatropha zeyheri, Mangifera indica, Opun- of such afiction. Taking into account this, we hypothesize tia fcus-indica, Panica granatum, Pyrenacantha grandifora, that the wide use of the above-listed six taxa in the treatment Rhoicissus tomentosa, Schkuhria pinnata, Sida cordifolia, of asthma by Bapedi THs is due to their efectiveness and Siphonochilus aethiopicus, Sorghum bicolor, Tragia dioica, thus must be investigated for their potential as new source of Tulbaghia violacea, Zantedeschia aethiopica, Zea mays, and asthma medication. In fact utilisation of E. axillare by these Ziziphus mucronata were used in a single municipality THs is already supported by scientifc studies. For instance, its located within one of the three studied districts (Table 2). extract exhibited both anti-infammatory and antiasthmatic Tis fnding might be attributed to the natural distribution activities [38]. Ethanol extracts of Clerodendrum serratum of these taxa in the studied districts or variation with respect Linn roots showed good antiasthmatic activity in experi- to THs’ indigenous knowledge related to their applications as mental animal [39], thus suggesting that a closely related antiasthmatic medicines. species C. ternatum (usedbyBapedi)mightalsopossesssame Te above can also be said for 19.3% (n=20) of plants, activity. namely, Adansonia digitata, Adenia fruticosa, Aloe spp., Citrus Most (50%, n=26) of the remaining plants, A. galpinii, limon, Clerodendrum glabrum, Cucumis metuliferus, Englero- A.erioloba,A.senegal,A.sieberiana,B.discolor,B.salvi- phytum magalismontanum, Erythrina lysistemon, Eucomis ifolia, C. edulis, C. glabrum, C. caulescens, C. metuliferus, autumnalis, Euphorbia schinzii, Lantana rugosa, Leonotis D. senecioides, Dioscorea sylvatica, E. magalismontanum, E. leonurus, Maerua juncea, Olea europaea, Pseudognaphalium schinzii,G.sulcata,H.cafrum,I.albivenia,J.zeyheri,L. luteo-album, Solanum catombelense, Solanum panduriforme, rugosa, P. grandifora, R. tomentosa, S. pinnata, Senna italica, Vepris refexa, Warburgia salutaris, and Xerophyta retinervis, S.catombelense,S.panduriforme,and Strophanthus speciosus, which were utilised by THs in particular municipalities used in this study to exclusively treat asthma were also located in one district. Te remainder (33.7%, n=35) of documented for the frst time in this study as remedies for the plant species recorded in the present study were also this condition. Tese species are also traditionally utilised as distributed in certain municipalities but in more than one medicine to treat diferent human diseases in South Africa district (Table 2). and other African countries. Terefore, their use in this study for asthma is an indication that they might be safe 3.4. Species Utilisation and Literature Comparison. Amongst for consumption as remedies. From conservation point of the 104 plants recorded in the current study, vast majority view restricted knowledge of the above-mentioned species (50.9%, n=53) were used by THs to exclusively manage to Bapedi THs as therapies for asthma to some extent has asthma, and 25.9% (n=27) for both asthma and the following advantage, as it decreases the impact of being extensively symptoms: fatigue, nasal congestion, tight chest, wheeze, and recurrently harvested across the countries to manage this laboured breathing, nasal congestion and wheezing, fatigue chronic disorder. andwheezing,andfatigueandlabouredbreathing,aswell Te utilisation of the rest (38.5%, n=20) of the species, as fatigue, laboured breathing, nasal congestion, and wheeze. namely, Alepidea amatymbica, Cassia abbreviata, Carpo- Te remaining 24.0% (n=25) of the taxa were used exclusively brotusedulis,D.anomala,E.camaldulensis,Gossypium to heal some of these symptoms (Table 1). Overall all taxa herbaceum, H. gymnocomum, L. leonurus, M. indica, O. recorded in this study are known medicinal plants in South europaea,O.fcus-indica,P.granatum,S.cordifolia,S. Africa and thus form part of local traditional ethnophar- aethiopicus, Securidaca longepedunculata, Ximenia cafra, X. macopoeia of various cultures in this country. However, the retinervis, Z. aethiopica, Z. mucronata, and Z. mays, used practice of Bapedi traditional healers to select various plant forasthmabyBapediTHswaspreviouslyculturallyvali- species to exclusively treat asthma might be attributed to a dated either in South Africa, in other African countries, or number of factors including the availability of some plants elsewhere. Nonjinge and Tarr [40] who worked with Zulu 22 Evidence-Based Complementary and Alternative Medicine per overall species treated Sum of ailment 11 325 33 55 22 725 011 813 04 08 06 02 01 06 01 01 03 02 02 03 03 857 068 05 04 09 01 03 01 01 01 611 (FC) Sum of ailment 1 6 : : - - - S A - AS:3” AS:1”:4 8 - - : - - - A Waterberg - - - - Lephalale Modimolle Mogalakwena Mookgophong Tabazimbi ------F ------A:-- - AS:6 -AS:1------F ------A:-- - - -AS:2------A F:------FA:5- Bela AS:3 - AS:2 AS:1 Bela- 1 1 1 1 3 5 7 2 0 0 0 0 0 0 0 0 0 0 4 0 0 6 0 0 0 0 0 0 0 0 0 39 (FC) Sum of ailment 4 : - - S FA:4 5 - 6 - : : - S S FA:6 ”-- ”A 1 1 : : - S S Sekhukhune Fetakgomo Makhudumathamaga Tubatse 2 -:2- - Districts and municipalities A Mogale Ephrime --- - - A:” - - -AS:1”- --A A:” - ----AS:1”------A ------A:” - AS:2 -AS:1”- F:” - - -FA:1”------F ------A ------A ------Elias FA: 6 - FA:13 FA:10 FA:6 Motsoaledi 1 1 1 1 1 1 1 3 3 3 3 2 3 2 5 7 0 0 0 4 0 0 6 0 9 0 0 11 15 14 10 68 (FC) Sum of ailment 1 3 2 : : : ------S S A AS:1 AS:7 AS:1” ------AS:3 Table 2: Use of species to treat asthma (AS) and related symptoms within the districts and municipalities. Molemole Polokwane 1-- 6-- 1-A 4-- 1 : : : : - S ------AS:13 - - - - - C C A Lepelle- Nkumpi Capricorn 3- - - : ------S AS:2 AS:6 --A --T ------N -A ------F ----A ------F - - FA:1”:8 FA:1 ------LB:1 FA:1 AS:1 AS:1 AS:1 AS:1 AS:1 AS:1 FA: 1 FA: 3 AS:1” AS:4” AS:3” - AS:4” AS:3” AS:1” - FA: 14 FA: 15 FA:13 FA: 11 FA: 15 WH:2 - FA:1”:2 - Aganang Blouberg Carpobrotus edulis Berchemia discolor Cassia abbreviata Cannabis sativa Blepharis diversispina Blepharis subvolubilis Buddleja salvifolia Catha edulis Callilepis laureola Artemisia afra Cassinopsis ilicifolia Species name Abutilon galpinii Adenia spinosa Adenia fruticosa Acacia erioloba Albizia adianthifolia Adansonia digitata Acacia senegal Alepidea amatymbica Allium sativum Acacia sieberiana Aloe spp. Aloe falcata Evidence-Based Complementary and Alternative Medicine 23 per overall species treated Sum of ailment 11 33 33 311 33 33 758 08 010 01 09 03 04 04 88 03 01 01 04 02 07 04 012 05 04 410 33 140 33 140 33 140 (FC) Sum of ailment - - - - - AS:1 AS:6 AS:6 AS:6 1 - : - - - S FA:3 AS:7 AS:7 AS:7 AS:3” WH:4 - - - - AS:1 AS:8 AS:8 AS:8 WH:3 Waterberg ------FA:3 NC:1 - Lephalale Modimolle Mogalakwena Mookgophong Tabazimbi 2 - : ------A A:-- - - -AS:3- A:-- - AS:3 -AS:1- FA:1 - AS:1 - Bela AS:3 - AS:7 AS:5 AS:7 AS:5 AS:7 AS:5 NC Bela- WH:1 - 5 2 7 0 0 0 0 0 0 0 0 0 0 0 4 0 0 4 0 0 4 0 0 0 4 39 39 39 39 (FC) Sum of ailment - - - AS:1 AS:1 FA:4 AS:4 AS:4 AS:4 NC:1 - - - AS:2 AS:2 FA:6 AS:6 AS:6 AS:6 NC:2 Table 2: Continued. - - - - Sekhukhune Fetakgomo Makhudumathamaga Tubatse Districts and municipalities Mogale Ephrime ------NC:1 - NC:1 ------0-- - - - 03 A:-AS:1- -AS:3------AS:1 - AS:1 - AS:6 AS:1 - AS:4 - Elias FA: 2 - FA:13 FA:10 FA:6 AS:13 AS:10 AS:6 AS:13 AS:10 AS:6 AS:13 AS:10 AS:6 Motsoaledi 1 1 1 3 3 3 2 2 2 8 4 8 0 0 0 9 0 0 0 0 0 0 0 0 12 12 10 68 68 68 (FC) Sum of ailment 1 3 : : - - - - C A FA:1 FA:1 FA:1 3- 9- : : ------S A AS:4 AS:5 Molemole Polokwane 8-- 1-T 8-- 2-- : : : : ------C C S C Lepelle- Nkumpi Capricorn - - - - AS:3 ---F --N --N ----- W:-- - -WH:4- - FA:1”:1 - ----F ------A --T ------A LB:1 FA:4 FA:7 FA:1” FA:1” FA:1” AS:14 AS:15 AS:13 AS:11 AS:15 AS:14 AS:15 AS:13 AS:11 AS:15 AS:14 AS:15 AS:13 AS:11 AS:15 WH: 2 WH:3 WH:5 - Aganang Blouberg naea viscosa odo Eucomis pallidifora Elephantorrhiza burkei Erythrina lysistemon Eucomis autumnalis Englerophytum magalismontanum Enicostema axillare Dombeya rotundifolia Drimia elata Elephantorrhiza goetzei Cryptocarya transvaalensis Cucumis metuliferus Clerodendrum glabrum Clerodendrum ternatum Clivia caulescens Species name Citrus limon Dicerocaryum senecioides Eucalyptus camaldulensis Cyperus sexangularis Croton gratissimus Dicoma anomala Dioscorea sylvatica D 24 Evidence-Based Complementary and Alternative Medicine 7 17 per overall species treated Sum of ailment 11 55 22 01 01 44 02 01 01 014 01 02 013 014 04 02 02 01 03 03 01 02 01 019 01 21 70 10 10 33 140 33 140 (FC) Sum of ailment 6 : - - S AS:1 AS:6 AS:6 AS: 6 3 A : ” 1 - - : S AS:1 AS:7 AS:7 AS:7 2 - - : S AS:3 AS:8 AS:8 AS:8 WH:3 Waterberg ------Lephalale Modimolle Mogalakwena Mookgophong Tabazimbi ------0 ------A:------AS:1------A -- - A ------Bela AS:7 AS: 5 AS:7 AS:5 Bela- WH:1 - 1 1 1 1 1 1 5 2 8 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 14 19 10 39 39 (FC) Sum of ailment 1 2 : : S - - S AS:1 FA:4 AS:4 AS:4 NC:1 1 - : 1 - : - S -- - H AS:6 AS:6 AS:6 AS:6 NC:2 Table 2: Continued. - - Sekhukhune Fetakgomo Makhudumathamaga Tubatse Districts and municipalities Mogale Ephrime - FA:3 FA:1 ------A ------F:” - - -FA:1”- -- - NC:1 NC:1 A:” - - - - -AS:1”- -FA:4- --- A ------F:” ---- - W --- - A -FA:1”- - AS:4 AS:6 AS:3 AS:2 AS:2 Elias AS:13 AS:10 AS:6 AS:13 AS:10 AS:6 AS:13 - Motsoaledi 1 1 1 3 3 2 2 2 2 8 0 0 0 0 0 0 9 0 0 0 0 0 0 0 0 13 17 39 68 68 (FC) Sum of ailment ------AS:1 AS:12 Molemole Polokwane 1-- 1-- 2-- 8-- 2-- 3-- : : : : : : - - - - - S C C C C S Lepelle- Nkumpi Capricorn - - - - AS:8 AS:7 AS:11 AS:13 ------A --N ------N ------A --N --N - FA:1 FA:7 FA:1 AS:1 LB:2 TC:5 TC:12 - FA: 2 FA:1” FA:2 AS:14 AS:15 AS:13 AS:11 AS:15 AS:14 AS:15 AS:13 AS:11 AS:15 Aganang Blouberg Ipomoea albivenia Moringa oleifera Maerua juncea Hypoxis obtusa Jatropha zeyheri Kalanchoe brachyloba Harpephyllum cafrum Mangifera indica Mimusops obovata Lantana rugosa Lasiosiphon cafer Leonotis leonurus Lippia javanica Kirkia wilmsii Hypoxis hemerocallidea Euphorbia schinzii Grewia sulcata Helichrysum caespititium Helichrysum gymnocomum Grewia hispida Species name Gossypium herbaceum Evidence-Based Complementary and Alternative Medicine 25 per overall species treated Sum of ailment -1 12 01 01 02 025 04 01 04 01 05 01 01 06 47 02 014 01 03 011 44 01 01 48 33 140 (FC) Sum of ailment - - - AS:6 - - AS:7 AS:3 ------AS:8 AS: 3 Waterberg - - - - Lephalale Modimolle Mogalakwena Mookgophong Tabazimbi ------L:-- - - -LB:1------AS:1 - AS:1 - Bela AS:7 AS:5 AS:4 - Bela- 1 1 1 1 1 1 1 5 2 2 0 0 4 4 0 0 0 0 4 0 0 0 6 10 39 (FC) Sum of ailment 4 4 4 : : : - - - - S S S FA:1 FA:1 AS:4 A 6 - : ------A AS:6 1 - A 1 - - : : Table 2: Continued. - - - S S - - - Sekhukhune Fetakgomo Makhudumathamaga Tubatse Districts and municipalities Mogale Ephrime --- - - A:-- - -AS:2------A:0 - - -AS:10------A --A ------F:” ------FA:1”- - A ------F --- - - A:” - - -AS:1”------FA:1 - FA:1 - FA:3 - NC:1 - Elias AS:1” - AS:1” - AS:13 AS:1”:9 AS:6 Motsoaledi 1 1 1 1 1 3 5 2 0 0 0 0 0 0 0 0 4 0 0 0 0 6 15 10 68 (FC) Sum of ailment 5 3 1 : : - - - S S -A - FA:3 FA:1 Molemole Polokwane 1-- 6-- 1-- 1-A 1 3-- : : : : : : - S - S S C B C AS:4 AS: 6 Lepelle- Nkumpi Capricorn 1- - - : S - - - AS:1” - FA:1” ------N ------L ------A ------A --N --A ------A ------LB:1” AS:1” AS:1”:13 AS:15 AS:13 AS:11 AS:15 Aganang Blouberg Schkuhria pinnata Sclerocarya birrea Schizoglossum nitidum Rhoicissus tomentosa Pyrenacantha grandifora Schinus molle Species name Olea europaea Panica granatum Opuntia fcus-indica Ptaeroxylon obliquum Psiadia punctulata Osyris lanceolata Plumbago zeylanica Peltophorum africanum Protea cafra Pseudognaphalium luteo-album 26 Evidence-Based Complementary and Alternative Medicine per overall species treated Sum of ailment 11 56 215 79 22 22 77 01 07 04 013 014 02 03 01 08 04 04 01 07 06 44 03 06 01 04 02 33 140 (FC) Sum of ailment ------AS:6 1 - 4 - : : S - - - - - S AS:7 AS:4 ------AS:8 Waterberg ------AS:1 Lephalale Modimolle Mogalakwena Mookgophong Tabazimbi ------A ------A ------AS:1 AS:1 AS:1 - AS:1 - Bela AS:2 - AS:7 - AS:7 AS:5 Bela- WH:7 - 1 1 1 1 5 3 2 2 0 0 4 0 0 0 0 4 0 4 0 0 0 0 0 6 6 6 39 (FC) Sum of ailment - - - FA:3 AS:2 AS:4 NC:1 6 - : 6 - 6 - : : - - - - H A A AS:1 AS:6 NC:2 Table 2: Continued. - Sekhukhune AS:1 Fetakgomo Makhudumathamaga Tubatse Districts and municipalities - AS:3 Mogale Ephrime WH . Plain numeric indicate number of healer/s who use a species to treat an ailments whilst numeric with a quotation mark indicate ------W - NC:1 NC:1 ------A:-- - - -AS:1------A:” - - -AS:1”- W:------WH:4- -AS:1”------F - F:” - - --- F -FA:1”- - FA:1 ------N:-- - 2 -NC:2- FA:1 FA:1 - AS:2 - Elias AS:13 AS:10 AS:6 Motsoaledi 1 1 1 1 1 3 7 7 8 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 14 68 (FC) Sum of ailment , wheezing: NC ” 3 1 : : - - - S S AS:1 AS:11 - - - - - Molemole Polokwane 1-- : 8-- 7-- 4-- : : : - - - - H LB , nasal congestion: S S C AS:6 Lepelle- Nkumpi Capricorn 1- - - : - - - S AS:3 ------N ----A --W ------A ------A ------A ------A ------AS:1 LB:1” AS:1” AS:14 AS:15 AS:13 AS:11 AS:15 AS:10 - , laboured breathing: Aganang Blouberg FA Fatigue: : Ziziphus mucronata Zea mays Sida cordifolia Xerophyta retinervis Ximenia cafra Warburgia salutaris Vernonia natalensis Senna italica Siphonochilus aethiopicus Solanum catombelense Zantedeshia aethiopica Withania somnifera Stylochaeton natalensis Sorghum bicolor Strophanthus speciosus Tragia dioica Solanum panduriforme Senecio serratuloides Species name Securidaca longepedunculata Zanthoxylum capense Tulbaghia violacea Vepris refexa number of healer/s who use a species in combination to treat an ailment/s. Key Evidence-Based Complementary and Alternative Medicine 27

THs of KwaZulu-Natal Province noted A. amatymbica as a forthisailmentbyTHsinCameroon.UtilisationofX. cafra valued medicine for asthma. In other studies conducted in as asthma therapy is also common in Swaziland [56]. Tese Zimbabwe [41, 42], this species was amongst the ten most fndings support the general notion that Africans share the used asthma remedies. However, in the present study, A. same indigenous knowledge [57]. amatymbica was only used by 7.8%(n=11) of all 58.3% (n=140) To the best of our knowledge ethnobotanical records THs who treated asthma, which might be attributed to its rare regarding uses of G. herbaceum, O. europaea, O. fcus- status across the country [43]. In view of this and the fact indica,andP. g ranatum in the management of asthma are that asthma is a chronic disorder requiring a readily available nonexistent in Africa, thus noted in this study for the frst medicine for its management, most THs in this study might time. However, the taxa G. herbaceum [58], O. europaea [59], have less preferred and considered A. amatymbica therapies O. fcus-indica [60], and P. g ranatum [61] are all used in as unsustainable. othercontinentsoftheworldcomparablytoBapediTHs, Te knowledge of D. anomala use by Bapedi THs to subsequently, indicating that these species might be helpful as treat asthma is supported by fnding of Van der Merwe [44] asthma remedies. Some of the aforementioned taxa, notably whoworkedwithZuluTHs.Infactmostofthepreviously E. camaldulensis, M. indica, O. fcus-indica, P. granatum,and ethnobotanically validated asthmatic species used in the Z. mays, are exotic in South Africa, thus suggesting two current study corroborate with those used by Zulu, compared things: (i) that the original knowledge of their application to with other cultures. for asthma by Bapedi was obtained via interactions with Use of L. leonurus as recorded in this study was previously outside THs and/or (ii) was given by ancestors via dreams. noted by Hutchings et al. [23] who questioned Zulu THs Telastpositisbasedonthefactthatmostofinterviewed and Nzue [45] who worked with Rastafarians of Western THs claimed that their ancestors show them new uses of Cape Province of South Africa. Similar fnding was reported medicinal plants via dreams while asleep. In general, fruits amongst Swati THs residing in Swaziland [46]. Te observed of M. indica, O. europaea, O. fcus-indica, P. granatum, X. similarities regarding the application of L. leonurus amongst cafra,andZ. mays werestatedbyTHsasalsobeingharvested South African and Swazi healers might be due to a cross- for household consumption. Terefore an investigation into border transfer/exchange of knowledge. Tis posit is ascribed the potential of fruits from these species as asthma therapies tothefactthatmostofSwazilandislockedwithinSouth will be interesting, and if efective it should be manufactured Africa, which might had allowed easy transfers of knowledge as beverages that assist in the asthma management. Ethanol amongst THs across geographical borders. extracts (100 mg/kg, p.o.) of P. g ranatum [61] and aqueous Similarly to Bapedi THs, Zulu also use S. aethiopicus as extract of O. europaea [62] fruits have already demonstrated a asthma medicine [23]. Widespread use of this species in the signifcant antiasthmatic activity at experimental model [61]. treatment of respiratory infections including asthma by Zulu THs has wiped out its entire local population within the 3.4.2. Asthma and Related Symptoms Terapies. As noted communal lands in KwaZulu-Natal Province [47]. However, earlier, 25.9% (n=27) of species were multiused by THs to in the present study extent of use of S. aethiopicus specifcally treat asthma and the following symptoms: fatigue, nasal for asthma might currently not have profound impact on congestion, tight chest, wheeze, laboured breathing, nasal reduction of its natural population based on the fact that congestion and wheezing, fatigue and wheezing, and fatigue it is only used by 0.7% (n=1) and also in combination with and laboured breathing, as well as fatigue, laboured breath- other species, which both put less harvesting pressure on the ing, nasal congestion, and wheeze (Table 1). Amongst these population. plants, 37% (n=10) comprising Aloe spp., A. fruticosa, Adenia Te utilisation of X. retinervis [48] and Z. mucronata [49] spinosa, Callilepis laureola, Cyperus sexangularis, Elephantor- by Bapedi THs in the treatment of asthma was previously rhiza burkei, Hypoxis hemerocallidea, M. juncea, Peltophorum highlighted by the mentioned authors amongst the unspeci- africanum, and Protea cafra were stated by THs as cure for fed South African ethnic groups. Extracts of X. retinervis [50] asthma and fatigue. Of these taxa only use of H. hemerocal- and Z. mucronata [51] were active against pathogens causing lidea for asthma [63] and fatigue [64], as well as P. af r i canum respiratory infections, which may possibly indicate that they for the latter condition [65], was previously reported in might be helpful in the management of asthma or related ethnobotanical literature. Use of H. hemerocallidea to cure symptoms. fatigue by Bapedi THs was expected mainly due to its With the exclusion of Z. aethiopica whichisalsousedas popularity as efective energy-booster. For instance, in almost medicine for asthma by the Xhosa people of South Africa every pharmaceutical chemist in Limpopo Province, there are [52], the remaining species, namely, E. camaldulensis, M. various scientifcally authenticated herbal formulations (e.g., indica, O. fcus-indica, P. g ranatum , S. longepedunculata, X. Hypo-Plus5) made from H. hemerocallidea [66], which are cafra,andZ. mays,usedexclusivelybyBapediforthis being advertised on local radios and newspapers as efective condition,arerecordedforthefrsttimeinSouthAfricaas energy and immune boosters. Tus, Bapedi THs might have asthma therapies. However, their use in the treatment and had a talk about this and decided to include H. hemerocallidea management of this condition is common in other African as part of their fatigue treatment in asthma suferers. On the countries or elsewhere. For instance, Nigerian THs also use other hand, use of this species as antiasthma by Bapedi THs E. camaldulensis [53], M. indica [54], and S. longepedunculata might be due to its efcacy in the management of asthma [55] to treat asthma. Comparably to our fndings, Naoumi and related conditions, attributed to its antiinfammatory [17] reported the use of M. indica and Z. mays as medicines activity [67]. Te use A. fruticosa, A. spinosa, C. laureola, 28 Evidence-Based Complementary and Alternative Medicine

C. abbreviata, C. sexangularis, E. burkei, M. juncea, P. caf ra the fact that it is mostly found in the markets. Tus in view (asthma and fatigue), and P. af r i canum (asthma) as therapies of chronic nature of asthma and lack of income to frequently for the mentioned aliments as disclosed by Bapedi THs was purchase its material, native people might have opted for an not found in literature, thus reported in the present study for alternative species available in free access communal lands. the frst time. Few (n=2) of Bapedi THs who use A. sativum in the present Species used as medicine for asthma and nasal congestion study harvest it from home gardens. made up 18.5% (n=5) and included K. wilmsii, P. punc tu l ata , Asthma, nasal congestion, and wheezing were treated P. z e y l ani ca ,S.nitidum,andV. natalensis.Amongstthese with two (7.4%, n=2) aromatic species A. afra and C. gratis- species only P. z e y l ani ca [68] and P. punc tu l ata [69] were simus. Utilisation of both species for wheezing is currently previously recorded in literature as asthma treatment but restricted to the Bapedi THs. However, our fnding regarding no records of its applications for nasal congestion exist. use of A. afra in the treatment of asthma and nasal congestion Restricted uses of K. wilmsii toBapediTHsasmedicinefor coincides with that reported by Mukinda [75] amongst Xhosa theseillnessesmightbeduetothefactthatitislocalisedin THs of the Western Cape Province (South Africa). Similarly, the Capricorn and Sekhukhune districts (Limpopo Province) application of C. gratissimus for asthma as noted in the both mainly inhabited by the Bapedi culture. Tis might be present study was previously highlighted by Morobe et al. [76] true since the known general medicinal usage of K. wilmsii is in South Africa. No previous record of C. gratissimus as nasal presently restricted to this culture. congestion remedy was found in literature; thus it is reported Only 7.4% (n=2) of species C. sativa and L. cafer were for the frst time in the present survey. used to heal asthma and tight chest in this study. Utilisation Atotaloftwo(7.4%)speciesD. elata and S. serratuloides of C. sativa as asthma medication was previously noted by were multiused by Bapedi THs to cure asthma, fatigue, and Van Wyk and Gericke [70] amongst the unspecifed South wheezing. Only use of D. elata as medicine for the frst con- Africanethnicgroups.Itsusefortightchestisrecorded dition was previously highlighted in ethnobotanical literature inourstudyforthefrsttimeinAfricanethnobotanical [77]. Te remainder of the applications of aforesaid species literature. However, C. sativa is commonly used for this is currently restricted to Bapedi THs. Anti-infammatory condition by THs in Pakistan [71]. Its restricted uses for properties of S. serratuloides were reported by Fawole et al. tightchesttoBapediTHsacrossAfricamightsomewhatbe [78], therefore suggesting that its use for asthma and related attributed to the fact that it is a legally declared drug; thus condition in the present study might be efective. anypersonwhoisfoundinitspossessionwithoutapermitis Another 7.4% (n=2) of species (Schinus molle and O. prosecuted. In fear of this most THs might retaliate to divulge lanceolata) were multiused by Bapedi THs for asthma, fatigue, its uses to researchers. No ethnobotanical record of L. cafer and laboured breathing. With the exclusion of using an exotic as treatment of asthma and tight chest was found in literature. S. molle as asthma medication which was culturally validated However, this species was used by all interviewed Bapedi THs in Peru [79], application of the rest of species is reported for (n=140) as cure for asthma, which might be a refection of its thefrsttimeinthisstudyacrossSouthAfricaandAfricaasa bioactivity against this condition. continent. Asthma and wheeze were also treated with two (7.4%) Overall an aromatic herb L. javanica was the only (3.7%, species, namely, W. salutaris and Z. capense.Amongstthese n=1) species widely used by Bapedi THs. For instance, it trees only use of W. salutaris as antiasthma was previously was multiused as medicine to heal asthma, fatigue, laboured reported in literature [23, 71]. Te remainder of documented breathing, nasal congestion, and wheeze. Use of L. javanica to uses of both the aforesaid trees is reported for the frst time treat asthma [80], fatigue, and nasal congestion [26] as well in this study. However, lack of literature based information as laboured breathing [81] is common amongst other South regarding their use for wheeze is understandable, based on Africancultures.However,itsuseforwheezeispresently the fact that this condition is one of the key symptoms of restricted to the Bapedi THs. In general, wide usage of L. asthma. Consequently, THs of other cultures might have javanica for asthma and perceived related symptoms by these realised that a successful asthma treatment or management THsmightbeascribedtoitswidelocalabundanceacross with W. salutaris and Z. capense automatically addresses all the Limpopo Province, and its popularity as treatment of symptoms. It is also possible that use of these species by respiratory infections [51]. Bapedi for wheeze has specifc impact on reducing constric- tion in the airways, and thus contributing towards reduction of wheeze sound. 3.4.3. Terapies for Asthma Symptoms. Te rest (24.0%, Speciesusedinthepresentstudyforasthmaandlaboured n=25) of the species recorded in this study as part of breathing were only (3.7%, n=1) A. sativum.Testateduses asthma management were exclusively used by THs to treat of this species are recorded in our study for the frst time various conditions they perceived as being associated with in South Africa but are common in other countries. For this infammatory condition (Table 1). Amongst these plants instance, its use as asthma medicine was previously reported 88% (n=22) were used to treat a single ailment, namely, in Egypt [72] and Nigeria [73]. However, as far as our fatigue (A. digitata, A. adianthifolia, A. falcata, B. diversispina, literature search went, application of A. sativum for laboured B. subvolubilis, C. edulis, C. ilicifolia, D. rotundifolia, E. goetzei, breathing is presently restricted to Bapedi THs in Africa but H. caespititium, H. obtusa, M. oleifera, P. luteo-album, S. used as such by THs in India [74]. Limited use of this species bicolor, T. dioica, and V. refexa), laboured breathing (D. amongstindigenouspeopleofSouthAfricamightbedueto viscosa), nasal congestion (G. hispida, K. brachyloba, and T. Evidence-Based Complementary and Alternative Medicine 29 violacea), tight chest (C. limon), and wheezing (E. lysiste- 3.6. Plant Parts Used, Mode of Preparations, Dosages, and mon). Te remainder (12%, n=3) of the species, namely, E. Administrations. Te majority of the herbal medicines used autumnalis (fatigue, nasal congestion), E. pallidifora (fatigue, byBapediTHsasasthmaandrelatedsymptomstherapies nasal congestion, and wheeze), and W. somnifera (fatigue and were mainly prepared from root (57%, n=61), leaf (15.8%, laboured breathing) were multiused. Overall, applications of n=17), bark (7.5%, n=8), bulb and whole plant (5.6%, n=6, an overwhelming majority of the above-listed species by THs for each), fruit and tuber (2.8%, n=3 for each), seed, stem, are recorded for the frst time in this study. For instance, and rhizome (0.9%, n=1, for each), respectively. Tree species, with the exclusion of A. digitata [82], C. edulis [83], M. L. leonurus (root and leaf), S. birrea (bark and fruit), and oleifera [84], and W. somnifera [85, 86], which their utilisa- P. af r i canum (bark and root), were harvested for their two tion as mentioned by Bapedi was previously highlighted in diferent parts. Contrary to the results of the present study, African literature, use/s of the remaining species are currently Sonibare and Gbile [18] found that THs in Nigeria prefer stem restricted to Bapedi THs. Overall, a larger number of the bark to make asthma remedies. Extensive use of root in this above-mentioned new medicinal use of commonly known studywasbasedontheperceptionthatitcarriesmorehealing speciesbyBapediTHswouldletonebelievethattheyarestill power as opposed to other plant parts, a fnding which experimenting or further exploring other potential uses of was previously reported by Semenya [88], who worked with localforawiththehopeofdiscoveringnewefectiveplants Bapedi THs. Indeed it has been scientifcally demonstrated that could contribute towards the wellbeing of asthmatic that plant root contains many bioactive principles [88]. patients. However, extensive exploitation of roots by these THs should proceed with caution as it might endanger the species. Higher 3.5.FidelityLevel(FL)andUseValue(UV).Fidelity lev- usageofleavesbyBapediTHsmightbelinkedtotheirease els of the recorded plant species difered widely for spe- of collection and transportation, both compared with other cifc disease/s. Te maximum fdelity level of 100% was parts. reported for 71.1% (n=74) of species, with the majority having Te above-mentioned plant parts (n=107) used for herbal extremely lower use-mention (UM) against a particular ail- preparation were mostly processed by Bapedi THs in their ment (Table 1). Indeed Ong and Kim [87], stated that high FL dried states (78.5%, n=84) than when they are fresh (21.4%, can only imply that a particular plant is most preferred if there n=23). Tis fnding might be attributed to the fact that these is considerable number of use-mentions from participants. THs preserve most of their medicine in dried form for future Terefore, we have correlated FL and UM in order to establish uses. Sclerocarya birrea was processed in both dried and fresh theaccurateFLofeachspecies.Inthisregard,specieswith states. Overall, a total of 153 recipes were used by Bapedi THs 100% FL coupled with use mentioned of less than 15 times to treat asthma. Of these formulae, monotherapies (75.1%, no were not considered. Accordingly, S. birrea (UM = 140 and FL = 115) based on a single plant preparation were dominant. = 100; asthma), S. natalensis (UM = 140 and FL = 100; asthma), A similar fnding was noted by Noumi [17] in Cameroon. E. axillare (UM = 140 and FL = 100; asthma), C. ternatum On the contrary Sonibare and Gbile [18] found that more of (UM = 140 and FL = 100; asthma), C. transvaalensis (UM = herbal medicine prescribed by THs in Nigeria are made from 140 and FL = 100; asthma), M. obovata (UM = 140 and FL more than one species (multitherapies) in Nigeria. High use = 100; asthma), L. cafer (UM = 140 and FL = 100; asthma, of monotherapies by Bapedi THs is perhaps an indication of and UM = 17 and FL = 10.8; tight chest),C.sexangularis(UM the efectiveness of used plant species. Tis is attributed to the =58andFL=89.2;fatigue),A. digitata (UM = 68 and FL= fact that these healers are known to combine species for the 100; fatigue), G. herbaceum (UM = 70 and FL= 100; asthma), increased efcacy [88]. Use of single therapies by Bapedi THs A. afra (UM = 25 and FL = 75.7%; asthma), A. spinosa (UM might also be due to simplifying the preparation and because = 25 and FL = 30.4; asthma and UM = 57 and FLl = 69.5; of the nature of asthma. For instance asthma attack is in most fatigue), P. obliquum (UM = 25 and FL = 100), E. schinzii cases sudden and thus requires immediate medical attention. (UM = 19 and FL = 100; asthma), M. oleifera (UM = 17 In light of this an overwhelming majority of THs in this study and FL = 100; fatigue), and S. speciosus (UM = 15 and FL = might prefer preparing medicine from a single species (which 100; asthma), respectively, scored the highest FL amongst the is both straightforward and less time consuming) in case of plants used by Bapedi THs for asthma and related symptoms, exigency. Only 24.8% (n=38) of the herbal preparations used thus suggesting their potential as therapies against the noted by interviewed Bapedi THs were multitherapies (Table 1). corresponding specifc conditions. Adenia spinosa and L. Healers who utilised this recipe disclosed that it enhances the cafer which were used to treat two conditions could be of efectiveness of medicine, which could be due to synergistic great importance in the management of various ailments. efects of several plant compounds that are active singly. Relatively high UVs was observed for L. cafer (UV = However, this postulation warrants further investigations. 1.2; asthma and tight chest), M. obovata (UV = 1; asthma), Remedies were prepared via boiling, macerating, pound- C. ternatum (UV = 1; asthma), C. transvaalensis (UV = 1; ing,squeezing,andrubbingandraw(prescribedashar- asthma), E. axillare (UV = 1; asthma), S. natalensis (UV = vested). Harvested parts from certain plant were prepared 1; asthma), and S. birrea (UV = 1; asthma). As noted earlier using more than one method or a same technique was used all these species exhibited maximum (100%) FL as antiasth- diferently amid THs (Table 1). Boiling (48.3%, n=74), pound- matics therapies; thus their highest UV for similar treatment ing (45%, n=69), pounding and boiling (2.6%, n=4), chewing further accentuates their prospective in the management of and macerating (1.3%, n=2, for each), rubbing (0.6%, n=1), asthma. and squeezing and pounding (0.6%, n=1), respectively, were 30 Evidence-Based Complementary and Alternative Medicine the principal methods of herbal preparation in the present of the world, and exchange of traditional healing knowledge study. Most of these methods are consistently reported in pertinent to these afictions. Our study also recorded a larger various ethnobotanical surveys conducted in Africa [17, 18] number of new records of known medicinal plants used in and elsewhere [89] focusing on asthma. High usage of boiling traditional healing by various cultures across South Africa plant parts by Bapedi THs might be due to the simplicity of and Africa at large, a fnding which contributes towards preparation. Bapedi THs prefer pounded remedies because establishments of an African database of antiasthma plants they have a far longer shelf life for the preparation [90]. and a new solid lead towards search for bioactive compounds Depending on an individual healer’s preference, a minimum against asthma. oftwotoamaximumof14minuteswasusedtoboilvarious plant parts. Plant parts were pounded with grinding stones Data Availability and metal equipment. Preparation times of these parts via maceration technique by Bapedi THs took from three to Tedatausedtosupportthefndingsofthisstudyare 24 hours (depending on an individual healer), which could available from the corresponding author upon request. explain its limited preference in this study. On the other hand, limited utilisation of squeezing and rubbing (n=1, for each) Conflicts of Interest amongstBapediTHsmightbeattributedtotheseasonal availability of fresh fruits and leaves, respectively (Table 1). Te authors declare that there are no conficts of interest Te present study further assessed the diferent modes regarding the publication of this paper. of application of the prepared remedies. Accordingly, of the 153 recorded recipes used for asthma and related symptoms, 80.9% (n=123) were administered orally, 19% (n=29) nasally, Acknowledgments and 0.6% (n=1) topically. Naoumi [17] also found that most Tis work was fnancially supported by the South African of the asthma medicines in his study are administered orally National Research Foundation (NRF), and Govan Mbeki with very few which were taken topically. Distinct preferences Research and Development Centre (GMRDC), University of of oral as route of herbal administration by Bapedi THs Fort.TeauthorsaregratefultoBapediTHspracticinginthe might be attributed to its convenience, for instance, it is Capricorn, Sekhukhune, and Waterberg districts, who shared straightforward and thus requires no special training. 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