Journal of Ethnopharmacology 138 (2011) 415–431 Contents lists available at SciVerse ScienceDirect Journal of Ethnopharmacology journa l homepage: www.elsevier.com/locate/jethpharm Traditional phytotherapy remedies used in Southern Rwanda for the treatment of liver diseases a,b b b c Marie-Jeanne Mukazayire , Védaste Minani , Christopher K. Ruffo , Elias Bizuru , a a,d,∗ Caroline Stévigny , Pierre Duez a Université Libre de Bruxelles (ULB), Laboratory of Pharmacognosy, Bromatology and Human Nutrition, CP 205-9, B-1050 Brussels, Belgium b Institute of Research in Science and Technology (I.R.S.T.), Phytomedecine and Life Sciences Research Programme, P.O. Box 227, Butare, Rwanda c National University of Rwanda, Department of Biology, P.O. Box 117, Butare, Rwanda d Université de Mons (UMONS), Department of Therapeutic Chemistry and Pharmacognosy, Bât. Mendeleiev, Av. Maistriau, 7000 Mons, Belgium a r t i c l e i n f o a b s t r a c t Article history: Ethnopharmacological relevance: Liver diseases represent a major health problem due to their complica- Received 30 April 2011 tions and limited treatment possibilities. In Rwanda, given low accessibility to modern treatments, most Received in revised form people still rely on traditional medicinal plants. The symptomatology of many hepatic troubles (icterus) 10 September 2011 is evident for traditional healers who have a high probability of selecting efficient herbal medicines. Accepted 16 September 2011 Objectives: To document medicines used in the treatment of “hepatitis” in Southern Rwanda with the Available online 22 September 2011 knowledge, attitudes and practices related to liver disorder recognition, control and treatment. Materials and methods: 56 traditional health practitioners, each a legal representative of an official associ- Keywords: Ethnopharmacology ation, were interviewed and participated in plant collection for the preparation of botanically identified Ethnomedicine herbarium specimens. Anti-hepatitis plants Results: 68 multi-component and 65 single-component herbal recipes were identified for the treatment of Southern Rwanda liver diseases with a total of 86 different herbs from 34 families identified. The most represented were the Asteraceae and the Lamiaceae. Crassocephalum vitellinum, Hypoestes triflora and Erythrina abyssinica were the most widely used plants. The principle of polymedication for complex (i.e. multifactorial) diseases (“Ifumbi” in Rwanda), is a constant in every traditional practice. It is striking that the Rwandese therapy of liver diseases proposes so many single-herb preparations (49% of all herbal preparations). Some of the recorded plants or other species from the same genus have previously been documented for liver protection using various in vivo and in vitro models. Conclusion: Herbal remedies for hepatitis are widely used and highly diverse in Southern Rwanda; further chemical, pharmacological and toxicological studies are clearly required to rationally develop the most important remedies. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Africa (Mets et al., 1993; Dasnoy et al., 1997; Thomas et al., 2011). In Rwanda, estimates from the University Hospital of Butare The predominant liver pathologies in a given country depend indicate that viral hepatitis and its complications, cirrhosis and on the lifestyle and economic conditions. Acute and chronic hep- hepatic carcinoma, represent 80% of all liver pathologies, the ninth atitis, liver cirrhosis (LC) and primary hepatocellular carcinoma most common cause of morbidity (Musemakweli, 1999). Modern (HCC) have become one of the major public health problems world- medicine is still quite limited in hepatic diseases prevention or wide and are very common in Africa, especially in Sub-Saharan treatment, apart from vaccines and interferon ␣-2b, used against some viral infections; the only drugs available are cholagogues, choleretics, and drugs for cholesterolic lithiasis, N-acetyl-cysteine and flavo-lignanes obtained from Silybum marianum (Evans, 2002). Abbreviations: CCl4, carbon tetrachloride; HCC, primary hepatocellular carci- This limitation of therapeutic options gives considerable interest noma; IRST, Institute of Research in Science and Technology; LC, liver cirrhosis; THPs, traditional health practitioners; WHO, World Health Organization. to the search for active compounds from plants traditionally used ∗ Corresponding author at: Laboratoire de Pharmacognosie, de Bromatologie et against liver diseases (Mukazayire et al., 2010; Jaeschke et al., 2011). de Nutrition humaine, Institut de Pharmacie, Université Libre de Bruxelles (ULB), Plants are an integral part of life in many indigenous communi- Campus de la Plaine – CP205/9, Bd du Triomphe, B-1050 Bruxelles, Belgium. ties, and Africa is no exception (Sidigia et al., 1995; Heinrich et al., Tel.: +32 26505172; fax: +32 26505430. 2009). Plant biodiversity plays major specific roles in the cultural E-mail addresses: [email protected] (M.-J. Mukazayire), [email protected] (P. Duez). evolution of local human societies (Mugabe and Clark, 1998) with 0378-8741/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.jep.2011.09.025 416 M.-J. Mukazayire et al. / Journal of Ethnopharmacology 138 (2011) 415–431 plants being important for their ethnomedical uses amongst other purposes. In Africa, as in many tropical countries, about 80% of the rural population still depends on traditional herbal remedies due to the limited availability and affordability of pharmaceuticals (WHO, 2002; Mueller and Mechler, 2005; Zirihi et al., 2005). The reasons for acceptability and use of traditional medicine by indigenous populations of developing countries have been well documented. These include the accessibility to herbal medicines at consider- ably reduced costs compared to imported medicines (Mueller and Mechler, 2005) and a considerable trust in traditional healers cou- pled to pride in local community knowledge (Mathur, 2003). The number of plant users is very important and does not depend on sex, age and socio-cultural level (Jouad et al., 2001). The use of indige- nous plants in Africa plays an important role in the treatment of a variety of disorders and is reflected by intense ethnobotanical and pharmacological studies (Hedberg and Hedberg, 1982; Chhabra et al., 1987; Ramathal and Ngassapa, 2001; Cos et al., 2002a,b). Although it is a challenge for medicinal plants to meet the modern criteria of quality control, efficacy and safety applied for pharmaceuticals (Wagner, 1997), the phytochemical, pharmaco- logical and toxicological profiles of the extracts should be a basic requirement for the production of improved phytodrugs. This rep- resents a huge and costly input for laboratory and clinical work. Fig. 1. Map of Rwanda highlighting the Southern Province where field work was Nevertheless, the World Health Organization (WHO) recognizes carried out. Districts: 1. Gisagara, 2. Huye, 3. Kamonyi, 4. Muhanga, 5. Nyamagabe, 6. Nyanza, 7. Nyaruguru, 8. Ruhango (Steverwanda, 2010). that the centuries-old use of certain plants as therapeutic resources could be taken into account as a good indication of their activity and possible harmlessness (WHO, 1993). The WHO considers phy- the eight districts (Nyanza, Ruhango, Muhanga and Kamonyi in totherapy in its health programs and suggests basic procedures for 2004; Nyaruguru, Nyamagabe, Gisagara and Huye in 2008). The the validation of drugs from plant origin in developing countries same number of informants were interviewed in each district. The (Vulto and Smet, 1998; Rates, 2001). The research on medicinal study community lives near the Nyungwe forest and it has been plant extracts used in folk medicine also represents an invaluable established, in other parts of Africa, that such communities pos- approach for the development of new drugs (Rates, 2001). sess authentic information on the utilization of natural resources Of the many diseases traditionally treated with medicinal plants, (Terashima, 2001; Kakudidi, 2004a,b). The national language of hepatitis ranks amongst one of the most severe. In contrast to many the country was used. In some cases, monetary incentives were other pathologies, the symptomatology of a number of hepatic given to compensate for time taken. In Rwanda, many traditional conditions (icterus) is evident. Traditional healers can easily eval- healers are working in associations organized by the Ministry of uate the response to treatments and thus select efficient herbal Health and the Institute of Research in Science and Technology medicines (Pandikumara et al., 2011). There is thus a widespread (IRST). Through the legal representatives of associations, local heal- use of traditional herbal remedies for the management of liver dis- ers were contacted and 56 of them, dispersed throughout the study eases (Thabrew and Hughes, 1996; Stickel and Schuppan, 2007). area (7 per district), were interviewed on a voluntary basis. There A scientific understanding of these plants however remains largely were 25 women and 31 men and the distribution of ages is shown unexplored (WHO, 2002; Negi et al., 2008). Hence there is a need to in Fig. 2. Interviews and plant collection for the preparation of collect ethnobotanical information on anti-hepatitis plants in order to further evaluate their activity and safety as remedies. The extent to which plant remedies are still used in the tra- ditional treatment of hepatitis and the concepts underlying the preparation of remedies specifically