HomeArticleHerbal remedies used for the treatment of infertility in males and females by traditional healers in the rural areas of the West Bank/Palestine
Herbal remedies used for the treatment of infertility in males and females by traditional healers in the rural areas of the West Bank/Palestine
Infertility
is considered one of the global public health problems and during human
history, it is also considered one of the unsolved problems of the
continuous human race. This study aimed to collect and document the
ethnopharmacological data on herbal remedies, which traditionally used
by Palestinian healers in the rural areas of the West Bank area for the
treatment of infertility in males and females.
Methods
Using
a semi-structured questionnaire, an ethnopharmacological survey of
medicinal plants used for the treatment of infertility in the West Bank
area of Palestine was investigated. This survey involved 51 traditional
healers which were interviewed in rural areas from 9 Palestinian
regions.
Results
Information
about 31 plants used in the treatment of infertility in females and 24
plants used in the treatment of infertility in males were collected.
This information including names of plants, parts used, mode and methods
of preparation which were obtained from 51 traditional healers
interviewed in rural areas of 9 regions of the West Bank/Palestine. This
investigation is the first scientific work in the Middle East area
which collected information about herbal remedies used by local
Palestinian traditional healers for the treatments of infertility in
males and females. The highest Frequency of Citation (FC) of herbal
remedies used in case of infertility in females, were 98.04% for pollen
grains from Ceratonia siliqua, 88.24% for Anastatica hierochuntica fruits and 84.31% for Parietaria judaica leaves, while the highest Frequency of Citation (FC) of herbal remedies used in case of infertility in males were 96.08% for Ferula hermonis roots, 88.24% for Phlomis brachyodon leaves and 86.27% for Phoenix dactylifera pollen grains.
Conclusion
Herbal
healers in the West Bank area of Palestine have a wide range of herbal
remedies used in case of infertility in males and in females.
Unfortunately, most of them lack scientific evidence of pharmacological
or toxicological nature. Therefore, the information obtained in this
study can serve as a scientific base for further investigations to
determine their efficacy and safety which might contribute to better
integration of Palestinian traditional medicine into the global health
system in the future.
Ethnopharmacological
surveys have been found to be one of the most reliable tools for the
discovery of the natural and semi-synthetic drug. In fact, herbals and
other natural products, including their chemical derivatives,
represented about 50% of all currently utilized medications worldwide [1].
The usage of plants Kingdom by human beings, as a source of medicines,
started from the immemorial time for treatment, protection, and
prevention of various illnesses. Till recent time, herbals are
considered one of the most important branches of traditional medicine.
In fact, this kind of medicine plays until now an important role in
health care systems, especially in rural areas in developed and
developing countries [2,3,4,5,6].
In fact, traditional medicine is considered a very important branch of
pharmacy and medicine and besides that, the used plants in this medicine
are considered major sources for the investigation of pharmacologically
active drugs in the pharmaceutical industry. In addition, the global
public interests are in continuous growing toward the use of this type
of medicine. In fact, about 80% of people in rural areas of developing
countries utilized traditional medicine, since it is available, cheap
and has a variety of health benefits [7,8,9].
In
Palestine and other countries, traditional healers are well-known by
different names such as traditional medical practitioners, traditional
doctors, people’s doctors, healers, practitioners of Arabian traditional
medicine, Arabian therapists, therapists in prophet medicine, and
Islamic practitioner healers [10].
According
to the World Health Organization and the International Committee for
Monitoring Assisted Reproductive Technology, infertility is a disorder
of the reproductive system which is defined by the failure to achieve a
clinical pregnancy after one year or more of regular unprotected sexual
intercourse [11].
Recently,
a huge number of factors caused an increase in infertility levels among
males and females, especially in developed countries. These factors
include the increased use of contraceptives, rising maternal age,
smoking, alcohol, genetic factors, pesticides, narcotics, rates of
abortion, and critical economic situations. Besides that, an increase in
male impotency could be due to the psychogenic factors, vascular
disturbances, neurogenic disorders, endocrine system disturbances and
drug treatment [12, 13].
This health care problem can lead to serious psychological disorders,
severe stressful and depressing life for parents. In fact, this global
problem ranked in the fourth position after the death of the mother, the
death of father and unfaithfulness of partner [14].
Accordingly, the treatment of infertility has become a large
pharmaceutical and medical industries issues, arranging from
manufacturing and prescribing fertility hormones and other drugs to in
vitro fertilization operations [15].
In 2010, the World Health Organization (WHO) estimated that about 48.5
million couples worldwide were infertile and 1.9% of women aged 20–44
who wanted a child were unable to have their first live birth. In
addition, 10.5% of women who had previously given birth were unable to
have another baby after five years of trying. This may raise the
question about the used measures that caused this high percentage [14, 16, 17].
In
the West Bank area, the infertility rate among men and women is
relatively high with a rate of about 15% in 2016 according to World
Health Organization, the Sixty-ninth World Health Assembly report [18].
The
treatment of infertility in males and females are varying in their
associated risks, intensity, and invasiveness which depend on the
duration, cause, age, and personal preferences. Meanwhile, the physical,
financial, and time commitment is the required factors for infertility
treatment. The infertility treatments can range from medication therapy
to induce ovulation to invasive manipulation of eggs and sperm outside
of the body [19].
As well as all the infertility treatments are very expensive, many of
poor patients or patients who believe in alternative medicine or others
people which their previous infertility treatments had failed, all of
those are seeking for the alternative herbal medicine to solve this
problem [20].
Throughout
this ethnopharmacological survey, the current study aimed to collect
information about herbal remedies used by local rural traditional
healers in 9 regions of the occupied West Bank Area of Palestine which
used in the treatment of infertility in males and females. The collected
data including the plant’s names, used parts, methods of preparations
and route of administrations.
Materials and methods
Study areas
Palestine
has been the battleground of the great powers and civilizations in the
region throughout its history, which occurred due to its specific
location at the crossroads of Africa, Asia, and Europe, Conquerors of
the region included Egypt, Assyria, Macedonia, Rome, Byzantium, Arabia,
and Turkey. Settlement in the area is believed to date back to about
8000 B.C.E., to the village of Jericho in the West Bank. West Bank area
is one of the important parts of historical Palestine (Holy Land), which
considered holy by Jews, Christians, and Muslims. Part of the
significance of the land stems from the religious significance of
Jerusalem, the historical region of Jesus’ ministry, the holiest city to
Judaism, and the site of the Isra and Mi’raj event in Islam.
Accordingly, this region represents a very important source of
information for the field of ethnomedicine. Due to specific geographical
location and climatic conditions (mostly Mediterranean), West Bank area
of Palestine is a suitable place for growing a huge variety of herbals.
Nowadays, of about 2700 plant species which have been identified in
this country [21].
The West Bank is an area of extensive wild biodiversity, farming, and valuable rangelands.
Its
central mountain chain endowed with a mild climate is grooved by deep
valleys, rich in natural resources, and stretches into rolling hills
that plunge further east into the Jordan Valley and the Dead Sea which
considered the lowest point on earth and has a worldwide attraction [22].
Due to its distinctive geographical location, climatic diversity,
historical profile, and religious variables, all these factors affected
positively and enriched the diversity of ethnomedicine in this small
area of the world [23].
Data collection from traditional healers
Ethnopharmacological
data about herbal remedies used in the treatment of infertility in
males and females were collected through open-ended semi-structured
interviews with 51 traditional healers (informants) during fieldwork.
The interviews were conducted in the Arabic language which is the native
language of the informants. This survey was conducted between June and
August 2017. During the transect walks, plants were collected under the
supervision of the traditional healers. Plant voucher specimens were
collected and deposited at the Natural products Laboratory, An-Najah
National University for identification. Plant names have been checked
and updated with the online website (www.theplantlist.org)
of the Royal Botanic Gardens, Kew, accessed on 3 July 2017. Areas
visited included some rural regions of the West Bank/ Palestine,
including rural areas of Nablus, Jenin, Tulkarem, Qalqilya, Ramallah,
Jericho, Jerusalem, Bethlehem, and Hebron regions (Fig. 1).
Fig. 1
Map of the West Bank/Palestine showing all surveyed areas
The
study protocol and the informed consent forms were approved by the
Institutional Review Board (IRB) at An-Najah National University
(Archived number 9th June 2017). The study was conducted in accordance
with the requirements of the declarations of Helsinki (World Medical
Association 2008), Harmonization (ICH1996) Guidelines, the current Good
Clinical Practice (GPC) Guidelines (EME 1997) and the International
Conference and written informed consent for participation in the study
was obtained from all informants.
To protect the interest of
traditional healers, they were informed by the researchers in details
about the current study and its purposes, also they were not offered any
incentives and they were able to withdraw from this study at any time.
The survey was carried out by using interviews among 51 traditional healers (N = 51)
from different rural areas of Nablus, Jenin, Tulkarem, Qalqilya,
Ramallah, Jericho, Jerusalem, Bethlehem and Hebron regions in the West
Bank/Palestine. These traditional healers were well-known in the various
Palestinian communities and herbalists which utilized herbal products
to treat infertility.
The plant’s vernacular names, methods of
preparation and administration of these herbal remedies were collected
throughout these interviewees (Social demographic factors are presented
in Table 1).
Table 1 Social-demographic factors related to the informants
The
Choice Value (CV) method is a valuable assessment tool to measure
related plant species for the treatment of infertility in males and
females [24].
The CV is calculated as in the following equation:
CVspecies=PcsScx100
Pcs: percent of informants that cited certain plant species for the treatment of infertility in males and females. Sc:
is the total number of species mentioned for the treatment of disease
by all informants. Choice values are ranked from 0 to 100 with 100
indicating complete preference and fewer alternatives.
The frequency of citation (FC) for all plants species in this study was calculated by using the following formula [25]:
The
results of social and demographic factors of informants showed that the
percentage of female healers is slightly higher than males and most of
them were uneducated. Precisely, the selected 51 traditional healers
from various rural areas of West Bank/Palestine comprised 45.1% of the
males and 54.9% females. The majority of traditional healers were
uneducated 52.9%, while the elementary and secondary schools’ education
levels represented 25.5 and 21.6%, respectively (Table 1).
The highest percent of informants was from Jericho rural area followed
by Bethlehem and Hebron which represented 17.6 and 13.7%. In addition,
the majority of them (52.9%) had experienced between 31 and 40 years as
well as the most important thing in this survey, 94.1% of these
traditional healers acquired their knowledge from their ancestors.
Results and discussion
The
results of the present study showed that a total of 31 plants from 24
families used for the treatment of infertility in females, meanwhile 24
plants from 20 families used for the treatment of infertility in males
in West Bank area of Palestine as shown in Tables 2 and 3.
Table
2 The used herbals for the treatment of infertility in females, the
plant’s parts used, Frequency of Citation (FC), Choice values, modes of
administration and methods of preparation
Table
3 The used herbals for the treatment of infertility in males, the
plant’s parts used, Frequency of Citations (FC), Choice values, modes of
administration and methods of preparation
Infusions
and decoctions were the most frequently used methods of preparation for
treatment of infertility in females as presented in Fig. 2.
Meanwhile, decoctions and infusions were the most frequently used
methods of preparation for treatment of infertility in males as
presented in Fig. 3.
Fig. 2
Frequency of herbal remedies preparation methods which used for the treatment of infertility in females
Flowers,
fruits, leaves, and seeds were reported to be the most frequently used
parts of plants for the treatment of infertility in females,
constituting about 65% of the parts used. This was followed by bark,
roots, rhizomes and pollen grains as shown in Fig. 4.
Fig. 4
Frequency of parts used from the utilized plants in the treatments of infertility in females in the West Bank
Correspondingly,
seeds, roots, leaves, and pollen grains were reported to be the most
frequent parts used of plants in the treatment of infertility in males,
constituting about 88% of the parts used. This was followed by fruits,
flowers, and bulbs as can be seen in Fig. 5.
Fig. 5
Frequency of parts used from the utilized plants in the treatments of infertility in males in the West Bank
The
utilization of herbals in the treatment of various physiological
disorders and diseases goes back to several millennia and more than 60%
of the world’s population, especially in the rural areas of developing
countries, utilized plants, and other natural products for
pharmaceutical and medical aims. In addition, about 25% of modern
medications are derived from herbal products and nowadays, the use of
natural herbal products has shown an increase in both developed and
developing countries [26, 27].
For huge numbers of childless people, infertility disease considered a
personal social and psychological problem, which equitably distributed
between males and females. Hence, since ancient times, herbal remedies
are considered one of the most available methods in the treatment of
this disorder [28].
Recently, various isolated natural compounds or crude plants extracts
are widely used in the treatment of infertility in males such as low
sperm accounts, sexual asthenia, erectile dysfunction, the absence of
libido and other psychological and physiological disorders [29].
Concerning
the fertility in females, it may be affected by many factors, including
various physiological diseases and disorders, malnutrition, and
malformations of the uterus [14].
Usually,
the selection of herbs and remedies by traditional healers is based on
their experience and information that have been inherited from their
ancestors. As shown in Table 1,
the majority of the informants (traditional healers) were females and
most of them were uneducated people. This result may be due to the
Palestinian culture where parents try to transfer the acquired knowledge
to their children. In addition, the reason why the majority of them
were uneducated may be due to the bad economic situation in this country
so many of them consider this tradition as a source of economic income.
Accordingly, the results may be of scientific value and good
credibility in some way, since these informants may be struggling to
find the best results in order to maintain their clients. The same table
also showed that high percentages of the informants were from the rural
area of Jericho. This region is considered a very old historical
profile as well as it considered the oldest city and the lowest area in
the entire world.
The results of the current study showed that the
Palestinian ethnopharmacology is rich in herbal remedies used in the
treatment of infertility in males and in females.
In fact, a huge
number of plants families (44 families) were reported to be effective in
the treatment of this disorder. However, different plants species were
used to treat infertility in females and males as reported in Tables 2 and 3. In addition, Table 4
showed the highest FC and CV values for the herbal remedies used in the
treatment of infertility among females and males in the West Bank area
of Palestine.
Table 4 The most cited herbal remedies used in the treatments of infertility in females and males
Moreover, in the case of infertility in females, Table 2
showed that 31 herbal remedies were used in the treatment of this
disorder and most of them were obtained from fruits and flowers, while
the most used method of preparation was an infusion. The same table also
showed that the highest Frequency of Citation (FC) of herbal remedies
in case of female infertility was 98.04% for pollen grains from Ceratonia siliqua, 88.24% for Anastatica hierochuntica fruits and 84.31% for Parietaria judaica leaves. Moreover, Table 3
showed that 24 plants prescribed by traditional healers in the West
Bank area of Palestine for the treatment of infertility in males and
most of them obtained from the plant’s seeds, whereas as the most used
method of preparations were decoctions. Meanwhile, the highest Frequency
of Citation (FC) of herbal remedies in case of infertility in males
were 96.08% for Ferula hermonis roots, 88.24% for Phlomis brachyodon leaves and 86.27% for Phoenix dactylifera pollen grains.
In
comparison with other regional ethnopharmacological surveys about
herbal remedies used for the treatment of infertility, Palestine is
considered the richest region with these remedies.
In fact, 11, 13
and 23 plants used in the treatment of infertility in males and females
were reported in the Lebanese, Jordanian and Egyptian folk medicine
respectively [30,31,32].
Table 2 showed that the highest Frequency of Citations of herbal remedies which used in case of infertility in males were 96.08% for Ferula hermonis roots, 88.24% for Phlomis brachyodon leaves and 86.27% for Phoenix dactylifera pollen grains.
Throughout literature review, in the neighboring countries as Lebanon and Jordan, Ferula hermonis was found to be used in case of infertility in males [33,34,35].
Moreover, Hadidi et. al. and by Zanoli et al., investigated the potential positive effect of F. hermonis on male’s infertility. Both groups of the study concluded that the acute use of F. hermonis
cause an increase in male fertility while the prolonged use of this
plant may lead to fertility disturbances. Moreover, the study conducted
by Zanoli et al showed a reduction in body weight and in weights of
testes and other sex accessory organs [36, 37]. Another study that was conducted by Homady et al. confirmed the aphrodisiac effect of Ferula hermonis in male and female mice after intragastric application of 3 mg/kg/day of this plant extract for 6 weeks [38].
Meanwhile, Phlomis brachyodon
did not mention in any folk medicine for the treatment of male’s
infertility also its pharmacological effect not verified yet. Moreover,
the pollen grains of Phoenix dactylifera has been used in the treatment of infertility in males in the folk medicine of several Arabian countries [39, 40].
Another study that was conducted by Bahmanpour et al. and Abedi et al., demonstrated that Phoenix dactylifera pollen grains extract can improve sperm parameters and reproductive system in adult male rats [41, 42].
However, to the best of our knowledge, no sufficient scientific studies
were conducted in order to prove the safety of consumption of pollen
grains of Phoenix dactylifera plant except that one which was conducted by Sadiq et al [43].
Moreover,
the highest Frequency of Citation (FC) remedies which used in case of
infertility in female were 98.04% for pollen grains from Ceratonia siliqua, 88.24% for Anastatica hierochuntica fruits and 84.31% for Parietaria judaica leaves.
To
the best of the authors’ knowledge, it has not been reported in
previous studies about folk medicine, evidence-based uses and toxicity
of the pollen grains of Ceratonia siliqua, the fruits of Anastatica hierochuntica and the leaves of Parietaria judaica in the treatment of infertility in females and this study will be the first one.
Concerning
the used preparation methods, infusions and decoctions were the most
frequently used methods of preparation for treatment of infertility in
females and males (Figs. 2 and 3).
However, these two methods are considered harsh methods and may
negatively affect the efficacy and the final organoleptic properties of
the obtained extracts. Therefore, it would be interesting to assess the
efficacy and the organoleptic properties of the most cited plants after
being extracted by using the friendliest extraction methods such as the
cold press and critical fluid extractors. Concerning the difference
between herbal remedies that were advised for male and female, this may
be due to the difference between genders in term of physiology and types
and level of hormones as well as due to the phytochemical constituents
that should affect this physiology and hormonal level.
The
limitations of the current study are pharmacological, toxicological and
clinical studies to confirm the most cited plant’s mechanism of actions,
safety, and pharmacological efficacy. Such studies usually include a
complete chemical analysis for identification of their different
chemical constituents, especially those responsible for their
pharmacological actions.
Conclusion
Throughout
history, males and females have tried to enhance or control their
fertility with various levels of societal support. This study showed
that the ethnomedicine in the West Bank area of Palestine is rich with
plants which used for the treatment of infertility in males and females
in comparison with the neighboring countries. Some of the plants found
in this study are also used for treating infertility problems elsewhere
while others are being reported for the first time. Also, it’s worthy to
take in considerations that these plants had not been evaluated
clinically to approve its safety and efficacy.
Availability of data and materials
The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
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The
authors are thankful for the kind help of traditional healers in the
study area and for An-Najah National University for its support.
Funding
None.
Author information
Affiliations
Department of Pharmacy Faculty of Medicine and Health Sciences, An-Najah National University, P.O. Box 7, Nablus, Palestine
Nidal Jaradat
& Abdel Naser Zaid
Contributions
NJ
and ANZ conceived, designed the current study, and analyzed the data
obtained. This paper was drafted by NJ. The authors read and approved
the final manuscript.
The aims of this study, protocols and the informed
consent forms were approved by the Institutional Review Board (IRB) at
An-Najah National University (IRB archived number: 9th June 2017). This
study was carried out according to the requirements of the declarations
of Helsinki. Written informed consent for participation in the study was
obtained from all informants.
Consent for publication
Not Applicable.
Competing interests
The authors declare that they have no financial and/or non-financial competing interests.
Herbal remedies used for the treatment of infertility in males and females by traditional healers in the rural areas of the West Bank/Palestine
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