Discussion
Complementary and alternative medicine remained the basic source of primary health care at the doorstep of both urban and rural people. A large population of the world in developing as well as developed countries still depends upon ethnomedicine, despite a great advancement in modern health facilities and allopathic medicine.
The local population of the study area is mostly dependent on ethnomedicine as the first choice of treatment. No previous study has been reported to document traditionally used animal-based and animal-plant recipes from southern areas of Khyber Pakhtunkhwa. Therefore, this study was aimed to fulfill the knowledge gap of reporting ethnomedicine used in southern regions of Khyber Pakhtunkhwa with the main objectives to document 1) recipes comprised of animals, animal parts, or animal products 2) recipes comprised of both plant and animal parts/products and 3) the highly preferred recipes by quantitative indices.
People living in rural areas mostly have a strong belief and prefer traditional medicine (Adhikari et al., 2020). All the informants were having substantial knowledge of using ethnomedicines. Female respondents were found to be more familiar with the use of ethnomedicines than males. Mostly, females were involved in using ethnomedicine due to taking care of their children and families. Most of them were educated and had a strong belief in using ethnomedicine rather than allopathic medicine. The main reason, which female respondents stressed, was the associated side effects of allopathic medicine. The result was supported by earlier reports Mahomoodally et al. (2019) confirming females as the most predominant users of animal-based recipes. However, male respondents were more dominant and actively involved in using ethnomedicines in Nepal, India, and Ethiopia (Borah and Prasad, 2017; Kendie et al., 2018; Adhikari et al., 2020). The ratio of male to female respondents that were interviewed in the present study and those reported earlier may justify this difference.
The participants of age group above 40 years secured a high percentage and were predominantly involved in using ethnomedicines. A similar trend was observed in previous studies conducted in Nepal Adhikari et al. (2020), Ethiopia Kendie et al. (2018), India Borah and Prasad (2017), and Pakistan Altaf et al. (2018) indicating that elder respondents possessed more knowledge and experience regarding ethnomedicines. Mostly respondents stated that they acquired knowledge from their elders. This further strengthens the belief that transmission of folk medicine occurs from elder to younger individuals. In contrast, the possible reason for less ethnomedicinal awareness among youngers could be due to their intention towards urbanization and the least interest in ethnomedicine (Borah and Prasad, 2017). The informants were mostly literate and least being with a primary level of education. However, the illiteracy was also of considerable level due to poor socioeconomic conditions, lack of access to education, and most had opted to farm as their profession because of their elders. Mostly, respondents (16.21%) were farmers having broad knowledge of ethnomedicine.
Thirty-two animal species were reported to be used by the local communities for curing 37 types of diseases including epilepsy, cancer, hepatitis, night blindness, whooping cough, asthma, paralysis, and brain hemorrhage among others. Use of Camelus dromedarius for treating cancer, hepatitis, diabetes, Capra hircus for enhancing sexual power and asthma, Oryctolagus cuniculus for paralysis, and Ovis aries for cough, flu, skin burn, weakness and joint pain has been reported earlier and were overlapping the current findings (Altaf et al., 2018). In Bahawalpur-Pakistan, the products/parts of the above-mentioned mammals have also been mentioned for skin diseases, jaundice, rickets, tuberculosis, weakness, paralysis, and asthma (Ahmad et al., 2021).
Similarly, 44 animal species, including Herpestes edwardsii, Sciurus caroliniensis, Bos indicus, Bubalus bubalis, and Vulpes bengalensis etc., were reported in Assam India to treat 40 diseases. The commonly treated diseases were cancer, asthma, rabies, epilepsy, piles, paralysis (Borah and Prasad, 2017). Local people of Ethiopia and Mauritius used 51 and 32 animal species to treat over 36 and 38 kinds of ailments, respectively (Kendie et al., 2018). Apart from Asia and Africa, animal use in ethnomedicine has also been documented in European countries (Quave et al., 2010; Benitez, 2011). Different active agents that are being used as potential drugs have been isolated from various animals Daly et al. (2005), Cragg and Newman (2013), Rodrguez et al. (2017), Zhan et al. (2020) which show the medicinal importance of the animals. For instance, Bufo gargarizan, a traditionally used medicinal animal, is a rich source of bioactive agents and approximately 118 bufadienolide monomers and 11 indole alkaloids have been isolated from it to date. The extracts and isolated compounds exhibit a wide range of in vitro and in vivo pharmacological effects such as detoxification, reduce swelling, anti-inflammation, antitumor, and immunomodulation (Zhan et al., 2020).
In our findings, mammals remained as the highly utilized animal group for therapeutic purposes. Similar studies have been reported in Pakistan, North-Western Ethiopia, Nepal, and South Africa Whiting et al. (2013), Altaf et al. (2018), Adhikari et al. (2020) where mammals were mostly used as medicines. Most of these animals were domesticated and therefore, easily accessible. The local inhabitants also believed that mammals are the rich sources of proteins, supplementary foods, and medicines and are commonly practiced by the local communities for meat and milk. In contrast, extensive use of insects has also been documented in India (Chakravorty et al., 2011; Borah and Prasad, 2017). However, in some reports reptiles are among the highest animals used in ethnomedicines (Altaf et al., 2020; da Nóbrega Alves et al., 2008; Fernandes-Ferreira et al., 2013). The number of different animal species shows the diversity in an area however, the composition of fauna, accessibility, and availability directly influences the zootherapeutic resources used in any given region (Alves and Rosa, 2007). Different indigenous tribal groups also sacrifice animals for different rituals and religious purposes in keeping with their mythological myths and beliefs. For example, people wear tiger and bear claws around their necks to protect from evils while animals like goats, buffalo, pigeons were sacrificed to please Gods for healing purposes (Solanki and Chutia, 2004; Mahawar and Jaroli, 2006; Alves, 2009).
Meat, whole animal, and milk were among the widely used animal products. Meat as the highest used part of ethnomedicine in Lahore and Jhelum has already been reported (Altaf et al., 2018). Similarly, another study in Ethiopia documented meat and fat as the commonly utilized medicinal products of animals (Kendie et al., 2018). In contrast, in some reports, the highest use of whole animals for medicinal purposes has also been documented (Borah and Prasad, 2017). Capra hircus, Macaca mulatta, Paraechinus micropus, Oryctolagus cuniculus, Funambulus palmarum, Anas platyrhynchos, and Gallus gallus meat was used to treat hepatitis, cough, cancer, asthma, epilepsy, anemia, weakness, and kidney problems. Similar uses of different animals’ meat have been reported to treat patients suffering from paralysis, asthma, rheumatism, arthritis, poor vision, and tuberculosis (Adhikari et al., 2020). Columba livia meat was utilized for early onset of puberty in females in our study. However, patients with paralysis were given cooked meat of C. livia in Nepal Adhikari et al. (2020), while fresh blood was used in India for curing the same disease (Mahawar and Jaroli, 2007). Meat and meat products are significant sources of proteins, vitamins (vitamin B12), minerals (zinc, iron, and phosphorus), and provide other essential components to our diet (Biesalski, 2005; Williams, 2007; McAfee et al., 2010). Vitamin B12 (also known as cyanocobalamin) has been found to inhibit the HCV internal ribosome entry site (IRES)-dependent translation of a receptor gene in vitro (Lott et al., 2001). Similarly, iron deficiency can lead to severe anemia and is essential for heme and hemoglobin formation (Camaschella et al., 2016). These health improving effects and rich nutritious value could justify the use of meat of different animal species for treating different types of diseases.
The eggs of pigeon and chicken were utilized to treat blood pressure, fever, cough, joints pain, and chest infection. Eggs have been previously reported for treating similar diseases (Altaf et al., 2018). Eggs of G. gallus are being used for curing weakness and cough Ahmad et al. (2021), nasal congestion to stop bleeding and dysentery Shams et al. (2019), and reinforces potency and enhances libido (Lev, 2003). Eggshell has been found useful in the treatment of urinary stones (Ahmad et al., 2021). Similarly, the egg shell of Struthio camelus has been utilized for treating eye diseases (Lev, 2003). Research shows that eggs have high nutritional value and provide an excellent source of both water-soluble (B1 and B12) and lipid-soluble (A, D, E, and K) vitamins, omega-3-fatty acids, and minerals such as phosphorus and iron (Anton et al., 2006). Moreover, lysozymes from egg albumin have antibacterial, antiviral activities (viral bronchitis, herpetic lesions, stomatitis, etc.), while ova albumin extracted from eggs is effective in preventing hypertension (Dedonder and Morias, 1974; Fujita et al., 1995).
Fats and oil of animals were used to treat baldness, joint, and muscle aches, and for sexual enhancement. It has been proven that fats and oil of animal origin contain omega-3 fatty acids which reduce inflammation (Wilson, 2015). Some studies have also verified that fats/oil of animals is beneficial in neurological disorders, atherosclerosis, thrombotic, and aging effects (Haag, 2003). However, rich fats comprised of a high fraction of saturated fatty acids are considered to be major factors of obesity, body mass gain, and heart disease (Anton et al., 2006). Therefore, the use of animal fat/oil could have adverse effects and may cause potential health issues.
Milk was utilized to relieve joints and back pain, gastric pain, treat cancer, paralysis, whooping cough, and reduce obesity. The findings are in parity with a study conducted by (Altaf et al., 2018). Milk contains nutritious and effective components that reduce joint pain, strengthen the body, and increase sexual potency (Alabdulkarim, 2012; Sabahelkhier et al., 2012). Milk is not only the source of bioactive components, but may also serve as an important delivery medium (Ebringer et al., 2008).
Apart from using animal products, people were also using animal-plant recipes. Plants and plant-derived products are usually used in combination with animal parts and byproducts to enhance the therapeutic effects of ethnomedicines (Borah and Prasad, 2017). Among the reported plant families, the most commonly used were Piperaceae and Apiaceae. Traditionally, individual plants of these families have also been used as folk medicine. In the present study, most of the plants of Piperaceae and Apiaceae were used as spices in recipe formulation as additional ingredients for good taste. Another main reason behind the wide use of these families in folk medicine is having vast pharmacological activities. Different compounds and extracts isolated from plant species belonging to Piperaceae have been experimentally tested for analgesic, antibacterial, antimalarial, and other pharmacological activities (Roersch, 2010). Similarly, plant species of Apiaceae possess antioxidant, anti-diuretic and anti-inflammatory activities (Dehpour et al., 2009; Matasyoh et al., 2009; Miguel et al., 2010; Hajhashemi et al., 2011). Cow milk was mixed with rhizome powder of C. longa to reduce injury pain and with honey to treat cough and throat infections. These preventive effects may be due to the presence of several nutrients and bioactive components in milk, among them caseins and whey proteins are of particular importance and have significant roles in immune and digestive systems, reduce blood pressure, antimicrobial, and anticarcinogenic effects (Ebringer et al., 2008). Compounds like curcumin (from C. longa) possess anti-inflammatory, antioxidant properties, and having a protective effect for rheumatism, sinusitis, biliary disorders, anorexia and immune diseases (Araujo and Leon, 2001; Yang et al., 2019). Literature has reported, the anti-arthritic effects of curcumin in humans with osteoarthritis (OA) and rheumatoid arthritis (RA) (Hewlings and Kalman, 2017). In the southern regions of Khyber Pakhtunkhwa, C. longa has also been used for pain and healing purposes (Adnan et al., 2014b). Similarly, the juice (leaves and barks) of Alstonia scholaris in combination with milk was used to treat chronic dysentery Borah and Prasad (2017) while cow urine is mixed with crushed seed of Sesbania grandiflora (L.) Pers (Bokful) for the treatment of epilepsy (Borah and Prasad, 2017). Some medicinal preparation where both plant and animals are utilized in combination is also reported from Brazil (Alves et al., 2013; Costa-Neto, 1999; da Nóbrega; Alves and Filho, 2007). However, the role of each component present in most of the mixtures is unclear. In animal-plant recipes, one component may act as a carrier, to enhance the therapeutic activity of each other, or reduce/mask the adverse effect(s) of one another. Hence, the role (s) of different components in mixture recipes should be explored in future research. These traditional ways of different combinations showing antagonistic/synergistic effects and providing new insights in the field of pharmacology that must be checked through in vitro and in vivo screening.
Cooking, boiling, juice, powder, frying, paste, and smoke were the common modes of ethnomedicine preparation. While drinking, eating, massaging, and wearing were the highly practiced modes of administration. Mostly, animal-based parts and products such as meat are properly cooked before consumption because raw consumption of animals’ parts is haram (forbidden) in the Islamic religion. A similar trend was observed in Nepal where 12 types of preparations were used and cooked meat and other animal parts were commonly practiced (31%) (Adhikari et al., 2020). On the other hand, raw consumption of animals and animal’s parts was the highly used way of taking animals in India and Korea (Kim and Song, 2013; Vijayakumar et al., 2015; Borah and Prasad, 2017). However, the consumption of raw meat may increase the risks of transmitting different types of parasites and diseases to humans (Lohani, 2012; Kim and Song, 2013). Zoonotic diseases can be transmitted by direct contact with animals and also by using animal products as foods and medicines. For instance, raw consumption of milk has been associated with toxoplasmosis infection in the past and such practice is discouraged (Sacks et al., 1982). Therefore, proper preparation methods should be adopted for consuming animals and animals products as ethnomedicines.
Liquid and solids were frequently administered orally, while some were applied topically. These results were following the study conducted by Borah and Prasad (2017) showed that traditional medicines are mostly administered orally as compared to applied topically. However, the dermal application of ethnomedicines is still very reliable in joints pain, muscle aches, wounds, piles and bone fractures (Jaroli et al., 2010; Kim and Song, 2013). Additive substances like water, honey, oil, milk, sugar, salt, and colors were also used in ethnomedicine preparations same as in a previous study by (Kendie et al., 2018). These additives are useful for easy ingestion, increase solubility, decrease/minimize any bitter taste of ethnomedicine.
Comparative analysis showed a limited number of ethnozoological studies conducted across the world. Medicinal use of animals is not extensively reported. India contributed predominantly to the ethnozoological studies and reported a higher number of studies as compared to other countries. Five studies were found to be published in Pakistan from Punjab regions describing the medicinal value of fauna and only one study was reported from Sawabi district of Khyber Pakhtunkhwa. Moreover, few studies were reported in the world where a mixture of plant and animal products was used for medicinal purposes. In this regard, the present data has potential value to the field of ethnobiology. Moreover, most studies were providing insufficient data regarding the traditional use of an animal as medicine. A detailed formulation of traditional medicine should be ensured in the future consisting of 1) accurate name of the reported species (scientific, vernacular, and English) 2) part and product used 3) mode of preparation 4) mode of administration 5) proper dose and number of doses per day 6) duration of treatment and 7) toxicity or adverse side effects (if any).
The quantitative analysis is of great importance in ethnomedicinal studies, because it provides baseline information for further ethnopharmacological studies. Animal species, both in animal-based and animal-plant recipes, having high FIC, and FL revealed the ethnomedicinal importance of these species and are recommended for further ethnopharmacological validation to better understand their zootherapeutic potential and explore the unknown bioactive compounds owing to ethnomedicinal efficacy.