Popular Medicinal Plants in Portland and Kingston, Jamaica 9783030489267, 9783030489274

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Advances in Economic Botany

Ina Vandebroek David Picking

Popular Medicinal Plants in Portland and Kingston, Jamaica

Advances in Economic Botany ISSN: 0741-8280 Launched in 1984 by The New York Botanical Garden’s Institute of Economic Botany, Advances in Economic Botany (AEB) is an international forum for the publication of original book-length research manuscripts, collections of edited papers, and symposia dealing with traditional and local plant knowledge, the use and management of plants and their ecosystems, as well as the social-ecological dimensions of plant use. An interdisciplinary series designed to showcase pure and applied studies, AEB has found its readership among researchers, teachers, policymakers, and students of ethnobotany, anthropology, botany, biology, ecology, economic botany, agronomy, geography, pharmacology, and medicine.

Advances in Economic Botany, Volume 19 Popular Medicinal Plants in Portland and Kingston, Jamaica Ina Vandebroek and David Picking Guest Editor for AEB volume 19: Dr. Michael J. Balick Institute of Economic Botany The New York Botanical Garden

More information about this series at http://www.springer.com/series/16354

Volumes 1-18 of AEB were published by NYBG Press: Ethnobotany in the Neotropics (AEB 1) The Life and Botanical Accomplishments of Boris Alexander Krukoff (AEB 2) Systematics and Economic Botany of the Oenocarpus-Jessenia (Palmae) Complex (AEB 3) Ethnobotany of the Chácobo Indians, Beni, Bolivia (AEB 4) Swidden-Fallow Agroforestry in the Peruvian Amazon (AEB 5) The Palm -Tree of Life: Biology, Utilization, and Conservation (AEB 6) Resource Management in Amazonia: Indigenous and Folk Strategies (AEB 7) New Directions in the Study of Plants and People (AEB 8) Non-Timber Products from Tropical Forests: Evaluation of a Conservation and Development Strategy (AEB 9)

Selected Guidelines for Ethnobotanical Research: A Field Manual (AEB 10) Beyond Slash and Burn: Building on Indigenous Management of Borneo’s Tropical Rain Forests (AEB 11) Medicinal Plants: Can Utilization and Conservation Coexist? (AEB12) Várzea: Diversity, Development, and Conservation of Amazonia’s Whitewater Floodplains (AEB 13) Ethnobotany of the Shuar of Eastern Ecuador (AEB 14) Ethnobotany and Conservation of Biocultural Diversity (AEB 15) The Amazonian Caboclo and the Açaí Palm: Forest Farmers in the Global Market (AEB 16) Bark: Use, Management, and Commerce in Africa (AEB 17) Vanilla Landscapes: Meaning, Memory, and the Cultivation of Place in Madagascar (AEB 18)

Volumes 1—18 are available as printed books exclusively from NYBG Shop: https://www.nybgshop.org/. AEB volumes 16 and 18 are also available as e-books exclusively from NYBG Shop. AEB volume 19 is available exclusively from Springer. Popular Medicinal Plants in Portland and Kingston, Jamaica (AEB 19)

Ina Vandebroek • David Picking

Popular Medicinal Plants in Portland and Kingston, Jamaica

Ina Vandebroek Institute of Economic Botany The New York Botanical Garden Bronx, NY, USA

David Picking Natural Products Institute The University of the West Indies, Mona Kingston, Jamaica

Intellectual Property Rights (IPR): The information in this book pertaining to the uses of medicinal plants or bush medicines in Windsor Forest (Portland Parish) and Payne Land (Kingston) represents the Traditional Knowledge (TK) and Intellectual Property (IP) of these communities and must be respected as such. It should not be used for the development of any commercial product without the Free Prior Informed Consent (FPIC) of the communities of Windsor Forest and Payne Land and their agreement on appropriate mechanisms of Access and Benefit Sharing, as per the Convention on Biological Diversity (CBD, 1992) and the Nagoya Protocol (2010). The publication of the traditional knowledge in this book establishes “prior art” and “prior knowledge” that is protected under international law from unauthorized patenting. Disclaimer: This book is intended as a reference work, in which the information provided herein is meant only for educational purposes. This information has been recorded in an attempt to preserve and return traditional knowledge about the uses of medicinal plants, or bush medicines, primarily to the participating communities in Windsor Forest, Portland, and Payne Land, Kingston. As such, this information is not to be used as a medical manual for self-treatment with plants, or as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. In matters of personal healthcare, a qualified medical specialist should be consulted. Delay in seeking appropriate medical care may worsen illness. The editors do not make any claims regarding the accuracy, completeness, timeliness, controversial nature, or usefulness of any information contained or referenced in this book since scientific knowledge changes frequently. Copyright: No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the editors. Pictures © Ina Vandebroek 2020. All Rights Reserved ISSN 0741-8280     ISSN 2662-284X (electronic) Advances in Economic Botany ISBN 978-3-030-48926-7    ISBN 978-3-030-48927-4 (eBook) https://doi.org/10.1007/978-3-030-48927-4 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

In loving memory of Edna “Juney” Pearcy, June 9, 1968 to May 8, 2017, Windsor Forest, Portland, Jamaica

Preface

We are delighted to bring a new edition of this book to a wider audience. Our book has grown from a community guide to a publication that will hopefully speak to a diverse group of worldwide readers. In this second edition, we have expanded the introduction, revised the botanical descriptions, added common plant names and scientific synonyms from the reference work The Flowering Plants of Jamaica written by C.D. Adams, added new plant pictures, conducted additional medical database searches up to 2020, and scrutinized the information from clinical and preclinical research studies into the bioactivity and safety of each species. We have also reorganized the monographs by scientific plant name instead of common name. Common plant names vary considerably across geographic boundaries and language, whereas their scientific or botanical name corresponds with only one accepted name. Therefore, Jamaicans and non-Jamaicans alike will be able to easily access information on individual plants. We hope that our readers particularly enjoy the interdisciplinary scientific expertise brought together in this book, regardless of whether someone’s specific interests lie in learning more about cultural plant uses in Jamaica or other countries, in the botanical identification, or in the known effectiveness and safety of these plants. It has been a very rewarding experience to go through the process of bringing our research data from the field to the desk. This has involved many months of interviews, plant collection and identification, developing and maintaining a reference herbarium, analysis of more than a thousand ethnobotanical records, as well as reviewing and condensing a vast amount of published literature. As ethnobotanists, we consider our work timely and urgent. Over the past few years, top scientific journals, major newspapers, and calls such as World Scientists’ Warning to Humanity have all addressed the accelerating loss of biological diversity and plant life around the world. These plant resources are not infinite, and as we learn about their multiple values, we should also take steps to protect them and the cultural knowledge associated with them. Our project has been a collaborative partnership with the communities in Jamaica, and as editors of this book, we remain committed to calling continued attention to the intellectual property rights of these knowledge holders, the vii

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c­ommunities of Windsor Forest and Payne Land, who have contributed to this research study. Any commercial use of their traditional knowledge should be first authorized by them, and contractual arrangements drawn up to ensure these communities can share in any potential benefits. We would like to extend our thanks to anonymous reviewers who have helped to improve this book. Research is not done in a vacuum, but exists through the dedication of the entire scientific community of ethnobotanists who continue to relentlessly work behind the scenes. Bronx, NY, USA  Ina Vandebroek Kingston, Jamaica   David Picking March 18, 2020

Preface to the First Edition

As humans, we excel when we unite our strengths. The richest collaborations are those that transcend boundaries. Regardless of field of occupation or culture, they bring together like-minded individuals, who are driven by a similar passion for what they do, even when they grew up on opposite sides of the planet. The wisdom that complements us is like a puzzle, one that can only be solved when all the pieces, held by different individuals, come together. Wisdom of plants comes in many forms. The farmer, man or woman, who works in the land stands each day in a living and breathing laboratory. Just like the student who attends school to learn, the bush is a very powerful teacher. The farmer observes the seasons, sky and stars, phases of the moon, and the behavior of the animals in and around the bush. Learning about plants is so much more than just learning about plants. It is ultimately about learning how humans, plants, and the environment depend on each other for survival. The farmer understands that humans are but a speck in the web of life. Even without an official degree, farmers have already graduated with honors from bush school, and—faced with continuous challenges brought about by climate change, drought, crop failure, or illness—continue to deepen their wisdom every day. When I first arrived in Windsor Forest in Portland Parish in the northeast of Jamaica in July 2010, I went on a bush trip with Edna “Juney” Pearcy. We climbed a hill at the edge of the John Crow Mountains, and there, overlooking a green oasis of bush in front of us, Juney asked me “isn’t this beautiful?” I knew then and there that I wanted to learn more about the plants growing in those mountains and their uses. I wanted to know if other people like Juney, who worked the land and roamed the bush, loved their hills so much. The National Geographic Society supported this idea, and collaborators from Jamaica and The University of the West Indies partnered to develop it further. Together we embraced the opportunity to do research about plants and people in Kingston as well, to better understand the rural–urban links of plant knowledge and use. Ultimately, all this work has resulted in this book. Collaborating with The University of the West Indies, Mona Campus, has been an incredibly rewarding experience. ix

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So now here we are, and we could not have done this without all the people who came together. Thank you, Juney, for taking me up that mountain in 2010. Thank you, Calvin, for being such a great cook of real Jamaican food and for making me laugh with your stories. Thank you, Peter, for taking me deep into the hills to look for blossoms on vines way up in the trees and for your wisdom about plants. The same goes for Tyrant (Dalman) and many others. Thank you, Enny Penny, for rhyming about the bush like no one else. Remember, Straw, that I am looking forward to your spoken-word performance. Thank you, Jason, for being the best shoulder to lean on and for watching over me in so many ways. Thank you, Professor Davidson, for connecting us with the community in Payne Land, through the office of The Most Honorable Portia Simpson Miller, and to Mr. Monroe and Hosanna, for making our research in Kingston possible. A huge thank you goes to everybody in the communities of Windsor Forest and Payne Land, for kindly sharing their knowledge and stories about bush medicines. We are all extremely grateful for the funding from the National Geographic Society Committee for Research and Exploration (CRE). My parents have instilled in me a sense of wonder for nature since I was a baby who proudly posed in front of the camera holding a little daffodil, even though I could barely walk. Jos and Rosa Vandebroek-Verhoeven were the first organic kitchen-garden farmers in my life. They continue to be so today, at the age of seventy-­six and seventy-two. Their straightforward and firm position in life has given me the endurance to take on any task. Michael J. Balick, Ph.D., continues to be a great source of inspiration to me. He carries forward the legacy of the founding father of modern ethnobotany, Richard Evans Schultes, Ph.D. It is a privilege to keep learning from his field experiences and wisdom. This book is dedicated to the people of Jamaica, their stories, their humor, their language, their creativity and skills, and last but not least, their knowledge of plants for medicine, root tonics, and culinary delights. May you always carry forward the melodic Patois language about the bush, and its secrets, held by the moon and the stars. It is my sincere hope that this book will stimulate Jamaican youth to follow in the footsteps of their farming relatives, and learn from them as much as I did. Lesson number one, always walk with a clean heart, watch the moon, and don’t forget to drink your jelly water. The true riches of Jamaica are in the land. This land will require continued attention and protection from the government and the communities, to enable it to continue to be as precious as it is today. Portland, Jamaica  Ina Vandebroek May 12, 2016

Acknowledgments

The editors greatly acknowledge the valuable assistance of the following scientists in making this research project a success and would like to extend special gratitude for their contributions: Stacey Aiken, M.Sc., helped with fieldwork in Kingston. Patrick Albert Lewis, M.Sc., Andreas Oberli, B.Sc., Richard Abbott, Ph.D., and Robbin Moran, Ph.D., were always there to assist with plant identification. Sylvia Mitchell, Ph.D., oversaw project progress in Jamaica and advised on the final plant monographs together with Rupika Delgoda, Ph.D.  Brian Boom, Ph.D., oversaw project progress at The New  York Botanical Garden and advised together with Elizabeth Kiernan, M.Sc., on GIS conservation analysis of Jamaican plant species. We also extend our thanks to NYBG Press and anonymous reviewers who have helped to improve this edition. Funding: Research activities that resulted in this book were funded by Grant # 9339- 13 (“Comparative Exploration of Plants and Local Knowledge in Portland Parish, Jamaica”) from the National Geographic Society Committee for Research and Exploration (CRE) to Ina Vandebroek. Citation: Vandebroek I, Picking D (Eds.) (2020) Popular medicinal plants in Portland and Kingston, Jamaica. Advances in Economic Botany 19. NY: Springer.

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Contents

1 Introduction����������������������������������������������������������������������������������������������    1 Plant Monographs 2 Aloe vera (L.) Burm.f. (Asphodelaceae) ������������������������������������������������   13 3 Annona muricata L. (Annonaceae) ��������������������������������������������������������   27 4 Antigonon leptopus Hook. & Arn. (Polygonaceae)��������������������������������   39 5 Argemone mexicana L. (Papaveraceae)��������������������������������������������������   45 6 Artocarpus altilis (Parkinson) Fosberg (Moraceae)������������������������������   55 7 Bryophyllum pinnatum (Lam.) Oken (Crassulaceae)����������������������������   61 8 Chromolaena odorata (L.) R.M.King & H.Rob. (Asteraceae)��������������   71 9 Citrus × aurantium L. (Rutaceae) ����������������������������������������������������������   79 10 Clinopodium brownei (Sw.) Kuntze (Lamiaceae)����������������������������������   89 11 Cocos nucifera L. (Arecaceae)����������������������������������������������������������������   95 12 Crescentia cujete L. (Bignoniaceae)��������������������������������������������������������  107 13 Cymbopogon citratus (DC.) Stapf (Poaceae)������������������������������������������  115 14 Dysphania ambrosioides (L.) Mosyakin & Clemants (Amaranthaceae)��������������������������������������������������������������������������������������  123 15 Eryngium foetidum L. (Apiaceae) ����������������������������������������������������������  131 16 Jatropha gossypiifolia L. (Euphorbiaceae) ��������������������������������������������  139 17 Momordica charantia L. (Cucurbitaceae)����������������������������������������������  149 18 Morinda citrifolia L. (Rubiaceae)������������������������������������������������������������  159

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19 Petiveria alliacea L. (Phytolaccaceae) ����������������������������������������������������  173 20 Pimenta dioica (L.) Merr. (Myrtaceae)��������������������������������������������������  181 21 Ricinus communis L. (Euphorbiaceae)��������������������������������������������������  187 22 Senna alata (L.) Roxb. (Fabaceae)����������������������������������������������������������  199 23 Senna occidentalis (L.) Link (Fabaceae)������������������������������������������������  207 24 Solanum torvum Sw. (Solanaceae)����������������������������������������������������������  219 25 Turnera ulmifolia L. (Passifloraceae) ����������������������������������������������������  229 26 Zingiber officinale Roscoe (Zingiberaceae)��������������������������������������������  235 Common Plant Name Index����������������������������������������������������������������������������  247 Index of Plant Names and Health Conditions ����������������������������������������������  251

About the Editors

Ina  Vandebroek, PhD  is a biologist and ethnobotanist. She is the Mathew Calbraith Perry Associate Curator of Economic Botany and Caribbean Program Director at The New York Botanical Garden. Ina is the Principal Investigator of the research project “Comparative Exploration of Plants and Local Knowledge in Portland Parish, Jamaica,” funded by the National Geographic Society, Committee for Research and Exploration (grant #9339-13). She studied biology at the University of Ghent in Belgium and holds a PhD in medical sciences from the same university. After earning her doctorate, Ina specialized in ethnobotany, the science that investigates how people perceive, use, and manage their plant resources in traditional and culturally appropriate ways. Through interviews with local community members and plant identification, Ina documents the traditional knowledge, beliefs, and practices of these communities, to help preserve their cultural heritage and contribute to plant conservation. She also trains medical students and healthcare providers in developing a more culturally appropriate and sensitive clinical practice. David  Picking, PhD  came to Jamaica as a Commonwealth Scholar in 2008 and went on to complete a doctorate in biochemistry at The University of the West Indies (UWI). David previously graduated from the School of Integrated Health, University of Westminster, London, as a medical herbalist and naturopath in 2007. David is currently a research fellow at the Natural Products Institute, UWI, where his research focuses on documenting traditional knowledge and the contemporary use of medicinal plants by Jamaicans. David has a particular interest in the integration of

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About the Editors

medicinal plants into the Jamaican healthcare system and, as part of his PhD, screened a number of the most commonly used plants for their potential interaction with pharmaceutical drugs, a key aspect of medicinal plant safety. David was part of a team that successfully undertook a “Traditional Medicines in the Islands” (TRAMIL) survey and completed Jamaica’s first contribution to the TRAMIL database and online plant pharmacopeia (www.tramil.net), adding to the body of knowledge from over 50 surveys completed across the Caribbean to date.

Chapter 1

Introduction

The flora of Jamaica is rich and diverse, with 3218 distinct species and varieties of seed plants, of which an estimated 34% occur only there, and are known as endemics. Jamaica ranks third among Caribbean islands for its percentage of endemic plants, after Cuba (50%) and Hispaniola (44%) (Acevedo-Rodríguez and Strong, 2008). This high degree of endemism, coupled with a high threat of habitat loss, marks the Caribbean as an important global biodiversity hotspot with a high priority for conservation (Kier et al., 2009; Anadón-Irizarry et al. 2012). Jamaican plant diversity is firmly embedded within a longstanding multicultural tradition of plant use that represents a blend of the traditional knowledge, worldviews, cultural beliefs, skills, and practices derived from Amerindian, European, African, Asian, and other groups. A review of the historical context of traditional knowledge systems in Jamaica is available elsewhere (Picking and Vandebroek 2019; Picking et al. 2019). Many plant species have a long oral history of use as medicines in Jamaica, predating written records of the eighteenth century (Sloane, 1707–1725). Medicinal plant use continues to be very popular in Jamaica today. In one study, 73% of Jamaicans commonly used plants to treat illness and maintain health (Picking et  al., 2011). A contemporary review listed at least 334 plant species ­growing in Jamaica—native as well as exotic plants—that are used as medicines (Mitchell and Ahmad, 2006). Given their popularity and historical records of use, it is likely that the actual number of medicinal plants is much higher. This illustrates the continued need for in-depth ethnobotanical research in Jamaica, using quantitative methods to compare the dynamics of plant knowledge over space and time. Medicinal plants in Jamaica are known as “bush medicines,” regardless of their growth habit as herbs, shrubs, trees, grasses, or vines. This book brings together cultural and scientific information on 25 popular medicinal plants that are used today in urban Jamaica (Payne Land, Kingston) and rural Jamaica (Windsor Forest, Portland parish). It is the result of ethnobotanical research carried out in 2014 and © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_1

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1 Introduction

2015, during which we interviewed 119 men and women about their knowledge and use of plants as medicines, including the common names of the plants and the health conditions they are used for. Through subsequent field trips with knowledgeable Jamaicans in the surrounding areas of their communities, we collected plants to make herbarium specimens that were used to identify botanical names, a methodology called botanical authentication. The goal of our research was to help preserve people’s traditional knowledge about plants. This information can be a useful tool to educate the next generations about cultural traditions and ultimately draw attention to the importance of biological diversity in Jamaica. Research data about plant uses gathered through fieldwork was supplemented with information from a review of the scientific literature, initially undertaken in 2015, and subsequently updated with a review in 2020. Following this approach, we were able to compare our data with ethnobotanical uses recorded by other authors worldwide and compile biomedical information about the safety of use and clinical effectiveness of the plants we recorded and collected in the field. Even though the specific focus of this research was on medicinal plants and their uses to treat health problems and maintain health, at the start of the project, we soon realized that people have a much broader range of knowledge about plants. This transcends a focus on medicine and health, to also cover the use of plants for spiritual purposes, as regular teas and wild foods, as utensils and tools, and to maintain healthy animals. We listed this information in the book under “cultural uses and beliefs,” as they embody important cultural dimensions of plant knowledge. As such, this broader record of cultural knowledge adds depth to medicinal plant use data for human health and should be valued on its own merit. Ethnoscientists, who explore the linkages between traditional and scientific knowledge, view plants as more than chemical factories for which the biological activity needs to be corroborated or refuted by laboratory data. The “emic” or insider’s perspective, an insight borrowed from anthropology, urges consideration of all knowledge within its own cultural context. Cultural beliefs and worldviews are also important agents of transmission, and can assist in the preservation of plant knowledge for future generations. This book thus includes spiritual uses of bush medicines, as they not only represent the reality of life in contemporary Jamaica but also place health in a cultural context. This approach is more in line with the Constitution of the World Health Organization that defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Globally, the current official record of medicinal plants used around the world surpasses 28,000 species (Kew Science, 2017), and it is expected that this number will only increase with continued research efforts to document oral traditions. Despite their popularity, some plants can represent danger for human health. The consumption of herbal remedies is often considered harmless because of their natural origin. Nonetheless, there exist plants that are known to be toxic, and others, including several that are listed in this book, are understudied for their biological activity and safety of use. For these plants, additional research is needed to clarify issues of safety, toxicity, appropriate dosage in relation to plant part used, contami-

Geographic location of research

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nation, adulteration, and potential interactions with synthetic (pharmaceutical) and other natural drugs.

Geographic location of research Our research took place in two communities (Fig. 1.1): Windsor Forest, Portland parish (rural Jamaica), and Payne Land, Downtown Kingston (urban Jamaica). Windsor Forest in Portland parish is a rural subsistence community of about 1000 residents. Socioeconomic activities consist of day labor jobs in construction, market trading, and hillside farming for household consumption and to supplement income. Animal husbandry is centered around goats mainly, and also cattle. Crops grown in agroforestry systems include root species and fruit trees (such as Dioscorea spp., Artocarpus altilis (Parkinson) Fosberg, Blighia sapida K.D.Koenig, Cocos nucifera L.) and to a lesser extent vegetables such as callaloo (Amaranthus viridis L.) (Sander and Vandebroek, 2016). The community is located at the fringes of the John Crow Mountains, about 2 km inwards from the coastal road between Boston Bay and Long Bay, and about 30 km east from the town of Port Antonio. The John Crow Mountains, joined together with the eastern tip of the Blue Mountains, are a designated UNESCO World Heritage site and a 495.2 km2 National Park. Average annual rainfall over a 47-year period (1971–2018) at the Portland weather station of Shirley castle was 3947 mm, with peak seasonal rainfall observed in the months of January, April, and from October to December (Programme for Building Regional Climate Capacity in the Caribbean, n.d.). In 2015, the Meteorological Service of Jamaica reported a mean minimum and maximum air temperature for Portland of 19 °C and 28 °C, respectively, with high humidity throughout the year. The community of Windsor Forest and its surrounding hillside farms are situated at around

Fig. 1.1  Location of the study areas in Jamaica

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120 m elevation on limestone hills (Sander and Vandebroek, 2016). No biomedical healthcare is available within the community. The nearest hospital is located in Port Antonio, but for serious health problems residents have to travel to other areas, including Kingston, to receive more specialized biomedical care. Payne Land is an inner-city community of around 3000 inhabitants, located within the parish of St. Andrew. It is situated along Spanish Town road, approximately 4 km northwest from the bus park in Downtown Kingston, and 1.5 km from the shore line. Comparison of meteorological data shows that Payne Land is much drier and hotter than Windsor Forest. Average annual rainfall at the nearest weather station (Norman Manley airport) over a 48-year period (1971–2019) was 798 mm, with peak seasonal rainfall observed in May and from September to October. Mean minimum and maximum air temperatures over 26 years (1993–2019) were 25 °C and 32 °C, respectively (Programme for Building Regional Climate Capacity in the Caribbean, n.d.). The vegetation in Payne Land consists mainly of plant species that thrive in inner-city areas, such as ruderals (plants growing on wasteland), weeds, and invasives, including Ricinus communis L., Stachytarpheta spp., Argemone mexicana L., Antigonon leptopus Hook. & Arn., and others (Vandebroek et al., 2018). Other species that people grow and tolerate in and around the community, often in their house yards and in small community plots, include trees such as Syzygium cumini (L.) Skeels, and aromatics such as Lippia alba (Mill.) N.E.Br. ex Britton & P.Wilson, and Clinopodium vimineum (L.) Kuntze.

Research methodology We carried out ethnobotanical fieldwork during 2014 and 2015. Through interviews with adults who had previously used bush medicines, we recorded common plant names and medicinal use data from each participant, which we combined with botanical methods to collect and identify plant species and cross-link common names with scientific names. Ethics Committee approval for this research project was granted by The University of the West Indies, Mona Campus. A permit for plant collection was obtained from the National Environmental Protection Agency (NEPA).

Ethnobotanical interviews In Windsor Forest and Kingston, we used two types of interviews (Alexiades, 1996; Thomas et  al., 2007): (1) photo interviews featuring 45 plant species growing in Jamaica and (2) semi-structured interviews based on a questionnaire, during which we asked people to free-list medicinal plants. All interviews were conducted in Patois, an English-based creole language with West African influences. Recruitment of interview participants was based on the following inclusion criteria: (a) residency in the community, (b) age 18 years or older, (c) having previously used medicinal

Research methodology

5

plants for the treatment of health problems and/or to maintain health, (d) confirming a willingness to be interviewed. We tried to balance gender and interviewed equal numbers of men and women. We did not specifically look for people who were known (or self-identified) as plant specialists or healers; rather, anyone who said they had previously used bush medicine could participate if they agreed to do the interview after Free Prior Informed Consent (FPIC). The main approach to find people to interview was either through referrals from a community leader or upon recommendation by others who had previously completed an interview. These people were approached in person and asked if they would participate in the study. If they agreed, details about the study were explained, and they were asked to provide their FPIC before the interview started. During photo interviews, the interviewer showed a picture of each plant, for a total of 45 species. If a person recognized the plant, information was recorded about its common name(s), medicinal uses, and other cultural information about the species. For the semi-structured interviews, a questionnaire was used to ask questions, and the answers were recorded in writing. One of the main questions involved asking people to free-list all the bush medicines they knew, and the health conditions for which they were used. Other topics in the questionnaire asked about where these bush medicines could be found, how people had learned about them, why they used bush medicines, what their opinion was about bush doctors and physicians, and if they knew about any illnesses a physician does not understand or cannot cure. In Windsor Forest, Ina Vandebroek completed 20 photo interviews and 20 semi-­ structured interviews (with 20 men and 20 women). In Kingston, a team of three persons (Ina Vandebroek, David Picking, and Stacey Aiken) conducted 41 photo interviews and 38 semi-structured interviews (with 40 men and 39 women).

Plant collection and identification Interviews yielded lists of common plant names in both communities. The next step was to verify the proper botanical identity of each named plant through collection trips and use of plant identification techniques to associate a common name with a scientific, binomial botanical name. Common plant names vary considerably across countries, as well as within different regions of the same country. In popular media, there often is no mention of plant identification methods. Binomials are regularly ascribed to common names imprudently. Without properly identified plant species, the results of any study are at best dubious and at worst dangerous (Nesbitt et al., 2010). After completing the interviews, we compiled a list of plants by common name and ranked them according to how frequently they were mentioned by all study participants. Next, guided by a knowledgeable person, we set out into the community surroundings to collect all the plants that were mentioned independently by at least three people. In addition, plants indicated as medicinal by the guide were also collected, even if they had not been previously mentioned during interviews.

6

1 Introduction

During plant collection, we prepared voucher specimens consisting of three to four duplicates of each species. In total, we collected 224 voucher numbers (654 plant specimens) that were dried, pressed, identified, and deposited at the herbarium of The University of the West Indies (UCWI), the herbarium of The New  York Botanical Garden (NY), and the Institute of Jamaica (IJ). The NY collection duplicates will be digitized and made freely available online on the C. V. Starr Virtual Herbarium (http://sweetgum.nybg.org/science/vh/), containing more than 140 botanical species. While collecting voucher specimens, we also took photos in the field with the goal to develop a photo library, which at present consists of more than 2000 pictures and serves as visual support material for our research data. To identify unknown specimens, we used Adams (1972). A scientific (botanical) plant name always consists of three parts: (a) a genus name (always capitalized), (b) a species name (never capitalized), and (c) an author name (from the person who first described the species in specialized scientific literature). For example, Solanum torvum Sw., consists of the genus name Solanum, the species name torvum, and the abbreviated author name Sw. Note that the botanical name (minus the author name) is always italicized (Nesbitt et al., 2010). The accepted botanical name and the correct spelling of this name were verified across several authoritative websites, including The Plant List (http://www.theplantlist.org/), the International Plant Names Index (https://www.ipni.org/), Plants of the World Online (http://www.plantsoftheworldonline.org/), the Catalogue of Life (https://www.catalogueoflife.org/col/), and the World Flora Online (http:// www.worldfloraonline.org/). Several of these websites also indicate the acceptance status of the botanical name, which can be “accepted,” a “synonym,” or “unresolved.” Family circumscriptions followed the Angiosperm Phylogeny Group (APG IV) Classification (Stevens, 2017). Based on new molecular data, botanical names can be subject to review and change. For example, Chromolaena odorata (L.) R.M.King & H.Rob. was formerly known as Eupatorium odoratum L., the latter now considered a synonym.

 ata analysis and selection of plant species for the monographs D in this work We entered interview data into Microsoft Excel spreadsheets, using rows for each plant use-report and columns for each participant, resulting in a total of 847 and 780 distinct plant use-reports in Windsor Forest and Kingston, respectively. An example of one such plant use-report is: “the leaves of King-of-the-Forest [botanical name Senna alata (L.) Roxb.] are rubbed on the skin for liver spots [a fungal skin infection].” Seventeen percent of all plant use-reports were confirmed by at least three people in Windsor Forest, whereas in Kingston, this proportion amounted to 21%. Analysis of our research data showed 44 plant species with medicinal uses that were confirmed independently by at least 20% of the people interviewed in each

Research methodology

7

community. About half of these species (48%) are native to Jamaica. From this list, we selected 25 plant species for the monographs in this book. We chose species that had the most use-reports, while balancing the number of exotic and native plants.

 eview of the scientific literature and criteria for inclusion R and exclusion We researched the scientific literature (PubMed, Biological Abstracts, Science Direct, Google Scholar) for clinical and safety information about each plant species, using the following keywords: “adverse,” “safety,” “toxic,” “toxicity,” “interaction,” “clinical,” “poison,” “poisoning,” “breastfeeding,” “pregnancy,” “medicine,” and “medicinal.” Database searches with these keywords led to individual scientific articles that were downloaded, read, and summarized in a few sentences to be added to the plant monographs. The bibliographic references of these articles are available at the end of each monograph. Major Caribbean reference books, such as those produced by TRAMIL (Traditional Medicine in the Islands), were also consulted, for example, Germosén-Robineau (2014). Our criteria for inclusion of scientific studies in the monographs were: (a) human case reports and clinical studies; (b) animal studies of whole plant extracts that were water- or alcohol-based and in dosages that correspond with the traditional use of these extracts; (c) ethnobotanical studies in the Caribbean and worldwide, describing the traditional use of the plant species in other cultural groups. Articles excluded from the monographs reported on: (a) intravenous administration of plant extracts (e.g., an article that demonstrated that soursop administered intravenously had a blood pressure-lowering effect), because traditional administration was never done intravenously; (b) in vitro studies (research with plant extracts in test tubes), because those are too far removed from human physiology; (c) the effects of individual (purified) plant compounds (chemicals); (d) extracts that did not correspond with traditional preparations, for example, n-butanolic extracts. An exception was made for in vitro studies about herb–drug interactions. We do report on those types of studies in the plant monographs (when they are available in the literature), because they are a useful first-line investigation to identify the plants that are likely to interact with pharmaceutical products. We repeated literature searches using synonyms listed in the reference work of Jamaican flowering plants (Adams, 1972). When scientific information on a plant species was scarce, for example, in the case of Clinopodium brownei (Sw.) Kuntze, we conducted a supplementary literature search at the genus level. Some plants, such as guinea hen weed (Petiveria alliacea L.), are well studied because they grow in tropical regions around the world, and their use is popular. The amount of information we were able to retrieve about this species stands in contrast to understudied plants, such as pennyroyal (Clinopodium brownei) or breadfruit (Artocarpus altilis (Parkinson) Fosberg).

8

1 Introduction

Organization of the information in the monographs Each monograph begins with the accepted botanical name of the species, followed by its plant family according to APG IV. In addition, where applicable, we also list the botanical synonyms from Adams (1972), as these may still be in use in Jamaica and elsewhere. A short botanical description follows the scientific and common names. This description includes information from interviews about the management or cultivation of the species and the type of habitat in which it can be found in Jamaica. The next paragraphs provide details of the specific plant parts that are used medicinally, noteworthy cultural uses and beliefs, and summarize the medicinal uses specific to each species. These medicinal uses were first quantified based on our interview data and then ranked. Under “major uses,” we list medicinal uses that were independently mentioned by at least 20% of interviewees in each community. For these uses, there existed a high degree of consensus among interview participants. They contrast with less popular uses, listed as “minor uses,” which were mentioned by at least 5% (but less than 20%) of the people interviewed in each community. Classifying the medicinal uses of plants as either “major” or “minor” visualizes patterns of plant knowledge in a study area and elegantly shows that plant knowledge is not anecdotal. For plant species that grow in different countries across geographical boundaries, these knowledge patterns enable cross-cultural comparisons with medicinal uses elsewhere. This book describes multiple types of medicinal preparations, including decoctions, infusions, poultices, macerations, and others. During decoction, plant parts are boiled. Infusion consists of plant parts being steeped in hot water. Poultice is compression of plant parts that are applied to the skin. Maceration consists of plant parts being shredded into pieces, oftentimes in water, by rubbing the hands. Each plant monograph has a section on “Reported medicinal uses across the Caribbean In that section, we report on information from the literature and also refer to the recommendations from TRAMIL (Traditional Medicines in the Islands), whenever that information is available. TRAMIL is a network of researchers and healthcare professionals that aims to study, validate, and expand medicinal plant use in primary healthcare and has completed over 50 surveys across the Caribbean to date. TRAMIL provides recommendations for medicinal plant use, based on their surveys and follow-up research, which are generally accompanied by a number of cautions. For example, for oral consumption relating to conditions such as asthma and pneumonia, an initial medical evaluation is recommended. In addition, where appropriate, the use of traditional treatments should be considered complementary to medical treatment. For topical applications, strict hygiene measures should be observed in order to avoid contamination or additional infection. For all recommendations, should there be a notable worsening of a patient’s condition, medical attention should be sought without delay. Data from our ethnobotanical research in Jamaica described in this book complements information from the TRAMIL surveys conducted across the Caribbean since

How to use this book

9

the 1980s in the following ways: (1) our surveys focused on plant species, whereas those by TRAMIL focused on health conditions; (2) Jamaica-specific medicinal plant use data is not yet available on the TRAMIL website (http://www.tramil.net/ en); (3) data for species-specific medicinal plant uses across the Caribbean is not yet available from TRAMIL for 7 of the 25 species in this book; (4) TRAMIL surveys in Jamaica in 2008–2009 did not record significant medicinal uses (reported by at least 20% of interviewees) for 16 of the 25 species in this book (Picking et al., 2015). Another section in each plant monograph is about “Clinical efficacy (effectiveness) studies in humans.” There, we report on, and summarize, information we encountered in the biomedical literature about clinical studies. Clinical studies are carried out with human volunteers, to first make sure that the medicine being tested is safe and second to establish whether it works. Different types of clinical studies exist. “Randomized, double blind, placebo controlled trials” are those in which groups of volunteers are randomly chosen to receive the medicine (either a plant extract or a pharmaceutical drug), and others are randomly chosen to receive a placebo (dummy or inactive treatment). No one, neither the researchers nor the human volunteers, know who gets the real treatment and who gets the placebo. Both the researchers who are giving the treatment and the human volunteers who are receiving the treatment are “blind” to the type of treatment, hence the wording “double blind.” Placebos are important because if researchers notice that the “treatment group” is different from the “placebo group,” they will know that the difference is because of the treatment. Without a “placebo group,” researchers cannot know if those changes would have happened anyway, no matter which medicine people had taken. “Open randomized trials” are those studies in which both the researcher and volunteer know which treatment they are receiving. There is no “blinding” in this type of study. A “crossover study” is one in which all the volunteers receive the same number of treatments, but at different times. For example, Group A might initially receive the medicine and Group B the placebo for 1 week, then in week 2, they would swap and Group A receives the placebo and Group B the medicine.

How to use this book This book is meant as an educational resource, not as an herbal guide for self-­ medication. It is for this reason that we did not include a separate section in the plant monographs on recommended dose and methods of preparation. Our aim was to develop a reference work that provides an overview of traditional (cultural) knowledge related to the use of bush medicines, as well as scientific studies highlighting the clinical effectiveness and safety of these plants based on human studies and animal safety studies. These two bodies of knowledge (traditional and scientific knowledge) can be considered as complementary. After reading this book, one can conclude that many plant species remain understudied for their safety, but especially from a clinical (human) perspective. It is our hope that this book will also be used by healthcare providers in their clinical practice to start a dialogue with patients

10

1 Introduction

about medicinal plants or bush medicines. This is especially important since the use of bush medicines remains a popular practice in rural and urban Jamaica today. In light of this popularity, in-depth discussion about medicinal plant safety, including potential plant–drug interactions, is long overdue. There are several reasons why we did not provide detailed preparation recipes (and precise dosages) in this book when we list the medicinal applications of plant species from our research. First, we interviewed more than 100 people, and recipes and amounts used by different people varied widely. Traditional knowledge is based on experimentation, and research has shown that the more a person experiments with plant medicines, the more idiosyncratic their knowledge becomes (Vandebroek, 2010). As a hypothetical example, one person can describe soaking two leaves in a cup of hot water for 2 min, whereas another person describes boiling a handful of leaves and bark from the same species to treat the same illness in a gallon of water for over an hour. There are no standardized ethnobotanical recipes in oral traditions, not even among healers. This is inherent to the richness of traditional knowledge. Second, the goal of this work was not to develop a recipe book. Ultimately, people can use this book as a starting point for discussing recipes with someone who is experienced in using these plant species. Consultation with an experienced person will limit health risks associated with improper plant use. Finally, recipes are often personal and may represent sensitive or even secret information. If a person did not spontaneously disclose details about the amount of plant material they used, or provided precise instructions for plant preparation during interviews, we did not inquire further about these details. We would love for this book to be useful to an audience as broad as possible. This includes ethnobotany students, medical students, practicing physicians, and also anybody interested in the evidence-based use of Jamaican plants, regardless of whether they are professionals in the field of botany, ethnobotany, pharmacology, natural products research, or medicine. We therefore deliberately abstained from using jargon biased toward these fields, without compromising on scientific quality. A previous study identified that 27% of Jamaicans who use medicinal plants to treat illness and maintain health did so in combination with pharmaceutical drugs and that only 19% of physicians knew about such practices (Picking et al., 2011). Extra care should be taken about dosage and possible toxicity before administering bush medicines to pregnant women and children. In most cases, it is not advisable to give bush remedies to pregnant women. There exists the common belief that bush medicines are safe because they are natural. However, some plants are toxic and potentially lead to serious side effects if taken at the same time as pharmaceutical drugs, so it is important to not start experimenting with bush medicines without supervision. One should always consult with a person knowledgeable about bush medicine and talk openly with a physician about such use.

Selected bibliography

11

Future studies Upon finishing this book, we realize that we have only touched the surface of Jamaican plant knowledge and that much remains to be studied. This is especially important in light of the current environmental crisis, and the alarming decrease of biological diversity worldwide, including the diversity of plants used as medicines (Applequist et al., 2020). At the same time, it is equally important to recognize that traditional knowledge about plants represents the intellectual property of the communities who have tirelessly transmitted this knowledge for countless generations by word of mouth. We, the editors, are merely the compilers of their knowledge. We could not have conducted this research without the assistance of community members who are our scientific peers in this work (Vandebroek, 2016). The information about medicinal uses that this study recorded comes from two field sites in the parishes of Portland and St. Andrew, namely Windsor Forest and Payne Land. Therefore, we do not claim this information to be representative of the rich diversity of medicinal plant knowledge encountered all over Jamaica. Future studies will need to be conducted to add to this wealth of information. We hope to expand on this work in other parishes, using the same systematic research methodology, to ultimately develop a medicinal plant guidebook that covers the whole of Jamaica.

Selected bibliography Acevedo-Rodríguez P, Strong MT (2008) Floristic richness and affinities in the West Indies. Botanical Review 74: 5-36. Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Alexiades MN (1996) Selected guidelines for ethnobotanical research: A field manual. Bronx, NY: New York Botanical Garden, 306 pp. Anadón-Irizarry V, Wege DC, Upgren A, Young R, Boom B, León YM, Arias Y, Koenig K, Morales AL, Burke W, Pérez-Leroux A, Levy C, Koenig S, Gape L, Moore P (2012) Sites for priority biodiversity conservation in the Caribbean Islands Biodiversity Hotspot. Journal of Threatened Taxa 4: 2806–2844. Applequist WL, Brinckmann JA, Cunningham AB, Hart RE, Heinrich M, Katerere DR, van Andel T (2020) Scientists’ warning on climate change and medicinal plants. Planta Medica 86: 10–18. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Kew Science (2017) State of the world’s plants 2017. Useful plant medicines. Accessed 21 December 2019 at https://stateoftheworldsplants.com/2017/useful-plants.html. Kier G, Kreft H, Lee MT, Jetz W, Ibisch PL, Nowicki C, Mutke J, Barthlott W (2009) A global assessment of endemism and species richness across island and mainland regions. PNAS 106: 9322–9327. Mitchell SA, Ahmad MH (2006) A review of medicinal plant research at The University of the West Indies, Jamaica, 1948–2001. West Indian Medical Journal 55: 243-269. Nesbitt M, McBurney RPH, Broin M, Beentje HJ (2010) Linking biodiversity, food and nutrition: The importance of plant identification and nomenclature. Journal of Food Composition and Analysis 23: 486–498.

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1 Introduction

Picking D, Younger N, Mitchell S, Delgoda R (2011) The prevalence of herbal medicine home use and concomitant use with pharmaceutical medicines in Jamaica. Journal of Ethnopharmacology 137: 305-311. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell, S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Picking D, Delgoda R, Vandebroek I (2019) A review of traditional knowledge systems and the role of traditional medicine in Jamaica. CAB Reviews 14: 1-13. Picking D, Vandebroek I (2019) Traditional and local knowledge systems in the Caribbean: Jamaica as a case study. In: Tribal and indigenous knowledge for the modern era. A natural and applied science perspective (Eds. Katerere DR, Applequist W, Aboyade OM, Togo C). Florida: CRC Press, pp. 89-116. Programme for Building Regional Climate Capacity in the Caribbean (n.d.) Carogen 01 v2. Accessed 23 December 2019 at http://carogen.cimh.edu.bb/index.php/component/countrydailydata/. Sander L, Vandebroek I (2016) Small-scale farmers as stewards of useful plant diversity: A case study in Portland parish, Jamaica. Economic Botany 70: 303–319. Sloane H (1707–1725) A voyage to the islands Madera, Barbados, Nieves, S. Christophers and Jamaica with the natural history of the herbs and trees, four-footed beasts, fishes, birds, insects, reptiles, &c. of the last of those islands; to which is prefix’d an intro., wherein is an account of the inhabitants, air, waters, diseases, trade, &c. of that place, with some relations concerning the neighbouring continent, and islands of America. London: Printed by B.M. for the author. Stevens PF (2017) Angiosperm Phylogeny Website. Version 14. Accessed 24 May 2018 at www. mobot.org/mobot/research/APweb/. Thomas E, Vandebroek I, Van Damme P (2007) What works in the field? A comparison of different interviewing methods in ethnobotany with special reference to the use of photographs. Economic Botany 61: 376-384. Vandebroek I (2010) The dual intracultural and intercultural relationship between medicinal plant knowledge and consensus. Economic Botany 64: 303-317 Vandebroek I (2016) Ethical aspects of working with local communities and their biological resources. In: Pharmacognosy: Fundamentals, applications and strategy (Eds. Badal S, Delgoda R). London, UK: Academic Press, Elsevier, pp. 645-651. Vandebroek I, Picking D, Aiken S, Lewis PA, Oberli A, Mitchell S, Boom B (2018) A review of coralilla (Antigonon leptopus): An invasive and popular urban bush medicine in Jamaica. Economic Botany 72: 229–245.

Chapter 2

Aloe vera (L.) Burm.f. (Asphodelaceae)

Synonyms: Aloe barbadensis Mill., Aloe vulgaris Lam., Aloe perfoliata var. vera L. (Adams, 1972) Common names in Jamaica: Sinkle bible, aloe vera Other common names in Jamaica: Bitter aloes, sempervivum (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_2

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14

2  Aloe vera (L.) Burm.f. (Asphodelaceae)

Botanical characteristics and propagation Succulent, short-stemmed or stem-less herb with spiny, lancet-shaped leaves in the form of a rosette. A main stalk of up to 1 m high holds the inflorescence of yellow flowers. The true origin of the species is unknown, but Aloe vera likely originated in the hot and dry regions of Arabia, Somalia, or Sudan (CABI, 2020). The succulent leaf is an adaptation to its dry native habitat. Today, Aloe vera is cultivated w ­ orldwide and grows wild in tropical climates. Jamaican farmers traditionally propagate the species by transplanting the rooting side-shoots, which they call suckers.

Where to find the plant The plant is cultivated in people’s yards.

Part used The transparent gel (the gelatinous part of the inner leaf that remains after peeling) and sometimes also the greenish-yellow “stain” (exudate) that comes out of the leaf when cut.

Jamaican cultural uses and beliefs The leaf of sinkle bible is cut up in the drinking water of animals, so it “melts” to “build chicken, goat and cow”; it is reported to “make them look fresh and pretty.” Another veterinary use is when animals have ticks. Then, sinkle bible is cut up with salt and pushed gently down their throats.

Jamaican medicinal uses In Kingston and Windsor Forest, the main use of the leaf of sinkle bible is as a body and blood cleanser and for skin problems, including rash and wounds. It is considered a good remedy for skin care and hair care. In Windsor Forest, people also popularly use sinkle bible to treat the common cold.

Jamaican medicinal uses

15

Major uses (mentioned by more than 20% of people) • Body cleanser (a detox, considered to cleanse the belly, the bowels, or the chest, to flush the system, and to remove gas): The leaf is peeled and the yellow stain is drained off. Then, the gel is cut into pieces and put in water for an hour; the gel is eaten raw, or the water is drunk. An ounce of gel is used for one pint of water. The gel can also be blended with orange juice and egg (beaten egg white) and drunk. Another preparation is to beat up the gel with egg yolk for 9 days and to take this remedy every 6 months. Or, the gel can be boiled together with cerasee (Momordica charantia L.) and other bitters and drunk. • Blood cleanser (to purge the blood, or when the “blood is too sweet”): People know when the blood is too sweet, stating: “bump come up on the skin. It scratch yuh.” If that happens, they say “yuh need fi drink bitters.” Thus, the cuticle of a leaf of sinkle bible is removed, and the gel is cut into pieces and eaten; or the gel is blended with orange juice and egg white and then drunk. Alternatively, the leaf can be peeled and drunk with jelly (coconut) water. • Common cold: The leaf is peeled, sliced up, and directly ingested, or it is first set in either water or jelly water, after which the water is drunk. In addition, the stain is dripped on the tongue. Alternatively, the leaf is boiled in water after which the water is consumed, or the leaf is prepared as a punch with milk. • Hair care (also to treat dandruff): The gel and stain are used to make shampoo. The gel is scraped from the leaf to make a sort of Vaseline for the hair that can be rubbed on the scalp and covered with a steam cap; after a couple of hours, the preparation is washed out. • Skin problems and skin care (including acne, eczema, fungus, rash): The gel is scraped from the leaf, blended and applied to the face, left for 10 min, and then removed. For skin care, the leaf is peeled and the slime scraped, first the yellow stain is applied to the skin and then the gel is rubbed in, followed by washing with cake soap. Another topical use is as follows: The “maca” (spines) are removed, then the green leaf part and gel are heated on the fire and rubbed on the skin. For internal use: The leaf (without the peel) is cut and boiled, or blended with water, and drunk. Alternatively, the middle part is scraped and boiled with medina (Alysicarpus vaginalis (L.) DC.), moringa (Moringa oleifera Lam.), and rice and peas (Antigonon leptopus Hook. & Arn.), sweetened and refrigerated, then drunk. Or, the gel can be soaked in water, blended with juice, and drunk. • Wounds: The leaf is sliced, and the gel or stain is applied warm to wounds.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Sprains (swelling foot): The leaf is baked and tied on the foot. • Tetanus (“nail jock yuh”): The leaf is heated and tied on the wound.

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2  Aloe vera (L.) Burm.f. (Asphodelaceae)

Reported medicinal uses across the Caribbean According to the Caribbean pharmacopeia, several preparations from the plant are recommended for a number of health conditions, as summarized in Table 2.1. These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (TRAMIL, 2015).

Table 2.1  Recommended health conditions across the Caribbean for Aloe vera Recommended use Asthmaa, cold, sinusitis, catarrh Baldness Cuts, burns, and skin rash

Plant part(s) used Fresh gel, liquefied, decoction or infusion, ingested Fresh gel, applied as a poultice (compress) Fresh gel, applied as a poultice (compress)

Due to health risks associated with asthma, an initial medical evaluation with a qualified healthcare practitioner is advised, and any use of the plant remedy should be considered complementary to medical treatment (TRAMIL, 2015)

a

Reported medicinal uses across the world Records dating back to 500 BC report use of Aloe vera to heal the skin and treat wounds, hemorrhoids, and hair loss (Shelton, 1991; Boon and Smith, 2004). Greek physician Dioscorides described the use of the plant gel to heal skin infections, chapping, and hemorrhoids (Gunther, 1934; Kuhn and Winston, 2001; Boon and Smith, 2004). Many legends exist on its reported uses, with one describing Aloe vera as the secret of Cleopatra’s beauty and another that it was used on the body of Christ following the crucifixion (Grindlay and Reynolds, 1985; Boon and Smith, 2004). In India, the plant has a history of use as a cathartic (powerful laxative), stomachic (improves function of the stomach), and anthelmintic (expel parasitic worms) (Chopra, 1956; Boon and Smith, 2004). In China, it is commonly used as a skin remedy and in Mexico as a treatment for skin irritations (Boon and Smith, 2004). Internationally, the contemporary use of Aloe vera is widespread, but it is important to note that it has two main, distinctly different preparations: first, those based on the Aloe vera clear and slimy inner leaf gel (referred to as Aloe vera gel, or simply as aloe gel) and, second, those based on the bitter, yellow-brownish sap (latex) found in the skin (peel) of the leaf (referred to as aloes). For many years, Aloe vera was cultivated in North America as a source of the dried latex (aloes) for its potent laxative properties. However, in more recent years, its use as a laxative has more or less been discontinued, and most cultivation is now focused on the production of the aloe gel (WHO, 1999; Boon and Smith, 2004).

Clinical efficacy studies in humans

17

Clinical efficacy studies in humans Given the extensive use of Aloe vera preparations, the number of well-designed clinical studies continues to be low but is growing. A review of clinical research identified 18 clinical trials using Aloe vera gel preparations, on a total of 7297 human participants, for numerous health conditions (Grundmann, 2012). Clinical studies for which efficacy has been established for external use of Aloe vera gel preparations include reduction in the incidence of alveolar osteitis (postoperative complication of tooth extraction) (Poor et  al., 2002), anal fissures (small tears in the lining of the anus) (Rahmani et  al., 2014), mild to moderate burns (Thamlikitkul et  al., 1991; Visuthikosol et  al., 1995; Akhtar and Hatwar 1996; Shahzad & Ahmed 2013), cesarean wound healing (Molazem et al. 2014), diaper dermatitis (rash) in children (Panahi et  al., 2012), erythema (skin inflammation) (Reuter et al., 2008), genital herpes (Syed et al., 1996b; Syed et al., 1997), nipple soreness in breastfeeding women (Alamolhoda et  al., 2019), oral lichen planus (inflammation in the mouth) (Choonhakarn et  al., 2008; Salazar-Sanchez et  al., 2010; Mansourian et  al., 2011), peristomal skin conditions such as colostomy (Rippon et al., 2017), seborrheic (scalp) dermatitis (Vardy et al., 1999), traumatic mouth ulcers (Leiva-Cala et al., 2019), chronic ulcers (Avijgan et al., 2016), vulvar lichen planus (inflammation of the female external genitals) (Rajar et al., 2008), and wound healing of skin graft donor sites (Burusapat et al., 2018). A comprehensive review of clinical trials for the external use of Aloe vera gel for the treatment of adverse effects of cancer radiation identified 54 papers published between 1999 and 2017 (Farrugia et al., 2019). Seven studies met the inclusion criteria for review, and the authors identified conflicting evidence for efficacy. Aloe vera gel appears to be effective for the treatment of acute radiation proctitis (inflammation and damage to the lower parts of the colon), but efficacy was not consistently established for radiation effects in breast cancer patients. A systematic review assessing the effectiveness of Aloe vera gel externally for the treatment of psoriasis vulgaris, a condition of the skin that forms scales and itchy patches, identified nine clinical trials completed prior to 2015. Four studies met the inclusion criteria, but the authors noted that the results were contradictory, and methodological gaps prevented them from reaching a final conclusion (Miroddi et al., 2015). Clinical studies demonstrating efficacy for internal use of Aloe vera gel preparations include angina pectoris (chest pain caused by reduced blood flow to the heart) (Agarwal, 1985), gastroesophageal reflux, a digestive disease (Panahi et al., 2015), HIV infection (Olatunya et  al., 2012), irritable bowel syndrome (IBS) (Størsrud et al., 2015; Hong et al. 2018), metabolic syndrome (Shakib et al. 2019), prediabetes and diabetes (Alinejad-Mofrad et al., 2015; Dick et al., 2016), and ulcerative colitis (chronic inflammation in the digestive tract) (Langmead et al., 2004). In the angina study, fresh Aloe vera gel, together with psyllium seeds (obtained from plants of the genus Plantago), was introduced into the diet of 5000 angina pectoris patients in India. Patients were observed over 5 years, and their blood cholesterol, glucose, and triglyceride levels were evaluated. Aloe vera gel showed a significant impact on normalizing blood parameters and relief of angina pectoris symptoms, as well as

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diabetic symptoms. The authors reported that the continued daily use of Aloe vera gel led to the discontinuation of prescription medications in many patients. However, a drawback of the study was the absence of a control group and lack of chemical characterization of the Aloe vera gel (Agarwal, 1985; Grundmann, 2012). A 2016 systematic review and meta-analysis of randomized controlled trials on the internal use of Aloe vera in the treatment of prediabetes and early stage diabetes found that studies were inconclusive and recommended larger, better designed trials (Zhang et al., 2016). A 2016 meta-analysis on the effectiveness of oral Aloe vera consumption on the reduction of fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) in prediabetic and diabetic patients reported significant reductions in both FBG and HbA1c. The authors recommended further robust and better controlled clinical trials to confirm these findings (Dick et al., 2016). Nine studies met the inclusion criteria, all nine included testing for FBG (n = 283 participants), and five included HbA1c data (n = 89 participants). Three of the studies tested Aloe vera gel juice (Bunyapraphatsara et al., 1996; Yongchaiyudha et al., 1996; Arora et al., 2009), one a gel preparation (Yagi et al., 2009), four powdered gel (Huseini et al. 2012; Choi et al., 2013; Devaraj et al., 2013; Choudhary et al., 2014), and one dried latex resin (Ghannam et al., 1986).

Safety information In reviewing the safety of Aloe vera, it is important to differentiate between the following known preparations: 1. Aloe vera gel. The inner leaf pulp, if correctly prepared, contains only the clear, slimy gel, which consists predominantly of water and polysaccharides, but may contain traces of the bitter latex found in the margins of the leaf (IARC, 2013). 2. Dried Aloe vera latex. This is the solidified liquid originating from the margins (peel) of the leaf, source of bitter plant chemicals known as anthraquinones, which act as a powerful laxative (WHO, 1999; IARC, 2013). 3. Aloe vera whole leaf extract. This is the water extract of the whole leaf containing the gel and the bitter latex (IARC, 2013). There also exists Aloe vera decolorized whole leaf extract. Using an activated carbon filtration process, the whole leaf is filtered to remove the bitterness and color of the latex caused by the anthraquinones (IARC, 2013).

Side effects Given the extensive use of Aloe vera gel externally, there have been few case reports detailing the side effects in the literature (Kuhn and Winston, 2001; Boon and Smith, 2004; Reider et al., 2005). Documented cases include dermatitis (Ernst, 2000). In

Safety information

19

two of 225 patients, an allergic skin reaction developed after breast surgery and postoperative radiation therapy on application of an Aloe vera formulation (Heggie et  al., 2002). Another case of dermatitis was reported in a 47-year-old man after prolonged oral and topical use (4 years) of a crushed, jelly-­like preparation of pure Aloe vera, taking one teaspoon three times a day and application to the face and neck after shaving (Morrow et al., 1980). A 66-year-­old woman who had been treating stasis dermatitis (skin inflammation caused by fluid buildup) on her lower leg with Aloe vera gel reported a skin reaction in other skin areas. Patch testing showed a strong reaction to Aloe vera (Hogan, 1988). A 72-year-old patient presented with contact dermatitis on the legs and eyelids after the application of a home-made Aloe vera juice. Patch tests were positive to this plant (Ferreira et al., 2007). In addition, there were reports of a burning sensation of the skin in four patients after applying a preparation of Aloe vera gel in areas previously subjected to chemical or surgical beauty treatments (Hunter and Frumkin, 1991; Ernst, 2000). In what appears to be the first published case of urticaria (skin sensitization or hives), a 57-year-old woman reported an allergic reaction after applying peeled rind of Aloe vera to a facial wound. Subsequent skin prick tests with rind, latex, gel, and whole leaf and topical challenge with leaf (rind removed) strongly indicated an IgEmediated allergic response (Alvarez-Perea et al., 2010). Aloe vera latex most commonly leads to side effects with long-term use, which tends to result in tolerance (reduction of the laxative effect). Long-term use may lead to reversible color changes in the lining of the colon, which disappear after 4–12  months when discontinued. Urine may become orange or reddish purple resulting from the breakdown products from the Aloe vera latex, being removed by the kidneys. Other reported side effects include severe abdominal cramping, nephritis (kidney inflammation), gastritis (inflammation of the stomach lining), vomiting, bloody diarrhea with mucus, and watery diarrhea, leading to osmotic imbalances (Morton, 1981; Boon and Smith, 2004).

Toxicology The topical use of Aloe vera gel is Generally Recognized as Safe (GRAS) according to both the American Pharmaceutical Association (Peirce, 1999) and the Cosmetic Ingredient Review Expert Panel (CIREP, 2007). A number of cases reported in the literature describe the toxicity associated with the consumption of Aloe vera preparations. However, in most of these cases, it is not clear whether the preparations were made from Aloe vera gel or the whole leaf. In addition, the preparations do not appear to have been analyzed to identify levels of anthraquinones, if they are present, or to rule out contamination. Several cases of hepatitis (liver inflammation) are associated with the consumption of Aloe vera tablets, capsules, and gel (Rabe et al., 2005; Kanat et al., 2006; Bottenberg et al. 2007; Lee et al., 2014), and there exists one case report of acute liver injury (Parlati et al. 2017). There is also one case of alteration of thyroid function concerning a patient

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with a history of prolonged oral and topical use of Aloe vera juice. After discontinuation, the clinical state of the patient improved (Pigatto and Guzzi, 2005). Two further case reports detail patients with a history of ingesting the juice or extract of Aloe vera who were diagnosed with inflammation of blood vessels and alterations in kidney function (Evangelos et al., 2005; Kim et al., 2007). The prolonged oral use of Aloe vera latex, and similar laxative products, has been linked to abnormalities in the tissue of the colon (large intestine) and increased risk of intestinal cancer (Siegers et  al. 1993; Willems et  al., 2003). The WHO’s working committee on carcinogenicity, the International Agency for Research on Cancer (IARC), states that there is currently inadequate evidence in humans regarding the carcinogenicity of Aloe vera. However, there is sufficient evidence in experimental animals for the carcinogenicity of whole leaf extract. In their overall evaluation, the IARC states that the whole leaf extract of Aloe vera is possibly carcinogenic to humans (IARC, 2013). In recent years, concerns have increased about the potential toxicity of orally consumed and topically applied Aloe vera preparations, due to high concentrations of anthraquinones (typically, aloin A and B). Based on research findings, the International Aloe Science Council, the non-profit trade organization for the Aloe vera industry, established limitations on the concentrations of anthraquinones in Aloe vera preparations for oral consumption. Certification requires Aloe vera preparations intended for oral consumption to contain 10 ppm (parts per million) or less of total aloin (AHP, 2012). Similar safety concerns led the Cosmetic Ingredient Review Expert Panel previously to establish a limit of no more than 50 ppm of aloin in topical preparations (CIREP, 2007).

Contraindications Aloe vera whole leaf extract and dried Aloe vera latex, as with other stimulant laxatives, should not be used in patients with intestinal narrowing or obstruction, atony (loss of tone in the intestinal muscle), severe dehydration with electrolyte depletion, or chronic constipation (symptoms that are persistent for 3  months or more), inflammatory intestinal diseases, such as appendicitis, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, or diverticulitis. It is also contraindicated during menstruation, and in patients with cramps, colic, hemorrhoids, nephritis (inflammation of the kidneys), or any undiagnosed abdominal symptoms, such as pain, nausea, or vomiting (WHO 1999; Boon and Smith, 2004).

Use in pregnancy and breastfeeding Oral use of Aloe vera preparations are not recommended during pregnancy and lactation. Aloe vera gel may contain trace amounts of anthraquinones, and their high concentration in Aloe vera latex and Aloe vera whole leaf extract can cause uterine

Recommendations

21

contractions and increase the risk of spontaneous abortion. Because it is not known if the anthraquinones are present in breast milk, it is better to avoid oral use of Aloe vera preparations during breastfeeding, so as not to induce diarrhea and spasms in the infant (Brinker 1998; Boon and Smith, 2004).

Drug interactions There appear to be a number of positive interactions in which Aloe vera gel is found to enhance the effects of other drugs or nutrients in a positive manner. For example, it has been reported that, used topically, the gel enhances the effects of hydrocortisone cream in the reduction of swelling (Brinker, 1998). And, when taken internally, it is reported to significantly increase the absorption of vitamins C and E (Vinson et al., 2005). It is generally recommended that the internal use of Aloe vera preparations, including the gel, whole leaf, decolorized whole leaf, and latex, is not taken in combination with antidiabetics, diuretics, laxatives, sevoflurane (anesthetic), and cardiac glycosides (heart medication) such as digoxin (Brinker, 1998; Grundmann, 2012; Delgoda and Picking, 2015). It is also recommended that oral consumption of any Aloe vera preparations, in combination with prescription or over-the-counter (OTC) drugs, is only undertaken with the advice and guidance of a qualified physician or pharmacist. In the case of antidiabetic drugs, the combined use with Aloe vera can lower blood sugar levels too far and may also cause problems in those patients who experience abnormally low blood sugar levels (hypoglycemia). Possible interactions exist between Aloe vera preparations and heart medications (cardiac glycosides), corticosteroids (hormones from the group of steroids and their derivatives which have immunosuppressive and strong anti-inflammatory properties), and sevoflurane (an anesthetic used in surgery). In the case of combined use with cardiac glycosides, risks are heart arrhythmias and hypertension (high blood pressure); in the case of sevoflurane, abnormal blood loss during surgery was observed (Lee et al., 2004; Boudreau and Beland, 2006; Delgoda and Picking, 2015).

Recommendations Natural Medicines (formerly Natural Standard and Natural Medicines Comprehensive Database) (2007) warns that patients should not apply Aloe vera to open wounds, surgical wounds, or bed sores. It is also advised to avoid taking Aloe vera by mouth when experiencing intestinal obstruction, (bloody) diarrhea, intestinal disease, hepatitis, irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease, or kidney disease. Aloe vera should not be ingested during pregnancy or breastfeeding, and patients requiring surgery should stop taking Aloe vera at least 2 weeks prior to the procedure.

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Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Agarwal OP (1985) Prevention of atheromatous heart disease. Angiology 36: 485-492. AHP (American Herbal Pharmacopoeia) (2012) Aloe vera leaf, Aloe vera leaf juice, Aloe vera inner leaf juice. Scotts Valley, CA: American Herbal Pharmacopoeia. Akhtar MA, Hatwar SK (1996) Efficacy of Aloe vera extract cream in management of burn wound. Journal of Clinical Epidemiology 49: S24. Alamolhoda HS, Mirabi P, Mojab F, (2019) Effects of both Aloe vera gel and breast milk on the improvement of nipple soreness in lactating women: A randomized controlled trial. Journal of Herbal Medicine. doi: https://doi.org/10.1016/j.hermed.2019.100327. Alinejad-Mofrad S, Foadoddini M, Saadatjoo SA, Shayesteh M (2015) Improvement of glucose and lipid profile status with Aloe vera in pre-diabetic subjects: A randomized controlled-trial. Journal of Diabetes and Metabolic Disorders 9: 14:22. Alvarez-Perea A, García AP, Hernández AL, de Barrio M, Baeza ML (2010) Urticaria due to Aloe vera: a new sensitizer? The Annals of Allergy, Asthma, & Immunology 105: 404-5. Arora D, Goyal M, Agarwal RP (2009) Efficacy of Aloe vera juice consumption on glycemic response in Type-2 diabetic patients. International Journal of Food Science and Technology 46: 160–162. Avijgan M, Kamran A, Abedini A (2016) Effectiveness of Aloe vera gel in chronic ulcers in comparison with conventional treatments. Iranian Journal of Medical Sciences 41: S30. Boon H, Smith M (2004) The complete natural medicine guide to the 50 most common medicinal herbs. Toronto: Robert Rose Inc. Boudreau MD, Beland FA (2006) An evaluation of the biological and toxicological properties of Aloe barbadensis (Miller), Aloe vera. Journal of Environmental Science and Health Part C 24: 103–154. Bottenberg MM, Wall GC, Harvey RL, Habib S (2007) Oral Aloe vera-induced hepatitis. Annals of Pharmacotherapy 41: 1740-1743. Brinker F (1998) Herb contraindications and drug interactions. 2nd edition. Sandy OR (Ed.), Eclectic Medical, pp. 28-30. Bunyapraphatsara N, Yongchaiyudha S, Rungpitarangsi V, Chokechaijaroenporn O (1996) Antidiabetic activity of Aloe vera L. juice II. Clinical trial in diabetes mellitus patients in combination with glibenclamide. Phytomedicine 3: 245-8. Burusapat C, Supawan M, Pruksapong C, Pitiseree A, Suwantemee C (2018) Topical Aloe vera gel for accelerated wound healing of split-thickness skin graft donor sites: A double-blind, randomized, controlled trial and systematic review. Plastic and Reconstructive Surgery 142: 217-226. CABI (2020) Aloe vera (true aloe) [original text by Rojas-Sandoval J]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www. cabi.org/isc/datasheet/4192. Choi HC, Kim SJ, Son KY, Oh BJ, Cho BL (2013) Metabolic effects of Aloe vera gel complex in obese prediabetes and early non-treated diabetic patients: Randomized controlled trial. Nutrition 29: 1110-4. Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P (2008) The efficacy of Aloe vera gel in the treatment of oral lichen planus: A randomized controlled trial. British Journal of Dermatology 158: 573-577. Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P (2010) A prospective, randomized clinical trial comparing topical Aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. Journal of the European Academy of Dermatology and Venereology 24: 168-172. Chopra RN (1956) Glossary of Indian medicinal plants, Part 1. New Delhi: Council of Scientific & Industrial Research.

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Choudhary M, Kochhar A, Sangha J (2014) Hypoglycemic and hypolipidemic effect of Aloe vera L. in non-insulin dependent diabetics. Journal of Food Science and Technology 51: 90-6. CIREP (Cosmetic Ingredient Review Expert Panel) (2007) Final report on the safety assessment of Aloe andongensis extract, Aloe andongensis leaf juice, Aloe arborescens leaf extract, Aloe arborescens leaf juice, Aloe arborescens leaf protoplasts, Aloe barbadensis flower extract, Aloe barbadensis leaf. International Journal of Toxicology 26: 1-50. Delgoda R, Picking D (2015) Potential drug interactions for commonly used medicinal plants & foods in Jamaica. Kingston: University of the West Indies, Natural Products Institute. Devaraj S, Yimam M, Brownell LA, Jialal I, Singh S, Jia Q (2013) Effects of Aloe vera supplementation in subjects with prediabetes/metabolic syndrome. Metabolic Syndrome and Related Disorders 11: 35-40. Dick WR, Fletcher EA, Shah SA (2016) Reduction of fasting blood glucose and hemoglobin A1c using oral Aloe vera: A meta-analysis. Journal of Alternative and Complementary Medicine 22: 450-7. Ernst E (2000) Adverse effects of herbal drugs in dermatology. British Journal of Dermatology 143: 923–929. Evangelos C, Spyros K, Spyros D (2005) Henoch Schonlein purpura associated with Aloe vera administration. European Journal of Internal Medicine 16: 59–60. Farrugia CE, Burke ES, Haley ME, Bedi KT, Gandhi MA (2019) The use of Aloe vera in cancer radiation: An updated comprehensive review. Complementary Therapies in Clinical Practice 35: 126-130. Ferreira M, Teixeira M, Silva E, Selores M (2007) Allergic contact dermatitis to Aloe vera. Contact Dermatitis 57: 278-9. Ghannam N, Kingston M, Al-Meshaal IA, Tariq M, Parman NS, Woodhouse N (1986) The antidiabetic activity of aloes: Preliminary clinical and experimental observations. Hormone Research 24: 288-94. Grindlay D, Reynolds T (1985) The Aloe vera phenomenon: A review of the properties and modern uses of the leaf parenchyma gel. Journal of Ethnopharmacology 16: 117-151. Grundmann O (2012) Aloe vera research review: An overview of its clinical uses and proposed mechanisms of action. Natural Medicine Journal 4 (9). Accessed 27 December 2019 at https:// www.naturalmedicinejournal.com/journal/2012-09/aloe-vera-gel-research-review Gunther RT (1934) The Greek herbal of Dioscorides. Oxford: Oxford University Press. Heggie S, Bryant GP, Tripcony L, Keller J, Rose P, Glendenning M, Heath J (2002) A Phase III study on the efficacy of topical Aloe vera gel on irradiated breast tissue. Cancer Nursing 5: 442–451.2: Hogan DJ (1988) Widespread dermatitis after topical treatment of chronic leg ulcers and stasis dermatitis. Canadian Medical Association Journal 138: 336-8. Hong SW, Chun J, Park S, Lee HJ, Im JP, Kim JS (2018) Aloe vera is effective and safe in shortterm treatment of Irritable Bowel Syndrome: A systematic review and meta-analysis. Journal of Neurogastroenterology and Motility 24: 528-535. Hunter D, Frumkin A (1991) Adverse reactions to vitamin E and Aloe vera preparations after dermabrasion and chemical peel. Cutis 47: 193-196. Huseini HF, Kianbakht S, Hajiaghaee R, Dabaghian FH (2012) Anti-hyperglycemic and anti-­ hypercholesterolemic effects of Aloe vera leaf gel in hyperlipidemic type 2 diabetic patients: a randomized double-blind placebo-controlled clinical trial. Planta Medica 78: 311-6. IARC (International Agency for Research on Cancer) (2013) Aloe vera. IARC monographs on the evaluation of carcinogenic risks to humans 108: 1-422. Kanat O, Ozet A, Ataergin S (2006) Aloe vera induced acute toxic hepatitis in a healthy young man. European Journal of Internal Medicine 17: 589. Kim EJ, Kim HJ, Kim SG, Lee YS, Oh JE, Seo JW, Koo JR, Noh JW (2007) Aloe-induced Henoch-­ Schonlein purpura. Nephrology 12: 109. Kuhn K, Winston D (2001) Herbal therapy & supplements: A scientific and traditional approach. Philadelphia: Lippincott.

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Langmead L, Feakins RM, Goldthorpe S, Holt H, Tsironi E, De Silva A, Jewell DP, Rampton DS (2004) Randomized, double blind, placebo controlled trial of oral Aloe vera gel for active ulcerative colitis. Alimentary Pharmacology and Therapeutics 19: 739-747. Lee A, Chui PT, Aun CST, Lau ASC (2004) Possible interaction between sevoflurane and Aloe vera. Annals of Pharmacotherapy 38:1651- 1654. Lee J, Lee MS, Nam KW (2014) Acute toxic hepatitis caused by an Aloe vera preparation in a young patient: A case report with a literature review. Korean Journal of Gastroenterology 64: 54-8. Leiva-Cala C, Lorenzo-Pouso AI, Centenera-Centenera B, López-Palafox J, Gándara-Vila P, García-García A, Pérez-Sayáns M (2019) Clinical efficacy of an Aloe vera gel versus a 0.12% chlorhexidine gel in preventing traumatic ulcers in patients with fixed orthodontic appliances: a double-blind randomized clinical trial. Odontology. 2019 [Epub ahead of print] PubMed PMID: 31664632. Mansourian A, Momen-Heravi F, Saheb-Jamee M, Esfehani M, Khalilzadeh O, Momen-Beitollahi J (2011) Comparison of Aloe vera mouthwash with triamcinolone acetonide 0.1% on oral lichen planus: A randomized double-blinded clinical trial. The American Journal of the Medical Sciences 342: 447-51. Miroddi M, Navarra M, Calapai F, Mancari F, Giofrè SV, Gangemi S, Calapai G (2015) Review of clinical pharmacology of Aloe vera L. in the treatment of psoriasis. Phytotherapy Research 29: 648-55. Molazem Z, Mohseni F, Younesi M, Keshavarzi S (2014) Aloe vera gel and cesarean wound healing: A randomized controlled clinical trial. Global Journal of Health Science 7: 203-9. Morrow DM, Rapaport MJ, Strick RA (1980) Hypersensitivity to aloe. Archives of Dermatology 116: 1064-1065. Morton J (1981) Atlas of medicinal plants of middle America: Bahamas to Yucatan. Springfield: Charles Thomas. Natural Medicines (2007) Formerly Natural Standard and Natural Medicines Comprehensive Database. Aloe vera. Accessed 27 December 2007 at https://naturalmedicines.therapeuticresearch.com/. Olatunya OS, Olatunya AM, Anyabolu HC, Adejuyigbe EA, Oyelami OA (2012) Preliminary trial of Aloe vera gruel on HIV infection. Journal of Alternative and Complementary Medicine 18: 850-3. Panahi Y, Sharif MR, Sharif A, Beiraghdar B, Zahiri Z, Amirchoopani G, Marzony ET and Sahebkar A (2012) A randomized comparative trial on the therapeutic efficacy of topical Aloe vera and Calendula officinalis on diaper dermatitis in children. Scientific World Journal 2012: 810234. Panahi Y, Khedmat H, Valizadegan G, Mohtashami R, Sahebkar A (2015) Efficacy and safety of Aloe vera syrup for the treatment of gastroesophageal reflux disease: A pilot randomized positive-controlled trial. Journal of Traditional Chinese Medicine 35: 632-6. Parlati L, Voican CS, Perlemuter K, Perlemuter G (2017) Aloe vera-induced acute liver injury: A case report and literature review. Clinics and Research in Hepatology and Gastroenterology 41: e39-e42. Peirce A (1999) The American Pharmaceutical Association practical guide to natural medicines. New York: William Morrow. Pigatto PD, Guzzi G. (2005) Aloe linked to thyroid dysfunction. Archives of Medical Research 36: 608. Poor MR, Hall JE, Poor AS (2002) Reduction in the incidence of alveolar osteitis in patients treated with the SaliCept patch, containing Acemannan hydrogel. Journal of Oral and Maxillofacial Surgery 60: 374-379. Rabe C, Musch A, Schirmacher P, Kruis W, Hoffmann R (2005) Acute hepatitis induced by an Aloe vera preparation: A case report. World Journal of Gastroenterology 11: 303-304.

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Rajar UD, Majeed R, Parveen N, Sheikh I, Sushel C (2008) Efficacy of Aloe vera gel in the treatment of vulval lichen planus. Journal of the College of Physicians and Surgeons Pakistan 18: 612-614. Rahmani N, Khademloo M, Vosoughi K, Assadpour S (2014) Effects of Aloe vera cream on chronic anal fissure pain, wound healing and hemorrhaging upon defection: A prospective double blind clinical trial. European Review for Medical and Pharmacological Sciences 18: 1078-1084. Reider N, Issa A, Hawranek T, Schuster C, Aberer W, Kofler H, Fritsch P, Hausen BM (2005) Absence of contact sensitization to Aloe vera (L.) Burm. f. Contact Dermatitis 53: 332-4. Reuter J, Jocher A, Stump J, Grossjohann B, Franke G, Schempp CM (2008) Investigation of the anti-inflammatory potential of Aloe vera gel (97.5%) in the ultraviolet erythema test. Skin Pharmacology and Physiology 21: 106-110. Reynolds T, Dweck AC (1999) Aloe vera leaf gel: A review update. Journal of Ethnopharmacology 68: 3-37. Rippon M, Perrin A, Darwood R, Ousey K (2017) The potential benefits of using Aloe vera in stoma patient skin care. British Journal of Nursing 26:S12-S19. Salazar-Sánchez N, López-Jornet P, Camacho-Alonso F, Sánchez-Siles M (2010) Efficacy of topical Aloe vera in patients with oral lichen planus: A randomized double-blind study. Journal of Oral Pathology and Medicine 39:735-40. Shahzad MN, Ahmed N (2013) Effectiveness of Aloe vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns. Journal of Pakistan Medical Association 63: 225-30. Shakib Z, Shahraki N, Razavi BM, Hosseinzadeh H (2019) Aloe vera as an herbal medicine in the treatment of metabolic syndrome: A review. Phytotherapy Research 33: 2649-2660. Shelton RM (1991) Aloe vera. Its chemical and therapeutic properties. International Journal of Dermatology 30: 679-683. Siegers CP, von Hertzberg-Lottin E, Otte M, Schneider B (1993) Anthranoid laxative abuse—A risk for colorectal cancer? Gut 34: 1099–1101. Størsrud S, Pontén I, Simrén M (2015) A pilot study of the effect of Aloe barbadensis Mill. extract (AVH200®) in patients with irritable bowel syndrome: A randomized, double-blind, placebo-­ controlled study. Journal of Gastrointestinal and Liver Diseases 24: 275-80. Syed TA, Ahmad SA, Holt AH, Ahmad SH, Afzal M (1996a) Management of psoriasis with Aloe vera extract in a hydrophilic cream: A placebo-controlled, double blind study. Tropical Medicine and International Health 1: 505-509. Syed TA, Cheeman KM, Ahmad SA, Holt AH (1996b) Aloe vera extract 0.5% in hydrophilic cream versus Aloe vera gel for the management of genital herpes in males. A placebo controlled, double blind, comparative study. Journal of the European Academy of Dermatology and Venereology 7: 294-295. Syed T, Afzal M, Ahmad SA, Holt A, Ahmad SA, Ahmad S (1997) Management of genital herpes in men with 0.5% Aloe vera extract in a hydrophilic cream: a placebo controlled double blind study. Journal of Dermatological Treatment 8: 99-102. Thamlikitkul V, Bunyapraphatsara N, Riewpaiboon W, Theerapong S, Chantrakul C, Thanaveerasuwan T (1991) Clinical trial of Aloe vera Linn. for treatment of minor burns. Siriraj Hospital Gazette 43: 313-316. TRAMIL (2015) Caribbean pharmacopeia. Aloe vera. Accessed 27 December 2019 at http://www. tramil.net/en/plant/aloe-vera. Vardy AD, Cohen AD, Tchetov T (1999) A double blind, placebo controlled trial of Aloe vera (A. barbadensis) emulsion in the treatment of seborrheic dermatitis. Journal of Dermatological Treatment 10: 7-11. Vinson J.A, Al Kharrat H, Andreoli L (2005) Effect of Aloe vera preparations on the human bioavailability of vitamins C and E. Phytomedicine 12: 760-65. Visuthikosol V, Chowchuen B, Sukwanarat Y, Sriurairatana S, Boonpucknavig V (1995) Effect of Aloe vera gel to healing of burn wound a clinical and histologic study. Journal of the Medical Association of Thailand 78: 403-409.

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WHO (World Health Organization) (1999) WHO monographs on selected medicinal plants volume 1. http://whqlibdoc.who.int/publications/1999/9241545178.pdf. Willems M, van Buuren HR, de Krijger R (2003) Anthranoid self-medication causing rapid development of melanosis coli. Netherlands Journal of Medicine 61: 22–24. Yagi A, Hegazy S, Kabbash A, Wahab EA (2009) Possible hypoglycemic effect of Aloe vera L. high molecular weight fractions on type 2 diabetic patients. Saudi Pharmaceutical Journal 17: 209-15. Yongchaiyudha S, Rungpitarangsi V, Bunyapraphatsara N, Chokechaijaroenporn O (1996) Antidiabetic activity of Aloe vera L. juice. I. Clinical trial in new cases of diabetes mellitus. Phytomedicine 3: 241-3. Zhang Y, Liu W, Liu D, Zhao T, Tian H (2016) Efficacy of Aloe vera supplementation on prediabetes and early non-treated diabetic patients: A systematic review and meta-analysis of randomized controlled trials. Nutrients 23: 388

Chapter 3

Annona muricata L. (Annonaceae)

Common name in Jamaica: Soursop Other common name in Jamaica: Sour sop (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_3

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Botanical characteristics and propagation Slender, evergreen, cold-intolerant tree reaching a height of 5–8 m that bears fruit after 3–5 years of planting. The leaves are distichous (arranged in the same plane), obovate to elliptic in shape, acuminate, glossy, leathery, and aromatic. The flower stalk is thick and curved, and the outer flower petals have a greenish-yellow color. The heart-shaped fruits have green skins with many soft-curved spines and a white, creamy pulp that has an acid-sweet to musky flavor, and black or brown seeds (Adams, 1972). The species originates in tropical America, although its exact origin remains unknown. Different authors consider the species either native or exotic to the Caribbean and West Indies (CABI, 2020). For example, according to Lim (2012), the species probably originated in the Antilles in the Caribbean, Central America, and in northern South America. It is important to note that already in the sixteenth century the Spanish historian Oviedo wrote that Annona muricata was abundant in the West Indies and in northern South America and that it is considered one of the fruit tree species of the Taino Amerindians who inhabited the Caribbean (Vega, 1996). Jamaican farmers reproduce soursop using the seeds. They fork up a small area of land and throw the seeds on there without covering them (this is called “setting the seeds”). When the plantlets grow to a certain size, they are transplanted to a desired location.

Where to find the plant On farm land and in people’s yards.

Part used The leaf and also the fruit; occasionally the bark or branch.

Jamaican cultural uses and beliefs Much appreciated for its fruit. The leaf is also boiled and drunk as a regular morning tea.

Jamaican medicinal uses Soursop leaf tea is a popular remedy to treat nerves.

Reported medicinal uses across the Caribbean

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Major uses (mentioned by more than 20% of people) • Nerves: In Kingston, people eat the fruit as a remedy for nerves. Alternatively, they wilt (“quail”) the leaf, or boil and drink a tea made with the green leaf. In Windsor Forest, people boil the branch, leaf, bark, fruit, or fruit skin and drink the tea.

Reported medicinal uses across the Caribbean In the Caribbean, it is believed that putting soursop leaves on the bed underneath a sleeping person with fever will break the fever by the next morning (Lim, 2012). Across the French-speaking West Indies, a tea of Annona muricata (plant part not specified) is used for its sedative and hypnotic effects, thus as a tranquilizer and sleep-inducer (Caparros-Lefebvre and Elbaz, 1999). Across individual countries: • Belize: The leaves are used in a ritual to treat high fever, and then crushed with salt and water, applied to the head, and changed every 20 min until the patient feels better. For cough, nine leaves of soursop are boiled together with nine leaves of cotton (Gossypium hirsutum L.) and nine leaves of avocado (Persea americana Mill.), sugar is added to the preparation, and one tablespoon is consumed every 30 min until the cough subsides (Balick and Arvigo, 2015). • Guadeloupe: A bath of the leaves is given for skin ailments (Boulogne et  al., 2011). • Jamaica: A survey in 2009 identified Annona muricata as the fifth most widely reported medicinal plant. Among people who reported using medicinal plants to treat nerves, 83% confirmed using Annona muricata (Picking et  al., 2015). Annona muricata is reported as a commonly used medicinal plant in the treatment of prostate and breast cancer in patients receiving orthodox cancer treatment (Foster et al. 2017). • Martinique: The crushed leaves are administered as a bath for skin rash and as a sedative (tranquilizer); the leaves are boiled and drunk as a sedative and for chest pain; and the bud is boiled and drunk for bronchitis (Longuefosse and Nossin, 1996). • Trinidad and Tobago: The leaves are used for high blood pressure (Lans, 2006). Extracts of Annona muricata prepared from the leaves, bark, fruit, and seeds were the most popular complementary therapy reported by patients receiving orthodox treatment for prostate, breast, and colorectal cancers at specialty care facilities in Trinidad (Clement et al., 2016).

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Reported medicinal uses across the world A comprehensive review summarized the use of Annona muricata in over 34 countries, covering the Americas, Africa, the Caribbean, South Asia, and the Pacific. Traditional medicines are prepared from many parts of the tree, with the most widely reported preparations being decoctions of the leaf, bark, root, or seed, used in the treatment of over 50 reported health conditions (Coria-Téllez et al., 2016). Across individual countries: • Bolivia: The fruit juice is drunk for kidney problems, and a decoction of the young leaf is given to treat high blood pressure (Hajdu and Hohmann, 2012). • Brazil: A decoction or infusion of the leaves is taken to lose weight. Annona muricata is also used in Brazil for the treatment of infections, snake bites, cancer, shortness of breath, high blood pressure, diabetes, fever, inflammation, low back pain, and dizziness (Cercato et al., 2015). Another study reported the use of the leaves for kidney problems (Albuquerque et al., 2007). • Cameroon: The leaves are used to manage diabetes and its complications (preparation methods not specified) (Ngueguim Tsofack et  al., 2014). A handful of leaves is boiled in 3 L of water for 20 min, and one cup is taken once a day for 7 days to treat malaria, aches, and back pain (Tsabang et al., 2012). • Indonesia: The leaves are pounded and applied to treat dermatitis (inflammation of the skin) (Roosita et al., 2008). • Madagascar: A tea of the leaves is drunk to treat heart palpitations, malaria, and liver problems (Novy, 1997). • Mauritius: An infusion of the leaves is drunk twice a week (one cup) to treat high blood pressure. The leaves of king-of-the-forest (Senna alata (L.) Roxb.) are sometimes added to this preparation (Mootoosamy and Mahomoodally, 2014). • Nicaragua: A decoction of the bark, seed, and leaf is used for women’s health and drunk to relieve bellyache (including postpartum pain) and back pain, induce abortion, stop excessive menstrual bleeding, reduce fever, alleviate digestive problems such as flatulence, heartburn, and constipation, and treat vaginal infections (Coe, 2008). • Nigeria: The leaves, seeds, bark, and root are taken as an infusion or decoction, and the fruit juice is drunk to treat diabetes (Ezuruike and Prieto, 2014). • Palestine: Women with breast cancer eat the fruit raw as a herbal remedy (Jaradat et al., 2016). • Peru: An infusion of the leaves is considered useful as a diuretic (promotes urination) (Sanz-Biset et al., 2009). Other authors found that an infusion of the leaves is drunk for cancer treatment and prevention, or for problems of the kidneys, prostate, and urinary tract (Monigatti et al., 2013). • Togo: A decoction of the leaves of Annona muricata, either alone or together with the leaves of guava (Psidium guajava L.), vervine (Stachytarpheta indica (L.) Vahl), moringa (Moringa oleifera Lam.), and Bauhinia thonningii Schum., is drunk for diabetes (Karou et al., 2011). A leaf decoction is also consumed in Togo to treat Alzheimer’s disease, epilepsy, dementia, and traumatic brain injury

Clinical efficacy studies in humans

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(Kantati et al., 2016). Juice from a maceration of the leaves is ingested to treat malaria and anemia (Koudouvo et al., 2011). • Vanuatu: An infusion of the leaves is applied as a bath against scabies (Bradacs et al., 2011).

Clinical efficacy studies in humans To date, 50 studies have been undertaken on various plant extracts and chemical constituents derived from Annona muricata. However, only 2% of these have been clinical studies in humans, whereas 66% were carried out in vitro (in test tubes) and 32% in vivo (in animals) (Coria-Téllez et al. 2016). In Nigeria, sterilized soursop fruit juice was administered to 25 children, aged 6–20 months, and five adults with acute watery diarrhea. Five milliliter of the juice was administered three times a day, for up to 72 h. The juice was able to stop diarrhea within 48 h (success rate not specified), suggesting the juice can be useful as a complementary oral rehydration therapy (Enweani et al., 1998). Brazilian researchers assessed the neurochemical profile of a hydroalcoholic extract from the leaves of Annona muricata with behavioral effects, in an attempt to elucidate the mechanism of action on the central nervous system, using female Swiss mice. HPLC analysis revealed the presence of flavonoids (quercetin, isoquercitrin, quercetrin, rutin, and kaempferol) and phenolic acids (gallic, chlorogenic, ellagic, and caffeic acids). The extract produced sedative, anxiolytic, and anticonvulsant-­ like effects similar to benzodiazepine drugs, associated with decreased neuronal excitability by modulating the activity of the GABAA receptor. The results indicate a possible interaction of the extract with the GABAergic and monoaminergic neuronal systems (Souza et al., 2018). In Peru, the antidiabetic (hypoglycemic) properties of an alcohol extract of Annona muricata leaves was clinically evaluated in a randomized, parallel-grouped, double-blind phase II clinical trial, in 60 patients aged 38–60 years with type 2 diabetes mellitus. The patients were randomly assigned to six groups. Neither the researchers nor the patients knew until the analysis of the results who was receiving which treatment. Three groups received capsules containing 180  mg of the plant leaf extract plus 5 mg glibenclamide (a pharmaceutical antidiabetic drug), and three groups received glibenclamide 5 mg tablets only, over a 30-day period. The results showed a significantly higher reduction in blood sugar levels for those receiving the Annona muricata leaf extract plus glibenclamide, as compared to those receiving glibenclamide alone. Clinical examinations revealed no adverse reactions in any of the participants. Five patients (8%) reported mild side effects, two cases with abdominal pain (epigastric pain), one of them associated with nausea, and three cases of nausea alone. The authors of the study concluded that treatment with Annona muricata alcoholic leaf extract plus glibenclamide over a 30-day period produced better blood sugar control in type 2 diabetic patients (Arroyo et al., 2009).

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Annona muricata has been promoted as an alternative treatment for a number of types of cancer (Lim, 2012; Coria-Téllez et al. 2016). Extracts of Annona muricata have demonstrated effects as an anti-cancer treatment or prevention and as an anti-­ tumorigenic (prevents the formation of tumors) in at least five animal studies into colorectal, breast, and pancreatic cancers (Dai et al., 2011; Hamizah, et al., 2012; Torres et  al., 2012; Okolie et  al., 2013; Zorofchian Moghadamtousi et  al., 2015; Coria-Téllez et al. 2016). In vitro tests have focused on the cytotoxicity (ability to kill or damage cancer cells) of different Annona muricata extracts, with at least 18 studies published to date (Coria-Téllez et al., 2016). A number of in vitro studies have shown the ability of Annona muricata extracts to kill some types of liver and breast cancer cells that are resistant to particular chemotherapy drugs (Cancer Research United Kingdom, n.d.). Many in vitro studies using cell lines are not conclusive, due to lack of data on bioavailability in the human body. However, an Indonesian research team used a novel research methodology to measure the impact of blood taken from patients who had ingested an Annona muricata leaf ethanol/water extract, standardized to 0.36% acetogenin (w/w), on a colorectal cancer cell line. Thirty outpatients with colorectal cancer who had undergone primary tumor removal by surgery were enrolled in this randomized double-blind placebo-controlled pre–post trial. They were divided equally into two groups, those who ingested the Annona muricata leaf extract and those who ingested a placebo daily for 8  weeks. The study showed higher cytotoxicity (death of cancer cells) in vitro, using the serum of the Annona muricata patient group compared with the placebo group (Indrawati et al., 2017). Few human studies have been published to date. However, a case study reported the successful stabilization, without side effects, of a 66-year-old female patient with metastatic breast cancer over a 5-year period. The patient’s disease had previously not responded to multiple lines of chemotherapy, including anthracyclines and taxanes. The successful treatment protocol included 8 oz of Annona muricata leaf decoction (10–12 dry leaves in water for 5–7 min), taken twice daily. This was taken in combination with the chemotherapy drug capecitabine (Xeloda) (2.5  g twice daily) (Hansra et al., 2014).

Safety information Side effects In addition to its health benefits, the consumption of Annona muricata as a fruit and in other forms such as a tea of the leaves (along with other members of the Annonaceae plant family) has been linked to the appearance of an atypical form of Parkinson’s disease in the Caribbean Island of Guadeloupe, first reported as a case study in 1999 (Caparros-Lefebvre and Elbaz, 1999; Caparros-Lefebvre et al., 2002). This association has also, subsequently, been reported in New Caledonia and in

Safety information

33

Caribbean patients living in London (Shaw and Höglinger, 2008). Research has identified two groups of potential toxins, alkaloids and acetogenins, which are present in Annona muricata (and other members of the Annonaceae plant family). Although not much is yet known about how Annona muricata affects the body, some researchers are concerned that the presence of alkaloids and acetogenins may cause nerve damage, movement disorders, and hallucinations when taken in large amounts. It is unlikely, however, that drinks or foods containing Annona muricata can cause harm when taken as part of a normal diet (Cancer Research UK, n.d.). The French National Health Security Agency (AFSSA), with responsibility for healthcare in Guadeloupe, issued a 2010 statement which concluded that on the basis of available experimental data, it is not possible to say that cases of atypical parkinsonian syndromes observed in Guadeloupe are linked to consumption of plant species belonging to the Annonaceae family (AFSSA, 2010; Coria-Téllez et al., 2016).

Toxicology In standard tests for toxicity (LD50 or the lethal dose at which half the group of test animals died), water extracts of the leaves, flowers, and pulp of Annona muricata demonstrated LD50 values greater than 5 g/kg body weight (Sousa and Vieira 2010), which is considered nontoxic by international standards set forth by the Organization for Economic Cooperation and Development (OECD) (Coria-Téllez et al. 2016). The freeze-dried extract of the fruit juice was administered to rats by mouth in doses of 0.08, 0.4, and 2 g/kg body weight for 60 days. No mortality was recorded up to the highest dose, and no significant toxic effects were observed (Awodele et al., 2014). A water extract of the leaves, administered by mouth to rats as a single dose of 2 or 5 g/kg body weight, did not produce behavioral modification, death, or visible lesions to organs. In addition, no signs of toxicity, death, or changes in body weight were recorded after daily administration of doses of the water extract at 0.2, 0.4, and 0.8 g/kg body weight for 4 weeks (Ngueguim Tsofack et al., 2014). Individual chemical compounds present in Annona muricata, such as acetogenins, and extracts derived from leaves, stems, twigs, and fruit pulp have demonstrated neurotoxicity (damage to brain cells) in both in vitro and in vivo studies (in test tubes and living animals). However, further research is required to determine the levels of exposure following normal digestion and metabolism in humans (Höllerhage et al. 2015; Coria-Téllez et al. 2016). A team of French, German, and Brazilian researchers testing a commercially available fruit juice of Annona muricata in transgenic and normal mice over a 12-month period, provided the first experimental evidence of early neuropathological changes with the development of a tauopathy (a type of neurodegenerative disease) in human wild-type and R406W-MAPT (a gene mutation considered pathogenic for frontotemporal dementia) transgenic mice (Rottscholl et al., 2016).

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A human study of an ethanol–water extract of Annona muricata leaves in colorectal cancer patients demonstrated safety of use (Indrawati et  al., 2016). Twenty eight persons completed the 8 week study and all biochemical parameters for blood, bone marrow, and organ function were reported within normal range, before and after supplementation, with no marked difference between the test and placebo groups. A 2020 systematic review on the safety and tolerability of Annona muricata leaf extract noted that dosages and durations used in a number of animal studies are unlikely to directly translate to effects in humans. The authors suggested that the current body of evidence points to a favorable safety and tolerability profile and concluded that clinical studies investigating the plant’s use in people diagnosed with a range of cancers are warranted (Chan et al. 2020).

Contraindications No information is available.

Use in pregnancy and breastfeeding No information is available.

Drug interactions Traditionally prepared water extracts of the dried leaves of Annona muricata were tested in the laboratory for their effect on a number of key human enzymes that are responsible for processing many pharmaceutical drugs in the body (cytochrome P450, CYPs 1A2, 2C19, 2D6, 3A4). The results showed a moderate to weak impact, indicating that clinically significant interactions with drugs metabolized by the same enzymes are unlikely (Shields, 2006; Delgoda and Picking, 2015). In the case of antidiabetic drugs, the combined use with Annona muricata has been shown to lower blood sugar levels in a human clinical study (Arroyo et al., 2009) and to lower blood sugar levels in a number of animal studies. A water extract of the leaves administered by mouth to diabetic rats in doses of 0.1 and 0.2 g/kg body weight for 1 day, or for 4 weeks, decreased the levels of blood sugar (Ngueguim Tsofack et al., 2014). An alcohol extract of the bark at doses of 0.15 and 0.3 g/kg body weight given by mouth to diabetic rats for 14 days also lowered blood sugar levels (Cercato et al., 2015). It is therefore advised that the ingestion of any Annona muricata preparation together with antidiabetic drugs only be undertaken under the guidance of a qualified physician or pharmacist.

Selected bibliography

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Recommendations The traditional use of soursop extracts for treatment of “nerves” has been extensively reported, yet there appear to be few, if any, laboratory studies (in test tubes or with animals), or human clinical studies, exploring this particular use of the plant. In addition, the underlying mechanism of action for the reported anxiolytic (calming) properties has yet to be confirmed. Clearly, further research is warranted. The consumption of soursop as part of a normal diet is reported to be safe. However, the use of excessive amounts of soursop fruit, or soursop plant extracts, over a long period of time should be avoided until further research has been able to clarify the safe levels of human exposure to specific chemical compounds found in the plant which have been linked to possible cases of neurotoxicity (damage to brain cells).

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Albuquerque UP, Muniz de Medeiros P, de Almeida ALS, Monteiro JM, Lins Neto EMF, Gomes de Melo J, dos Santos JP (2007) Medicinal plants of the Caatinga (semi-arid) vegetation of NE Brazil: A quantitative approach. Journal of Ethnopharmacology 114: 325-354. AFSSA (Agence Française de Sécurité Sanitaire des Aliments) (2010) Avis de l’Agence française de sécurité sanitaire des aliments relatif aux risques liés à la consommation de corossol (Annona muricata L.) et de ses préparations. Accessed 27 December 2019 at https://www. anses.fr/fr/system/files/NUT2008sa0171.pdf. Arroyo J, Martınez J, Ronceros G, Palomino R, Villarreal A, Bonilla P, Palomino C (2009) Efecto hipoglicemiante coadyuvante del extracto etanólico de hojas de Annona muricata L. (guanábana), en pacientes con diabetes tipo 2 bajo tratamiento de glibenclamida. Anales de la Facultad de Medicina 70: 163-167. Awodele O, Ishola IO, Ikumawoyi VO, Akindele AJ, Akintonwa A (2014) Toxicological evaluation of the lyophilized fruit juice extract of Annona muricata Linn. (Annonaceae) in rodents. Journal of Basic and Clinical Physiology and Pharmacology 25: 411-421. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. Boulogne I, Germosén-Robineau L, Ozier-Lafontaine H, Fleury M, Loranger-Merciris G (2011) TRAMIL ethnopharmalogical survey in Les Saintes (Guadeloupe, French West Indies): A comparative study. Journal of Ethnopharmacology 133: 1039–1050. Bradacs G, Heilmann J, Weckerle CS (2011) Medicinal plant use in Vanuatu: A comparative ethnobotanical study of three islands. Journal of Ethnopharmacology 137: 434–448. CABI (2020) Annona muricata (soursop) [original text by Datiles MJ, Acevedo-RodrÍguez P] In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 15 July 2020 at https://www.cabi.org/isc/datasheet/5812. Cancer Research UK (n.d.) Can graviola (soursop) cure cancer? Accessed 27 December 2019 at https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/ complementary-alternative-therapies/individual-therapies/graviola. Caparros-Lefebvre D, Elbaz A (1999) Possible relation of atypical parkinsonism in the French West Indies with consumption of tropical plants: A case-control study. Lancet 354: 281–286.

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Caparros-Lefebvre D, Sergeant N, Lees A, Camuzat A, Daniel S, Lannuzel A, Duyckaerts C, (2002) Guadeloupean parkinsonism: a cluster of progressive supranuclear palsy-like tauopathy. Brain 125: 801–811. Cercato LM, White PAS, Nampo FK, Santos MRV, Camargo EA (2015) A systematic review of medicinal plants used for weight loss in Brazil: Is there potential for obesity treatment? Journal of Ethnopharmacology 176: 286-296. Clement YN, Mahase V, Jagroop A, Kissoon K, Maharaj A, Mathura P, Quan CM, Ramadhin D, Mohammed C (2016) Herbal remedies and functional foods used by cancer patients attending specialty oncology clinics in Trinidad. BMC Complementary and Alternative Medicine 16: 399. Chan WJ, McLachlan AJ, Hanrahan JR, Harnett JE (2020) The safety and tolerability of Annona muricata leaf extract: a systematic review. Journal of Pharmacy and Pharmacology 72: 1-16. Coe FG (2008) Rama midwifery in eastern Nicaragua. Journal of Ethnopharmacology 117: 136–157. Coria-Téllez AV, Montalvo-Gónzalez E, Yahia EM, Obledo-Vázquez EN (2016) Annona muricata: A comprehensive review on its traditional medicinal uses, phytochemicals, pharmacological activities, mechanisms of action and toxicity. Arabian Journal of Chemistry 11: 662-691. Dai Y, Hogan S, Schmelz EM, Ju YH, Canning C, Zhou K (2011) Selective growth inhibition of human breast cancer cells by graviola fruit extract in vitro and in vivo involving downregulation of EGFR expression. Nutrition and Cancer 63: 795-801. Delgoda R, Picking D (2015) Potential drug interactions for commonly used medicinal plants & foods in Jamaica. Kingston: University of the West Indies, Natural Products Institute. Enweani IB, Esebelahie NO, Obroku J, Obi LC (1998) Use of soursop and sweetsop juice in the management of diarrhea in children. Journal of Diarrheal Diseases Research 16: 252-253. Ezuruike UF, Prieto JM (2014) The use of plants in the traditional management of diabetes in Nigeria: Pharmacological and toxicological considerations. Journal of Ethnopharmacology 155: 857–924. Foster K, Younger N, Aiken W, Brady-West D, Delgoda R (2017) Reliance on medicinal plant therapy among cancer patients in Jamaica. Cancer Causes and Control 28: 1349-1356. Hajdu Z, Hohmann J (2012) An ethnopharmacological survey of the traditional medicine utilized in the community of Porvenir, Bajo Paraguá Indian Reservation, Bolivia. Journal of Ethnopharmacology 139: 838–857. Hamizah S, Roslida AH, Fezah O, Tan KL, Tor YS, Tan CI (2012) Chemopreventive potential of Annona muricata L. leaves on chemically-induced skin papillomagenesis in mice. Asian Pacific Journal of Cancer Prevention 13: 2533–2539. Hansra DM, Silva OP, Mehta A, Ahn E (2014) Patient with metastatic breast cancer achieves stable disease for 5 years on graviola and xeloda after progressing on multiple lines of therapy. Advances in Breast Cancer Research 3: 84-87. Höllerhage M, Rösler TW, Berjas M, Luo R, Tran K, Richards KM, Sabaa-Srur AU, Maia JG, Moraes MR, Godoy HT, Höglinger GU, Smith RE (2015) Neurotoxicity of dietary supplements from Annonaceae species. International Journal of Toxicology 34: 543-50. Indrawati L, Purwantyastuti P, Abdullah M, Surono IS, Basir I (2016) Safety of Annona Muricata extract supplementation for colorectal cancer patients. Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy 17: 170-175 Indrawati L, Ascobat P, Bela B, Abdullah M, Surono IS (2017) The effect of an Annona muricata leaf extract on nutritional status and cytotoxicity in colorectal cancer: A randomized controlled trial. Asia Pacific Journal of Clinical Nutrition 26: 606-612. Jaradat NA, Shawahna R, Eid AM, Al-Ramahi R, Asma MK, Zaid AN (2016) Herbal remedies use by breast cancer patients in the West Bank of Palestine. Journal of Ethnopharmacology 178: 1–8. Kantati YT, Kodjo KM, Dogbeavou KS, Vaudry D, Leprince J, Gbeassor M (2016) Ethnopharmacological survey of plant species used in folk medicine against central nervous system disorders in Togo. Journal of Ethnopharmacology 181: 214–220.

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Karou SD, Tchacondo T, Tchibozo MAD, Abdoul-Rahaman S, Anani K, Koudouvo K, Batawila K, Agbonon A, Simpore J, de Souza C (2011) Ethnobotanical study of medicinal plants used in the management of diabetes mellitus and hypertension in the Central Region of Togo. Pharmaceutical Biology 49: 1286-1297. Koudouvo K, Karou DS, Kokou K, Essien K, Aklikokou K, Glitho IA, Simpore J, Sanogo R, De Souza C, Gbeassor M (2011) An ethnobotanical study of antimalarial plants in Togo Maritime Region. Journal of Ethnopharmacology 134: 183–190. Lans CA (2006) Ethnomedicines used in Trinidad and Tobago for urinary problems and diabetes mellitus. Journal of Ethnobiology and Ethnomedicine 2: 45–55. Lim TK (2012) Annona muricata. In: Medicinal and non-medicinal edible plants, vol. 1. Dordrecht: Springer-Verlag Berlin, pp. 190-200. Longuefosse JL, Nossin E (1996) Medical ethnobotany survey in Martinique. Journal of Ethnopharmacology 53: 117-142. Monigatti M, Bussmann RW, Weckerle CS (2013) Medicinal plant use in two Andean communities located at different altitudes in the Bolivar Province, Peru. Journal of Ethnopharmacology 145: 450–464. Mootoosamy A, Mahomoodally MF (2014) Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius. Journal of Ethnopharmacology 151: 413–444. Ngueguim Tsofack F, Massa Zibi B, Kouamouo J, Tchuidjang A, Dzeufiet Djomeni PD, Kamtchouing P, Dimo T (2014) Antidiabetic and antioxidant effects of Annona ­muricata (Annonaceae), aqueous extract on streptozotocin-induced diabetic rats. Journal of Ethnopharmacology 151: 784–790. Novy JW (1997) Medicinal plants of the eastern region of Madagascar. Journal of Ethnopharmacology 55: 119—126. Okolie NP, Agu K, Eze GI (2013) Protective effect of ethanolic leaf extract of Annona muricata Linn on some early events in cycas-induced colorectal carcinogenesis in rats. Journal of Pharmaceutical and Scientific Innovation 2: 14–21. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Roosita K, Kusharto CM, Sekiyama M, Fachrurozi Y, Ohtsuka R (2008) Medicinal plants used by the villagers of a Sundanese community in West Java, Indonesia. Journal of Ethnopharmacology 115: 72–81. Rottscholl R, Haegele M, Jainsch B, Xu H, Respondek G, Höllerhage M, Rösler TW, Bony E, Le Ven J, Guérineau V, Schmitz-Afonso I, Champy P, Oertel WH, Yamada ES, Höglinger GU (2016) Chronic consumption of Annona muricata juice triggers and aggravates cerebral tau phosphorylation in wild-type and MAPT transgenic mice. Journal of Neurochemistry 139: 624-639. Sanz-Biset J, Campos-de-la-Cruz J, Epiquién-Rivera MA, Cañigueral S (2009) A first survey on the medicinal plants of the Chazuta valley (Peruvian Amazon). Journal of Ethnopharmacology 122: 333–362. Shaw CA, Höglinger GU (2008) Neurodegenerative diseases: Neurotoxins as sufficient etiologic agents? NeuroMolecular Medicine 10: 1–9. Shields M (2006) The effect of Jamaican medicinal plants on the activities of cytochrome P450 enzymes. Kingston, Jamaica: University of the West Indies, MPhil Dissertation. Sousa OV, Vieira GDV (2010) Antinociceptive and anti-inflammatory activities of the ethanol extract of Annona muricata L. leaves in animal models. International Journal of Molecular Science 11: 2067–2078. Souza DO, Dos Santos Sales V, de Souza Rodrigues CK, de Oliveira LR, Santiago Lemos IC, de Araújo Delmondes G, Monteiro ÁB, do Nascimento EP, Sobreira Dantas Nóbrega de Figuêiredo FR, Martins da Costa JG, Pinto da Cruz GM, de Barros Viana GS, Barbosa R, Alencar de Menezes IR, Bezerra Felipe CF, Kerntopf MR (2018) Phytochemical analysis and central effects of Annona muricata Linnaeus: Possible involvement of the Gabaergic and Monoaminergic systems. Iranian Journal Pharmaceutical Research 17: 1306-1317.

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Torres MP, Rachagani S, Purohit V, Pandey P, Joshi S, Moore ED, Batra SK (2012) Graviola: A novel promising natural-derived drug that inhibits tumorigenicity and metastasis of pancreatic cancer cells in vitro and in vivo through altering cell metabolism. Cancer Letters 323: 29-40. Tsabang N, Tsouh Fokou PF, Yamthe Tchokouaha LR, Noguem B, Bakarnga-Via I, Dongmo Nguepi MS, Nkongmeneck BA, Boyom FF (2012) Ethnopharmacological survey of Annonaceae medicinal plants used to treat malaria in four areas of Cameroon. Journal of Ethnopharmacology 139: 171–180. Vega B (1996) Las frutas de los Taínos. Santo Domingo: Amigo del Hogar, Fundación Cultural Dominicana. Zorofchian Moghadamtousi S, Rouhollahi E, Karimian H, Fadaeinasab M, Firoozinia M, Ameen Abdulla M, Abdul Kadir H (2015) The chemopotential effect of Annona muricata leaves against azoxymethane-induced colonic aberrant crypt foci in rats and the apoptotic effect of Acetogenin Annomuricin E in HT 29 cells: A bioassay-guided approach. PLoS One 10: e0122288.

Chapter 4

Antigonon leptopus Hook. & Arn. (Polygonaceae)

Common names in Jamaica: Rice and peas, bees bush Other common names in Jamaica: Coralilla, coralita (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_4

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4  Antigonon leptopus Hook. & Arn. (Polygonaceae)

Botanical characteristics and propagation Fast-growing, drought-tolerant vine with heart-shaped leaves and underground potato-like tubers. The plant attaches itself easily with tendrils (slender, thread-like appendages that grow in a spiral form) to climb up, or sprawl over, other vegetation. It has striking, bright pink flowers that are borne in clusters. The species is a native of Mexico. Antigonon leptopus is cultivated or appreciated as an ornamental for its showy flowers and has been introduced in North America and across the tropics in the Caribbean, South America, Africa, Asia, and Oceania. It is a weedy climber that owes its invasive success to the fact that it grows year-long, alternating between flowering, fruiting, and vegetative phases (Raju et al., 2001). It does not need as much sunlight as other species, and thrives in poor soil. The species vastly reproduces through several methods. Seeds are able to float on water, allowing it to spread widely throughout water bodies. Animals also spread the seeds. When Antigonon leptopus is damaged, it can re-sprout by underground tubers, spreading even further. Its ability to thrive in tropical climates, its pervasiveness once established, and the difficulties encountered in controlling or eradicating this species have triggered invasion alerts and caution against its introduction on tropical islands (Burke and DiTommaso, 2011).

Where to find the plant The species readily invades areas that are disturbed by human activity, taking over the existing vegetation (CABI, 2019). It can be found all over open spaces in Downtown Kingston where it is clearly invasive, but currently it is only sparsely present in Windsor Forest (Vandebroek et al., 2018).

Part used The whole plant, branch, leaf, occasionally the root or flower.

Jamaican cultural uses and beliefs In Kingston, Jamaicans appreciate the plant as a “nice” (meaning pleasantly tasting) tea bush and as a good bush for beekeepers. People recognize the plant’s ability to withstand drought, saying “it only needs one good shower of rain to come up again.”

Reported medicinal uses across the world

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Jamaican medicinal uses In Kingston, the bush is a very popular remedy to treat the common cold.

Major uses (mentioned by more than 20% of people): • Common cold: In Kingston, the bush is boiled until the water is red, or steeped, and drunk. It can be used dry or fresh. Alternatively, the vine is wrapped around the head and tied with a warm cloth. Rice and peas is sometimes combined with ginger (Zingiber officinale Roscoe), garlic (Allium sativum L.), or rosemary (Salvia rosmarinus Spenn., formerly known as Rosmarinus officinalis L.).

Reported medicinal uses across the Caribbean In Trinidad and Tobago, Antigonon leptopus is used to treat diabetes. The method of preparation was not stated (Lans, 2006).

Reported medicinal uses across the world Across individual countries: • Nigeria: The root of Antigonon leptopus is used to treat disorders of the liver and spleen, and asthma. The method of preparation was not stated (Idu and Onyibe, 2007). • Mexico: The root is used in a decoction with other plants, such as the bark of the Jamaican plum (Spondias purpurea L.), a handful of Heliotropium angiospermum Murray, a handful of Senna atomaria (L.) H.S.Irwin & Barneby, three slices of pear seed (Persea americana Mill.), and two twigs of dogblood (Rivina humilis L.), to treat bloody or slimy diarrhea, foamy diarrhea, and abdominal pain. For this purpose, the leaves of Antigonon leptopus are also mixed and boiled with the leaves of Trema micrantha (L.) Blume and the root of Jack-in-­ the-bush (Chromolaena odorata (L.) R.M.King & H.Rob.) (Vera-Ku et al., 2010). • Thailand: The Thai pharmaceutical handbook of the School of Traditional Medicine Association mentions 92 flowers that possess medicinal properties. Antigonon leptopus is among the most common edible flowers included in the everyday diet in the northern part of Thailand and used for the preparation of tea. Its medicinal use in Thailand was not specified (Kaisoon et al., 2012).

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4  Antigonon leptopus Hook. & Arn. (Polygonaceae)

Clinical efficacy studies in humans No information is available.

Safety information Side effects No information is available.

Toxicology One study found neither mortality nor signs of delayed toxicity of an ethanol extract of the leaves of Antigonon leptopus given orally to rats in doses of 2–5 g/kg body weight. The same authors observed dose-dependent analgesic (pain relieving) and muscle-relaxant effects of these extracts at doses between 0.05 and 0.25 g/kg body weight (Ranjan et al., 2015).

Contraindications No information is available.

Use in pregnancy and breastfeeding No information is available.

Drug interactions No information is available.

Selected bibliography

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Recommendations No scientific data for human (clinical) studies are available to date. No obvious toxic effects for extracts of the roots and leaves were observed in mice and rats in doses of 2–5 g/kg body weight. Absence of safety data in humans means that the use of this plant should be avoided during pregnancy and breastfeeding.

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Burke JM, DiTommaso A (2011) Corallita (Antigonon leptopus): Intentional introduction of a plant with documented invasive capability. Invasive Plant Science and Management 4: 265–273. CABI (2019) Antigonon leptopus (coral vine) [original text by Rojas-Sandoval J, Acevedo-­ Rodriguez P]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 27 December 2019 at https://www.cabi.org/isc/datasheet/112316 Idu M, Onyibe HI (2007) Medicinal plants of Edu State, Nigeria. Research Journal of Medicinal Plants 1: 32-41. Kaisoon O, Konczak I, Siriamornpun S (2012) Potential health enhancing properties of edible flowers from Thailand. Food Research International 46: 563–571. Lans CA (2006) Ethnomedicines used in Trinidad and Tobago for urinary problems and diabetes mellitus. Journal of Ethnobiology and Ethnomedicine 2: 45. Raju AJS, Raju VK, Victor P, Naidu SA (2001) Floral ecology, breeding system and pollination in Antigonon leptopus L. (Polygonaceae). Plant Species Biology 16: 159–164. Ranjan P, Tiwari DK, Tripathi K (2015) Analgesic and muscle relaxant activities of ethanolic extract of Antigonon leptopus. International Journal of Pharmaceutical Chemistry & Toxicology 1: 37-41. Vandebroek I, Picking D, Aiken S, Lewis PA, Oberli A, Mitchell S, Boom B (2018) A Review of coralilla (Antigonon leptopus): An invasive and popular urban bush medicine in Jamaica. Economic Botany 72: 229–245. Vera-Ku M, Méndez-González M, Moo-Puc R, Rosado-Vallado M, Simá-Polanco P, Cedillo-­ Rivera R, Peraza-Sánchez SR (2010) Medicinal potions used against infectious bowel diseases in Mayan traditional medicine. Journal of Ethnopharmacology 132: 303–308.

Chapter 5

Argemone mexicana L. (Papaveraceae)

Common names in Jamaica: Holy thistle, blessed thistle Other common names in Jamaica: Mexican poppy, yellow thistle (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_5

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5  Argemone mexicana L. (Papaveraceae)

Botanical characteristics and propagation Prickly annual herb with a branched stem that grows up to 1 m tall. When cut, the plant releases a yellow sap that smells unpleasant. The flowers are solitary and bright yellow. The thick and leathery, thistle-like leaves are bluish-green, toothed and spiny, and sit alternately on the stem. The fruit is a prickly capsule with numerous small black seeds. As a weed associated with crops and wastelands, it is a hardy bush that withstands drought and poor soils. The species is native to tropical America, although its exact native range remains disputed (CABI, 2019). It is often considered native to Florida, Mexico, Central America, the Caribbean, and tropical South America. It is known as a naturalized weed throughout the Old World Tropics. The plant can be propagated by seeds that germinate best in moist soil with a temperature of up to 25 °C (PROTA, 2008).

Where to find the plant Holy thistle grows wild in the community, along roadsides, and on fallow and disturbed lands. It is a weed primarily associated with agricultural crops (CABI, 2019).

Part used The leaf or entire bush.

Jamaican cultural uses and beliefs Holy thistle is considered a spiritual bush that can be used in a bath to remove a spirit (“tek spirit off yuh”). In Windsor Forest, people say in Patois: “It [is] a strong bush. If evil come in di yard, di bush smell very strong, like basley [plant species of the genus Ocimum].” The seeds are used to trap birds. It is also a tea bush that is boiled and drunk in the morning “to give appetite.”

Jamaican medicinal uses Holy thistle is considered a good remedy to treat the common cold, including cough and shortness of breath.

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Major uses (mentioned by more than 20% of people) • Common cold: In Kingston, the leaf or bush is first drained by quailing (wilting), after which it is boiled in water for 25 min and drunk, or the water is used to bathe. In Windsor Forest, the whole bush, or a branch, is boiled for 4 min and drunk black. Garlic (Allium sativum L.) is sometimes added to this preparation.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Body cleanser (constipation, flushes the system; it “builds the baby,” this means it is believed to strengthen the infant): In Windsor Forest, the leaf or the whole bush is boiled, or steeped in boiling water, and drunk. • Loss of appetite: In Windsor Forest, the bush is boiled and drunk.

Reported medicinal uses across the Caribbean The Caribbean pharmacopeia recommends a decoction of the root, taken by mouth, for stomachache. This recommendation is based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-­ Robineau, 2014). A decoction of the stem is used to stimulate menstruation and to treat high blood pressure in the Caribbean (Halberstein, 2005).

Reported medicinal uses across the world Argemone mexicana is used in different parts of the world for treatment of skin diseases (including tumors and warts), inflammation, arthritis, jaundice, leprosy, microbial infections, and malaria (Brahmachari et al., 2013). The scientific name of the bush refers to the Greek word “argemos,” meaning white spot or eye cataract, also referring to one of its traditional uses. Across individual countries: • Bolivia: An infusion of the flowers is drunk for cough, the yellow sap is applied to the skin for dermatitis, and the seeds are used as a laxative (Muñoz et al., 2000).

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5  Argemone mexicana L. (Papaveraceae)

• Brazil: An infusion or decoction of a teaspoon of seeds in a cup of water is drunk after meals as a purgative, laxative, and digestive; the latex is applied to the eyes for conjunctivitis (Agra et al., 2007). • Djibouti (Horn of Africa): A leaf paste is applied to wounds (Hassan-Abdallah et al., 2013). • Ghana: The aboveground parts are used fresh or dry (preparation and administration not specified) for malaria, either alone or together with the leaves of cerasee (Momordica charantia L.) and moringa (Moringa oleifera Lam.) (Komlaga et al., 2015). • Guinea-Bissau: The leaves are used to treat intestinal problems (preparation not specified) (Catarino et al., 2016). • India: A paste of the seeds is applied to itching skin, and the seed oil is used externally to treat ringworm. The yellow latex is applied to skin sores. The latex, together with cow’s milk, is kept in a copper pot for 3 days and then applied to white spots and patches on the skin (Sharma et al., 2014). The powder of the leaves (2 g) is taken orally three times a day with unboiled milk to relieve dysentery; the seed powder alone also serves for this purpose (Gairola et al., 2013). To treat jaundice, the latex is taken with sugar twice a day for 2 weeks; or the whole plant is dried and powdered with sugar, and 2 g of the powder is taken with milk curd twice a day for 2–3 weeks (Sharma et al., 2012). Other Indian authors mention that the latex is used orally in 20 mL doses for 3–4 days for jaundice, and it is also applied topically to treat chronic skin diseases, including scabies, and also rheumatic pain and toothache (Singh et  al., 2002). The roots (preparation not specified) are useful in cases of urolithiasis (formation of stones in the urinary system) (Agarwal and Varma, 2015). The latex is rubbed on teeth in cases of dental caries, boils, and pimples and applied to the eyes to treat conjunctivitis. A decoction of the leaves is used internally for fever twice a day. A paste of the seeds, mixed with mustard oil, is applied to scabies, boils, and pimples for about 5–6  days. The seed paste is also smeared on fractured and swollen bones (Kamaraj et  al., 2012). The seed powder (100–200  mg, taken twice a day for 2  weeks) is used to treat asthma (Savithramma et  al., 2007). The seed oil is applied to the genitals 2–3 times daily for 21–30 days to treat gonorrhea, syphilis, and genital warts. The fresh juice of the root is boiled with water until powdery, and small tablets prepared from this powder together with butter are taken once daily for 21 days to treat gonorrhea (Behera and Misra, 2005). The root is crushed and placed on a painful tooth (Hebbar et al., 2004). Indian researchers have identified a potential role for the root extract of Argemone mexicana in combating the spread of dengue fever, the debilitating viral disease spread by the Aedes aegypti mosquito. A hexane extract of the root was found to be an effective larvicide, demonstrating a high level of toxicity to the larval stage of the mosquito’s life cycle (Warikoo and Kumar, 2013). • Mexico: A mouthwash of the leaves is used to treat caries and gum disease (Rosas-Piñón et al., 2012). A maceration of the flowers, or the latex, is applied to eye and skin infections, including wounds (Juárez-Vázquez et al., 2013). • Nepal: The stem is pounded and drunk for cough, and the seed juice is drunk for indigestion (Shrestha and Dhillion, 2003).

Safety information

49

• Nigeria: The whole plant is boiled and taken as water in severe cases of measles. When infection with measles is mild, two teacupfuls are taken twice daily (Sonibare et al., 2009). • Pakistan: A powder of the flowers is used for sexual problems, including premature ejaculation, whereas the latex is taken internally as a laxative and applied as a skin moisturizer (Mahmood et  al., 2013). The fresh latex is also taken with honey for malaria (Shah et al., 2014). • Philippines: The latex, pounded stems, or leaves are applied to cuts and wounds (Abe and Ohtani, 2013). • Tanzania: The sap is applied directly to wounds and sores. Crushed leaves are soaked in cold water that is used as a bath for skin infections (Maregesi et al., 2007).

Clinical efficacy studies in humans The Department of Traditional Medicine in Mali has recognized Argemone mexicana as a standardized herbal medicine for home-based treatment of malaria (Willcox et al., 2007; Willcox, 2011; Schrader et al., 2012). The water extract of the aboveground plant parts exhibited antimalarial activity against the chloroquine-­ resistant strain of the parasite Plasmodium falciparum. In a randomized, controlled clinical trial, 89% of patients recovered clinically (versus 95% with standard artemisinin-­ based combination therapy), although parasite clearance was only achieved in 9% of patients (Schrader et al., 2012). There was no worsening of severe malaria in patients older than 5 years, and 2% deterioration in children aged 5 years or younger (Schrader et al., 2012). In a follow-up retrospective study in Mali in 2013, following the original clinical study undertaken in 2003, the researchers reported 100% cure or improvement in children older than 5  years, who were treated for uncomplicated malaria with a preparation made of aerial plant parts of Argemone mexicana (Graz et al., 2015).

Safety information Side effects There exists a Mexican case report of a female patient who took Argemone mexicana (plant part and preparation not specified) twice over a time period of 1 year to treat digestive problems. At both times, she developed diarrhea, jaundice (yellowish pigmentation of the skin), and general malaise and showed abnormalities in tests of liver functioning (Meléndez González, 2013). Also in Mexico, burning of the eyes has been reported as a side effect of using the flowers and latex for eye infections (Juárez-Vázquez et al., 2013).

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In Djibouti in the Horn of Africa, side effects reported with excess use of Argemone mexicana (plant parts not specified) included mental instability, laxative effects, and internal bleeding (hemorrhage) (Hassan-Abdallah et al., 2013). Argemone mexicana is considered the culprit of epidemic dropsy outbreaks in India and elsewhere (Meléndez González, 2013). Epidemic dropsy is a multi-­system disease involving the heart and blood vessels, liver, kidneys, and eyes. Onset is usually gradual with watery diarrhea and vomiting lasting a few days to more than a week. Symptoms include bilateral edema (swelling) of the lower limbs from the ankles up to the scrotum and belly. It is a toxic disease caused by the unintentional ingestion of Argemone mexicana seeds as an adulterant of wheat flour, or more commonly, of cooking oil such as mustard oil. Contamination happens during harvesting of mustard seeds with the wild seeds of Argemone mexicana that commonly grows alongside mustard plantations. Epidemic dropsy was reported in more than 3000 cases and 65 deaths in 1998 in New Delhi, India, as a consequence of adulteration of cooking oil with the seeds of Argemone mexicana (Verma et  al., 2001). Currently, epidemic dropsy still sporadically exists in India (Sharma et al., 2013), with continued reports of serious symptoms and deaths, despite a ban on the sale of unbottled mustard oil (Tomar et al., 2015). An epidemic in Addis Ababa (Ethiopia) in 2008 led to five confirmed deaths linked to the consumption of edible oils contaminated with Argemone mexicana (Alebachew et al., 2013; Schneider et al., 2013).

Toxicology In Mali, the population did not report toxicity for a malaria remedy that consisted of a water decoction of the aboveground parts of Argemone mexicana (prepared by stirring 500 g of leaves in 2 L of boiling distilled water for 3 h). According to the researchers of this study, no reference to toxicity was found in the literature either (Simoes-Pires et al., 2014). In the water decoction, there was no trace of the toxic compound sanguinarine that is present in the plant. The authors specified that “Before proceeding to clinical studies, WHO guidelines state that if a product has been traditionally used without demonstrated harm, no specific restrictive regulatory action should be undertaken unless new evidence demands a revised risk-benefit assessment. Preclinical toxicity testing is only required for new medicinal herbal products which contain herbs with no established traditional history of use.” However, it should be noted that the Mali researchers ensured that the seeds of the plant were carefully removed before the aboveground (aerial) parts of Argemone mexicana were prepared in the traditional way (Simoes-Pires et al., 2014). Argemone oil, produced from the seeds of Argemone mexicana was found to be genotoxic (damages the genetic material in a cell), even at low concentrations, when tested on Swiss Albino mice (Ghosh and Mukherjee, 2016).

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Contraindications No information is available.

Use in pregnancy and breastfeeding In Mali, authors mentioned that “Argemone mexicana decoction is regularly used by pregnant women […], and animal studies showed no evidence of reproductive toxicity” (Willcox et al., 2011). These authors, however, did mention that the number of patients in their study was not large enough to detect rare adverse effects with any certainty and that they were not able to follow up all pregnant women to the end of their pregnancy.

Drug interactions A water extract of aboveground (aerial) parts of Argemone mexicana at a dose of 0.4 g/kg body weight given by mouth to diabetic rats showed a decrease in their blood sugar levels (Nayak et al., 2011). This effect needs to be confirmed in humans, but there exists the possibility that a tea of this plant may increase the effect of diabetes medication.

Recommendations Argemone mexicana contains sanguinarine, a known toxic compound, and therefore should be used with great care. Boiling the aboveground (aerial) parts of the plant did not produce toxicity in Mali, and sanguinarine was not found in this traditional preparation. The Caribbean pharmacopeia recommends oral administration of a decoction of the roots as a treatment for stomachache. However, the level of toxicity can depend on many variables, including growing conditions of the plant, plant part, and exact amount used, as well as the specific details of the preparation. It is best to avoid drinking Argemone mexicana as a remedy during pregnancy and breastfeeding to avoid toxicity altogether. The seeds of Argemone mexicana have been shown to be highly toxic to humans, and it is therefore recommended that the use of any preparations derived from them be avoided, for both internal and external use.

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Selected bibliography Abe R, Ohtani K (2013) An ethnobotanical study of medicinal plants and traditional therapies on Batan Island, the Philippines. Journal of Ethnopharmacology 145: 554–565. Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Agarwal K, Varma R (2015) Ethnobotanical study of antilithic plants of Bhopal district. Journal of Ethnopharmacology 174: 17-24. Agra MF, Baracho GS, Nurit K, Basilio IJLD, Coelho VPM (2007) Medicinal and poisonous diversity of the flora of “Cariri Paraibano”, Brazil. Journal of Ethnopharmacology 111: 383–395. Alebachew A, Aseffa A, TekleMariam S, Azazh A, Tadesse S, Bane A, Wondabeku M, Urga K, Seboxa T, Habte M, Messele T, Tadesse Z, Amare B, Bekele Y, Assefa D, Habte D, Kebede A (2013) Outbreak investigation of epidemic dropsy in Addis Ababa, Ethiopia. Ethiopian Medical Journal (Supplement 2): 9-20. Behera SK, Misra MK (2005) Indigenous phytotherapy for genito-urinary diseases used by the Kandha tribe of Orissa, India. Journal of Ethnopharmacology 102: 319–325. Brahmachari G, Gorai D, Roy R (2013) Argemone mexicana: Chemical and pharmacological aspects. Revista Brasileira de Farmacognosia 23: 559-575. CABI (2019) Argemone mexicana (Mexican poppy) [original text by Vélez-Gavilán J]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 27 December 2019 at https://www.cabi.org/isc. Catarino L, Havik PJ, Romeiras MM (2016) Medicinal plants of Guinea-Bissau: Therapeutic applications, ethnic diversity and knowledge transfer. Journal of Ethnopharmacology 183: 71–94. Gairola S, Sharma J, Gaur RD, Siddiqi TO, Painuli RM (2013) Plants used for treatment of dysentery and diarrhea by the Bhoxa community of district Dehradun, Uttarakhand, India. Journal of Ethnopharmacology 150: 989–1006. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Ghosh I, Mukherjee A (2016) Argemone oil induces genotoxicity in mice. Drug and Chemical Toxicology 13: 1-5. Graz B, Willcox M, Berthe D, Ardiet DL, Falquet J, Diallo D, Giani S (2015) Home treatments alone or mixed with modern treatments for malaria in Finkolo AC, South Mali: Reported use, outcomes and changes over 10 years. Transactions of the Royal Society of Tropical Medicine and Hygiene 109: 209-213. Halberstein RA (2005) Medicinal plants: Historical and cross-cultural usage patterns. Annals of Epidemiology 15: 686-699. Hassan-Abdallah A, Merito A, Hassan S, Aboubaker D, Djama M, Asfaw Z, Kelbessa E (2013) Medicinal plants and their uses by the people in the Region of Randa, Djibouti. Journal of Ethnopharmacology 148: 701–713. Hebbar SS, Harsha VH, Shripathi V, Hegde GR (2004) Ethnomedicine of Dharwad district in Karnataka, India—plants used in oral health care. Journal of Ethnopharmacology 94: 261–266. Juárez-Vázquez MDC, Carranza-Álvarez C, Alonso-Castro AJ, González-Alcaraz VF, Bravo-­ Acevedo E, Chamarro-Tinajero FJ, Solano E (2013) Ethnobotany of medicinal plants used in Xalpatlahuac, Guerrero, México. Journal of Ethnopharmacology 148: 521–527. Kamaraj C, Kaushik NK, Rahuman AA, Mohanakrishnan D, Bagavan A, Elango G, Zahir AA, Santhoshkumar T, Marimuthu S, Jayaseelan C, Kirthi AV, Rajakumar G, Velayutham K, Sahal D (2012) Antimalarial activities of medicinal plants traditionally used in the villages of Dharmapuri regions of South India. Journal of Ethnopharmacology 141: 796– 802. Komlaga G, Agyare C, Dickson RA, Mensah MLK, Annan K, Loiseau PM, Champy P (2015) Medicinal plants and finished marketed herbal products used in the treatment of malaria in the Ashanti region, Ghana. Journal of Ethnopharmacology 172: 333–346. Mahmood A, Mahmood A, Malik RN, Shinwari ZK (2013) Indigenous knowledge of medicinal plants from Gujranwala district, Pakistan. Journal of Ethnopharmacology 148: 714-723.

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Maregesi SM, Ngassapa OD, Pieters L, Vlietinck AJ (2007) Ethnopharmacological survey of the Bunda district, Tanzania: Plants used to treat infectious diseases. Journal of Ethnopharmacology 113: 457–470. Meléndez González CA (2013) Riesgos de la herbolaria: Reporte de un caso de hepatitis por cardo santo (Argemone mexicana L.) [Risks of herbalism: A case report of Mexican poppy (Argemone mexicana L.) induced liver toxicity]. Medwave 13: e5763. Muñoz V, Sauvain M, Bourdy G, Arrázola S, Callapa J, Ruiz G, Choque J, Deharo E (2000) A search for natural bioactive compounds in Bolivia through a multidisciplinary approach Part III. Evaluation of the antimalarial activity of plants used by Alteños Indians. Journal of Ethnopharmacology 71: 123–131. Nayak P, Kar DM, Maharana L (2011) Antidiabetic activity of aerial parts of Argemone mexicana L. in alloxan induced hyperglycaemic rats. Pharmacologyonline 1: 889-903. PROTA (2008) Plant resources of tropical Africa. vol. 11 (1). Medicinal plants, vol. 1. (Schmelzer GH, & A. Gurib-Fakim, (Eds.). Wageningen: PROTA Foundation-Backhuys-CTA, 869 pp. Rosas-Piñón Y, Mejía A, Díaz-Ruiz G, Aguilar MI, Sánchez-Nieto S, Rivero-Cruz JF (2012) Ethnobotanical survey and antibacterial activity of plants used in the Altiplane region of Mexico for the treatment of oral cavity infections. Journal of Ethnopharmacology 141: 860-865. Savithramma N, Sulochana Ch, Rao KN (2007) Ethnobotanical survey of plants used to treat asthma in Andhra Pradesh, India. Journal of Ethnopharmacology 113: 54–61. Schneider J, Azazh A, Bane A, Seboxa T (2013) Epidemic dropsy: Case report and the morphologic features in a patient who died at Tikur Anbessa Specialized Hospital. Ethiopian Medical Journal (Supplement 2): 33-37. Schrader FC, Barho M, Steiner I, Ortmann R, Schlitzer M (2012) The antimalarial pipeline - An update. International Journal of Medical Microbiology 302: 165-171. Shah GM, Abbasi AM, Khan N, Guo X, Khan MA, Hussain M, Bibi S, Nazir A, Tahir AA (2014) Traditional uses of medicinal plants against malarial disease by the tribal communities of Lesser Himalayas–Pakistan. Journal of Ethnopharmacology 155: 450–462. Sharma J, Gairola S, Gaur RD, Painuli RM (2012) The treatment of jaundice with medicinal plants in indigenous communities of the Sub Himalayan region of Uttarakhand, India. Journal of Ethnopharmacology 143: 262-291. Sharma J, Gairola S, Sharma YP, Gaur RD (2014) Ethnomedicinal plants used to treat skin diseases by Tharu community of district Udham Singh Nagar, Uttarakhand, India. Journal of Ethnopharmacology 158: 140-206. Sharma N, Mohan N, Bhalla A, Sharma A, Singh S (2013) Changing pattern of epidemic dropsy in North India. Asia Pacific Journal of Medical Toxicology 2: 87-91. Shrestha PM, Dhillion SS (2003) Medicinal plant diversity and use in the highlands of Dolakha district, Nepal. Journal of Ethnopharmacology 86: 81–96. Simoes-Pires C, Hostettmann K, Haouala A, Cuendet M, Falquet J, Graz B, Christen P (2014) Reverse pharmacology for developing an anti-malarial phytomedicine. The example of Argemone mexicana. International Journal for Parasitology: Drugs and Drug Resistance 4: 338–346. Singh AK, Raghubanshi AS, Singh JS (2002) Medical ethnobotany of the tribals of Sonaghati of Sonbhadra district, Uttar Pradesh, India. Journal of Ethnopharmacology 81: 31-41. Sonibare MA, Moody JO, Adesanya EO (2009) Use of medicinal plants for the treatment of measles in Nigeria. Journal of Ethnopharmacology 122: 268-272. Tomar LR, Raizada A, Yadav A, Agarwal S (2015) Epidemic dropsy 2013: Case series. Tropical Doctor 45: 137-139. Verma SK, Dev G, Tyagi AK, S Goomber S, Jain GV (2001) Argemone mexicana poisoning: autopsy findings of two cases. Forensic Science International 115: 135-141. Warikoo R and Kumar S (2013) Impact of Argemone mexicana extracts on the cidal, morphological, and behavioral response of dengue vector, Aedes aegypti L. (Diptera: Culicidae). Parasitology Research 112: 3477-3484.

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Willcox M (2011) Improved traditional phytomedicines in current use for the clinical treatment of malaria. Planta Medica 77: 662-671. Willcox ML, Graz B, Diakite C, Falquet J, Dackouo F, Sidibe O, Giani S, Diallo D (2011) Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT. Transactions of the Royal Society of Tropical Medicine and Hygiene 105: 23–31. Willcox ML, Graz B, Falquet J, Sidibe O, Forster M, Diallo D (2007) Argemone mexicana decoction for the treatment of uncomplicated falciparum malaria. Transactions of the Royal Society of Tropical Medicine and Hygiene 101: 1190-1198.

Chapter 6

Artocarpus altilis (Parkinson) Fosberg (Moraceae)

Synonyms: Sitodium altile Parkinson ex F.A.Zorn, Artocarpus communis J.R.Forst. & G.Forst., Artocarpus incisus (Thunb.) L.f. (Adams, 1972) Common name in Jamaica: Breadfruit Other common name in Jamaica: Breadnut (seeded varieties) (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_6

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Botanical characteristics and propagation Evergreen tree that grows 15 m high or more, with dark green, deeply lobed, leathery leaves. The leaves are up to 100 cm long and 60 cm wide, elliptical in shape, and have up to seven acuminate lobes along each margin (Adams, 1972). When a part of the tree is broken off, a white latex (locally called “milk”) will come out. The fruit is round to oval, with a smooth skin texture and a yellowish-green color when mature. The fruit flesh is creamy white. Fruits are mature and ready to cook or roast in 15–19 weeks. A breadfruit tree starts bearing around 3–5 years of age and does so for several decades. The exact origin of the species is uncertain, but it is considered native to Papua New Guinea, the Moluccas (an archipelago in eastern Indonesia), and the Philippines (CABI, 2020). It has been widely cultivated in southeast Asia and the Pacific region for thousands of years and is now cultivated throughout the tropics. In rural Jamaica, farmers transplant suckers found underneath a breadfruit tree to other places; they also exchange suckers of much-­ appreciated varieties with each other, such as the “jackfruit breadfruit,” also called “maca breadfruit,” a variety that is considered easier to roast. In Jamaica, varieties with seeds have been referred to as “breadnut” (Adams, 1972).

Where to find the plant Breadfruit trees are common in cultivation in Jamaica but are mostly found at lower elevations in areas with sufficient rainfall (Adams, 1972).

Part used The leaf is used medicinally. The fruit is eaten.

Jamaican cultural uses and beliefs Breadfruit is considered a tonic fruit. It is part of the Jamaican national dish, together with ackee (Blighia sapida K.D.Koenig) and saltfish (salted cod). The fruit can be boiled and blended for a juice or punch. Jamaicans also use the ripe fruit to bake pudding. There is a Patois saying “if yuh eat too much breadfruit, it make yuh coward.” The leaf of breadfruit is an appreciated regular tea in the morning and evening, sometimes with sweet milk, vanilla, and nutmeg added. Milk from the chopped breadfruit tree can serve as chewing gum, or to catch birds, by putting the gum on a

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bamboo stick that is then placed in a tree. A lesser-known use is as a cosmetic, by steeping an ounce to a pint of breadfruit leaves and flowers in water.

Jamaican medicinal uses Breadfruit leaf is applied to the head, and drunk as a tea, to treat high blood pressure.

Major uses (mentioned by more than 20% of people) • Blood pressure: In Kingston, people treat high blood pressure by tying a warm leaf on the head, together with rubbing alcohol. Alternatively, in Kingston and Windsor Forest, people boil or draw the ripe (yellow) breadfruit leaf for as little as 2 min, or up to an hour, in water. Some people say that when you pick a leaf from the tree for tea it “cannot drop on the ground.” Breadfruit leaf is sometimes steeped or boiled together with the leaf of guinep (Melicoccus bijugatus Jacq.).

Reported medicinal uses across the Caribbean All parts of Artocarpus altilis are used medicinally in the Caribbean and Pacific, especially the latex, leaf tips, and inner bark. In the West Indies, the yellowing leaf is brewed and drunk to lower high blood pressure and to treat asthma. The leaf tea is also believed to control diabetes. In the Caribbean and Pacific, the latex is massaged into the skin to treat broken bones and sprains and is bandaged on the spine to relieve sciatica (pain affecting the back, hip, and outer side of the leg, caused by compression of a nerve). It is commonly used to treat skin ailments and fungus diseases such as “thrush,” which are also treated with crushed leaves. Diluted latex is taken internally to treat diarrhea, stomach ache, and dysentery. The sap from the crushed stems or leaves is used to treat ear infections or sore eyes. The root is astringent and used as a purgative; when macerated it is used as a poultice (compress) for skin ailments. The bark is also used to treat headache in several islands (Ragone, 2006). In Martinique, a decoction of breadfruit leaf is drunk to treat high blood pressure, liver disease, and diabetes, while the milk of the fruit is ingested for diabetes and applied externally for pain in the back (Longuefosse and Nossin, 1996). In Trinidad and Tobago, breadfruit leaf is used to treat high blood pressure as well (Lans, 2006).

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Reported medicinal uses across the world Across individual countries: • Indonesia: A decoction of the leaves has been used traditionally for the treatment of liver cirrhosis, hypertension (high blood pressure), and diabetes (Wang et al., 2006). • Mauritius: A leaf decoction of Artocarpus altilis is drunk to treat diabetes, one cup twice per week (Mootoosamy and Mahomoodally, 2014). • Pacific Islands: Latex and juice from the crushed leaves are both traditionally used to treat ear infections. The root is an astringent (able to tighten body tissues) and is used as a purgative, and when macerated, it is used as a poultice for skin ailments. The bark is used to treat headache (Orwa et al., 2009). • Taiwan: The leaves are used to treat liver disease and fever, and an extract from the flowers is said to be effective in treating ear swelling (edema) (Orwa et al., 2009).

Clinical efficacy studies in humans No information is available.

Safety information Side effects One respondent in the Jamaican TRAMIL survey reported experiencing hypotension (low blood pressure) as a result of drinking breadfruit leaf tea (Picking et al., 2015).

Toxicology In an acute toxicity study of breadfruit leaf and bark extracts in rats (2 g/kg body weight administered orally for 2 weeks), no toxic reaction or mortality was observed. These results suggest the safety of the extracts in therapeutic uses (Sairam and Urooj, 2014).

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Contraindications No information is available.

Use in pregnancy and breastfeeding No information is available.

Drug interactions Traditionally prepared water extracts of the dried leaves of Artocarpus altilis were tested in the laboratory for their effect on a number of key human enzymes that are responsible for processing many pharmaceutical drugs in the body (cytochrome P450, CYPs 2D6, and 3A4). The results showed moderate to weak impact, indicating that clinically significant interactions with drugs metabolized by the same enzymes are unlikely (Nwokocha et  al., 2012; Murray, 2014; Delgoda and Picking, 2015).

Recommendations Absence of human (clinical) studies warrants caution for use of breadfruit leaf tea as a medicine in humans, especially in pregnant or breastfeeding women and in children. Hypertension (high blood pressure) is a serious condition that needs to be followed up by a qualified healthcare provider. People who self-medicate with breadfruit leaf tea should disclose this information to their physician.

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. CABI (2020) Artocarpus altilis (breadfruit) [original text by Rojas-Sandoval J, Acevedo-RodrÍguez P]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/1822. Delgoda R, Picking D (2015) Potential drug interactions for commonly used medicinal plants & foods in Jamaica. Kingston: University of the West Indies, Natural Products Institute. Lans CA (2006) Ethnomedicines used in Trinidad and Tobago for urinary problems and diabetes mellitus. Journal of Ethnobiology and Ethnomedicine 2: 45.

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Longuefosse J, Nossin E (1996) Medical ethnobotany survey in Martinique. Journal of Ethnopharmacology 53: 117-142. Mootoosamy A, Mahomoodally MF (2014) Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius. Journal of Ethnopharmacology 151: 413-444. Murray J (2014) Inhibition of human cytochrome P450 enzymes by local herbs, natural and synthetic isolates. Kingston: University of the West Indies, M.Phil. Dissertation. Nwokocha CR, Owu DU, McLaren M, Murray J, Delgoda R, Thaxter K, McCalla G, Young L (2012) Possible mechanisms of action of the aqueous extract of Artocarpus altilis (breadfruit) leaves in producing hypotension in normotensive Sprague-Dawley rats. Pharmaceutical Biology 50: 1096-1102. Orwa C, Mutua A, Kindt R, Jamnadass R, Simons A (2009) The Agroforestree (AFT) Database: A tree reference and selection guide version 4.0. World Agroforestry Centre, Kenya. Accessed 27 December 2019 at http://www.worldagroforestry.org/output/agroforestree-database. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell, S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Ragone D (2006) Artocarpus altilis (breadfruit), ver. 2.1. In: Elevitch CR (Ed.) Species profiles for Pacific Island agroforestry. Permanent Agriculture Resources (PAR), Holualoa, Hawai‘i. Sairam S, Urooj A (2014) Safety evaluation of Artocarpus altilis as pharmaceutical agent in Wistar rats. Journal of Toxicology 2014: 980404. Wang Y, Deng T, Lin L, Pan Y, Zheng X (2006) Bioassay-guided isolation of anti-atherosclerotic phytochemicals from Artocarpus altilis. Phytotherapy Research 20: 1052-1055.

Chapter 7

Bryophyllum pinnatum (Lam.) Oken (Crassulaceae)

Synonyms: Kalanchoe pinnata (Lam.) Pers., Cotyledon pinnata Lam. (Adams, 1972) The Plant List considers Bryophyllum pinnatum the accepted name, whereas the Catalogue of Life lists Kalanchoe pinnata as the accepted scientific name. Common names in Jamaica: Leaf of life, tree of life Other common name in Jamaica: Leaf-of-life (Adams, 1972) © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_7

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Botanical characteristics and propagation Succulent perennial shrub that can grow up to 2 m in height. The yellowish-green colored leaves are opposite and have curved margins, from which small plantlets grow that drop on the ground and form new plants. The lower leaves are simple, whereas the upper leaves are often 3- or 5-foliate (CABI, 2020). The flowers are yellowish-green to pinkish-red in color, bell-shaped, drooping, and arranged in branched clusters. Some authors consider Bryophyllum a subgenus of Kalanchoe, while others see them as distinct genera based on a larger set of morphological characters (e.g. flowers are pendulous in Bryophyllum, and erect or spreading in Kalanchoe), as well as evidence of polyphyly within Kalanchoe sensu lato. The species is native to Madagascar but has naturalized widely in the tropics, where it has become invasive in many countries (CABI, 2020). It propagates very easily. On moist tissue paper, the leaf will sprout small rooted shoots along the border. A leaf falling to the ground produces a new plant shortly.

Where to find the plant Leaf of life grows wild in the community along trails and roadsides.

Part used The leaf.

Jamaican cultural uses and beliefs Leaf of life is considered a spiritual bush that keeps away evil spirits. It is used for church healing. The leaf is broken in a bucket of spring water, and this spiritual water is consumed with a biscuit. Children use the bush to make a toy (called “dolly”) that has two arms and feet. The bush also serves to feed rabbits.

Jamaican medicinal uses Leaf of life is considered a powerful bush for treating the common cold. It is known to have a harsh taste and a strong smell.

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Major uses (mentioned by more than 20% of people) • Common cold (on the chest, sometimes called “stomach,” also in babies), congestion, bronchitis: In Kingston and Windsor Forest, the leaf or bush is used to bathe, drink, or eat. It is boiled, drawn, or eaten raw with salt. When using it raw, two to three leaves are chewed with salt, or the leaf is beaten, squeezed, and drunk, with salt added. Or, the bush is steeped in spring water (also the leaves are boiled for about 6–45 min) and given to drink by teaspoon to a pickney (child). Alternatively, it is soaked in hot water overnight, or even for up to 3 days. The leaf is juiced and mixed with honey, and several spoonfuls are consumed. Leaf of life is sometimes combined with Spanish needle (Bidens pilosa L.), search-mi-­heart (Rhytidophyllum tomentosum (L.) Mart.), and coconut oil (Cocos nucifera L.).

Minor uses (mentioned by more than 5% of people, but less than 20%) • Bellyache (from water, gas, or “cold in belly button”): In Kingston, people beat, wring, throw salt on the leaves and drink the juice, or they boil the leaves and drink the tea. Ginger (Zingiber officinale Roscoe) is sometimes added to the preparation. • Fever (“flush out infection”): In Kingston, people boil the bush to drink, or eat it raw with salt. It is also used to bathe. • Blood pressure: In Kingston, people chew two to three leaves, beat and salt the juice, or boil the leaves for 6  min and drink this remedy to treat high blood pressure.

Reported medicinal uses across the Caribbean According to the Caribbean pharmacopeia, the plant is recommended for headache (leaf as a poultice), common cold (leaf as a juice or tea), and cough (leaf as a tea). These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-­Robineau, 2014). Across individual countries: • Belize: A tea of the leaves is drunk for malaise, cough, common cold, sore throat, flu, and weakness. For asthma and wheezing, the juice from the leaves is taken with honey. For headache, swelling, bruises, skin boils, burns, pain, and cuts, the leaves are mashed and applied as a poultice. For eye infection and pinkeye, the juice from the leaf is applied as eye drops. For mastitis, the leaves are mashed with castor oil (Ricinus communis L.) and applied to the breasts. For bad spirits,

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the leaves are boiled and the water is used to bathe, and a bush is planted around the house (Balick and Arvigo, 2015). • Cuba: The leaves of Bryophyllum pinnatum are boiled as a bath for skin inflammation (of the legs). The crushed fresh leaves are applied as a poultice for leg ulcers. The leaves are chewed to ease cough, and the juice of the warm leaf is applied as drops for ear infections (Beyra et al., 2004). • Jamaica: A TRAMIL survey undertaken in 2009 identified Bryophyllum pinnatum as the second most widely reported medicinal plant. Among survey respondents who used medicinal plants to treat the common cold, 52% identified their use of Bryophyllum pinnatum (Picking et al., 2015). • Trinidad and Tobago: Leaf extracts are used to treat hypertension and kidney and urinary disorders (Lans, 2006).

Reported medicinal uses across the world Leaf preparations of Bryophyllum pinnatum are reportedly used for the treatment of fever and malaria across three continents, Africa, Asia, and Latin America (Willcox and Bodeker 2004). Across individual countries: • Brazil: The Maroons in Brazil use Bryophyllum pinnatum to treat flu, nasal congestion, and cough (Farias de Santana et al., 2016). A 36-year-old man with an active cutaneous leishmaniasis was successfully treated using 30 g wet weight of Bryophyllum pinnatum leaves per day for 14 days (Torres-Santos et al., 2003). Leishmaniasis, a tropical parasitic disease, is an extremely difficult disease to treat that affects more than 12 million people in 88 countries. • Germany: The use of Bryophyllum pinnatum has been documented in the official German D Monographs since 1989 (Fürer, 2014). • Ghana: The plant is used as a paste (poultice) for guinea worm and as a decoction for abdominal pain (Agyare et al., 2014). • India and Pakistan: The leaves of Bryophyllum pinnatum are crushed and applied directly for boils and head lice and to treat general skin problems (Saikia et al., 2006; Ahmad et al., 2016). The leaves are used internally to treat stones in the kidney, bladder, or pancreas or for general kidney problems (Mahmood et  al., 2013; Agarwal and Varma, 2015; Ahmad et al., 2016). In Pakistan, the leaves are used for high blood pressure and gastrointestinal problems (Ahmad et al., 2016). In India, the juice of boiled leaves is taken for diabetes (Tarak et al., 2011), and the juice of fresh leaves is used for the treatment of jaundice (Yadav and Dixit 2003). • Mauritius: A decoction of the leaves of Bryophyllum pinnatum is used to prepare a footbath to treat diabetic nerve damage, including pain in the feet (Mootoosamy and Mahomoodally, 2014). • Nigeria: The leaves are eaten alone, or together with the fruit of Garcinia kola Heckel, to treat high blood pressure (Gbolade, 2012), and herbalists use the

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aqueous leaf extract for the prophylaxis (prevention) of asthma and treatment of cough (Salami et al., 2013). • South Africa: A concoction of Bryophyllum pinnatum leaves is boiled together with two other plants (Opuntia stricta (Haw.) Haw. and Euphorbia hypericifolia L.) and applied as an enema to treat gonorrhea (De Wet et al., 2012). • Suriname: The leaves are heated and applied hot to sores on the skin (Mans et al., 2016). Maroons in Suriname use the plant to treat asthma in children (Ruysschaert et al., 2009). • Switzerland: Bryophyllum pinnatum was introduced as a medicine for the treatment of hysteria in 1921 by Rudolph Steiner, the founder of anthroposophical medicine. Leaf preparations have been used as tocolytic agents to prevent premature labor since 1970 and, in addition, to treat sleep disorders induced by restlessness, anxiety, overactive bladder, pain, and recurrent inflammation. Today, various preparations of Bryophyllum pinnatum are authorized by the state regulatory body, the Swiss Agency for Therapeutic Products (Fürer, 2014).

Clinical efficacy studies in humans In a double-blind, randomized, placebo-controlled study with 20 women in ­menopause for 8  weeks (ten patients taking three times per day two chewing ­capsules of 350 mg Bryophyllum pinnatum, and ten patients taking a placebo (lactose)), Bryophyllum pinnatum showed improvement in micturition (frequency of bladder emptying). The authors recommended that Bryophyllum pinnatum be ­further evaluated as a favorable treatment option for overactive bladder syndrome (Betschart et al., 2013). A multicenter, prospective observational study assessed the use of Bryophyllum pinnatum preparations in obstetrics and gynecology in Swiss clinics to document potential effects and possible adverse reactions. A total of 174 women and 208 prescriptions were recorded over 31 months, using an online questionnaire. The authors reported that 87% of the patients were pregnant. Of the 83% of pregnant women to whom Bryophyllum pinnatum was prescribed, 95% reported good or very good effectiveness. A further 14% of the patients received Bryophyllum pinnatum for sedation (calmness) against daytime restlessness and 5% for sleep problems, with good results. Thirteen percent of the patients suffered from hyperactive bladder, and two-thirds of them classified the effectiveness of the plant remedy as very good. In 92% of the cases, Bryophyllum pinnatum 50% chewable tablets were prescribed (Fürer et al., 2015). Twenty cancer patients suffering from sleep problems were treated with Bryophyllum pinnatum (350 mg tablets, corresponding to 50% of pressed leaf juice, 175  mg of fresh plant material per tablet, taking four tablets a day) and showed improvements in sleep quality (Simões-Wüst et al., 2015). Fifty pregnant women suffering from sleep problems were treated with Bryophyllum pinnatum (350 mg tablets, 50% pressed leaf juice) in a prospective,

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multicenter, observational study. Sleep quality, daily sleepiness, and fatigue were assessed at the beginning of the treatment, and after 2 weeks, and possible adverse drug reactions recorded. The authors reported that the number of wake-ups as well as the subjective quality of sleep was significantly improved. The Epworth Sleeping Scale decreased, indicating a decrease in tiredness during the day. There was no evidence for the prolongation of sleep duration, reduction in the time to fall asleep, or changes in the Fatigue Severity Scale. No serious adverse drug reactions were detected. The authors concluded that Bryophyllum pinnatum is a suitable treatment for sleep problems in pregnancy and that further clinical investigations are warranted (Lambrigger-Steiner et al., 2014). In a retrospective clinical study, 67 pregnant women experiencing early labor were treated with an intravenous infusion of a 100% aqueous leaf extract of Bryophyllum pinnatum to a maximum dose of 600 mg/h, corresponding to 30 mg of plant, for at least 48 h. When contractions stopped, treatment was switched to oral administration of 50% leaf extract at a mean dose of 200 mg every 2 h (corresponding to 100  mg of plant). The results were compared to a second closely matched group of 67 pregnant women, also experiencing early labor, but treated with standard anti-contraction medications (intravenous beta-agonist infusion with fenoterol to 4 mg/min, or hexoprenaline to 0.3 mg/min; after contractions stopped, the treatment was switched to an oral beta-agonist, fenoterol to 40 mg/day, or hexoprenaline to 4 mg/day). The results of the study demonstrated that Bryophyllum pinnatum was as effective as the standard treatment in prolonging pregnancy, increasing gestational age at delivery, and showed greater maternal tolerability. Thus, the mothers receiving the Bryophyllum pinnatum treatment experienced fewer side effects. Conventional labor inhibitors (tocolytics) can have important and well-documented adverse effects, notably on the cardiovascular system, in both mother and child (Plangger et al., 2006). A case series documented the treatment of restless legs syndrome (RLS) with Bryophyllum pinnatum preparations (chewable tablets or tincture). The authors reported improvement in RLS symptoms and sleep quality in four out of five cases and hypothesized that spasmolytic properties and the sedative effect of Bryophyllum pinnatum preparations played a role (von Manitius et al., 2019).

Safety information Side effects Treatment with Bryophyllum pinnatum (350 mg tablets, four times a day) was well tolerated by the majority of 20 cancer patients, with only six patients reporting discomfort possibly caused by the plant, including fatigue (three persons), dry throat (one person), agitation (one person), or difficult digestion (one person). No serious adverse reactions were detected (Simões-Wüst et al., 2015).

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Treatment with an intravenous infusion and subsequent oral extracts of Bryophyllum pinnatum to prevent early labor were better tolerated by patients, with far fewer side effects than those receiving treatment with conventional labor inhibitors (beta-agonists) (Plangger et al., 2006).

Toxicology Toxicity in cattle, following the ingestion of Bryophyllum pinnatum and other species of Bryophyllum, has been documented and linked to steroidal compounds known as bufadienolides (McKenzie et al., 1987; Reppas, 1995). However, the same toxic effect, specifically of Bryophyllum pinnatum, has not been seen in humans; it is thought that this is due to the relatively low concentrations of bufadienolides (Fürer, 2014). Bryophyllum pinnatum taken orally in chewing capsules proved safe in a clinical trial of overactive bladder syndrome in postmenopausal women (Betschart et al., 2013). The acute toxicity (72 h and 2 weeks) and subacute toxicity (35 days) of a water extract of the leaf was assessed in rats. The results of the toxicity study (LD50 value or lethal dose at which half the group of test animals died) demonstrated the absence of death and gross toxicological manifestations after an oral dose of up to 5 g/kg body weight, pointing to the safety of the water extract of the leaf (Ozolua et al., 2010). Normal female mice were given high doses of a water extract of Bryophyllum pinnatum for 30 days and subsequently showed no changes in the serum levels of alanine-aminotransferase (ALT), aspartate-aminotransferase (AST), urea, and alkaline phosphatase, indicating the absence of chronic toxicity to the liver, heart, or kidney (Torres-Santos et al., 2003).

Contraindications No information is available.

Use in pregnancy and breastfeeding Bryophyllum pinnatum is a tocolytic agent, used to prevent premature birth, with a documented history of safe use in pregnancy (see Clinical efficacy studies). The use of the plant during breastfeeding has not been documented, and caution is advised.

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The use of any medicinal plant preparation during pregnancy and breastfeeding should only be undertaken under the supervision of a qualified healthcare professional.

Drug interactions Juice extracted from the fresh leaves of Bryophyllum pinnatum was tested in the laboratory for its effect on a key human enzyme that is responsible for processing many pharmaceutical drugs in the body (cytochrome P450, CYP3A4). The results showed weak impact, indicating that clinically significant interactions with drugs metabolized by the same enzyme (CYP3A4) are unlikely (Picking, 2014; Delgoda and Picking, 2015). However, it is advised that the oral consumption of any Bryophyllum pinnatum preparation, in combination with prescription medicine or over-the-counter (OTC) drugs, is only undertaken with the advice and guidance of a qualified physician or pharmacist.

Recommendations Bryophyllum pinnatum is a widely used medicinal plant in tropical regions in the world. The Caribbean pharmacopeia recommends its use for headache, common cold, and cough (Germosén-Robineau, 2014). Use of the plant seems to be safe in pregnant women (Plangger et  al., 2006) but should always be undertaken under medical supervision.

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Agarwal K, Varma R (2015) Ethnobotanical study of antilithic plants of Bhopal district. Journal of Ethnopharmacology 174: 17-24. Agyare C, Spiegler V, Sarkodie H, Asase A, Liebau E, Hensel A (2014) An ethnopharmacological survey and in vitro confirmation of the ethnopharmacological use of medicinal plants as anthelmintic remedies in the Ashanti region, in the central part of Ghana. Journal of Ethnopharmacology 158: 255–263. Ahmad M, Zada Khan MP, Mukthar A, Zafar M, Sultana S, Jahan S (2016) Ethnopharmacological survey on medicinal plants used in herbal drinks among the traditional communities of Pakistan. Journal of Ethnopharmacology 184: 154–186. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press. Betschart C, von Mandach U, Seifert B, Scheiner D, Perucchini D, Fink D, Geissbühler V (2013) Randomized, double blind placebo controlled trial with Bryophyllum pinnatum versus placebo for the treatment of overactive bladder in postmenopausal women. Phytomedicine 20: 351–358.

Selected bibliography

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Beyra A, del Carmen León M, Iglesias E, Ferrándiz D, Herrera R, Volpato G, Godínez D, Guimarais M, Álvarez R (2004) Estudios etnobotánicos sobre plantas medicinales en la provincia de Camagüey (Cuba). Anales del Jardín Botánico de Madrid 61: 185-204. CABI (2020) Kalanchoe pinnata (cathedral bells) [original text by Rojas-Sandoval J, Acevedo-­ Rodriguez P]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/29328. Delgoda R, Picking D (2015) Potential drug interactions for commonly used medicinal plants & foods in Jamaica. Kingston, Jamaica: University of the West Indies, Natural Products Institute. De Wet H, Nzama VM, Van Vuuren SF (2012) Medicinal plants used for the treatment of sexually transmitted infections by lay people in northern Maputaland, KwaZulu–Natal Province, South Africa. South African Journal of Botany 78: 12-20. Farias de Santana B, Voeks RA, Funch LS (2016) Ethnomedicinal survey of a maroon community in Brazil’s Atlantic tropical forest. Journal of Ethnopharmacology 181: 37-49. Fürer K (2014) Bryophyllum pinnatum - metabolite profiling and in vitro effects on porcine detrusor contractility. Basel, Switzerland: University of Basel, PhD Dissertation. Fürer K, Simões-Wüst AP, Winkler A, Amsler N, Schnelle M, von Mandach U (2015) The application of Bryophyllum pinnatum preparations in obstetrics and gynaecology: a multicenter, prospective observational study. Forschende Komplementarmedizin 22: 231-6. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán. Gbolade A (2012) Ethnobotanical study of plants used in treating hypertension in Edo State of Nigeria. Journal of Ethnopharmacology 144: 1-10. Lambrigger-Steiner C, Simões-Wüst AP, Kuck A, Fürer K, Hamburger M, von Mandach U (2014) Sleep quality in pregnancy during treatment with Bryophyllum pinnatum: an observational study. Phytomedicine 21: 753-7. Lans CA (2006) Ethnomedicines used in Trinidad and Tobago for urinary problems and diabetes mellitus. Journal of Ethnobiology and Ethnomedicine 2: 45. Mahmood A, Mahmood A, Malik RN, Shinwari ZK (2013) Indigenous knowledge of medicinal plants from Gujranwala district, Pakistan. Journal of Ethnopharmacology 148: 714-723. Mans DRA, Beerens T, Magali I, Soekhoe RC, Schoone GJ, Oedairadjsingh K, Hasrat JA, van den Bogaart E, Schallig HDFH (2016) In vitro evaluation of traditionally used Surinamese medicinal plants for their potential anti-leishmanial efficacy. Journal of Ethnopharmacology 180: 70–77. McKenzie RA, Franke FP, Dunster PJ (1987) The toxicity to cattle and bufadienolide content of six Bryophyllum species. Australian Veterinary Journal 64: 298-301. Mootoosamy A, Mahomoodally MF (2014) Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius. Journal of Ethnopharmacology 151: 413–444. Ozolua RI, Idogun SE, Tafamel GE (2010) Acute and sub-acute toxicological assessment of aqueous leaf extract of Bryophyllum pinnatum (Lam.) in Sprague-Dawley rats. American Journal of Pharmacology and Toxicology 5: 145-151. Picking D (2014) The contemporary use of medicinal plants in Jamaica & assessment of potential medicinal plant-drug interactions of select plants. Kingston, Jamaica: University of the West Indies, PhD Dissertation. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell, S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Plangger N, Rist L, Zimmermann R, von Mandach U (2006) Intravenous tocolysis with Bryophyllum pinnatum is better tolerated than beta-agonist application. European Journal of Obstetrics & Gynecology and Reproductive Biology 124: 168-172. Reppas GP (1995) Bryophyllum pinnatum poisoning of cattle. Australian Veterinary Journal 72: 425-427. Ruysschaert S, van Andel T, Van de Putte K, Van Damme P (2009) Bathe the baby to make it strong and healthy: Plant use and child care among Saramaccan Maroons in Suriname. Journal of Ethnopharmacology 121: 148–170.

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Saikia AP, Ryakala VK, Sharma P, Goswami P, Bora U (2006) Ethnobotany of medicinal plants used by Assamese people for various skin ailments and cosmetics. Journal of Ethnopharmacology 106: 149–157. Salami EO, Ozolua RI, Okpo SO, Eze GI, Uwaya DO (2013) Studies on the anti-asthmatic and antitussive properties of aqueous leaf extract of Bryophyllum pinnatum in rodent species. Asian Pacific Journal of Tropical Medicine 6: 421–425. Simões-Wüst AP, Al Hassani T, Müller-Hübenthal B, Pittl S, Kuck A, Meden H, Eberhard J, Decker M, Fürer K, von Mandach U (2015) Sleep quality improves during treatment with Bryophyllum pinnatum: An observational study on cancer patients. Integrative Cancer Therapies 14: 452-459. Tarak D, Namsa ND, Tangjang S, Arya SC, Rajbonshi B, Samal PK, Mandal M (2011) An inventory of the ethnobotanicals used as anti-diabetic by a rural community of Dhemaji district of Assam, Northeast India. Journal of Ethnopharmacology 138: 345–350. Torres-Santos EC, Da Silva SA, Costa SS, Santos AP, Almeida AP, Rossi-Bergman B (2003) Toxicological analysis and effectiveness of oral Kalanchoe pinnata on a human case of cutaneous leishmaniasis. Phytotherapy Research 17: 801-803. von Manitius S, Flügel D, Gievers Steinlein B, Schnelle M, von Mandach U, Simões-Wüst AP (2019) Bryophyllum pinnatum in the treatment of restless legs syndrome: A case series documented with polysomnography. Clinical Case Reports 7: 1012-1020. Willcox ML, Bodeker G (2004) Traditional herbal medicines for malaria. British Medical Journal 329: 1156-1159. Yadav NP, Dixit VK (2003) Hepatoprotective activity of leaves of Kalanchoe pinnata Pers. Journal of Ethnopharmacology 86: 197-202.

Chapter 8

Chromolaena odorata (L.) R.M.King & H.Rob. (Asteraceae)

Synonyms: Eupatorium odoratum L., Osmia odorata (L.) Sch.Bip. (Adams, 1972) Common name in Jamaica: Jack-in-the-bush Other common name in Jamaica: Christmas bush (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_8

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Botanical characteristics and propagation Erect or scrambling shrub with multiple woody stems that can grow up to 3 m tall (Adams, 1972). Leaves opposite, triangular to elliptical, with coarsely toothed ­margins, aromatic when crushed. The leaf blades are trinerved a few millimeters after the base. White to soft pinkish flowers that are arranged in a much-branched inflorescence. The small, dry, one-seeded fruits called achenes are somewhat hairy and stick to clothes and fur. The species is considered native to tropical Central and South America, from Mexico, and the Caribbean to Brazil, but the exact limits of its native range remain uncertain (CABI, 2019). It can regenerate from the roots and spreads underground, contributing to its success as a weed. The seeds are hardy and can sprout after many years in the soil. Propagation is also possible by stem cuttings (Atagana et al., 2013).

Where to find the plant Jack-in-the-bush grows wild in the community along roadsides and trails. It is a widely distributed tropical shrub that is still expanding its range. It can form dense thickets in pure stands and is considered one of the worst weeds in the world, but is appreciated by some agriculturalists as it shortens fallow time in shifting cultivation (CABI, 2019).

Part used The leaf and branch.

Jamaican cultural uses and beliefs Jack-in-the-bush is a favorite aromatic tea bush that many people have drunk since their youth. It is often boiled with coconut juice or milk and spiced with nutmeg. The flowers can be fried with dumplings as food.

Jamaican medicinal uses Jack-in-the-bush is a popular remedy for the common cold.

Reported medicinal uses across the world

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Major uses (mentioned by more than 20% of people) • Common cold (and bronchitis): In Kingston and Windsor Forest, the dry leaves and branches are boiled as a tea for 7  min. Alternatively, the quailed (wilted) leaves are steeped green in hot water for 2 min. Jack-in-the-bush is sometimes combined with other plants, such as leaf of life (Bryophyllum pinnatum (Lam.) Oken), fevergrass (Cymbopogon citratus (DC.) Stapf), donkey weed (Stylosanthes hamata (L.) Taub.), cerasee (Momordica charantia L.), king-of-the-forest (Senna alata (L.) Roxb.), or fence stake (Gliricidia sepium (Jacq.) Walp.).

Reported medicinal uses across the Caribbean A TRAMIL survey undertaken in Jamaica in 2009 identified Chromolaena odorata as the third most commonly reported medicinal plant. Among people who reported using medicinal plants to treat the common cold, 33% identified drinking a decoction of Chromolaena odorata prepared from either fresh or dried leaves and stems, or leaves alone (Picking et al., 2015). In Belize, branches with leaves of Jack-in-the-bush are boiled and drunk to treat fever, cough, common cold, strained muscles, headache, nervousness, anxiety, depression, lethargy, and insomnia and to promote sweating. A bath of the leaves is also applied to treat general pain, headache, nervousness, and insomnia (Balick and Arvigo, 2015). In the Spanish-speaking Caribbean Diaspora in New York City, the species is an important spiritual plant known as rompe zaragüey (rompe saragüey) and used in Santería (an Afro-American religion) in cleansing baths to move ahead from evil and difficult situations in life (Vandebroek, unpublished results). Puerto Rican salsa legend Hector Lavoe (1946–1993), who moved to New  York City at the age of 16 years, has dedicated a whole song about the plant, in which he sings how rompe saragüey cleanses and “cuts out everything that is bad” (“rompe saragüey rompe todo lo malo”). The Caribbean pharmacopeia recommends application of the warm leaves to treat skin ulcers and boils. This recommendation is based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-Robineau, 2014).

Reported medicinal uses across the world A comprehensive review states that a history of traditional use exists for Chromolaena odorata in West Africa, but no known traditional use currently exists in eastern and southern Africa. The authors identify 15 categories of use in Asia and West Africa,

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most of which utilize only the leaf, with seven external and eight internal uses. Internal uses include the treatment of cough and common cold (plant squeezed in water), diarrhea (decoction), dysentery (leaf juice), fever resulting from malaria (leaf decoction combined with neem, Azadirachta indica A.Juss.), fungal infection (leaf juice), headache (leaf juice), stomachache (leaf juice), and stomach ulcer (leaf juice with honey). External uses include antiseptic (leaf juice), skin eruptions, infection and wounds and to stop bleeding (leaf juice), skin disease (leaf juice added to bath), toothache (leaf juice applied to tooth) (Owoyele et  al., 2005; Omokhua et al., 2016). Across individual countries: • Angola: Dried leaves are chewed in the management of sleeping sickness (human African trypanosomiasis) (Vahekeni et al., 2019). • Cameroon: The plant is used for skin infections, fungal infections, urinary infections, and flu (Ngane et al., 2006). • Ghana: A poultice (compress) of the leaves is applied to new and old wounds (Agyare et al., 2009). • India: In the south of the country, the leaves are applied as a paste to treat cuts (Xavier et al., 2014). • Malaysia: A poultice made from the leaves is traditionally applied to cuts and wounds to stop bleeding and promote healing. It is also applied topically as an antidote against the sting from the spine of the common sea catfish. A water decoction of the roots is used for fever and pain (analgesic remedy), and a leaf extract with salt is used as a gargle for sore throat and colds (Ling et al., 2007). • Nigeria: The plant is eaten as a vegetable in southern Nigeria, probably because of its high nutritional content (Omokhua et al., 2016). In Southwest Nigeria, the root and leaves are boiled with lime, or the leaves are squeezed to obtain the juice, and these preparations are taken by mouth in the treatment of malaria (Olorunnisola et al., 2013). • South America: The fresh leaves are prepared as a poultice for wounds, burns, and to stop bleeding; and as a decoction for the treatment of diarrhea, malaria, and diabetes (Boudjeko et al., 2015). • Suriname: Saramaccan Maroons use the leaves or whole bush in baths for healthcare of children, to treat diarrhea, epilepsy, and skin problems, to promote general child health, and to stimulate walking (Ruysschaert et al., 2009). • Thailand: The leaves of Chromolaena odorata are used for wounds and rashes (as a compress), for diabetes (oral administration), and as an insect repellent (in a spray). Preparations consisted of pounding the leaves, followed by boiling or a water infusion (Inta et al., 2013). • Vietnam: The leaves are used externally to treat leech bites, soft tissue wounds, burn wounds, skin infections, and dento-alveolitis (tooth socket inflammation) (Phan et al., 2001).

Safety information

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Modern research is increasingly confirming the antimicrobial, hemostatic (stops bleeding), and antioxidant properties of remedies prepared from the leaves of Chromolaena odorata both in vitro and in vivo (Pandith et al., 2013; Phan et al., 2001; Owoyele et al., 2005; Ling et al., 2007).

Clinical efficacy studies in humans No information is available.

Safety information Side effects In Southwest Nigeria, dizziness and convulsions were reported as possible side effects by malaria patients taking two cups twice daily of a preparation made with the leaves and root of Chromolaena odorata (Olorunnisola et al., 2013). Oral administration of the water extract of the leaf of Chromolaena odorata to male rats, in doses of 0.25 and 0.5 g/kg body weight for 14 days, interfered with the production of sperm cells, with a negative effect on male fertility (Yakubu et al., 2007).

Toxicology The roots and mature flower heads of Chromolaena odorata contain a class of potentially toxic chemical substances called pyrrolizidine alkaloids (PAs) that can be hazardous to the health of humans and animals. However, the leaves and stems appear to be almost devoid of PAs, making them less likely to pose a risk to human health (Biller et al., 1994; Omokhua et al., 2016). In mice, oral administration of a water extract of the leaf of Chromolaena odorata at a dose of 0.1 g/kg body weight induced mild clastogenicity (damage to the genetic material of cells) and mild liver toxicity, but strangely, gave a significant degree of protection when given prior to exposure of the mice to a known carcinogen, sodium arsenite (Akinwumi et al., 2009). However, a number of other animal studies have demonstrated either absence of toxicity or low levels of toxicity, for traditional preparations of Chromolaena odorata.

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An acute toxicity study in rats given an alcohol extract of the leaf by mouth, at doses of 0.2 and 0.4 g/kg body weight (length of study not stated) reported these doses to be safe and well tolerated (Aba et al., 2015). Another study showed that rats had good tolerance to single oral doses of an alcohol extract of the leaf of Chromolaena odorata as high as 2 g/kg body weight. In the same study, doses of 0.2 and 0.4 g/kg body weight given by mouth for 15 days did not produce any noticeable signs of toxicity (behavioral changes), nor mortality, during 30 days (Onkaramurthy et al., 2013). In yet another study, the water–alcohol extract of the leaf given orally to mice was found to be nontoxic in acute toxicity tests, with an LD50 (lethal dose at which half the group of test animals died) of more than 20  g/kg body weight (Ngane et al., 2006). In contrast, in a study performed to test the effects of an orally administered ethanol extract of the leaves of Chromolaena odorata in albino rats, three test groups demonstrated adverse effects on kidney function and intestine histology. The three test groups were given 0.05, 0.1, and 0.25 g/kg for 6 weeks, compared to a control group given distilled water (Anyanwu et al., 2017).

Contraindications No information is available.

Use in pregnancy and breastfeeding No information is available.

Drug interactions An alcohol extract of the leaf of Chromolaena odorata, given by mouth to diabetic rats in doses of 0.2 or 0.4 g/kg body weight, was capable of lowering blood sugar levels after a single administration for 1 day and also when given multiple times for 8 weeks (Onkaramurthy et al., 2013). This effect in animals needs to be confirmed in humans before jumping to conclusions, especially for water extracts such as teas, but there exists a possibility that the species may add to the effect of conventional diabetes medication, with the danger of driving down blood sugar levels too low (and thus causing hypoglycemia).

Selected bibliography

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Recommendations Chromolaena odorata is popularly drunk as a bush tea in rural and urban Jamaica and much appreciated by people as a cold medicine. The Caribbean pharmacopeia recommends its external use for skin ulcers and boils. Since scientific toxicology reports on the safety of its use internally are scanty, and there are concerns about the presence of potentially toxic plant compounds, no endorsements can be made at this point about internal use of this plant. People drinking the tea and experiencing any negative effects should immediately consult with a healthcare provider.

Selected bibliography Aba PE, Joshua PE, Ezeonuogu FC, Ezeja, MI, Omoja VU, Umeakuana PU (2015) Possible anti-­ diarrheal potential of ethanol leaf extract of Chromolaena odorata in castor oil-induced rats. Journal of Complementary and Integrative Medicine 12: 301-306. Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Agyare C, Asase A, Lechtenberg M, Niehues M, deters A, Hensel A (2009) An ethnopharmacological survey and in vitro confirmation of ethnopharmacological use of medicinal plants used for wound healing in Bosomtwi-Atwi-ma-Kwanwoma area, Ghana. Journal of Ethnopharmacology 125: 393-403. Akinwumi K, Odunola O, Osifeso O (2009) Effect of crude Chromolaena odorata leaf extract alone and in combination with sodium arsenite in mice. Toxicology Letters 189S: R12. Anyanwu S, Inyang IJ, Asemota EA, Obioma OO, Okpokam DC, Agu VO (2017) Effect of ethanolic extract of Chromolaena odorata on the kidneys and intestines of healthy albino rats. Integrative Medicine Research 6: 292-299. Atagana HI, Anyasi RO, Nogemane N (2013) Root development of Chromolaena odorata stem cuttings enhanced by indole butyric acid. Pakistan Journal of Botany 45: 1363-1368. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. Biller A, Boppre M, Witte L, Hartmann T (1994) Pyrrolizidine alkaloids in Chromolaena odorata. Chemical and chemoecological aspects. Phytochemistry 35: 615-619. Boudjeko T, Megnekou R, Woguia AL, Kegne FM, Ngomoyogoli JE, Tchapoum CD, Koum O (2015) Antioxidant and immunomodulatory properties of polysaccharides from Allanblackia floribunda Oliv stem bark and Chromolaena odorata (L.) King and H.E. Robins leaves. BMC Research Notes 8: 759. CABI (2019) Chromolaena odorata (Siam weed) [original text by Pasiecznik N]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 27 December 2019 at https://www.cabi.org/isc/datasheet/23248. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Inta A, Trisonthi P, Trisonthi C (2013) Analysis of traditional knowledge in medicinal plants used by Yuan in Thailand. Journal of Ethnopharmacology 149: 344-351. Ling SK, Pisar MM, Man S (2007) Platelet-activating factor (PAF) receptor binding antagonist activity of the methanol extracts and isolated flavonoids from Chromolaena odorata (L.) King and Robinson. Biological and Pharmaceutical Bulletin 30: 1150-1152.

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Ngane AN, Etame RE, Ndifor F, Biyiti L, Zollo PHA, Bouchet P (2006) Antifungal activity of Chromolaena odorata (L.) King & Robinson (Asteraceae) of Cameroon. Chemotherapy 52: 103–106. Olorunnisola OS, Adetutu A, Balogun EA, Afolayan AJ (2013) Ethnobotanical survey of medicinal plants used in the treatment of malaria in Ogbomoso, Southwest Nigeria. Journal of Ethnopharmacology 150: 71-78. Omokhua AG, McGaw LJ, Finnie JF, van Staden J (2016) Chromolaena odorata (L.) R.M. King & H. Rob. (Asteraceae) in sub-Saharan Africa: A synthesis and review of its medicinal potential. Journal of Ethnopharmacology 183: 112-122. Onkaramurthy M, Veerapur VP, Thippeswamy BS, Reddy TN, Rayappa H, Badami S (2013) Anti-­ diabetic and anti-cataract effects of Chromolaena odorata Linn., in streptozotocin-induced diabetic rats. Journal of Ethnopharmacology 145: 363-372. Owoyele VB, Adediji JO, Soladoye AO (2005) Anti-inflammatory activity of aqueous leaf extract of Chromolaena odorata. Inflammopharmacology 13: 479-484. Pandith H, Zhang X, Liggett J, Min KW, Gritsanapan W, Baek SJ (2013) Hemostatic and wound healing properties of Chromolaena odorata leaf extract. ISRN Dermatology: 168269. Phan TT, Wang L, See P, Grayer RJ, Chan SY, Lee ST (2001) Phenolic compounds of Chromolaena odorata protect cultured skin cells from oxidative damage: Implication for cutaneous wound healing. Biological and Pharmaceutical Bulletin 24: 1373-1379. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell, S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Ruysschaert S, van Andel T, Van de Putte K, Van Damme P (2009) Bathe the baby to make it strong and healthy: Plant use and child care among Saramaccan Maroons in Suriname. Journal of Ethnopharmacology 121: 148–170. Vahekeni N, Neto PM, Kayimbo MK, Mäser P, Théophile J, da Costa E, Falquet J, van Eeuwijk P (2019) Use of herbal remedies in the management of sleeping sickness in four northern provinces of Angola. Journal of Ethnopharmacology 112382. Xavier TF, Kannan M, Lija L, Auxillia A, Rose AKF, Kumar SS (2014) Ethnobotanical study of Kani tribes in Thoduhills of Kerala, South India. Journal of Ethnopharmacology 152: 78-90. Yakubu MT, Akanji MA, Oladiji AT (2007) Evaluation of antiandrogenic potentials of aqueous extract of Chromolaena odorata (L.) K. R. leaves in male rats. Andrologia 39: 235–243.

Chapter 9

Citrus × aurantium L. (Rutaceae)

Synonym: Citrus × vulgaris Risso (Adams, 1972) Common names in Jamaica: Sour orange, bitter orange, Seville orange

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_9

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Botanical characteristics and propagation Erect tree, up to 10 m high, with thorny branches. This species has more thorns and a denser canopy than the sweet orange. The flowers are white and fragrant. The ­relatively large aromatic leaves have a slightly winged petiole. The leaf blade is up to 20 cm long and 7 cm broad, with diminutively toothed margins. The bitter-tasting fruit is 7–9 cm in diameter, has a fairly thick, rough, and fragrant skin, and matures bright orange (Adams, 1972). The species is native to Southeast Asia (Morton, 1987). When Jamaican farmers find suckers along trails, they often transplant them on their farmland to add to their agroforestry orchard of fruit trees. Farmers also scatter the seeds on their land to obtain new plants.

Where to find the plant Sour orange grows commonly on people’s farm land.

Part used The fruit and leaf.

Jamaican cultural uses and beliefs The leaf and fruit skin are used to prepare a regular tea, and the fruit to make juice is considered rich in vitamin C. The fruit juice can clear rust from a utensil. Burning the dry fruit skin chases away mosquitoes. Animals are bathed with the juice of the fruit to treat mange and fleas. The inner part of the fruit is roasted and applied when the goat “hurt him foot.”

Jamaican medicinal uses Sour orange is a popular remedy for the common cold, both in Kingston and Windsor Forest.

Reported medicinal uses across the Caribbean

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Major uses (mentioned by more than 20% of people) • Common cold (including cough): The fruit is roasted in fire, after which the juice is squeezed, and honey is added; two teaspoons are taken or the juice is drunk with salt. The roasted fruit flesh can be scraped and eaten with sugar. Alternatively, a tea is boiled with the leaves.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Fever (and to keep cool): The roasted fruit is eaten or used to bathe. The fruit is roasted in the fire and the juice is drunk with salt or mixed with Dragon stout.

Reported medicinal uses across the Caribbean According to the Caribbean pharmacopeia, the plant is recommended for colic (fresh leaf decoction or infusion), cough (fruit juice), inflammation of the eye (conjunctivitis) (juice), diarrhea (juice), fever (fresh leaf decoction or infusion, fruit peel decoction), flatulence (fruit peel infusion), flu (fresh leaf decoction or infusion, juice), headache (fresh leaf decoction or infusion), and intestinal parasites (fresh leaf decoction). These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-Robineau, 2014). In Haiti, the plant is widely used for medicine, food, agriculture, construction, and voodoo. Medicinally, leaves of the plant are combined with the leaves of Annona muricata L., boiled and added to the bath water, while the leaves are used to massage the patient, acting as an antipyretic. Leaf decoctions serve to treat flu symptoms. A leaf decoction made with equal amounts of coffee leaves (Coffea arabica L.) is taken for emotional shock, to calm the patient, and to regularize the heartbeat. The fruit is cooked in the ashes of a fire, mixed with castor oil (Ricinus communis L.), and massaged into areas of bruising, to restore local circulation and remove coagulated blood. Leaves are heated and applied directly to the forehead to relieve headaches. The fruit is mashed with water and left overnight, and the resulting water is used to wash the face over a 2-week period, to remove skin blemishes. The juice from the fruit is used in a number of ways: Taken orally by patients suffering from anemia, mixed with sodium bicarbonate and taken orally in the morning to treat liver ailments, and mixed with large amounts of salt and used as an enema to treat digestive disorders (Paul and Cox, 1995).

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Reported medicinal uses across the world Across individual countries: • Africa: The cut-open fruit is applied directly to ulcers, yaws (a type of chronic bacterial infection), and areas of the body affected by arthritis (Morton, 2013). • China: Citrus  ×  aurantium preparations have a history of use in traditional Chinese medicine (TCM) for the treatment of a number of health conditions, including constipation, diarrhea, dysentery, indigestion, and as an expectorant (clears mucus) (Stohs and Shara, 2007). The dried fruit and, less commonly, the peel are used to treat a prolapsed uterus and anus, and for blood in the stool (Leung and Foster, 1996). • Europe: The peel of Citrus × aurantium is traditionally used to treat indigestion and related conditions, and in Germany, as a supportive measure in treating stomach complaints, such as insufficient formation of gastric juice, and as an appetite stimulant (Bisset and Wichtl, 1994). The German Commission E ­Monographs recognize the medicinal value of Citrus  ×  aurantium peel in the treatment of appetite loss and digestive complaints (Blumenthal et al., 1998). • Latin America and Italy: A leaf decoction is used as an anti-spasmodic, diaphoretic (induces sweating), stimulant, stomachic (improves action of the stomach and increases appetite), and tonic. The flowers are prepared as a syrup with reported sedative properties for nervous disorders and to help induce sleep. Infusions of the bitter bark are prepared and taken as an antipyretic (to reduce fever), stimulant, tonic, and vermifuge (to expel intestinal worms) (Morton, 2013). • USA: Citrus  ×  aurantium was traditionally used by the Eclectic physicians (early American herbalists) in the late nineteenth and early twentieth centuries as a digestive tonic and as a flavoring agent for other herbal medicines (Blumenthal, 2004; 2005).

Clinical efficacy studies in humans The use of Citrus × aurantium and one of its active phytochemicals (p-synephrine) increased significantly following a United States ban on the sale of dietary supplements containing a similar phytochemical (ephedrine), due to growing concerns about adverse events caused by ephedrine, including a number of fatalities. Other active phytochemicals from Citrus × aurantium include hesperidin, limonene, linalool, and linalyl-acetate. Both ephedrine and p-synephrine are thought to support weight loss by increasing the metabolic rate and/or decreasing energy intake and energy absorption. Citrus × aurantium extracts and p-synephrine are promoted as a safe alternative to ephedrine-containing supplements and plants, such as ephedra (Haaz et al., 2006).

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Most published clinical studies examined the use of Citrus × aurantium extracts for weight loss and as athletic performance aids, with few studies looking into the more traditional uses listed above. In a review of the literature, up to the year 2002, Blumenthal (2004; 2005) identified two studies relating to weight loss, three to increased thermogenesis (energy expenditure), and one assessing the safety profile of Citrus × aurantium extracts. A more recent review of clinical studies, also involving Citrus  ×  aurantium extracts and p-synephrine, identified 16 published studies. Eight of the studies measured the impact on metabolism and/or weight loss, seven studies measured the impact on cardiovascular outcomes (e.g., blood pressure, heart rate), and one study measured the impact on key drug metabolizing enzymes (highlighting potential herb–drug interactions). The authors of the review concluded that Citrus  ×  aurantium extracts, used in combination products, and p-synephrine used alone, increased energy expenditure and metabolic rate, with modest increases in weight loss when given for 6–12 weeks. They recommended longterm studies with larger study groups to further assess the efficacy of these products (Stohs et al., 2012). In one of the seven safety studies, a randomized, placebo-controlled, crossover, double-blind study with 25 healthy volunteers was used to investigate the cardiovascular effects of a dietary supplement containing Citrus  ×  aurantium ­ extract, green tea extract, and caffeine. The authors reported that no effects of the supplement were observed on heart rate, systolic and diastolic blood pressure, or mean arterial pressure (Seifert et al., 2011). In a study on weight loss, a double-blind, randomized, placebo-controlled study with 23 overweight healthy volunteers, in combination with a prescribed diet and exercise program, was used to investigate a supplement containing Citrus × aurantium extract, St. John’s wort, and caffeine. The authors concluded that the supplement was safe and effective, when combined with mild caloric restriction and exercise for promoting both weight and fat loss in healthy, overweight adults (Colker et al., 1999). A 2015 clinical study that was blind and placebo-controlled compared the effects of bitter orange dried flower capsules (500 mg containing 20% limonene, 32% linalool, and 5% flavonoid) on anxiety in postmenopausal women, against a control group receiving placebo capsules containing 500 mg of starch. Bitter orange significantly reduced the mean anxiety scores compared with the control group [adjusted mean difference: 1.99 (95% confidence interval, 3.64–0.34)] after an 8-week period of treatment (Farshbaf-Khalili et al., 2018). The bitter orange dried flower preparation was also tested in the same group of postmenopausal women for its impact on sleep quality. After 8 weeks, bitter orange significantly improved the mean sleep score compared with the control group [adjusted mean difference: −1.50 (95% confidence interval: −2.22 to −0.78)] (Kamalifard et al., 2018).

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Safety information Side effects The use of a supplement containing multiple plant ingredients, including Citrus × aurantium, gave rise to two reports of mild gastric problems, in a review of adverse reactions from plant food supplements across six European countries (Restani et al., 2016). Citrus  ×  aurantium was among the ten most frequently reported plant-based supplements for adverse reactions between 2006 and 2010, documented across selected European and Brazilian poison centers. However, most cases involved mild gastric symptoms that resolved without clinical intervention. A major limitation of the study was the lack of information detailing the type of extract and the plant part used (Lüde et al., 2016). The use of plant-based supplements with multiple ingredients makes it difficult to attribute the side effects specifically to Citrus × aurantium (Lüde et al., 2016; Restani et al., 2016). A review of 22 United States Food and Drug Administration (FDA) adverse event reports and ten published clinical case reports over a 5-year period, from 2004 to 2009, concluded that no serious adverse reactions could be directly attributed to Citrus × aurantium extracts or p-synephrine (Stohs, 2010).

Toxicology The Caribbean pharmacopeia, based on toxicity studies, has validated the safe use of several traditional preparations of Citrus × aurantium, such as fresh leaf decoction and infusion, fruit peel decoction and infusion, and fresh juice (Germosén-­ Robineau, 2014). A review of Citrus × aurantium and p-synephrine concluded that bitter orange extract is safe for human consumption and that there are no credible adverse effects associated with oral ingestion (Stohs and Preuss, 2010). A Citrus × aurantium extract, standardized to 50% p-synephrine, was assessed for acute and 14-day oral toxicity in rats. The results of the study demonstrated an exceedingly high LD50 (lethal dose at which half the group of test animals died) for Citrus × aurantium extract and p-synephyrine, showed a lack of adverse events and pathological effects at very high doses, and indicated a lack of mutagenicity (the capacity to cause mutations or genetic alterations). The authors stated that the results affirm and extend previous knowledge regarding the safety of bitter orange extract and p-synephrine (Deshmukh et al., 2017).

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Contraindications There are conflicting reports in the literature regarding contraindications for Citrus × aurantium. According to one study, the blood pressure of healthy young adults increased after taking a Citrus  ×  aurantium supplement containing 6% of p-synephrine (Bui et al., 2006). However, according to an extensive review of the scientific literature, the juice of Citrus  ×  aurantium showed no effect on blood pressure or heart rate in healthy subjects (Brinker, 2010). The author suggested contraindication for Citrus × aurantium in patients who suffer from ulcers of the stomach or intestine, due to bitter orange’s tonic effect on the gastrointestinal tract. In addition, bitter orange is also contraindicated in case of severe high blood pressure, rapid heart rate, and narrowangle glaucoma (a disease that damages the eye’s optic nerve and may lead to blindness), due to its p-synephrine content (although this was noted as speculative by the author). Its use is also contraindicated in children due to the presumption that excessive doses can produce “toxic effects” and in combination with ultraviolet light due to the potential photosensitizing effect.

Use in pregnancy and breastfeeding Traditional Chinese Medicine (TCM) texts advise caution in the use of Citrus × aurantium preparations during pregnancy (Dharmananda, n.d.).

Drug interactions The impact of crude extracts of Citrus × aurantium was tested and found to inhibit the activity of an important human drug metabolizing enzyme, CYP3A4, in laboratory-based screens (Guo et al., 2001). In addition, Citrus × aurantium contains two phytochemicals, 6′-and 7′-dihydroxybergamottin and bergapten, both of which have been shown individually to potently inhibit the same enzyme, CYP3A4 (FughBerman and Myers, 2004). Known inhibitors of CYP3A4 include grapefruit juice which has, to date, been shown to interact with over 40 pharmaceutical drugs, giving rise to dangerous increases in drug levels and serious adverse drug reactions (Delgoda and Picking, 2015). However, tests in the laboratory, while providing a useful first-stage indication of potentially harmful drug interactions, require confirmation in human clinical studies. Gurley et al. (2004) conducted studies in 12 healthy human subjects, who were given 350  mg of Citrus  ×  aurantium extract (standardized to 4% p-synephrine)

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twice a day for 28 days. A comparison of the results before and after supplementation demonstrated weak inhibition of the key drug metabolizing enzymes tested, CYPs 1A2, 2D6, 2E1, and 3A4. The authors concluded that the Citrus × aurantium extract tested posed minimal risk for cytochrome P450-mediated herb–drug interactions in humans. However, the authors noted that Citrus  ×  aurantium extracts are generally ­prepared by hot water extraction and that the key phytochemicals, 6′-and 7′-dihydroxybergamottin and bergapten, present in the fresh fruit juice, were notably absent from the tested extract (Gurley et al., 2004). Therefore, caution is advised in the use of the fresh fruit juice of Citrus × aurantium in combination with a significant number of pharmaceutical drugs, such as the immunosuppressant drug tacrolimus (Lin et al., 2011), the antihypertensive drug felodipine (Malhotra et al., 2001), the antiretroviral drug indinavir (Penzak et al., 2002), the antitussive (to treat cough) dextromethorphan (Di Marco et al., 2002), and other drugs metabolized by CYP3A4, including acetaminophen, codeine, cyclosporin, diazepam, and erythromycin (Edwards et al., 1999).

Recommendations The United States Food and Drug Administration (FDA) has classified the use of Citrus × aurantium in food as GRAS (Generally Recognized as Safe). According to Natural Medicines (formerly Natural Standard and Natural Medicines Comprehensive Database) (2007), Citrus × aurantium is probably safe when used by mouth in quantities available in food. It may be safe to use the essential oil of bitter orange applied topically or inhaled in aromatherapy. It may not be safe to use bitter orange in higher doses, because it contains the substance p-synephrine, which is a stimulant. However, this view is controversial and not universally accepted. Current research indicates that ingestion of Citrus × aurantium and p-synephrine in the form of supplements, fruit, juice, and other citrus food products are safe (Stohs et al., 2011). No credible adverse reactions have been directly attributed to bitter orange or, its primary phytochemical, p-synephrine. However, research does indicate that caution is necessary for those people taking a number of over-thecounter (OTC) and prescription drugs together with the fresh juice (out of theoretical concern), and the guidance of a qualified physician or pharmacist should always be sought. The use of Citrus × aurantium during pregnancy is traditionally cautioned against in Traditional Chinese Medicine (TCM). The effects of bitter orange in nursing women are not known, and its use should best be avoided during pregnancy or breastfeeding.

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Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Bisset NG, Wichtl M (1994) Herbal drugs and phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers. Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall T, Riggins CW, Rister RS (Eds.). Klein S, Rister RS (Trans.) (1998) The complete German Commission E Monographs: Therapeutic guide to herbal medicines. Austin, TX: American Botanical Council. Blumenthal M (2004; 2005) Bitter orange peel and synephrine. Parts 1 & 2. American Botanical Council. Accessed 27 December 2019 at http://abc.herbalgram.org/site/DocServer/Bitter_ Orange_Peel_and_Synephrine.pdf?docID=221. Brinker F (2010) Herbal contraindications and drug interactions plus herbal adjuncts with medicines, expanded 4th edition. Sandy: Eclectic Medical Publications. Bui LT, Nguyen DT, Ambrose PJ (2006) Blood pressure and heart rate effects following a single dose of bitter orange. The Annals of Pharmacotherapy 40: 53-57. Colker CM, Kaiman DS, Torina GC, Perlis T, Street C (1999) Effects of Citrus aurantium extract, caffeine, and St. John’s Wort on body fat loss, lipid levels, and mood states in overweight healthy adults. Current Therapeutic Research 60: 145-153. Delgoda R, Picking D (2015) Potential drug interactions for commonly used medicinal plants & foods in Jamaica. Kingston: University of the West Indies, Natural Products Institute. Deshmukh NS, Stohs SH, Magar CC, Kale A, Sowmya B (2017). Bitter orange (Citrus aurantium L.) extract subchronic 90-day safety study in rats. Toxicology Reports 4: 598-613. Dharmananda S (n.d.) Synephrine: Is Chih-shih (Zhishi) toxic? Accessed 27 December 2019 at http://www.itmonline.org/arts/syneph.htm. Di Marco MP, Edwards DJ, Wainer IW, Ducharme MP (2002) The effect of grapefruit juice and seville orange juice on the pharmacokinetics of dextromethorphan: The role of gut CYP3A and P-glycoprotein. Life Sciences 71: 1149-1160. Edwards DJ, Fitzsimmons ME, Schuetz EG, Yasuda K, Ducharme MP, Warbasse LH, Woster PM, Schuetz JD, Watkins P (1999) 6’,7’-dihydroxybergamottin in grapefruit juice and seville orange juice: Effects on cyclosporine disposition, enterocyte CYP3A4, and P-glycoprotein. Clinical Pharmacology and Therapeutics 65: 237-244. Farshbaf-Khalili A, Kamalifard M, Namadian M (2018) Comparison of the effect of lavender and bitter orange on anxiety in postmenopausal women: A triple-blind, randomized, controlled clinical trial. Complementary Therapies in Clinical Practice 31: 132-138. Fugh-Berman A, Myers A (2004) Citrus aurantium, an ingredient of dietary supplements marketed for weight loss: Current status of clinical and basic research. Experimental Biology and Medicine 229: 698-704. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán. Guo LQ, Taniguchi M, Chen QY, Baba K, Yamazoe Y (2001) Inhibitory potential of herbal medicines on human cytochrome P450-mediated oxidation: Properties of umbelliferous or citrus crude drugs and their relative prescriptions. Japanese Journal of Pharmacology 85: 399-408. Gurley BJ, Gardner SF, Hubbard MA, Williams DK, Gentry WB, Carrier J, Khan IA, Edwards DJ, Shah A (2004) In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Clinical Pharmacology and Therapeutics 76: 428-440. Haaz S, Fontaine KR, Cutter G, Limdi N, Perumean-Chaney S, Allison DB (2006) Citrus aurantium and synephrine alkaloids in the treatment of overweight and obesity: an update. Obesity Reviews 7: 79-88. Kamalifard M, Farshbaf-Khalili A, Namadian M, Ranjbar Y, Herizchi S (2018) Comparison of the effect of lavender and bitter orange on sleep quality in postmenopausal women: A triple-blind, randomized, controlled clinical trial. Women & Health 58: 851-865.

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Leung AY, Foster S (1996) Encyclopedia of natural ingredients used in foods, drugs, and cosmetics. New York: John Wiley. Lin SP, Wu PP, Hou YC, Tsai SY, Wang MJ, Fang SH, Chao PD (2011) Different influences on tacrolimus pharmacokinetics by coadministrations of zhi ke and zhi shi in rats. Evidence-Based Complementary and Alternative Medicine, Article ID 751671, 6 pages. Accessed 27 December 2019 at https://www.hindawi.com/journals/ecam/2011/751671/. Lüde S, Vecchio S, Sinno-Tellier S, Dopter A, Mustonen H, Vucinic S, Jonsson B, Müller D, Veras Gimenez Fruchtengarten L, Hruby K, De Souza Nascimento E, Di Lorenzo C, Restani P, Kupferschmidt H, Ceschi A (2016) Adverse effects of plant food supplements and plants consumed as food: Results from the poisons centres-based PlantLIBRA Study. Phytotherapy Research 30: 988-996. Malhotra S, Bailey DG, Paine MF, Watkins PB (2001) Seville orange juice-felodipine interaction: Comparison with diluted grapefruit juice and involvement of furocoumarins. Clinical Pharmacology and Therapeutics 69: 14-23. Morton J (1987) Sour orange. In: Fruits of warm climates. Miami, Florida: Julia F. Morton. Pp. 130-133. Morton J (2013) Fruits of warm climates. Brattleboro: Echo Point Books and Media. Natural Medicines (2007) Formerly Natural Standard and Natural Medicines Comprehensive Database. Citrus aurantium. Accessed 31 December 2007 at https://naturalmedicines.therapeuticresearch.com/. Paul A, Cox PA (1995) An ethnobotanical survey of the uses for Citrus aurantium (Rutaceae) in Haiti. Economic Botany 49: 249-256. Penzak SR, Acosta EP, Turner M, Edwards DJ, Hon YY, Desai HD, Jann MW (2002) Effect of seville orange juice and grapefruit juice on indinavir pharmacokinetics. Journal of Clinical Pharmacology 42: 1165-1170. Restani P, Di Lorenzo C, Garcia-Alvarez A, Badea, M, Ceschi A, Egan B, Serra-Majem L (2016) Adverse effects of plant food supplements self-reported by consumers in the PlantLIBRA Survey involving six European countries. PLoS One 11: e0150089. Seifert JG, Nelson A, Devonish J, Burke ER, Stohs S J (2011) Effect of acute administration of an herbal preparation on blood pressure and heart rate in humans. International Journal of Medical Sciences 8: 192-197. Stohs SJ, Shara M (2007) A review of the safety and efficacy of Citrus aurantium in weight management. In Obesity: Epidemiology, pathophysiology, and prevention. Bagchi D, Preuss HG (Eds). Boca Raton: CRC Press. Stohs SJ (2010) A review and assessment of the FDA adverse events reports and clinical case reports between April 2004 and October 2009. Journal of Functional Foods 2: 235–238. Stohs SJ, Preuss HG (2010) The safety of bitter orange (Citrus aurantium) and p-synephrine. HerbalGram 89: 34-39. Stohs SJ, Preuss HG, Shara M (2011) The safety of Citrus aurantium (bitter orange) and its primary protoalkaloid p-synephrine. Phytotherapy Research 25: 1421-1428. Stohs SJ, Preuss HG, Shara M (2012) A review of the human clinical studies involving Citrus aurantium (bitter orange) extract and its primary protoalkaloid p-synephrine. International Journal of Medical Sciences 9: 527-538.

Chapter 10

Clinopodium brownei (Sw.) Kuntze (Lamiaceae)

Synonyms: Satureja brownei (Sw.) Briq., Thymus brownei Sw., Micromeria brownei (Sw.) Benth. (Adams, 1972) Common name in Jamaica: Pennyroyal Other common name in Jamaica: Penny royal (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_10

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Botanical characteristics and propagation Aromatic, slender, and sprawling herb with square stems and opposite leaves that smell like mint. The flowers are solitary in the axils; they are light violet in color, with dark dots in the corolla throat, and a calyx mouth with a fringe of white hairs (Adams, 1972). The plant roots freely at the nodes and creeps, but ascends when flowering, with erect shoots sometimes up to 20  cm high. It is native to the ­southeastern United States, Mexico, Central and South America, and the West Indies (Acevedo-Rodríguez and Strong 2007). The plant can be easily propagated by stem cuttings.

Where to find the plant Clinopodium brownei spreads well in moist, damp, and warm areas and can be found in marshy places.

Part used Whole plant.

Jamaican cultural uses and beliefs The species is sometimes drunk as a morning tea for its aromatic flavor.

Jamaican medicinal uses Pennyroyal is much appreciated as a tea for women’s health.

Major uses (mentioned by more than 20% of people) • To clean the womb and treat blocked tubes (female sterility): In Windsor Forest, the whole plant or the leaves are steeped in boiling water and drunk. Often, dogblood (Rivina humilis L.) and vervine (Stachytarpheta jamaicensis (L.) Vahl and Stachytarpheta cayennensis (Rich.) Vahl) are added to the preparation.

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Minor uses (mentioned by more than 5% of people, but less than 20%) • Abortion: In Windsor Forest, it is said to draw pennyroyal in boiling water, mix it with Dragon stout, and drink the remedy. Other plants that are regularly added include vervine, marigold/mary ghoule (Sphagneticola trilobata (L.) Pruski), and three leaves of guacko (Mikania micrantha Kunth). These plant remedies are boiled together, a lukewarm Pepsi is added, and the preparation is drunk. • Menstrual cramps: In Windsor Forest, people draw the plant in boiling water and drink this remedy. • Menstruation (induces or regulates): In Windsor Forest, the leaves are steeped in boiling water and drunk.

Reported medicinal uses across the Caribbean In Jamaica, earlier work has reported that the use of a handful of green or dried pennyroyal is used to ease bronchial problems, stomach cramps, diarrhea, nausea, and flatulence. A root decoction is used to treat venereal disease, chest congestion, and regulate menstrual flow. The macerated plant is used as a poultice for the chest and head to relieve the common cold. Boiling pennyroyal with marigold (Sphagneticola trilobata), cerasee (Momordica charantia L.), and a rusty nail can induce abortion (Asprey and Thornton, 1953; Warner, 2007). Jamaican Maroon herbalist Ivelyn Harris recommends an infusion of Clinopodium brownei for the treatment of fever, headache, colds, nervousness, colic, and insect bites, a decoction to be used as a gargle for toothache, and a poultice to be applied to insect bites and stings (Harris, 2010).

Reported medicinal uses across the world Across individual countries: • Ecuador: The leaves and flowers are used to treat green diarrhea and stomachache (Ansaloni et al., 2010). • Guatemala: Clinopodium brownei is used for respiratory problems, including asthma, common cold, chest problems, sore throat, and sinusitis (Caceres et al., 1991) and macerated overnight in water and used to bathe children as a treatment for Chikiq’Yaj (dry sick—a condition in which sick children become dehydrated) (Vargas and Andrade-Cetto 2018).

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• Mexico: The whole plant is macerated in alcohol, together with love grass (Cuscuta aff. corymbosa) and the seed of avocado (Persea americana Mill.); the preparation is taken in the morning before breakfast to treat anemia or the evil eye (Martinez Alfaro, 1984). It is also used to treat bloody or mucous diarrhea, foamy diarrhea, and abdominal pain as a fresh maceration together with semi-­contract (Dysphania ambrosioides (L.) Mosyakin & Clemants) (Vera-Ku et al., 2010).

Clinical efficacy studies in humans A related species, Satureja khuzistanica Jamzad, which only grows in Iran, was used in a double-blind, randomized clinical trial in 21 type 2 diabetic patients with hyperlipidemia (people who suffer from diabetes and an abnormally high concentration of fats in the blood). Neither the patients nor the researchers knew until analysis of the data which of the patients was receiving tablets containing 250 mg of dried leaves of the plant or placebo tablets without an active substance. All patients were taking antidiabetic and antihyperlipidemic medications at least 3 months before the start of the study, and any changes in their medication were avoided. Treatment with Satureja khuzistanica for 60  days induced a significant decrease in levels of total cholesterol and “bad cholesterol” (LDL-cholesterol) in the blood, while the plant remedy increased blood levels of “good cholesterol” (HDL-cholesterol). There was no effect of Satureja khuzistanica treatment on blood sugar levels. In the control group of patients (who received placebo medication), no changes were observed in levels of LDL-cholesterol, HDL-cholesterol, total cholesterol, or blood sugar. The authors recommended supplementation of drug treatment with Satureja khuzistanica for diabetic type 2 patients with hyperlipidemia (Vosough-Ghanbari et al., 2008).

Safety information Side effects No information is available.

Toxicology No information is available.

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Contraindications No information is available.

Use in pregnancy and breastfeeding In Windsor Forest, several people commented on the plant’s ability to induce abortion, usually as part of a mixture with other bush medicines. Someone remarked that pennyroyal tea is good to get pregnant, but that a woman cannot drink it when she is pregnant. Someone else reported that, while “pennyroyal helps you to have children, [it can] throw away young belly too,” meaning that it can provoke spontaneous abortion. The literature also mentions that pregnant women are advised not to use the herb (Warner, 2007).

Drug interactions No information is available.

Recommendations Clinopodium brownei is used in the Americas and Jamaica for gastrointestinal and respiratory problems, and for women’s health, but there currently exists a lack of scientific studies on this species. It is advisable not to use pennyroyal during pregnancy because of reported cultural information about its abortifacient properties.

Selected bibliography Acevedo-Rodríguez P, Strong MT (2007) Catalogue of the seed plants of the West Indies. Accessed 27 December 2019 at https://naturalhistory2.si.edu/botany/WestIndies/. Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Ansaloni R, Wilches I, León F, Orellana A, Peñaherrera E, Tobar V, de Witte P (2010) Estudio preliminar sobre plantas medicinales utilizadas en algunas comunidades de las Provincias de Azuay, Cañar y Loja, para afecciones del aparato gastrointestinal. Revista Tecnológica ESPOL 23: 89-97. Asprey GF, Thornton P (1953) Medicinal plants of Jamaica. Part I. West Indian Medical Journal 2: 233–252.

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Caceres A, Alvarez AV, Ovando AE, Samayoa BE (1991) Plants used in Guatemala for the treatment of respiratory diseases. 1. Screening of 68 plants against gram-positive bacteria. Journal of Ethnopharmacology 31: 193-208. Harris I (2010) Healing herbs of Jamaica. Florida: AhHa Press Inc., 212pp. Martinez Alfaro MA (1984) Medicinal plants used in a Totonac community of the Sierra Norte de Puebla: Tuzamapan de Galeana, Puebla, Mexico. Journal of Ethnopharmacology 11: 203-221. Vargas JM, Andrade-Cetto A (2018). Ethnopharmacological field study of three Q’eqchi communities in Guatemala. Frontiers in Pharmacology 9: 1246. Vera-Ku M, Méndez-González M, Moo-Puc R, Rosado-Vallado M, Simá-Polanco P, Cedillo-­ Rivera R, Peraza-Sánchez SR (2010) Medicinal potions used against infectious bowel diseases in Mayan traditional medicine. Journal of Ethnopharmacology 132: 303–308. Vosough-Ghanbari S, Rahimi R, Kharabaf S, Zeinali S, Mohammadirad A, Amini S, Yasa N, Salehnia A, Toliat T, Nikfar S, Larijani B, Abdollahi M (2008) Effects of Satureja khuzestanica on serum glucose, lipids and markers of oxidative stress in patients with type 2 diabetes mellitus: A double blind randomized controlled trial. eCAM 7: 465–470. Warner, MF (2007) Herbal plants of Jamaica. Oxford: Macmillan, 176 pp.

Chapter 11

Cocos nucifera L. (Arecaceae)

Common names in Jamaica: Coconut, dreadnut

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_11

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Botanical characteristics and propagation Palm tree that reaches up to 30 m in height. All the leaflets of the leaf-blade are situated in the same plane (Adams, 1972). The old leaves break away cleanly from the trunk. The coconut tree has many thin roots that grow outward from the plant near the surface. The fruit consists of the following parts (from outside to inside): The green skin (exocarp), fibrous husk (mesocarp), and a hard, dark brown shell (endocarp). The white coconut meat is called the endosperm. Cocos nucifera is a native of the Old World tropics. Two independent geographical origins of coconut cultivation have been proposed: Island Southeast Asia and the southern margins of the Indian subcontinent (Gunn et al., 2011). The species was spread to eastern Polynesia and subsequently introduced to the Pacific coasts of Latin America, most likely by pre-Columbian seafarers from the Philippines. In the Indian Ocean, there was an expansion moderated by humans westward to Madagascar. Later, coconut was introduced by Europeans from India to the Atlantic coasts of Africa and South America and to the Caribbean (Gunn et al., 2011). Coconut trees are generally classified into two types: tall and dwarf. During our research, we recorded at least 15 named varieties or landraces in Windsor Forest, including brown maypan, light brown maypan, yellow maypan, red maypan, green maypan, greenskin native, dwarf yellow, dwarf red, dwarf orange, dwarf green, dwarf greenskin, san blas, native, ingraft native, and yellow jelly. This illustrates the rich cultural diversity associated with coconut trees in Jamaica. Coconut is propagated from the dry seeds, not from maturing seeds that carry “jelly water.” According to farmers in Windsor Forest, you “set” the seeds (put them down) in a cool place and “transplant them after they burst.” People stated that maypan and dwarf are the varieties that suffer most from a disease called lethal yellowing. It is believed that coconut trees deeper in the forest are better protected from the disease.

Where to find the plant Coconut trees grow all over the island, near the beach, in forested areas, and on farm land.

Part used Various parts of the fruit (jelly water, juice or milk, white “meat” that is called “trash” when it is grated and wrung out, and the brown fibrous husk) and sometimes also the root.

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Jamaican cultural uses Jamaicans say “we can’t [get] sick when we eat coconut.” Coconut milk is used in the preparation of bissy tea (Cola acuminata (P.Beauv.) Schott & Endl.), porridge, rundown, “all-in-one,” and on Sunday to make rice and peas. The root of the coconut tree is boiled as a regular tea with milk. Coconut trash is much appreciated to make coconut drops and gizarda. Burning the brown husk runs mosquitoes and brings a nice smell to the house. The fibers from the husk are useful to clean the house. The dark brown hard shell serves to make pendants for necklaces.

Jamaican medicinal uses In Kingston, the main use of home-boiled coconut oil is to treat the common cold.

Major uses (mentioned by more than 20% of people) • Common cold: The milk is boiled together with pimento (Pimenta dioica (L.) Merr.) seed or garlic (Allium sativum L.), and a tablespoon of the skimmed oil is ingested.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Asthma (to clean off the chest, commonly called “the stomach”): In Kingston, coconut milk and garlic are boiled together, and a teaspoon of the oil is given to babies. Coconut water is believed to clean off the chest. Some people mix the oil with camphor from the drugstore and drink this remedy. Please be aware that camphor is poisonous in larger doses. Toxicity symptoms of camphor include irritability, disorientation, lethargy, muscle spasms, vomiting, abdominal cramps, and fits. • Bellyache (including colon cleanse and ulcer): In Kingston, the coconut meat or trash is eaten for bellyache, or the milk is drunk with nutmeg (Myristica fragrans Houtt.), vanilla, cinnamon powder (Cinnamomum verum J.Presl), and salt. • Body cleanser: In Windsor Forest, the dry meat is eaten or the milk is drunk, or coconut roots are boiled as part of a root tonic. • Diabetes (sugar): In Kingston and Windsor Forest, coconut oil is considered a better oil for consumption for people with diabetes. The bark and shell (fibers)

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can be boiled and drunk for diabetes, either alone or mixed with breadfruit leaf (Artocarpus altilis (Parkinson) Fosberg) and bitter wood (not identified). • Heart sickness: A teaspoon of coconut oil, or a serving of jelly water, is believed to “wash off the heart”. • High blood pressure: In Windsor Forest, people boil the milk and skim the oil, prepare a root tonic using coconut roots, or boil the fruit husk to treat high blood pressure. • Skin care: In Kingston, the oil is extracted and rubbed, and the meat eaten to “soothe, moisture and clean” the skin.

Reported medicinal uses across the Caribbean Cocos nucifera has a long history of traditional use across the Caribbean (Lima et al., 2015). According to the Caribbean pharmacopeia, several preparations from the plant are recommended for a number of health conditions, summarized in Table 11.1. These recommendations are based on significant traditional uses documented in TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (TRAMIL, 2016). Across individual countries: • Haiti: A decoction of the dry pericarp (it is unclear if this refers to the fruit skin, fibrous husk, or hard shell) is used for oral treatment of absence of menstruation (amenorrhea), and the oil is applied as an ointment to burns (Weniger et  al., 1986). • Jamaica: The husk fiber extract is used to treat diabetes (Morrison, 1994). • Trinidad: Bark extract is used orally for a number of menstrual problems (amenorrhea and dysmenorrhea), and bark tea is used to treat venereal diseases (Wong, 1976). Table 11.1 Recommended health conditions across the Caribbean for Cocos nucifera

Recommended use Arthritis Asthenia and weakness Asthmaa Burns (superficial) Flu Skin boils Urinary tract infectiona

Plant part(s) used Fruit juice, external massage Fruit water, administered orally Fruit oil, administered orally Fruit oil, poultice Fruit oil, rubbed on chest Fruit oil, poultice or direct external application Fruit water, administered orally

Due to health risks associated with asthma and urinary tract infection, an initial medical evaluation with a qualified healthcare practitioner is advised, and any use of the plant remedy should be considered complementary to medical treatment (TRAMIL, 2016)

a

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Reported medicinal uses across the world Cocos nucifera has a long history of traditional use across the world (Lima et al., 2015). Across individual countries: • Brazil: An extract from the husk fibers of Cocos nucifera is used to treat diarrhea (Esquenazi et al., 2002). • Fiji: Coconut oil is used to prevent hair loss, and coconut water is used to treat kidney disease (Singh, 1986). • Ghana: People use coconut milk to treat diarrhea (Yartey et al., 1993). • Guatemala: The husk fiber extract is used as an antipyretic (lowers fever), to reduce kidney inflammation, and as a topical ointment for skin inflammation (dermatitis), abscesses, and injuries (Caceres et al., 1987). • Hawaii: A water extract of the husk fibers is ingested to treat asthma (Hope et al., 1993). • India: Infusions made with coconut flowers are used for the oral treatment of menstrual cycle disorders (Bhandary et al. 1995). • Indonesia: The oil is used as a wound ointment, the coconut milk is used as an oral contraceptive, and fever and diarrhea are treated with the root extract (Hirschhorn, 1983). • Kenya: The fruit is used to relieve skin rash caused by HIV infection (Nagata et al., 2011). • Malaysia: A decoction of the white flesh of the fruit is used to treat fever and malaria (Al-Adhroey et al., 2011). • Mexico: Extracts from the husk fibers of coconut are used to treat urinary tract infection (Calzada et al., 2007). • Mozambique: The fruit is consumed by men as an aphrodisiac (Amico, 1977). • Papua New Guinea: The leaves and roots of young plants are chewed as a treatment for stomachache and diarrhea (Holdsworth, 1992). • Peru: The water extract of fresh coconut fibers is used orally for asthma, as a diuretic, and for treating gonorrhea (Ramirez et al., 1988).

Clinical efficacy studies in humans There continues to be rigorous debate about the effects of consuming coconut products for human health. This is taking place within the context of contemporary dietary advice, which recommends limiting coconut intake, in particular coconut oil, due to its high content (92%) of saturated fat. In a review, commissioned by the New Zealand Heart Foundation, a leading specialist in oils and fats, Dr. Lawrence Eyres, stated that he found nothing which disputes the fact that coconut oil raises cholesterol and potentially increases the risk for coronary heart disease (Eyres, 2014; Eyres et al., 2016).

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A meta-analysis of prospective epidemiological studies reported that there is insufficient evidence to conclude that dietary saturated fat is associated with an increased risk of coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) (Siri-Tarino et al., 2010). There is growing evidence that various forms of coconut may lower levels of both total cholesterol and LDL cholesterol (“bad cholesterol”), reduce systolic blood pressure (the first number, e.g., “120” in the reading 120/80  mmHg), and improve insulin resistance (a precursor to and cause of diabetes), the latter being of particular interest in reducing the risk for Alzheimer’s disease (AD). In this latter area of AD research, a small number of clinical trials and animal studies, using coconut formulations, have reported significant improvement of cognition (mental ability) in AD patients. The use of coconut oil to treat or prevent AD is not yet supported by large cohort clinical data, and any positive findings are currently based on small clinical trials; however, coconut remains a product of interest requiring further investigation (Fernando et al., 2015). A review of the current evidence for the use of coconut oil, and derivative medium chain fatty acids (MCFAs), in the prevention and treatment of Alzheimer’s disease identified neuroprotective properties of coconut oil and MCFAs on cognition, amyloid-β pathogenicity, inflammation, and oxidative stress (Chatterjee et al., 2020). The authors concluded that coconut oil and MCFAs are promising treatments for preclinical Alzheimer’s disease, mild cognitive impairment, and symptomatic Alzheimer’s disease and that these should be explored further for the management of brain glucose hypometabolism. They also noted the positive influence of coconut oil and MCFAs on other chronic disorders which are risk factors for Alzheimer’s disease. These authors pointed to the increasing body of evidence that coconut oil contains phenolic compounds that can help combat inflammation, oxidative stress, and other Alzheimer’s disease-associated risk factors (Chatterjee et al., 2020). In a randomized, double-blind clinical trial in Brazil in 2007, 40 women aged 20–40 years with abdominal obesity (overweight), were given either 30 mL of coconut oil or 30 mL of a control oil (soybean, both at 270 kcal), for 12 weeks, together with a low carbohydrate diet and a daily 50-min walking regimen. The results indicated that, while both groups experienced a similar reduction in weight and body mass index (BMI), only the coconut oil group showed reduced waist size (1.4 cm) and demonstrated a reduction in LDL to HDL ratio, and an increase in HDL (“good cholesterol”). The authors concluded that dietetic supplementation with coconut oil does not cause an abnormal amount of fats in the blood (dyslipidemia) and, furthermore, appears to promote a reduction in abdominal obesity (overweight) (Assunção et al., 2009). It is worth noting that the form of coconut oil used in this research was virgin oil rather than refined or hydrogenated coconut oil. Researchers in the Philippines examined the association between coconut oil consumption and lipid profiles (the amount of cholesterol and fats called triglycerides in the blood) in a cohort (a group of people with shared characteristics) of 1839 Filipino women (aged 35–69 years). Coconut oil intake was measured using 24-h dietary recalls of individual intake (in which people were asked to recall what they ate). Cholesterol profiles were measured in plasma samples collected after an over-

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night fast. Dietary coconut oil intake was positively associated with optimum levels of HDL (“good cholesterol”), and the results appeared to support the beneficial effects of coconut oil use (Feranil et al., 2011). A study in 58 healthy volunteers assessed the effect of a diet enriched with saturated fats from fresh coconut on blood plasma lipids (fats) and red blood cell membrane fatty acid composition over 3  months. The study authors concluded that consumption of coconut rich in saturated fatty acids for 3 months had no significant harmful effect on red blood cells or lipid-related factors. They noted that, in fact, there was an increase in anti-atherogenic HDL levels (“good cholesterol”) and the anti-­inflammatory precursor dihomo-γ-linolenic acid (DGLA) in red blood cell lipids and suggested that coconut consumption may not have any harmful effects on cardiovascular risk in normal subjects. It should be noted that the authors reported a statistically significant increase in LDL levels (“bad cholesterol”) in the coconut group, but no significant increase in total cholesterol levels, and they suggested that the increase was within physiological variability in the study population of normal men and women (Nagashree et al., 2017). A 4-week randomized trial studied the effects of coconut oil, olive oil, and butter on blood lipids and other cardiovascular risk factors in healthy men and women. The results showed no statistically significant increases in LDL concentrations (“bad cholesterol”) for coconut and olive oil. Coconut oil significantly increased beneficial HDL (“good cholesterol”) and significantly lowered C-reactive protein (high levels are a marker for inflammation) compared with butter and olive oil. There were no significant differences in changes in weight, BMI (body mass index), percent body fat, fasting blood glucose, systolic or diastolic blood pressure among the coconut oil, olive oil, or butter groups (Khaw et al., 2018). An 8-week study investigated the effects of coconut and other vegetable oil supplements on anthropometric (size, shape, and body composition) and biochemical measurements in obese women on a low-calorie diet with lifestyle modifications. Seventy-five women (body mass index, BMI, 30–39.9 kg/m2) were randomized into four groups: Coconut oil (18 women), safflower oil (19 women), chia oil (19 women), and soybean oil placebo (19 women). Overall, the coconut oil group showed greater weight loss, reduced BMI, waist circumference, waist-to-height ratio, conicity index (abdominal obesity), and percentage body fat and increased percentage lean mass. The coconut group achieved the highest reductions in biochemical parameters for glycemia (blood sugar levels), glycated hemoglobin (a form of hemoglobin that is chemically linked to a sugar), the highest reduction in total cholesterol, LDL (“bad cholesterol”), and triglycerides, and an increase in HDL (“good cholesterol”). The coconut oil also had the most pronounced effect on abdominal adiposity (excess weight around the center of the body). The authors concluded that coconut oil is potentially effective for treating obesity as it encourages a loss of excess weight around the abdomen and an improvement in glycemic parameters without any undesirable alterations in the lipid profile (Oliveira-de-Lira et al., 2018). Adams and Bratt (1992) demonstrated that young coconut water can be used for preventing dehydration in well-nourished children with mild acute diarrhea who

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showed no clinical or laboratory signs of dehydration, when used in combination with age-appropriate foods. The trial was undertaken with 40 children, aged 6 weeks to 3 years, in Trinidad in 1991. Another study in Trinidad investigated the effect of two tropical fruit drinks, Cocos nucifera and Colubrina arborescens (Mill.) Sarg. (common name: mauby), on the control of hypertension (high blood pressure). Twenty-eight hypertensive persons were assigned to four equal groups, and their systolic (heart pumping) and diastolic (heart resting) blood pressure was recorded for 2 weeks before and then for another 2 weeks, while receiving one of four treatments. One group (the control) received bottled drinking water, the second coconut water, the third mauby, and the fourth group a mixture of coconut water and mauby. Significant decreases were observed in the mean systolic blood pressure for the groups receiving coconut water (71%), mauby (40%), and the mixture (43%). Significant decreases in the mean diastolic blood pressure were observed for the groups receiving coconut water (29%), mauby (40%), and the mixture (57%) (Alleyne et al., 2005). An open, randomized controlled trial was undertaken in 2003, in a premature child unit and postnatal ward of a major teaching hospital in an Indian metropolitan city, to compare the effect of massage with coconut oil versus mineral oil and placebo (powder), on growth velocity and neurobehavior in well-term and preterm babies. The conclusions of the research were that coconut oil massage has beneficial effects on weight gain in premature children compared to massage with mineral oil (Sankaranarayanan et al., 2005).

Safety information Side effects There is a concern that coconut oil, due to its high content of saturated fat, increases weight and raises the levels of total cholesterol and LDL (“bad cholesterol”). Jellin et al. (2009) stated that coconut oil could raise the level of LDL that increases the risk of cardiovascular events. However, these concerns have not been proven by scientific research, and there is contradictory evidence that shows that coconut oil might actually increase the level of HDL (“good cholesterol”) and has little to no effect on total or LDL cholesterol levels (see section on “Clinical efficacy studies in humans” above). A study comparing 32 patients with ischemic heart disease (characterized by a reduction of blood flow to the heart) and 16 healthy volunteers did not find a specific role of the consumption of coconut oil in the cause of this disease in Southern India (Kumar, 1997). Immediate hypersensitive reactions to coconut fruit are rare. There is a case of a 3-year-old child who experienced an allergic reaction after consuming fresh coco-

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nut (Tella et al., 2003). Another case reported two patients with severe nut allergies reacting negatively to the ingestion of Cocos nucifera. However, the authors also mentioned that “coconut allergy in patients with nut allergies is rare; these are the first two cases so far and therefore there is no general indication to advise patients with nut allergies to avoid using coconut” (Teuber and Peterson, 1999).

Toxicology The Caribbean pharmacopeia, based on toxicity studies, has validated the safe use of several traditional preparations of coconut for both internal and external use (see section on “Reported medicinal uses across the Caribbean”) (TRAMIL, 2016). The topical use of coconut oil is considered to be safe as a cosmetic ingredient according to a safety assessment (Burnett et al., 2011).

Contraindications No information is available.

Use in pregnancy and breastfeeding Coconut oil is safe for pregnant and breastfeeding women when used in amounts normally found in the diet. But the safety of using coconut oil in larger amounts is not known.

Drug interactions Coconut water has been shown to decrease mean systolic and diastolic blood pressure in humans (see Clinical efficacy studies above) (Alleyne et al., 2005). Alcohol extracts of the brown shell of Cocos nucifera lowered blood pressure in rats with hypertension (Bankar et al., 2011). Therefore, patients taking antihypertensive medication are advised to monitor their blood pressure to avoid the risk of hypotension (low blood pressure) and to discuss any concerns with a qualified healthcare practitioner.

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Recommendations Coconut oil is generally safe for most people if used in amounts found in foods. Also, it appears to be safe when applied to the scalp and body as a cosmetic ingredient. Because of the high saturated fat content in coconut oil, there are concerns that it may increase body weight if used in large quantities or that it could increase cholesterol levels. However, these concerns have not been substantiated, and a number of scientific studies appear to contradict these claims. The safety of coconut oil used in medicinal quantities is unknown. It is best to stick to the quantities found in food during pregnancy or breastfeeding (Jellin et al., 2009). If a history of high cholesterol exists, it is recommended that the internal use of coconut be discussed with a qualified healthcare professional and that cholesterol levels are regularly monitored.

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Adams W, Bratt DE (1992) Young coconut water for home rehydration in children with mild gastroenteritis. Tropical and Geographic Medicine 44: 149-153. Al-Adhroey AH, Nor ZM, Al-Mekhlafi HM, Amran AA, Mahmud R (2011) Evaluation of the use of Cocos nucifera as antimalarial remedy in Malaysian folk medicine. Journal of Ethnopharmacology 134: 988-991. Alleyne T, Roache S, Thomas C, Shirley A (2005) The control of hypertension by use of coconut water and mauby: Two tropical food drinks. West Indian Medical Journal 54: 3-8. Amico A (1977) Medicinal plants of Southern Zambesia. Fitoterapia 48: 101–139. Assunção ML, Ferreira HS, dos Santos, AF, Cabral CR Jr, Florencio TM (2009) Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity. Lipids 44: 593-601. Bankar GR, Nayak PG, Bansal P, Paul P, Pai KS, Singla RK, Bhat VG (2011) Vasorelaxant and antihypertensive effect of Cocos nucifera Linn. endocarp on isolated rat thoracic aorta and DOCA salt-induced hypertensive rats. Journal of Ethnopharmacology 134: 50-54. Bhandary MJ, Chandrashekar KR, Kaveriappa KM (1995) Medical ethnobotany of the Siddis of Uttara Kannada district, Karnataka, India. Journal of Ethnopharmacology 47: 149-158. Burnett CL, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG Jr, Shank RC, Slaga TJ, Snyder PW, Andersen FA (2011) Final report on the safety assessment of Cocos nucifera (coconut) oil and related ingredients. International Journal of Toxicology 30: 5s-16s. Caceres A, Giron LM, Alvarado SR, Torres MF (1987) Screening of antimicrobial activity of plants popularly used in Guatemala for the treatment of dermatomucosal diseases. Journal of Ethnopharmacology 20: 223-237. Calzada F, Yepez-Mulia L, Tapia-Contreras A (2007) Effect of Mexican medicinal plant used to treat trichomoniasis on Trichomonas vaginalis trophozoites. Journal of Ethnopharmacology 113: 248-251. Chatterjee P, Fernando M, Fenando B, Dias CB, Shah T, Silva R, Williams S, Pedrini S, Hillebrandt H, Goozee K, Barin E, Sohrabi HR, Garg M, Cunnane S, Martins RN (2020) Potential of coconut oil and medium chain triglycerides in the prevention and treatment of Alzheimer’s disease. Mechanisms of Ageing and Development 186: 111209.

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Esquenazi D, Wigg MD, Miranda MM, Rodrigues HM, Tostes JB, Rozental S, Alviano CS (2002) Antimicrobial and antiviral activities of polyphenolics from Cocos nucifera Linn. (Palmae) husk fiber extract. Research in Microbiology 153: 647-652. Eyres L (2014) Coconut oil and the heart. A review of the evidence for the New Zealand Heart Foundation. Accessed 27 December 2019 at https://www.heartfoundation.org.nz/resources/ coconut-oil-and-the-heart-evidence-paper. Eyres L, Eyres MF, Chisholm A, Brown RC (2016) Coconut oil consumption and cardiovascular risk factors in humans. Nutrition Reviews 74: 267–280. Feranil AB, Duazo PL, Kuzawa, CW, Adair LS (2011) Coconut oil is associated with a beneficial lipid profile in pre-menopausal women in the Philippines. Asia Pacific Journal of Clinical Nutrition 20: 190-195. Fernando WM, Martins IJ, Goozee KG, Brennan CS, Jayasena V, Martins RN (2015) The role of dietary coconut for the prevention and treatment of Alzheimer’s disease: Potential mechanisms of action. British Journal of Nutrition 114: 1-14. Gunn BF, Baudouin L, Olsen KM (2011) Independent origins of cultivated coconut (Cocos nucifera L.) in the Old World Tropics. PLoS ONE 6: e21143. doi:https://doi.org/10.1371/journal.pone.0021143. Hirschhorn HH (1983) Botanical remedies of the former Dutch East Indies (Indonesia). Part I: Eumycetes, Pteridophyta, Gymnospermae, Angiospermae (Monocotyledones only). Journal of Ethnopharmacology 7: 123-156. Holdsworth D (1992). Medicinal plants of the Gazelle peninsula, New Britain Island, Papua New Guinea, Part I. International Journal of Pharmacognosy 30: 185–190. Hope BE, Massey DG, Fournier-Massey G (1993) Hawaiian materia medica for asthma. Hawaii Medical Journal 52: 160-166. Intahphuak S, Khonsung P, Panthong A (2010) Anti-inflammatory, analgesic, and antipyretic activities of virgin coconut oil. Pharmaceutical Biology 48: 151-157. Jellin JM, Gregory PJ, et  al. (2009) Pharmacist’s Letter/Prescriber’s Letter Natural Medicines Comprehensive Database. 11th ed. Stockton, CA: Therapeutic Research Faculty, 2323 pp. Kumar PD (1997) The role of coconut and coconut oil in coronary heart disease in Kerala, South India. Tropical Doctor 27: 215-217. Khaw KT, Sharp SJ, Finikarides L, Afzal I, Lentjes M, Luben R, Forouhi NG (2018) Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women. BMJ Open 8: e020167. Lima EBC, Sousa CNS, Meneses LN, Ximenes NC, Santos Júnior MA, Vasconcelos GS, Vasconcelos SMM (2015) Cocos nucifera (L.) (Arecaceae): A phytochemical and pharmacological review. Brazilian Journal of Medical and Biological Research 48: 953-964. Morrison EY (1994) Local remedies. Yeh or nay. West Indian Medical Journal 43: 9. Nagashree RS, Manjunath NK, Indu M, Ramesh M, Venugopal V, Sreedhar P, Pavithra N, Nagendra HR (2017) Effect of a diet enriched with fresh coconut saturated fats on plasma lipids and erythrocyte fatty acid composition in normal adults. Journal of the American College of Nutrition 36: 330-334. Nagata JM, Jew AR, Kimeu JM, Salmen CR, Bukusi EA, Cohen CR (2011) Medical pluralism on Mfangano Island: Use of medicinal plants among persons living with HIV/AIDS in Suba District, Kenya. Journal of Ethnopharmacology 135: 501-509. Oliveira-de-Lira L, Santos EMC, de Souza RF, Matos RJB, Silva MCD, Oliveira LDS, Nascimento TGD, Schemly PALS, Souza SL (2018) Supplementation-dependent effects of vegetable oils with varying fatty acid compositions on anthropometric and biochemical parameters in obese women. Nutrients 10: 932-946. Ramirez VR, Mostacero LJ, Garcia AE, Mejia CF, Pelaez PF, Medina CD, Miranda CH (1988) Vegetales empleados en medicina tradicional Norperuana. Trujillo, Peru: Banco Agrario del Peru & NACL Univ. Trujillo.

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Sankaranarayanan K, Mondkar JA, Chauhan MM, Mascarenhas BM, Mainkar AR, Salvi RY (2005) Oil massage in neonates: An open randomized controlled study of coconut versus mineral oil. Indian Pediatrics 42: 877-884. Singh YN (1986) Traditional medicine in Fiji: Some herbal folk cures used by Fiji Indians. Journal of Ethnopharmacology 15: 57-88. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM (2010) Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. American Journal of Clinical Nutrition 91: 535-546. Tella R, Gaig P, Lombardero M, Paniagua MJ, García-Ortega P, Richart C (2003) A case of coconut allergy. Allergy 58: 825-826. Teuber SS, Peterson WR (1999) Systemic allergic reaction to coconut (Cocos nucifera) in 2 subjects with hypersensitivity to tree nut and demonstration of cross-reactivity to legumin-like seed storage proteins: New coconut and walnut food allergens. The Journal of Allergy and Clinical Immunology 103: 1180-1185. TRAMIL (2016) Caribbean pharmacopeia. Cocos nucifera. Accessed 27 December 2019 at http:// www.tramil.net/en/plant/cocos-nucifera. Weniger B, Rouzier M, Daguilh R, Henrys D, Henrys JH, Anton R (1986) [Traditional medicine in the Central Plateau of Haiti. 2. Ethnopharmacologic inventory]. Journal of Ethnopharmacology 17: 13-30. Wong W (1976) Some folk medicinal plants from Trinidad. Economic Botany 30: 103-142. Yartey J, Harisson EK, Brakohiapa LA, Nkrumah FK (1993) Carbohydrate and electrolyte content of some home-available fluids used for oral rehydration in Ghana. Journal of Tropical Pediatrics 39: 234-237.

Chapter 12

Crescentia cujete L. (Bignoniaceae)

Common names in Jamaica: Calabash, pakee, gourdy

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_12

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Botanical characteristics and propagation Evergreen tree growing up to 10 m high with a wide crown, rough bark, and twisted branches covered with clusters of simple leaves and gourd-like fruits. The nocturnal, pale green, bell-shaped flowers appear directly on the trunk and branches throughout most of the year (Morton, 1968). The large, green-colored and smooth-­ skinned fruits have a hard and durable shell and take about 6 months to ripen. The species is native to Mexico, Central and South America, and the West Indies (Acevedo-Rodríguez and Strong, 2007). According to farmers in Windsor Forest, Portland, you can “chop a limb [branch] and plant it” to propagate the species.

Where to find the plant The tree grows wild along trails and roadsides and in old pastures, thickets, and woodland margins (Adams, 1972).

Part used The young fruit.

Jamaican cultural uses and beliefs The calabash fruit is excellent to make a plate (dish), a cup or bowl, a handbag, a container to store water and keep it cool, and a shaker for music. It is often called the “rasta plate.” The calabash fruit can also be used for court dealings. A young calabash is picked, put in the fridge together with the name of the person with whom one has a court issue (written on parchment paper), and left there. The outcome is that the person battled in court cannot win.

Jamaican medicinal uses In Windsor Forest, calabash fruit is well known as a remedy for “blow to the back with battered blood.” In Kingston, it is known by fewer people who recognize the fruit’s internal cleansing and speech-promoting abilities.

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Major uses (mentioned by more than 20% of people) • Blow to the back with battered blood: In Windsor Forest, the young fruit is roasted in ashes until it is ready to juice the inside. Castor oil, or salt, is added, and the remedy is taken by mouth.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Body cleanser (“wash out,” “run yuh belly”): In Kingston, the inside of the fruit (pulp) is eaten, boiled, drained for its juice, or made into wine, and the preparation is taken orally. • Speech problems in children: According to local lore, when someone’s child (pickney) cannot talk or stammers, the child’s food should be served in a calabash plate. It is believed in Kingston that the medicine in the calabash will be activated by the hot food and improve speech. Alternatively, the fruit can be broken into two, boiled, and drunk as a remedy for this problem.

Reported medicinal uses across the Caribbean The Caribbean pharmacopeia recommends application of the juice from the heated leaf for earache. This recommendation is based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-­ Robineau, 2014). In the West Indies, a syrup made from the pulp is used for dysentery (infection of the intestines resulting in severe diarrhea with the presence of blood and mucus) and as a chest medicine (Lim, 2012). In the Antilles (and West Africa as well), the fruit pulp, macerated in water, is considered purifying, cooling, and a febrifuge (breaks fever); it is applied to the head for headaches and burns. The fruit pulp roasted in ashes is used for dropsy (swelling of the body). The fresh leaves and tops are ground and used externally for wound healing (Lim, 2012). Across individual countries: • Belize: The juice of the heated flowers is applied to treat earache. The inside of a fruit is cleaned and washed out, filled with water, and consumed to relieve hiccups. For cough, the pulp and seeds of two fruits are boiled in water, mixed with brown sugar, rum, and olive oil, and consumed by tablespoon for adults or by teaspoon for children. Common cold is treated with a syrup from the fruit. For cough, asthma, bronchitis, and congestion, the fruit mass, or a handful of leaves or flowers, is boiled with sugar and taken by teaspoon. Water drunk during a ritual from an empty fruit is also used to prevent high blood pressure. To “build the blood,” the leaves are boiled in salted water, or fried in oil with garlic, and consumed. Dysentery

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is treated by consuming the leaves as well. For the early stage of an inguinal hernia (situated in the groin area), the fruit is heated in ashes, wrapped in a cloth, and massaged over the affected area; also, the fruit is partially filled with honey and roasted over coals until soft, and the juice is consumed by tablespoon. To expel a retained placenta, the bark or leaves are boiled and drunk (Balick and Arvigo, 2015). Cuba: The fruit flesh of Crescentia cujete is cooked, pounded, and stirred by Cubans and Cuban-Haitian populations in plant mixtures and consumed to treat respiratory problems (asthma, pneumonia, catarrh, and tuberculosis), stomach pains, venereal infections, and female health (cold of the uterus, menstrual irregularity, female infertility). The fruit is cooked, pounded, and mixed with honey and consumed for the treatment of catarrh and intestinal parasites. The flowers are mixed with plantain (Musa × paradisiaca L.) to relieve earache (preparation and administration were not specified) (Cano and Volpato, 2004; Volpato et al., 2009). Curaçao: The pulp of roasted fruits, administered as a syrup (called “strop di kalbas”), has a good reputation as an effective remedy for the cough, common cold, and other pulmonary ailments. A decoction of calabash pulp and leaves of lignum vitae (Guaiacum officinale L.) is a local remedy for diabetes. The fruit flesh is applied to the skin for healing coral cuts and wounds and to prevent skin poisoning by manchineel (Hippomane mancinella L.) (Morton, 1968). Jamaica: The young fruit of calabash is boiled for 90 min, together with fresh cut (Justicia pectoralis Jacq.), milk wiss (Pinochia floribunda (Sw.) M.E.Endress & B.F.Hansen), sea onion (Hymenocallis latifolia (Mill.) M.Roem.), and Joseph’s coat (Acalypha wilkesiana Müll.Arg.), and drunk by teaspoon for asthma and bronchitis (Austin and Thomas, 2009). Asprey and Thornton (1953) reported on the traditional Jamaican use of Crescentia cujete to treat coughs and colds and to “clean the womb,” in which young fruits are roasted, the juice squeezed out, and taken with castor oil. The fruit pulp is also considered to be a purgative (a strong laxative) when mixed with castor oil, and of use as a poultice. Barham (1794) stated that the fruit pulp was well known to “force the menses, birth and afterbirth,” a description that fits the traditional classification of an emmenagogue. Beckwith (1927) described the use of young calabash in a cough syrup recipe that consisted of nine young roasted and strained calabash fruits, 1 lb of sugar, five sweetsop leaves, five leaves of chigger nut (Tournefortia hirsutissima L.), boiled down to a thick consistency, after which a pint of wine is added, as well as a measure of overproof rum. Of this remedy, a wineglass was to be taken three times a day. Martinique: A decoction of the leaf is drunk for chest pain, chills and fever. The leaf is crushed and applied externally on sprains (Longuefosse and Nossin, 1996).

Reported medicinal uses across the world Across individual countries: • Bolivia: A jam of the fruit pulp is consumed for kidney problems, an infusion of the young (immature) fruit is drunk for ovary problems, and the crude young

Clinical efficacy studies in humans

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• • • • • • •

• • • • •

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fruit pulp is eaten for liver problems. It is well known for its curative effect on the reproductive and urinary system (Hajdu and Hohmann, 2012). Colombia: The internal part of the fruit is prepared as a decoction and taken orally as a treatment for flu (Gomez-Estrada et  al., 2011). In north-western Colombia, the unripe fruits (preparation and administration method not specified) are one of a number of plants used by traditional healers to treat snakebite (Otero et al., 2000). French Guiana: A compress (poultice) of the bark is applied to skin lesions caused by Leishmaniasis (a parasitic disease transmitted by the bite of sand flies that affects the skin or internal organs) (Odonne et al., 2011). Guinea: A decoction of the leaf is used to treat diarrhea (Baldé et al., 2016). The branch is boiled and drunk to treat diabetes (Diallo et al., 2012). India: The fruit pulp is applied in a compress (poultice) as a chest medicine (Lim, 2012). Ivory Coast: A decoction of the leaf is drunk for high blood pressure because of its diuretic effect (promotes urination) (Lim, 2012). Mexico: The bark and fruit pulp are used for dermatological problems, respiratory ailments, and conditions of the muscular-skeletal system (internal and external administration to heal bruises and sprains) (Frei et al., 1998). Nicaragua: A syrup of the fruit is used in midwifery to calm fever (Coe, 2008). Peru: The leaves are used to treat malaria (Ruiz et al., 2011). The fruit pulp is mixed with the dye of Genipa americana L. and painted over the child’s body, so that it will gain weight. The leaves are boiled with ginger (Zingiber officinale Roscoe), basil (Ocimum campechianum Mill.), avocado (Persea americana Mill.), an undetermined species (Grias spp.), and gungo pea leaves (Cajanus cajan (L.) Millsp.), and the decoction is taken for complications after childbirth (Odonne et al., 2013). South Africa: An unspecified preparation of the seed is given internally for snake bites and applied to the skin as well (Lim, 2012). Sumatra, Indonesia: A decoction of the bark is used to clean wounds, and the pounded leaves are used as a compress (poultice) for headache (Lim, 2012). Venezuela: A decoction of the bark is given internally for diarrhea (Lim, 2012). Vietnam: The fruit serves as a cough medicine, laxative, and stomach medicine (Lim, 2012). West Africa: The pulp roasted in ashes is mildly purgative and diuretic (promotes urination) (Lim, 2012).

Clinical efficacy studies in humans No information is available.

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Safety information Side effects The juice of the fresh heated leaf, applied externally to the skin of three rabbits, did not cause swelling, redness, or irritation (Germosén-Robineau, 2014). During our survey work in Kingston, people mentioned that the fruit is a laxative.

Toxicology The Caribbean pharmacopeia mentions potential toxicity of the fruit due to the chemical compound hydrogen cyanide (Germosén-Robineau, 2014). The presence of cyanogenic glycosides (chemical compounds that can release hydrogen cyanide when macerated) was also mentioned by other researchers (Ortiz de Montellano and Browner, 1985). However, according to another author (Lim, 2012), the wet and dry fruit pulp did not contain hydrogen cyanide when analyzed; he added that young fruits are traditionally pickled or candied and eaten as a food (country not specified). This finding was supported by analysis of the mature fruit pulp in Nigeria, in which the level of hydrogen cyanide was found to be far below the accepted safety level (although the safety level was not stated) (Ogbuagu, 2008). In contrast, another group of Nigerian researchers subsequently recorded a hydrogen cyanide concentration in the fruit pulp of 0.11 ppm (parts per million), which they claimed exceeds the World Health Organization’s value for safe levels in drinking water, the latter being 0.01  ppm. These authors cautioned that the continual consumption of the fruit may eventually lead to hydrogen cyanide toxicity (Ejelonu et al., 2011). Infusion of the leaf in doses of 1–10 g/kg body weight did not demonstrate toxicity in mice (Germosén-Robineau, 2014). During our survey work in Windsor Forest, someone attested that calabash is a poison.

Contraindications No information is available.

Use in pregnancy and breastfeeding In Mexico, a concoction and infusion of the cortex of Crescentia cujete has been reported to speed up childbirth by stimulating contractions of the uterus (Ortiz de Montellano and Browner, 1985; Zamora-Martinez and Pola, 1992).

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In Belize, traditional healers reported that Crescentia cujete should not be taken during pregnancy, as it may cause abortion (Balick and Arvigo, 2015). The Caribbean pharmacopeia advises against internal use of the fruit pulp during pregnancy because of its ability to provoke abortion in cattle (Germosén-­ Robineau, 2014). However, human data is lacking.

Drug interactions No information is available.

Recommendations Crescentia cujete has a long and widespread history of use for conditions of the respiratory and urinary system, the muscular-skeletal system (muscles and bones), and women’s health. Human experimental data is lacking, but based on cultural knowledge about the plant’s ability to provoke abortion, it is best to entirely avoid the use of the fruit, leaves, and bark during pregnancy. Caution is warranted for consumption of the fruit, given mixed reports about potential hydrogen cyanide toxicity.

Selected bibliography Acevedo-Rodríguez P, Strong MT (2007) Catalogue of the seed plants of the West Indies. Accessed 27 December 2019 at https://naturalhistory2.si.edu/botany/WestIndies/. Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Asprey G, Thornton P (1953) Medicinal plants of Jamaica Part I. West Indian Medical Journal 2: 233–252. Austin S, Thomas MB (Eds.) (2009) Common medicinal plants of Portland, Jamaica. 2nd edition. Charleston, SC: CIEER, Inc. Baldé AM, Traoré MS, Baldé MA, Barry MS, Diallo A, Camara M, Traoré S, Kouyaté M, Traoré S, Ouo-Ouo S, Myanthé AL, Keita N, Haba NL, Goumou K, Bah F, Camara A, Diallo MST, Sylla M, Baldé ES, Diané S, Pieters L, Oularé K (2016) Ethnomedical and ethnobotanical investigations on the response capacities of Guinean traditional health practitioners in the management of outbreaks of infectious diseases: The case of the Ebola virus epidemic. Journal of Ethnopharmacology 182: 137–149. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. Barham H (1794) Hortus Americanus: The trees, shrubs, and other vegetable productions, of South-America and the West-Indian Islands, and particularly of Jamaica. Kingston: Alexander Aikman, 266 pp.

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Beckwith MW (1927) Notes on Jamaican ethnobotany. New  York: Vassar College Folklore Foundation, 47 pp. Cano JH, Volpato G (2004) Herbal mixtures in the traditional medicine of Eastern Cuba. Journal of Ethnopharmacology 90: 293–316. Coe FG (2008) Rama midwifery in eastern Nicaragua. Journal of Ethnopharmacology 117: 136–157. Diallo A, Traore MS, Keita SM, Balde MA, Keita A, Camara M, Van Miert S, Pieters L, Balde AL (2012) Management of diabetes in Guinean traditional medicine: An ethnobotanical investigation in the coastal lowlands. Journal of Ethnopharmacology 144: 353–361. Ejelonu BC, Lasisi AA, Olaremu AG, Ejelonu OC (2011) The chemical constituents of calabash (Crescentia cujete). African Journal of Biotechnology 10. 19631-19636. Frei B, Baltisberger M, Sticher O, Heinrich M (1998) Medical ethnobotany of the Zapotecs of the Isthmus-Sierra (Oaxaca, Mexico): Documentation and assessment of indigenous uses. Journal of Ethnopharmacology 62: 149–165. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Gomez-Estrada H, Diaz-Castillo F, Franco-Ospina L, Mercado-Camargo J, Guzman-Ledezma J, Medina JD, Gaitan-Ibarra R (2011) Folk medicine in the northern coast of Colombia: An overview. Journal of Ethnobiology and Ethnomedicine 7: 27-37. Hajdu Z, Hohmann J (2012) An ethnopharmacological survey of the traditional medicine utilized in the community of Porvenir, Bajo Paraguá Indian Reservation, Bolivia. Journal of Ethnopharmacology 139: 838–857. Lim TK (2012) Crescentia cujete. In: Edible medicinal and non-medicinal plants. Volume 1, fruits (Lim, Ed.). Dordrecht, The Netherlands: Springer, pp. 480-485. Longuefosse JL, Nossin E (1996) Medical ethnobotany survey in Martinique. Journal of Ethnopharmacology 53: 117-142. Morton JF (1968) The calabash (Crescentia cujete) in folk medicine. Economic Botany 22: 273-280. Odonne G, Berger F, Stien D, Grenand P, Bourdy G (2011) Treatment of leishmaniasis in the Oyapock basin (French Guiana): A K.A.P. survey and analysis of the evolution of phytotherapy knowledge amongst Wayãpi Indians. Journal of Ethnopharmacology 137: 1228–1239. Odonne G, Valadeau C, Alban-Castillo J, Stien D, Sauvain M, Bourdy G (2013) Medical ethnobotany of the Chayahuita of the Paranapura basin (Peruvian Amazon). Journal of Ethnopharmacology 146: 127–153. Ogbuagu MN (2008) The nutritive and anti-nutritive compositions of calabash (Crescentia cujete) fruit pulp. Journal of Animal and Veterinary Advances, 7: 1069-1072. Ortiz de Montellano BR, Browner CH (1985) Chemical bases for medicinal plant use in Oaxaca, Mexico. Journal of Ethnopharmacology 13: 57-88. Otero R, Nunez V, Barona J, Fonnegra R, Jimenez SL, Osorio RG, Saldarriaga M, Diaz A (2000) Snakebites and ethnobotany in the northwest region of Colombia. Part III: Neutralization of the haemorrhagic effect of Bothrops atrox venom. Journal of Ethnopharmacology 73: 233-241. Ruiz L, Ruiz L, Maco M, Cobos M, Gutierrez-Choquevilca AL, Roumy V (2011) Plants used by native Amazonian groups from the Nanay River (Peru) for the treatment of malaria. Journal of Ethnopharmacology 133: 917–921. Volpato G, Godinez D, Beyra A, Barreto A (2009) Uses of medicinal plants by Haitian immigrants and their descendants in the province of Camaguey, Cuba. Journal of Ethnobiology and Ethnomedicine 5: 16-25. Zamora-Martinez MC, Pola CNP (1992) Medicinal plants used in some rural populations of Oaxaca, Puebla and Veracruz, Mexico. Journal of Ethnopharmacology 35: 229-257.

Chapter 13

Cymbopogon citratus (DC.) Stapf (Poaceae)

Synonym: Andropogon citratus DC. (Adams, 1972) Common names in Jamaica: Fevergrass, lemongrass Other common names in Jamaica: Fever grass, lemon grass (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_13

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Botanical characteristics and propagation Perennial aromatic grass that grows in dense clumps. The fragrant, narrow leaves measure up to 1 m or more and have a noticeable smell of lemon. The inflorescence is compound, a panicle. The species is considered native to Malaysia, but is now growing in all continents except Antarctica. It was one of the species of the historical spice route from Asia to Europe and now produces a commercially important lemongrass oil (CABI, 2020). Propagation can be done by division of established clumps. In Jamaica, farmers report that it is easy to transplant a side-shoot with roots because it “catches quickly.”

Where to find the plant Found commonly cultivated in yards and on farm land.

Part used The leaf and sometimes the root.

Jamaican cultural uses Fevergrass is very appreciated for its nice aroma as a regular tea bush in the morning and evening. People say: “When you feel bad, you take a cup of it.” In the kitchen, it can be used to wash and season meat. The plant is put in clothes and inside the house for its nice smell. Some Jamaican farmers in Windsor Forest know it as an insect repellent on vegetable crops. As a cosmetic, it reportedly cleanses the oily glands on the face.

Jamaican medicinal uses Widely used for fever.

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Major uses (mentioned by more than 20% of people) • Fever: Some people boil nine leaves, others boil it quailed (wilted) or dry. The plant is also rubbed to smell it, or put in the bed at night to sleep with it as a treatment for fever.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Common cold (and warms the body): The leaves are boiled for 3 min. They are either steeped green in hot water, or boiled quailed (wilted), and drunk. • Bellyache (caused by gas or indigestion): The leaves are boiled and drunk. • Menstrual cramps: In Windsor Forest, the leaves are either boiled or steamed for 5–6 min in boiling water and drunk.

Reported medicinal uses across the Caribbean A TRAMIL survey undertaken in Jamaica in 2009 identified Cymbopogon citratus as the 18th most widely reported medicinal plant. Among survey respondents who reported using medicinal plants to treat fever, 70% identified taking an infusion or decoction of Cymbopogon citratus prepared from fresh or dried leaves (Picking et al., 2015). In the Caribbean, Cymbopogon citratus is considered a fever-reducing plant, particularly suitable for reducing fever in children, hence the common name, fevergrass (Chevallier, 2001). A survey in Trinidad, using the TRAMIL methodology, identified similar patterns of use to those in Jamaica with a decoction of the leaves and roots of Cymbopogon citratus being the most reported medicinal plant to treat fever. The plant was also widely reported in the treatment of the common cold and cough and for cooling/cleansing (Clement et al., 2015). The Caribbean pharmacopeia recommends oral consumption of a water decoction or infusion of the leaf for colds, cough, diarrhea, fever, flatulence, flu, and stomachache. For cases of diarrhea, consumption of the tea can be considered complementary to oral rehydration therapy. These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (TRAMIL, 2016).

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Reported medicinal uses across the world Internationally, Cymbopogon citratus is commonly consumed as a tea for digestive problems. Reportedly, it relaxes the muscles of the stomach and gut and relieves cramping pain and flatulence. Externally, it is applied as a poultice, or as a diluted essential oil, to ease pain and arthritis (Chevallier, 2001). Cymbopogon citratus is an important medicinal plant in Ayurveda, the traditional health system of India, in which it is used for the treatment of cough, elephantiasis (a parasitic infection that causes extreme swelling in the arms and legs), flu, gingivitis (inflammation of the gums), headache, leprosy, malaria, pneumonia, and ­vascular disorders. Mixed with pepper, it is a home remedy for menstrual troubles and nausea. Cymbopogon citratus is thought to be a good cleanser that helps to detoxify the liver, pancreas, kidney, bladder, and digestive tract. It is claimed to cut down uric acid, cholesterol, excess fat, and other toxins in the body while stimulating digestion, blood circulation, and lactation. It is also reported to alleviate indigestion and gastroenteritis (Manvitha and Bidya, 2014). Externally, a paste of the leaves is smeared on patches of ringworm (Chevallier, 2001).

Clinical efficacy studies in humans In a human pilot study in South Africa, Cymbopogon citratus helped reduce oral thrush (a fungal infection of the mouth) in HIV-positive patients. In a randomized controlled trial, 30 HIV-positive patients, clinically diagnosed with oral thrush, were treated with a Cymbopogon citratus infusion prepared from dried leaf powder, three times a day for 10 days. Seventeen patients completed the study and 15 were clinically cured. In comparison, 30 patients were treated with a pharmaceutical preparation, gentian violet, of which 17 completed the study and nine were clinically cured (Wright et al., 2009). Another study evaluated the effect of drinking Cymbopogon citratus tea in 105 healthy men and women, aged 18–35 years, for 1 month. Volunteers were divided into three groups, each receiving tea made with 2, 4, or 8 g of dried leaf once a day. Various blood measurements were taken before, during, and after the experimental period, and it was found that drinking the tea significantly increased red blood cell count and hemoglobin concentration in all those tested. It appears from the research that drinking Cymbopogon citratus increased the oxygen-carrying capacity of the volunteers’ blood. The authors concluded that their results show the potential use of Cymbopogon citratus tea in the prevention and treatment of anemia (Ekpenyong et al., 2015a). A study in human volunteers (aged 19–24 years) taking Cymbopogon citratus leaf tea daily for 2 weeks (one group taking tea made with 2 g and a second group 4 g) did not demonstrate a reduction in anxiety or benefit in sleep compared to a

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group taking placebo (tea that tastes the same but contains no actual Cymbopogon citratus) (Leite et al., 1986). A 2015 study of Cymbopogon citratus essential oil aroma inhaled by healthy male volunteers, exposed to a stress inducing situation, demonstrated anxiolytic effects in comparison to control groups. The group exposed to the test aroma demonstrated a reduction in anxiety, subjective tension, and complete recovery within 5 min, unlike the control groups (Goes et al., 2015). There has been promising laboratory-based research on the potential anti-cancer properties of Cymbopogon citratus, with extracts inducing apoptosis (cell death) in some human cancer cell lines, but this has not yet been studied in cancer patients (Halabi and Sheikh, 2014; Thangam et al., 2014; Bao et al., 2015).

Safety information Side effects Side effects reported for Cymbopogon citratus included dizziness, drowsiness, dry mouth, excessive urination, and increased appetite (Leite et  al., 1986; Wright et al., 2009).

Toxicology In the Caribbean pharmacopeia, there are no reported cases of toxicity for traditionally prepared preparations (TRAMIL, 2016). An infusion of Cymbopogon citratus leaves in rats administered orally for 2 months in doses of up to 20 times the corresponding human dose was found harmless (Souza Formigoni et al. 1986). The substance myrcene in the essential oil was not found to be genotoxic (damaging to the genetic information within a cell causing mutations, which may lead to cancer) after oral administration in rats (Zamith et al., 1993). The LD50 (lethal dose at which half the group of test animals died) of Cymbopogon citratus (unknown preparation) is greater than 5 g/kg body weight given orally to rats, which is considered to be nontoxic, and up to 5 g/kg body weight applied topically in rabbits (Natural Medicines, 2007). Human volunteers (aged 19–24 years) taking Cymbopogon citratus leaf tea daily for 2 weeks (one group taking tea made with 2 g and a second group made with 4 g) did not demonstrate abnormalities in the blood serum, urine, or in their EEG (brain activity) or ECG (heart activity). There were slight elevations of direct bilirubin (a yellowish pigment found in bile, a fluid made by the liver) and amylase (an enzyme

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indicative of the health status of the pancreas) in some volunteers, but there were no clinical manifestations (Leite et al., 1986). There were authors who observed adverse effects on kidney function following high doses, or prolonged consumption of a low dose, of Cymbopogon citratus tea (see section on “Clinical efficacy studies in humans” above for details on the study) (Ekpenyong et al., 2015b). These authors stated that in view of the novelty of their findings, and the absence of scientific evidence of kidney problems in areas where Cymbopogon citratus is widely consumed as a tea, further human study is recommended. These findings contradicted the earlier findings of Leite et  al. (1986) (see above).

Contraindications No information is available.

Use in pregnancy and breastfeeding High doses of citral and myrcene, two phytochemicals that are components of the essential oil of lemongrass (responsible for its distinctive aroma), caused birth defects in rats (Delgado et  al., 1993; Nogueira et  al., 1995). Although such high levels of citral and myrcene are unlikely to be present in tea preparations consumed by humans, it is recommended that consumption of the tea be avoided during pregnancy. In addition, Cymbopogon citratus is described as a uterine stimulant and an emmenagogue (stimulates blood flow in the pelvic area and uterus and can promote menstruation), further supporting the recommendation to avoid its use during pregnancy (Brinker, 2000).

Drug interactions Traditionally prepared water extracts of the leaves were tested in the laboratory for their effect on several key human enzymes that are responsible for processing many pharmaceutical drugs in the body (cytochromes P450, CYPs 1A1, 1A2, 3A4). The results showed moderate to weak impact, indicating that clinically significant interactions with drugs metabolized by the same enzymes are unlikely (Picking, 2014).

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Recommendations Fevergrass is Generally Recognized As Safe (GRAS) by the United States Food and Drug Administration (FDA). Natural Medicines (formerly Natural Standard and Natural Medicines Comprehensive Database) (2007) considers administration of Cymbopogon citratus as a tea for 2 weeks probably safe. Its use is possibly unsafe during pregnancy, due to the lack of human evidence and the presence of fetal abnormalities in rats at high doses (Natural Medicines, 2007). The Caribbean pharmacopeia recommends taking a water decoction or infusion of the leaf for the common cold, cough, diarrhea, fever, flatulence, flu, and stomachache (TRAMIL, 2016).

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Bao XL, Yuan HH, Wang CZ, Fan W, Lan MB (2015) Polysaccharides from Cymbopogon citratus with antitumor and immunomodulatory activity. Pharmaceutical Biology 53: 117-124. Brinker FJ (2000) The toxicology of botanical medicines, 3rd Ed. Sandy, Oregon: Eclectic Medical Publications. CABI (2020) Cymbopogon citratus (citronella grass). In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/ datasheet/17377 Chevallier A (2001) Encyclopedia of medicinal plants. 2nd Ed. London: Dorling Kindersley. Delgado IF, Carvalho RR, Nogueira AC, Mattos AP, Figueiredo LH, Oliveira SH, Paumgartten FJ (1993) Study on embryo-fetotoxicity of beta-myrcene in the rat. Food and Chemical Toxicology 31: 31-35. Clement YN, Baksh-Comeau YS, Seaforth CE (2015) An ethnobotanical survey of medicinal plants in Trinidad. Journal of Ethnobiology and Ethnomedicine 11: 67. Ekpenyong CE, Daniel NE, Antai AB (2015a) Bioactive natural constituents from lemongrass tea and erythropoiesis boosting effects: Potential use in prevention and treatment of anemia. Journal of Medicinal Food 18: 118-127. Ekpenyong CE, Daniel NE, Antai AB (2015b) Effect of lemongrass tea consumption on estimated glomerular filtration rate and creatinine clearance rate. Journal of Renal Nutrition 25: 57-66. Goes TC, Ursulino FR, Almeida-Souza TH, Alves PB, Teixeira-Silva F (2015) Effect of Lemongrass aroma on experimental anxiety in humans. Journal of Alternative and Complementary Medicine 21: 766-73. Halabi MF, Sheikh BY (2014) Anti-proliferative effect and phytochemical analysis of Cymbopogon citratus extract. Biomedical Research International 2014: Article ID 906239, 8 pages. Leite JR, Seabra Mde L, Maluf E, Assolant K, Suchecki D, Tufik S, Klepacz S, Calil HM, Carlini EA (1986) Pharmacology of lemongrass (Cymbopogon citratus Stapf). III.  Assessment of eventual toxic, hypnotic and anxiolytic effects on humans. Journal of Ethnopharmacology 17: 75-83. Manvitha K, Bidya B (2014) Review on pharmacological activity of Cymbopogon citratus. International Journal of Herbal Medicine 1: 5-7. Natural Medicines (2007) Formerly Natural Standard and Natural Medicines Comprehensive Database. Cymbopogon citratus. Accessed 31 December 2007 at https://naturalmedicines. therapeuticresearch.com/.

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Nogueira AC, Carvalho RR, Souza CA, Chahoud I, Paumgartten FJ (1995) Study on the embryofeto-toxicity of citral in the rat. Toxicology 96: 105-113. Picking D (2014) The contemporary use of medicinal plants in Jamaica & assessment of potential medicinal plant-drug interactions of select plants. Kingston, Jamaica: University of the West Indies, PhD Dissertation. Picking D, Delgoda R, Younger N, GermosenRobineau L, Boulogne I, Mitchell S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Souza Formigoni ML, Lodder HM, Gianotti Filho O, Ferreira TM, Carlini EA (1986) Pharmacology of lemongrass. Part 2. Effects of daily two month administration in male and female rats and in offspring exposed in utero. Journal of Ethnopharmacology 17: 65-74. Thangam R, Sathuvan M, Poongodi A, Suresh V, Pazhanichamy K, Sivasubramanian S, Kannan S (2014) Activation of intrinsic apoptotic signaling pathway in cancer cells by Cymbopogon citratus polysaccharide fractions. Carbohydrate Polymers 107: 138-150. TRAMIL (2016) Caribbean pharmacopeia. Cymbopogon citratus. Accessed 27 December 2019 at http://www.tramil.net/en/plant/cymbopogon-citratus. Wright SC, Maree JE, Sibanyoni M (2009) Treatment of oral thrush in HIV/AIDS patients with lemon juice and lemon grass (Cymbopogon citratus) and gentian violet. Phytomedicine 16: 118-124. Zamith HP, Vidal MN, Speit G, Paumgartten FJ (1993) Absence of genotoxic activity of beta-­ myrcene in the in-vivo cytogenetic bone marrow assay. Brazilian Journal of Medical and Biological Research 26: 93-98.

Chapter 14

Dysphania ambrosioides (L.) Mosyakin & Clemants (Amaranthaceae)

Synonym: Chenopodium ambrosioides L. (Adams, 1972) Common names in Jamaica: Semi-contract, Semi-conscience Other common names in Jamaica: Bitter weed, hedge mustard, Mexican tea, semicontract, wormseed (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_14

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Botanical characteristics and propagation Aromatic erect subshrub with a pungent smell that grows up to 1 m tall. The plant is irregularly branched from a woody base and has small, lanceolate or oblanceolate leaves that carry yellow glandular dots beneath, margins ranging from deeply lobed to serrate and entire, depending on their position on the plant (CABI, 2020). Flowers are small and green, growing in a long, dense, terminal cluster. The species is native to Mexico and tropical regions of Central and South America but is considered a cosmopolitan weed that has successfully colonized disturbed and agricultural areas around the world. Currently, the species can be found naturalized in Europe, the United States, the West Indies, Africa, Australia, the Pacific Islands, and Asia. It produces thousands of small seeds that can be easily dispersed by human activities (CABI, 2020). It has been actively introduced by humans as a culinary and aromatic herb, tea, and as a spice. The plant is propagated by stem cuttings that root easily in moist loamy soil.

Where to find the plant Semi-contract grows wild, is reported to “come up spontaneously,” and is then kept in people’s yards close to the house as a useful plant.

Part used The leaf and the whole plant.

Jamaican cultural uses and beliefs Semi-contract can be drunk as a regular tea in the morning and evening. In Kingston, someone also said it can be used when “ghost [spirit] dem pon baby.” In that case, the leaves are put in the baby’s bed, and when they turn brown in color, people ­consider it proof that the remedy has worked.

Jamaican medicinal uses To expel worms.

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Major uses (mentioned by more than 20% of people) • Expel worms (including roundworm and hookworm): In Kingston and Windsor Forest, the green leaf or whole bush is boiled for 5–10 min, or steeped in hot water for 5–15 min (some people even soak it overnight) to worm out children during nine mornings. People we interviewed remarked that, while children are taking this remedy, white spots will appear on the face to show it is working. In Windsor Forest, people reported that semi-contract is sometimes combined with lime leaf (Citrus × aurantiifolia (Christm.) Swingle), cow tongue (Campyloneurum phyllitidis (L.) C. Presl), soursop leaf (Annona muricata L.), vervine (Stachytarpheta jamaicensis (L.) Vahl and Stachytarpheta cayennensis (Rich.) Vahl), and worm grass (Spigelia anthelmia L.).

Minor uses (mentioned by more than 5% of people, but less than 20%) • Common cold: In Kingston and Windsor Forest, people boil the leaf or bush (for 30 min) or draw them to make tea, or they beat the bush to get the natural juice out of it, and drink the remedy. In Windsor Forest, worm grass, cow tongue, and soursop leaf were mentioned in combination with boiling semi-contract. • Fever: In Kingston, the bush is beaten to get its natural juice, or it is steeped or boiled, and drunk. • Gripe, bellyache: In Kingston and Windsor Forest, three leaves are steeped in a cup for a couple of minutes, soaked overnight, or the leaves are boiled and drunk.

Reported medicinal uses across the Caribbean According to the Caribbean pharmacopeia, several preparations of the plant are recommended for a number of health conditions, summarized in Table 14.1. These recommendations are based on significant traditional uses documented in TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information. The use for intestinal parasites is recommended only when the disorder is caused by Ascaris (roundworms), pinworms, and hookworms, not for other intestinal parasites (TRAMIL, 2016). Across individual countries: • Jamaica: A TRAMIL survey, undertaken in 2009, identified Dysphania ambrosioides as the nineteenth most widely reported medicinal plant. Among survey respondents who reported using medicinal plants to treat intestinal worms, 73% identified their use of the whole plant, aboveground parts, or leaf of Dysphania

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Table 14.1 Recommended health conditions across the Caribbean for Dysphania ambrosioides

Recommended use Plant part(s) used Diarrhea Aerial parts or leaf, infusion or decoction, taken orally Intestinal parasites Aerial parts, infusion or decoction, taken orally Stomachache Aerial parts, infusion or decoction, taken orally Skin ulcer Aerial parts, crushed, applied locally

ambrosioides, prepared as an infusion, decoction, or juice extract (Picking et al., 2015). Dysphania ambrosioides is universally used as a vermifuge or anthelmintic agent (expels parasitic worms). In addition, Jamaicans reported using the plant for arthritis, asthma, colds, fever, stomach, and bowel problems (Warner, 2007). • Trinidad: An infusion of the plant (parts not stated) is used as a vermifuge to expel intestinal parasites (Asprey and Thornton, 1953).

Reported medicinal uses across the world Across individual countries: • Brazil, Colombia, Ecuador, and Peru: Indigenous people use the bush to expel intestinal worms and as a mild laxative; one cup of the leaf decoction is consumed for three consecutive mornings before eating (Taylor, 2005). • French Guiana and Brazil: Indigenous people use a decoction of the plant (part not stated) to treat upset stomach and internal bleeding, caused by falls (Taylor, 2005). • Mexico: Dysphania ambrosioides is called epazote or apazote, and indigenous groups have since long traditionally used the bush to treat asthma, chorea (a type of arthritic fever), excess phlegm, intestinal parasites, and nervous problems (Taylor, 2005). • Peru: In Andean countries, the bush is known as paico. A leaf decoction is used to treat cramps, intestinal gas, hemorrhoids, intestinal worms and parasites, nervous disorders, as a mild laxative, and as an insecticide. Some indigenous groups bathe in a decoction of the plant to reduce fever, and burn the fresh green plant as a mosquito repellent (Taylor, 2005). • Spain and Portugal: Reports date back to the eighteenth century of the use of Dysphania ambrosioides to treat digestive disorders, cough with slime (catarrh), and as an anthelmintic (vermifuge) (Pardo de Santayana et al., 2005). • USA: The plant is referred to as wormseed based on its long history of use against intestinal worms (Taylor, 2005).

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Clinical efficacy studies in humans Mexican clinical field trials undertaken in 1985, in a community of Mayan farmers in Chiapas, called into question the efficacy of Dysphania ambrosioides as a traditional herbal anthelmintic (vermifuge). Researchers confirmed that decoctions containing up to 300 mg of dry plant material per kilogram body weight were widely used and traditionally highly regarded in the treatment of ascariasis (disease caused by a parasitic roundworm, Ascaris lumbricoides). However, therapeutic doses of up to 6 g of powdered, dried plant material, per kilogram body weight, had no significant anthelmintic effect on the adults of Necator (hookworm), Trichuris (whipworm-­type of roundworm of the large intestine), or Ascaris (roundworm of the small intestine). Chemical analysis of the plant samples consistently demonstrated the presence of the chemical compound ascaridol in the expected amounts. The researchers concluded that the results of these controlled field studies did not confirm the widely held traditional beliefs, nor the therapeutic practices regarding this plant (Kliks, 1985). A Peruvian clinical study also evaluated Dysphania ambrosioides as an anthelmintic agent. Leaf extracts were given to 72 patients (children and adults) infected with intestinal parasites. Stool analysis was undertaken before, and 8 days after, the intervention. The researchers observed anthelmintic effects in 56% of the cases, with 100% effectiveness against Ancylostoma (hookworm) and Trichuris, and 50% against Ascaris. No significant differences were observed relative to age or sex (Giove Nakazawa, 1996). Another Peruvian clinical trial was undertaken with children aged between 3 and 14  years, who received either Dysphania ambrosioides juice or the anthelmintic pharmaceutical drug Albendazole, to treat infection with roundworm and tapeworm. Both the treatments demonstrated the same level of effectiveness against roundworm, but Dysphania ambrosioides was significantly more effective in the treatment of tapeworm. Both the treatments demonstrated similar numbers of adverse effects (López De Guimaraes et al., 2001).

Safety information Side effects Warner (2007) refers to fatalities resulting from overdosing (case reports, references not provided) but does not state whether this was following ingestion of the plant extract or the essential oil. There exist reports of two fatal cases of poisoning in Morocco involving a 5-month-old infant and a 10-year-old girl presenting to hospital with toxic encephalopathy (brain disease) and severe dehydration, respectively, following the reported

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ingestion of undetermined doses of an infusion of Dysphania ambrosioides, taken as an antipyretic (to reduce fever) (Badinga et al., 2018). Both the children died in less than 12  h following admission. In both the cases, the authors did not state whether the identity of the plant and part(s) used were confirmed but indicate that both the children received large and repeated doses. The essential oil, extracted from both the whole plant and the seeds, has a history of use as a vermifuge, dating back several centuries. The essential oil was once listed in the United States pharmacopeia as a drug prescribed for the treatment of amoebas, roundworms, and hookworms. However, due to a number of side effects experienced at the therapeutic dose, internal use of the essential oil fell from favor a number of years ago. The consumption of 10 mg of the essential oil has been linked to side effects such as cardiac (heart) problems, convulsions, respiratory problems, drowsiness, vomiting, weakness, and even death (Taylor, 2005).

Toxicology A water extract of the leaf administered orally to rats once, or for 15 days, in doses ranging from 0.3 to 3 g/kg body weight, did not reveal any signs of toxicity in the behavior of the animals. But, according to the authors, the blood test results after higher doses (1 and 3 g/kg body weight) indicated that the water extract from the leaves produced slight liver damage in the rats (da Silva et al., 2014). Another study in mice that were given an oral alcohol–water extract of the leaf in doses ranging from 0.005 to 0.5 g/kg body weight for 15 days showed neither death nor changes in the body weight of the animals, but did cause changes in the weight of some of their organs with the highest doses, and other signs of alterations at the cellular level. The authors concluded that it is safe to use this remedy in the right dose (Pereira et al., 2010). In Mexican cuisine, dry branches (usually without flowers or seeds) of the bush are used to season beans and to prevent flatulence (intestinal gas). No acute toxicity has been reported about this use. The essential oil is extracted from the whole plant, especially from the seeds or fruits, by steam distillation. The toxicity of this oil, and of its main chemical component, ascaridol, is well established. Ascaridol is present in the highest concentration in the seeds. The oil is an irritant to the tissue of the gastrointestinal tract, kidney, and liver. Overdoses of this oil have caused death in men and rats. The primary symptoms during an acute intoxication are gastrointestinal, such as gastroenteritis, followed by alterations in the central nervous system, such as headache, facial redness, impaired vision, dizziness, spasms, signs of paralysis, and a sensation of tingling or numbness of the skin (Gadano et al., 2006), as well as hearing loss that can last for years. Cases of death have been observed following the intake of 10 mg of the oil by adults and much less for children (Brinker, 2000).

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Contraindications Use of Dysphania ambrosioides is contraindicated in individuals with liver and kidney disorders, weakened individuals, and the elderly (TRAMIL, 2016).

Use in pregnancy and breastfeeding Dysphania ambrosioides should not be used by women during pregnancy as it may be abortifacient, during breastfeeding, or by children under 5  years old (TRAMIL, 2016).

Drug interactions No information is available.

Recommendations It is important to distinguish between the use of the raw plant, and the refined product from this plant (distilled seed oil). Using the raw plant may be relatively safe in small quantities (except for pregnant and nursing women) and has been approved for both internal and external use by the Caribbean pharmacopeia, while the use of the seed oil has been shown to be toxic. Pregnant and nursing mothers should avoid using this plant at all because of its possible toxic effects. The seed oil contains a rather large concentration of ascaridol and other monoterpenes. When taken internally, the high concentration of these chemicals in the oil may cause extensive damage to the liver and kidneys, cause rhythm disturbances in the heart, and affect the nervous system. The essential oil from Dysphania ambrosioides should therefore not be used internally or externally (Brinker, 2000).

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Asprey G, Thornton P (1953) Medicinal plants of Jamaica Part I. West Indian Medical Journal 2: 233–252.

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Badinga LPCL, Mekaoui N, Karboubi L, Dakhama BSB (2018) [M’khinza-related intoxication: about two observations]. Pan African Medical Journal 31: 18. Brinker F (2000) The Toxicology of Botanical Medicines. 3rd ed. Sandy, OR: Eclectic Medical Publications. CABI (2020) Dysphania ambrosioides (Mexican tea) [original text by Rojas-Sandoval J, Acevedo-­ Rodrigues P]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/113977 Da Silva MG, Amorim RN, Camara CC, Fontenele Neto JD, Soto-Blanco B (2014) Acute and sub-chronic toxicity of aqueous extracts of Chenopodium ambrosioides leaves in rats. Journal of Medicinal Food 17: 979-984. Gadano AB, Gurni AA, Carballo MA (2006) Argentine folk medicine: Genotoxic effects of Chenopodiaceae family. Journal of Ethnopharmacology 103: 246-251. Giove Nakazawa RA (1996) [Traditional medicine in the treatment of enteroparasitosis]. Revista de Gastroenterología del Perú 16: 197-202. Kliks, MM (1985) Studies on the traditional herbal anthelmintic Chenopodium ambrosioides L.: Ethnopharmacological evaluation and clinical field trials. Social Science & Medicine 21: 879-886. López De Guimaraes D, Neyra Llanos RS, Romero Acevedo JH (2001) Ascariasis: Comparison of the therapeutic efficacy between paico and albendazole in children from Huaraz. Revista de Gastroenterología del Perú 21: 212-219. Pardo de Santayana M, Blanco E, Morales R (2005) Plants known as te in Spain: An ethno-­ pharmaco-­botanical review. Journal of Ethnopharmacology 98: 1-19. Pereira WS, Ribeiro BP, Sousa AI, Serra IC, Mattar NS, Fortes TS, Reis AS, Silva LA, Barroqueiro ES, Guerra RN, Nascimento FR (2010) Evaluation of the subchronic toxicity of oral treatment with Chenopodium ambrosioides in mice. Journal of Ethnopharmacology 127: 602-605. Picking D, Delgoda R, Younger N, Germosen Robineau L, Boulogne I, Mitchell S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Taylor, L (2005) The Healing power of rainforest herbs (2nd ed.). New  York: Square One Publishers. TRAMIL (2016) Caribbean pharmacopeia. Chenopodium ambrosioides. Accessed 27 December 2019 at http://www.tramil.net/en/plant/chenopodium-ambrosioides. Warner M (2007) Herbal Plants of Jamaica. Oxford: MacMillan Education.

Chapter 15

Eryngium foetidum L. (Apiaceae)

Common names in Jamaica: Fitweed, spiritweed Other common names in Jamaica: Fit weed, spirit weed (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_15

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Botanical characteristics and propagation Prickly, evergreen aromatic perennial herb with a thick and long taproot. The plant is edible and has a smell similar to coriander (Coriandrum sativum L.). The spiny-­ toothed leaves grow in a basal rosette. The branched inflorescence stalk carries flower heads consisting of tiny, light green-colored flowers supported by spiny bracts. Eryngium foetidum is native to tropical America and the West Indies (Acevedo-Rodriguez and Strong, 2007). It can easily be propagated by seed or stem cuttings (Van den Bergh, 1999).

Where to find the plant The species grows wild in the community and can be found as a weed on farm land. Farmers say that it “comes up naturally” on their land.

Part used The whole plant, leaf, or root.

Jamaican cultural uses and beliefs Spiritweed is considered a spiritual plant. People mentioned that it has a strong fragrance and say that it starts to smell very strong when a ghost (duppy) comes in the yard and that it “mek di duppy go away.” It is claimed that when you look for spiritweed at night, you cannot call it by its name, or else you will not find the plant. A bath prepared with spiritweed, lemongrass (Cymbopogon citratus (DC.) Stapf), and guinea henweed (Petiveria alliacea L.) will remove bad luck. A folk legend describes Nanny of Maroon Town using this herb to become invisible when fighting the English. Spiritweed is appreciated as a nice tea to drink in the morning, and the leaves can be added as an ingredient of fresh jerk seasoning, a Jamaican signature spice mixture.

Jamaican medicinal uses Spiritweed or fitweed is a popular Jamaican remedy to treat fits (seizures) and for teething babies, mostly given to drink as a tea, or rubbed for its smell.

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Major uses (mentioned by more than 20% of people) • Fits, seizures: In Windsor Forest, the leaf, bush, or root is boiled green for a couple of minutes, then the stove is turned off, and the remedy is given to drink. Or, the bush can be rubbed up. Three cloves of garlic (Allium sativum L.) and a plant called rat ears (Peperomia pellucida (L.) Kunth) are sometimes added to the preparation and given to drink three times a day. • Teething baby: In Windsor Forest, two leaves are boiled for 30 min and drunk. It has a nice smell. Or, the root is boiled for 4 min and drunk, and also rubbed up.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Common cold: In Windsor Forest and Kingston, the bush, leaf, or root is boiled, or steeped in boiling water, and drunk. Orange peel (Citrus × aurantium) and fowl gizzard are sometimes added to the preparation.

Reported medicinal uses across the Caribbean In the West Indies and tropical America where the plant is indigenous, the prevailing use of the plant is as a food, and as a medicine to treat fever, common cold, and flu (Paul et al., 2011). The Caribbean pharmacopeia recommends boiling the leaf for chest pain, palpitations, and fatigue. An infusion or decoction of the whole plant (or leaf) is recommended for fever, flatulence, flu, and vomiting. All these preparations are drunk. These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-­ Robineau, 2014). Across individual countries: • Belize: The leaves are chopped, steeped in boiling water, and drunk for diarrhea, stomach gas, indigestion, and vomiting in children. The leaves are eaten by adults to treat flatulence. For dysentery (infection of the intestines resulting in severe diarrhea with blood and mucus), three entire plants are boiled together with a young lime (Citrus × aurantiifolia (Christm.) Swingle) and drunk. For babies with colic and adults with high cholesterol, the leaf is boiled and drunk. Snakebites are treated by chopping and frying the leaves together with garlic (Allium sativum L.); this remedy is then applied to the bite as a compress ­(poultice) (Balick and Arvigo, 2015).

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• Haiti: The whole bush is used against fever and venereal (sexually transmitted) infections. It is also known as an anti-fertility remedy (Weniger, 1982). • Jamaica: A decoction of the plant (plant parts not specified) has been reported previously for its use for colds and convulsions or fits in children. The plant is also rubbed on the body for fainting fits and convulsions (Asprey and Thornton, 1953; Honeychurch, 1986). Traditional Maroon herbalist, Ivelyn Harris (2010) recommends the use of an infusion of fresh or dried leaves and flowers to treat menopausal symptoms, fainting spells, fits, and fever, and a decoction of the whole plant (including the roots) for weight loss and high blood pressure (hypertension). She also recommends inhalation of freshly pounded leaves for anyone experiencing fainting spells or fits. • Martinique: The bush is boiled and drunk to treat fever, chills, and flu and to stimulate menstruation. A tincture of the bush is rubbed on the body for arthritis (Longuefosse and Nossin, 1996). • Trinidad and Tobago: The leaves are used to treat menstrual pain, to shorten labor, and to remove the placenta (Lans, 2007).

Reported medicinal uses across the world Across individual countries: • Brazil: Eryngium foetidum is used for fever associated with cold and flu, but not in the case of malaria (Oliveira et al., 2015). A tea of the whole plant serves to facilitate delivery during labor (Rodrigues, 2007; Coelho-Ferreira, 2009; Yazbek et al., 2016). A tea made with the root is useful in case of a urinary infection (Coelho-Ferreira, 2009). • China: The leaves are crushed and used as a dressing on a centipede bite (Ghorbani et al., 2011). The leaf, root, and whole plant are toasted or boiled for eye disease and fever (administration includes massage, wash, and ingestion) (Zheng and Xing, 2009). • French Guiana: Eryngium foetidum is used for malaria, in combination with other plants, including species of Geissospermum, Quassia amara L., Tinospora crispa (L.) Hook. f. & Thomson, Aristolochia trilobata L., species of Artemisia, and turmeric (Curcuma longa L.) (Vigneron et al., 2005). • Honduras: The leaves are used for earache and digestive problems (Lentz et al., 1998). • India: The leaf paste is used to treat diarrhea (administration was not specified) (Panda, 2014). The leaves are consumed either raw or cooked for indigestion (Kichu et al., 2015). Victims of fits and epilepsy are made to smell the leaf paste (Sharma et al., 2013). The leaf juice is given orally to stop convulsions during high fever, and also drunk to improve stomach problems (Sharma et al., 2001). • Mexico: Eryngium foetidum is used to treat stomachache. This use is also reported from Panama, the Caribbean, and South America (Heinrich et al., 1992).

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• Nicaragua: A decoction or infusion of the leaves, applied externally as a bath and taken internally as well, is used in midwifery to relieve pain of the abdomen and back, stop belly pain after labor, reduce fever, alleviate flatulence, heartburn, and stomach ache, and treat vaginal infections. A leaf infusion is used to treat anemia (Coe, 2008). • Peru: The leaves are boiled for diarrhea, stomachache, and malaria (administration was not specified) (Roumy et al., 2007). The juice from the stem is put in the ear for earache, and the leaves are boiled together with semi-contract (Dysphania ambrosioides (L.) Mosyakin & Clemants) and drunk for malaria (Odonne et al., 2013). • Sri Lanka: The bush is applied externally for snakebites (Dharmadasa et  al., 2016).

Clinical efficacy studies in humans Human studies on Eryngium foetidum are lacking. The refined extract of the plant showed remarkable in vitro activity against infective larvae of threadworm (Strongyloides stercoralis), a severe skin-penetrating parasite that causes long-enduring, low-grade internal infections in humans in the Caribbean. These findings were the basis for a US patent application by researchers at The University of the West Indies (Paul et al., 2011). Results from rat studies showed a positive effect of water extracts from Eryngium foetidum in epilepsy (fits or convulsions) (Simon and Singh, 1986; Paul et al., 2011).

Safety information Side effects Constipation is mentioned as a possible side effect after consumption of the crushed plant (Paul et al., 2011).

Toxicology The LD50 (lethal dose at which half the group of test animals died) in rats was 11 g of dry leaf ingested per kilogram body weight. Thus, the leaves are considered nontoxic. Chronic toxicity studies in rats and mice showed no toxic evidence (no macroscopic damage to the kidney, liver, and marrow) (Germosén-Robineau, 2014).

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A chronic toxicity study was undertaken in mice using a diet that included the leaves of Eryngium foetidum equivalent to approximately 35, 73, and 155 times that of human consumption, for 24 weeks. The study results indicated that the diet at 35 times human consumption did not affect blood and biochemical parameters when compared to the control group. In the groups consuming 73 and 155 times the amount of human consumption, significant increases in serum blood urea nitrogen (BUN) levels were produced, together with kidney histopathological lesions. The study authors concluded that the consumption of Eryngium foetidum leaves at a high dose for a long time may cause kidney lesions in mice (Janwitthayanuchit et al., 2016).

Contraindications No information is available.

Use in pregnancy and breastfeeding The use of Eryngium foetidum is not advisable during pregnancy because it is reported to provoke uterine contractions (Paul et al., 2011). Brazilian communities also mentioned that Eryngium foetidum should not be drunk as a tea during pregnancy because of its use to facilitate delivery of the baby (Rodrigues, 2007; CoelhoFerreira, 2009; Yazbek et al., 2016). In Cuba and Venezuela, the root is reported to provoke abortion and to stimulate menstruation (Kumar et al., 2012).

Drug interactions No information is available.

Recommendations Eryngium foetidum is widely used as a condiment and medicinal plant. Human ­studies about its medicinal uses are lacking. Animal studies have confirmed the ­following properties of the plant: Anti-convulsant (against seizures), anti-inflammatory, and anthelmintic (expels parasitic worms). The Caribbean pharmacopeia recommends the use of Eryngium foetidum for chest pain, palpitations, fatigue, flatulence, fever, flu, and vomiting. Ingestion of the plant or tea should be suspended during pregnancy, because of cultural information about its labor-inducing effects.

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Selected bibliography Acevedo-Rodríguez P, Strong MT (2007) Catalogue of the seed plants of the West Indies. Accessed 27 December 2019 at https://naturalhistory2.si.edu/botany/WestIndies/. Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Asprey G, Thornton P (1953) Medicinal plants of Jamaica Part I. West Indian Medical Journal 2: 233–252. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. Coe FG (2008) Rama midwifery in eastern Nicaragua. Journal of Ethnopharmacology 117: 136-157. Coelho-Ferreira M (2009) Medicinal knowledge and plant utilization in an Amazonian coastal community of Marudá, Pará State (Brazil). Journal of Ethnopharmacology 126: 159–175. Dharmadasa RM, Akalanka GC, Muthukumarana PRM, Wijesekara RGS (2016) Ethnopharmacological survey on medicinal plants used in snakebite treatments in Western and Sabaragamuwa provinces in Sri Lanka. Journal of Ethnopharmacology 179: 110–127. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Ghorbani A, Langenberger G, Feng L, Sauerborn J (2011) Ethnobotanical study of medicinal plants utilised by Hani ethnicity in Naban River Watershed National Nature Reserve, Yunnan, China. Journal of Ethnopharmacology 134: 651–667. Harris, I (2010) Healing herbs of Jamaica. Royal Palm Beach, FL: AhHa Press Inc., 212p. Heinrich M, Rimpler H, Barrera NA (1992) Indigenous phytotherapy of gastrointestinal disorders in a lowland Mixe community (Oaxaca, Mexico): Ethnopharmacologic evaluation. Journal of Ethnopharmacology 36: 63-80. Honeychurch PN (1986) Caribbean wild plants and their uses. Barbados: MacMillan Caribbean, 176 pp. Janwitthayanuchit K, Kupradinun P, Rungsipipat A, Kettawan A, Butryee C (2016) A 24-weeks toxicity study of Eryngium foetidum Linn. leaves in mice. Toxicological Research 32: 231-7. Kichu M, Malewska T, Akter K, Imchen I, Harrington D, Kohen J, Vemulpad SR, Jamie JF (2015) An ethnobotanical study of medicinal plants of Chungtia village, Nagaland, India. Journal of Ethnopharmacology 166: 5–17. Kumar D, Kumar A, Prakash O (2012) Potential antifertility agents from plants: A comprehensive review. Journal of Ethnopharmacology 140: 1–32. Lans C (2007) Ethnomedicines used in Trinidad and Tobago for reproductive problems. Journal of Ethnobiology and Ethnomedicine 3: 13. Lentz DL, Clark AM, Hufford CD, Meuer-Grimes B, Passreiter CM, Cordero J, Ibrahimi O, Okunade AL (1998) Antimicrobial properties of Honduran medicinal plants. Journal of Ethnopharmacology 63: 253–263. Longuefosse JL, Nossin E (1996) Medical ethnobotany survey in Martinique. Journal of Ethnopharmacology 53: 117-142. Odonne G, Valadeau C, Alban-Castillo J, Stien D, Sauvain M, Bourdy G (2013) Medical ethnobotany of the Chayahuita of the Paranapura basin (Peruvian Amazon). Journal of Ethnopharmacology 146: 127–153. Oliveira DR, Krettli AU, Aguiar ACC, Leitão GG, Vieira MN, Martins KS, Leitão SG (2015) Ethnopharmacological evaluation of medicinal plants used against malaria by quilombola communities from Oriximiná, Brazil. Journal of Ethnopharmacology 173: 424–434. Panda SK (2014) Ethno-medicinal uses and screening of plants for antibacterial activity from Similipal Biosphere Reserve, Odisha, India. Journal of Ethnopharmacology 151: 158–175. Paul JHA, Seaforth CE, Tikasingh T (2011) Eryngium foetidum L.: A review. Fitoterapia 82: 302-308. Rodrigues E (2007) Plants of restricted use indicated by three cultures in Brazil (Caboclo-river dweller, Indian and Quilombola). Journal of Ethnopharmacology 111: 295–302.

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Roumy V, Garcia-Pizango G, Gutierrez-Choquevilca AL, Ruiz L, Jullian V, Winterton P, Fabre N, Moulis C, Valentin A (2007) Amazonian plants from Peru used by Quechua and Mestizo to treat malaria with evaluation of their activity. Journal of Ethnopharmacology 112: 482–489. Sharma HK, Chhangte L, Dolui AK (2001) Traditional medicinal plants in Mizoram, India. Fitoterapia 72: 146-161. Sharma J, Gairola S, Gaur RD, Painuli RM, Siddiqi TO (2013) Ethnomedicinal plants used for treating epilepsy by indigenous communities of sub-Himalayan region of Uttarakhand, India. Journal of Ethnopharmacology 150: 353–370. Simon OR, Singh N (1986) Demonstration of anticonvulsant properties of an aqueous extract of Spirit Weed (Eryngium foetidum L.). West Indian Medical Journal 35: 121-125. Van den Bergh MH (1999) Eryngium foetidum L. [Internet] Record from Proseabase. De Guzman, CC, Siemonsma JS (Eds). PROSEA (Plant Resources of South-East Asia) Foundation, Bogor, Indonesia. Accessed 6 January 2020 at http://www.proseanet.org. Vigneron M, Deparis X, Deharo E, Bourdy G (2005) Antimalarial remedies in French Guiana: A knowledge, attitudes and practices study. Journal of Ethnopharmacology 98: 351–360. Weniger B (1982) Plants of Haiti used as antifertility agents. Journal of Ethnopharmacology 6: 61– 84. Yazbek PB, Tezoto J, Cassas F, Rodrigues E (2016) Plants used during maternity, menstrual cycle and other women’s health conditions among Brazilian cultures. Journal of Ethnopharmacology 179: 310–331. Zheng XL, Xing FW (2009) Ethnobotanical study on medicinal plants around Mt. Yinggeling, Hainan Island, China. Journal of Ethnopharmacology 124: 197–210.

Chapter 16

Jatropha gossypiifolia L. (Euphorbiaceae)

Common names in Jamaica: Cassava marble, wild cassava Other common names in Jamaica: Belly-ache bush, cassada marble (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_16

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Botanical characteristics and propagation Shrub that can reach up to 2 m in height. The leaves are green or purple in color, palmately lobed, and sticky when young. When broken, the plant exudates a sap that is turbid and has a yellowish color (Adams, 1972). The clustered, purplish-red flowers with yellow centers turn into cherry-sized seed pods that are poisonous (Nelson et  al. 2007). The species is native to Mexico, South America, and the Caribbean islands. It can be readily propagated by seeds or by stem cuttings (Kumar and Swamkar, 2003).

Where to find the plant The species grows wild in the community and is tolerated in yards as a useful bush medicine. According to Adams (1972), it is “locally common in waste places near the sea.”

Part used Whole plant and individual parts.

Jamaican cultural uses and beliefs Cassava marble is well known in rural Jamaica as a medicine for animals. The leaf and root are boiled, together with black mint (Mentha spicata L.) and other species of Lamiaceae, and given to drink to pigs for excess pain after labor, and to pass out the afterbirth. The whole bush also serves to treat “stoppage of water” in goats, in Patois explained as “when di balls [testicles of the animal] swell up.”

Jamaican medicinal uses Cassava marble is popularly used for “stoppage of water,” a condition that may be linked to prostate health. Some people describe stoppage of water as a weak bladder that drips urine, caused by lifting heavy objects.

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Major uses (mentioned by more than 20% of people) • Stoppage of water (difficult urination in men): In Windsor Forest, people boil and drink the whole plant, aboveground parts, leaf, seed or root. Vervine (Stachytarpheta jamaicensis (L.) Vahl and S. cayennensis (Rich.) Vahl), wild mint (Salvia occidentalis Sw.), and castor oil (Ricinus communis L.) are sometimes added to the preparation.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Gripe in the baby: In Windsor Forest, the leaf or root is boiled or steeped, and drunk. • Period overflow, hemorrhage in women: In Windsor Forest, the bush, leaf, or root is boiled and drunk.

Reported medicinal uses across the Caribbean Earlier reports in Jamaica list the oral use of the leaves of cassava marble, either as a decoction or “boiled like spinach” for constipation, or as a laxative and purgative. In these reports, the seeds were said to be purgative, the oil being similar to castor oil (Beckwith, 1928; Asprey and Thornton, 1953, 1955). Jatropha gossypiifolia is described as being toxic to some degree, but the leaves are commonly boiled down to make an all-purpose traditional medicine (Warner, 2007).

Reported medicinal uses across the world Across individual countries: • Bangladesh: The seed and fruit (preparation and administration not specified) are used by traditional healers and religious healers to treat leprosy (Mollik et al., 2009). • Benin: A decoction of the leaf and stem is taken for malaria and anemia (Yetein et al., 2013). • Brazil: The leaf is used as an amulet to ward off evil energies and the evil eye and to treat hepatitis (preparation and administration not specified) (Albuquerque et al., 2007; Crepaldi et al., 2016). Other medicinal uses include stroke and headache (Crepaldi et al., 2016).

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• Ghana: The leaves are boiled and drunk together with the leaves of Combretum adenogonium Steud. ex A.Rich. and the whole plant of Ocimum americanum L. to treat malaria. The bush is also used in steam baths (Asase et al., 2005). • Guinea-Bissau: The sap is used for skin inflammation, wounds, and burns (Catarino et al., 2016). • India: The juice is taken by mouth for gastrointestinal ulcers (Yabesh et  al., 2014). Jaundice (yellow skin coloration indicating liver disease) is treated with a leaf paste (mixed with water) consisting of Jatropha gossypiifolia, Tinospora sinensis (Lour.) Merr., and a pinch of turmeric (Curcuma longa L.). The preparation is drunk continuously and applied to the face for 3  days (Sharma et  al., 2012). The leaf decoction is used for bathing wounds. The stem sap is used to stop bleeding and for itching of cuts and scratches. The roots are employed against leprosy, as an antidote for snakebite, and in urinary complaints. A decoction of the bark is used as an emmenagogue (stimulates menstruation), and a decoction of the leaves is considered good for stomachache, venereal diseases, and as a blood purifier (Panda et al., 2009). • Nicaragua: A decoction of the leaf is drunk in midwifery to alleviate digestive ailments (flatulence, heartburn, and stomachache), treat vaginal infections, promote healing of the baby’s navel, and alleviate constipation (Coe, 2008). The Garifuna in Nicaragua drink a decoction of the leaf for diarrhea and other digestive problems (stomachache, ulcer, and constipation), infections, diabetes, skin rashes and sores, cuts and hemorrhage, and as a purgative and laxative (Coe and Anderson, 1996). • Nigeria: The sap from the stem is used to stop bleeding from the nose, gum, and skin (Oduola et al., 2005). • Peru (Amazon region): Healer apprentices drink an infusion of the aboveground parts of Jatropha gossypiifolia for purification, cleansing and strengthening, and bathe and drink the bush (mashed in water) for protection and defense (Jauregui et al., 2011). The juice obtained from the leaf and seed is drunk as a depurative (cleanser) and emetic (induces vomiting). Lightly boiled, the leaf and seed are used as a wound disinfectant and vaginal wash (for Candida infections). The leaf is squeezed and mixed with other plants and substances (aboveground parts of Oxalis lespedezioides G. Don, lemon juice, commercial cinnamon, magnesium salt, and crushed leaves of physic nut, Jatropha curcas L.) to treat shingles (Sanz-­ Biset et al., 2009). • Suriname: The fruit is sold in the markets as a laxative (van Andel et al., 2007). • Togo: A decoction of the leaf is used to treat liver problems (Kpodar et al., 2016), and the leafy stem is boiled and drunk to treat anemia (Koudouvo et al., 2011). • Venezuela: The whole plant is used to treat obesity (overweight) and diabetes (Alonso-Castro et al., 2015). • West Africa: The sap is applied to fungal skin infections on the baby’s tongue. The seed is used as a purgative. The bush is planted as a fence to keep snakes away (Stauble, 1986).

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Clinical efficacy studies in humans Human clinical studies are lacking, despite the plant’s popular use in traditional medicine. In Brazil, Jatropha gossypiifolia is included in the National List of Medicinal Plants of Interest to the Brazilian Public Health System, according to a report published by the Brazilian Health Ministry in February 2009 that includes 71 species of plants that have the potential to generate pharmaceutical products for public health (Félix-Silva et al., 2014). So far, there exists only one published study with human subjects. In Nigeria, tests measuring the length of time of coagulation (blood clotting) and bleeding were performed with the stem sap of Jatropha gossypiifolia in 30 healthy subjects, within 6 h of collection of the fresh sap. In the blood clotting test, 8 mL of human blood was tested in vitro for clotting. In the bleeding time test, three punctures were made in the forearm of each person, and the length of bleeding was recorded as a control. On the other forearm, the procedure was repeated, but a drop of Jatropha gossypiifolia sap was applied to the bleeding punctures. In both tests, blood clotting and bleeding times were significantly lower after treatment with the sap, as compared to the controls (Oduola et al., 2005).

Safety information Side effects Species of the plant genus Jatropha are notable for their toxic potential, related primarily to the sap (latex) and seeds. When fruits or seeds are ingested (often because of their similarity with those of edible plants), side effects include gastrointestinal disorders, such as abdominal pain, nausea, vomiting, and diarrhea. Other complications concern the cardiovascular (heart), neurological (brain), and renal (kidney) systems (Félix-Silva et al., 2014).

Toxicology An acute toxicity study in rats, using an orally administered ethanol leaf extract at concentrations of 0.5–2 g/kg for 14 days, did not show mortality or signs of behavioral or physical change (Nagaharika et al., 2013). Another acute toxicity study in Wistar rats, using an oral single dose of the ethanol extract of the aerial plant parts at 1.2–5 g/kg body weight per day for 14 days, demonstrated relatively low toxicity. The plant extract reduced body weight and induced ptosis (drooping upper eyelids) and hindlimb paralysis. The lethal dose at

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which half the group of test animals died (LD50) was higher than 4 and 5 g/kg for male and female rats, respectively (Mariz et al., 2006). A subsequent chronic toxicity study by the same research team, using the same extract, in lower doses ranging from 45 to 405 mg/kg that were administered orally over 13 weeks, demonstrated neurological, gastrointestinal, hepatic, renal, and pulmonary toxicity. The dose of 405 mg/kg killed 47% of the male rats and 13% of female rats. These results, associated with lethality at doses close to therapeutic levels, indicate chronic oral toxicity in rats for the ethanol extract of the aerial parts of the plant (Mariz et al., 2012). A toxicity study of the root of the plant in Wistar rats, through oral administration of an ethanolic extract at concentrations of 10, 20, and 30 mg/kg body weight for 7–14 days, demonstrated toxicity to the kidneys and increased urea retention in the blood, pointing to kidney failure (Medubi et al., 2010). A subacute toxicity study, using an orally administered single daily dose of the water extract of the leaf, at doses of 240–583  mg/kg, in Wistar rats for 28  days, demonstrated generalized loss of body weight, weakness, dizziness, loss of appetite, and restlessness. Treatment was shown to profoundly change the architecture of the liver and kidney. Pathological lesions disrupted the normal concentrations of serum biomarkers, with increased levels of glutamic-oxaloacetic transaminase (AST), glutamic-pyruvic transaminase (ALT), and alkalinephosphatase (ALP). More severe effects and mortality were recorded in groups exposed to higher doses of 1 and 2 g/ kg body weight (Magili and Bwatanglang, 2018). A poisoning study in sheep demonstrated lethality at a single dose of 40 g/kg body weight of fresh green leaves, with clinical signs of digestive, lung, and heart disturbances, and slight microscopic liver and kidney regressive changes (Oliveira et al., 2008). The safety of the topical use of the stem latex as a hemostatic agent that stops bleeding was studied in Wistar rats by applying different doses of crude latex to incised skin daily for 18 days. Application of the latex did not produce any significant differences in the biochemical and blood parameters in both experimental and control animals. Based on these results, the authors concluded that the stem latex has no harmful effects in rats (Oduola et al., 2007). Researchers in Brazil evaluated the topical safety of a gel containing 1% lyophilized aqueous leaf extract of Jatropha gossypiifolia in a preclinical study using male and female Swiss albino mice. The animals were subjected to a dermal irritation/ corrosion test, in which the gel containing the 1% extract and a placebo formulation were topically applied to the shaved backs of two groups of mice over a period of 14 days. No signs of toxicity were observed in either the placebo or the test group (Xavier-Santos et al., 2018). A genotoxicity study was undertaken with crude latex in freshwater fish Channa punctata, by means of micronucleus and comet assays that are used to identify DNA damage and DNA mutations. Fish were exposed to 20 and 40% of the 24 h lethal

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concentration dose at which half the group of test animals died (LD50), using an extract containing 22.33  mg/L crude latex. The extract induced significant genotoxic effects, and the maximum micronucleus induction was reached at the highest concentration (40%), 96 h after exposure. The authors concluded that the results, demonstrating the genotoxicity of the latex in fish, could indicate the potential for DNA damage in humans (Singh et al., 2014).

Contraindications No information is available.

Use in pregnancy and breastfeeding No information is available.

Drug interactions No information is available.

Recommendations Some studies have demonstrated the toxic properties of Jatropha gossypiifolia after ingestion, whereas others have shown absence of toxicity, depending on the plant part used, and whether the preparation was taken only once, or over a long period of time. One-time use of a water extract (tea) of the leaves appeared to be relatively safe in rats; however, chronic (long-term) intake was injurious to the brain, liver, kidney, lungs, and digestive system of these animals. Since no human studies are available to confirm or refute these results in animals, it is advisable to remain vigilant at all times and consult with a qualified healthcare provider immediately in case side effects occur. Pregnant and breastfeeding women, as well as children, should abstain from consuming this plant as a tea because of the toxicity concerns.

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Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Albuquerque UP, Monteiro JM, Alves Ramos M, Cavalcanti de Amorim EL (2007) Medicinal and magic plants from a public market in northeastern Brazil. Journal of Ethnopharmacology 110: 76–91. Alonso-Castro AJ, Domínguez F, Zapata-Morales JR, Carranza-Álvarez C (2015) Plants used in the traditional medicine of Mesoamerica (Mexico and Central America) and the Caribbean for the treatment of obesity. Journal of Ethnopharmacology 175: 335–345. Asase A, Oteng-Yeboah AA, Odamtten GT, Simmonds MSJ (2005) Ethnobotanical study of some Ghanaian anti-malarial plants. Journal of Ethnopharmacology 99: 273–279. Asprey GF, Thornton P (1953) Medicinal Plants of Jamaica: Part 1. West Indian Medical Journal 2: 233-252. Asprey GF, Thornton P (1955) Medicinal Plants of Jamaica: Part 3. West Indian Medical Journal 4: 69-82. Beckwith MW (1928) Notes on Jamaican ethnobotany. New York: Vassar College. Catarino L, Havik PJ, Romeiras MM (2016) Medicinal plants of Guinea-Bissau: Therapeutic applications, ethnic diversity and knowledge transfer. Journal of Ethnopharmacology 183: 71–94. Coe FG (2008) Rama midwifery in eastern Nicaragua. Journal of Ethnopharmacology 117: 136–157. Coe FG, Anderson GJ (1996) Screening of medicinal plants used by the Garifuna of Eastern Nicaragua for bioactive compounds. Journal of Ethnopharmacology 53: 29-50. Crepaldi CG, Campos JLA, Albuquerque UP, Sales MF (2016) Richness and ethnobotany of the family Euphorbiaceae in a tropical semiarid landscape of Northeastern Brazil. South African Journal of Botany 102: 157–165. Félix-Silva J, Brandt Giordani R, da Silva-Jr AA, Zucolotto SM, Fernandes-Pedrosa MDF (2014) Jatropha gossypiifolia L. (Euphorbiaceae): A review of traditional uses, phytochemistry, pharmacology, and toxicology of this medicinal plant. Evidence-Based Complementary and Alternative Medicine 2014: 369204. Jauregui X, Clavo ZM, Jovel EM, Pardo-de-Santayana M (2011) “Plantas con madre”: Plants that teach and guide in the shamanic initiation process in the East-Central Peruvian Amazon. Journal of Ethnopharmacology 134: 739–752. Koudouvo K, Karou DS, Kokou K, Essien K, Aklikokou K, Glitho IA, Simpore J, Sanogo R, De Souza C, Gbeassor M (2011) An ethnobotanical study of antimalarial plants in Togo Maritime Region. Journal of Ethnopharmacology 134: 183–190. Kpodar MS, Karou SD, Katawa G, Anani K, Gbekley HE, Adjrah Y, Tchacondo T, Batawila K, Simpore J (2016) An ethnobotanical study of plants used to treat liver diseases in the Maritime region of Togo. Journal of Ethnopharmacology 181: 263–273. Kumar RV, Swamkar GK (2003) Rooting response in stem cuttings of Jatropha gossypiifolia. Indian Journal of Agroforestry 5: 131-133. Magili ST, Bwatanglang IB (2018) Toxicity study of aqueous leaves extract of Jatropha gossypiifolia from Nigerian in Albino rats: Serum biochemistry and histopathological evaluation. International Journal of Biochemistry Research & Review: 21: 1-12. Mariz SR, Cerqueira GS, Araújo WC, Duarte J, Melo AFM, Santos HB, Oliveira K, Melo Diniz MFF, Medeiros IA (2006) [Acute toxicological studies of the ethanol extract of the aerial parts of Jatropha gossypiifolia L. in rats]. Revista Brasileira de Farmacognosia 16: 372–378. Mariz SR, Cerqueira GS, Araújo WC, Dantas JG, Ramalho JA, Palomaro TV, Duarte JC, dos Santos HB, Olveira K, Araújo MST, Diniz MFFM, Medeiros IA (2012) [Chronic toxicologic study of the ethanolic extract of the aerial parts of Jatropha gossypiifolia in rats]. Revista Brasileira de Farmacognosia 22: 663-668. Mollik MAH, Hossain MF, Sen D, Hassan AI, Rahman MS (2009) Traditional Asian medicine and leprosy in Bangladesh. European Journal of Integrative Medicine 1: 191-192.

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Nagaharika Y, Kalyani V, Rasheed S, Ramadosskarthikeyan (2013) Anti-inflammatory activity of leaves of Jatropha gossypifolia L. by hrbc membrane stabilization method. Journal of Acute Disease 2: 156-158. Nelson LS, Shih RD, Balick MJ (2007) Handbook of poisonous and injurious plants. Second edition. Boston, MA: Springer. Oduola T, Adeosun GO, Oduola TA, Avwioro GO, Oyeniyi MA (2005) Mechanism of action of Jatropha gossypiifolia stem latex as a haemostatic agent. European Journal of General Medicine 2: 140–143. Oduola TA, Popoola GB, Avwioro OG, Ademosun AA, Lawal MO (2007). Use of Jatropha gossypifolia stem latex as a haemostatic agent: how safe is it? Journal of Medicinal Plants Research 8: 001-004. Oliveira LI, Jabour FF, Nogueira VA, Yamasaki EM (2008) [Experimental poisoning by the leaves of Jatropha gossypifolia (Euphorbiaceae) in sheep. Pesquisa Veterinária Brasileira 28: 275-278. Panda BB, Gaur K, Kori ML, Tyagi LK, Nema RK, Sharma CS, Jain AK (2009) Anti-inflammatory and analgesic activity of Jatropha gossypiifolia in experimental animal models. Global Journal of Pharmacology 3: 1-5. Sanz-Biset J, Campos-de-la-Cruz J, Epiquién-Rivera MA, Cañigueral S (2009) A first survey on the medicinal plants of the Chazuta valley (Peruvian Amazon). Journal of Ethnopharmacology 122: 333–362. Sharma J, Gairola S, Gaur RD, Painuli RM (2012) The treatment of jaundice with medicinal plants in indigenous communities of the Sub-Himalayan region of Uttarakhand, India. Journal of Ethnopharmacology 143: 262–291. Singh P, Dabas A, Srivastava R (2014) Evaluation of genotoxicity induced by medicinal plant Jatropha gossypifolia in freshwater fish Channa punctatus (Bloch). Turkish Journal of Fisheries and Aquatic Science 14: 1–8. Stauble N (1986) Etude ethnobotanique des Euphorbiacees d’Afrique de l’ouest. Journal of Ethnopharmacology 16: 23-103. van Andel T, Behari-Ramdas J, Havinga R, Groenendijk S (2007) The medicinal plant trade in Suriname. Ethnobotany Research & Applications 5: 351-372. Warner M (2007) Herbal Plants of Jamaica. Oxford: MacMillan Education, 176 pp. Xavier-Santos JB, Félix-Silva J, Passos JGR, Gomes JAS, Fernandes JM, Garcia VB, de Araujo-­ Junior RF, Zucolotto SM, Silva-Junior AA, Fernandes-Pedrosa MF (2018) Development of an effective and safe topical anti-inflammatory gel containing Jatropha gossypiifolia leaf extract: Results from a pre-clinical trial in mice. Journal of Ethnopharmacology 227: 268-278. Yabesh JEM, Prabhu S, Vijayakumar S (2014) An ethnobotanical study of medicinal plants used by traditional healers in silent valley of Kerala, India. Journal of Ethnopharmacology 154: 774–789. Yetein MH, Houessou LG, Lougbégnon TO, Teka O, Tente B (2013) Ethnobotanical study of medicinal plants used for the treatment of malaria in plateau of Allada, Benin (West Africa). Journal of Ethnopharmacology 146: 154–163.

Chapter 17

Momordica charantia L. (Cucurbitaceae)

Common name in Jamaica: Cerasee Other common name in Jamaica: Wild cerasee (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_17

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Botanical characteristics and propagation Tender annual climbing vine with yellow flowers and bright green, deeply lobed, alternate leaves. The color of the prickly or warted pendulous fruits changes from green to orange during ripening. The seeds are covered in a conspicuous red pulp that is sweet and edible. The species is native to the Old World tropics, including tropical and subtropical Africa and Asia. It is now pantropical, thus widely distributed throughout tropical and subtropical regions on all continents (CABI, 2020). Fruits of Momordica charantia exist in diverse shapes, colors, and sizes. Chinese and Indian varieties are well known as bitter melon, and the fruits of these cultivated varieties measure up to 20 cm long and are a bitter green vegetable. The wild variety known as cerasee in Jamaica has small fruits (usually measuring only up to 5 cm). Cerasee is not traditionally cultivated on the island, although with increasing demand it could be easily propagated from seeds. Jamaican farmers in Windsor Forest reported that when they burn down land in preparation for cultivation, the plant comes up spontaneously.

Where to find the plant The species grows spontaneously on fences and becomes easily entangled in hedges. It is very common in disturbed areas (Adams, 1972).

Part used The green part (vine with leaf), sometimes the fruit.

Jamaican cultural uses and beliefs People drink cerasee as a regular tea bush and mention that it is very bitter. They say the tea “hide[s] the sugar [in the blood].” Several people in Windsor Forest said in Patois: “man cannot get a child if him feed pon it” [drinks it regularly]. Children eat the fruit.

Jamaican medicinal uses Cerasee is commonly used as a “bitters” to cleanse the blood or body and to treat bellyache.

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Major uses (mentioned by more than 20% of people) • Bellyache (“belly cut yuh,” cold or gas): In Kingston and Windsor Forest, the dry or green bush is steeped or boiled for 5 min and drunk. No sugar is added in order to bring out its bitterness. Or, it is squeezed green and drunk. This remedy is sometimes combined with ginger (Zingiber officinale Roscoe) and garlic (Allium sativum L.). • Blood cleanser (“blood is too sweet”): In Kingston and Windsor Forest, the bush is boiled or steeped in hot water without adding sugar, or it is squeezed green, and drunk for nine mornings. Ginger is sometimes added to the preparation. In Windsor Forest, people may also combine cerasee with another bitter herb, marigold/mary ghoule (Sphagneticola trilobata (L.) Pruski). • Body cleanser (“wash out,” constipation, expel worms): In Kingston, people draw or boil and drink the bush for “wash out” and to expel worms (e.g., the dry leaves are boiled for half an hour and the remedy is drunk as a tea or water). Or the fruit is eaten. In Windsor Forest, people dry the bush, throw boiling water on it to let it draw, and drink the remedy to “loosen the bowels, for constipation, to purge the body and to clean yuh out.”

Minor uses (mentioned by more than 5% of people, but less than 20%) • “Biliousness” (dizziness): In Windsor Forest, the quailed leaves are either steeped or boiled and drunk. Some people boil it strong for 25 min. • Cancer: In Windsor Forest, the leaves are boiled, or steeped in boiling water, and drunk. • Cold (including cough): In Kingston, people boil and drink the leaf tea throughout the day. • Diabetes (sugar): In Kingston, the bush is boiled until the water turns green, or the leaves are chewed. • Prenatal care (“baby born with a pretty skin”): In Kingston, pregnant women boil the bush to drink, or they squeeze the juice from the leaves and drink it green. • Skin rash: In Kingston and Windsor Forest, the bush is drunk, rubbed on the skin, or people prepare a bath with it. They dry, draw or boil, or beat and drink the remedy. Alternatively, they rub the juice from the fresh leaf directly onto the skin or juice the leaf out in water and take a bath with the water. They also eat the fruit to treat skin problems, including eczema, chicken pox, measles, and sores.

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Reported medicinal uses across the Caribbean A TRAMIL survey undertaken in Jamaica in 2009 identified Momordica charantia as the most popular medicinal plant. Of those who reported using medicinal plants, 40% identified their use of Momordica charantia as a tonic, 44% for bellyache and gas, 67% as a blood cleanser, and 22% for “wash out” [body cleanser] (Picking et al., 2015). In Puerto Rico, Cuba, and the Dominican Republic, Momordica charantia has been traditionally used as a decoction (one glass after meals three times daily), or taken as capsules of the dried powdered leaves and stems (one or two after meals three times a day), to treat high blood sugar and diabetes since the early 1900s (Pons and Stevenson, 1943). According to the Caribbean pharmacopeia, several preparations from Momordica charantia are recommended for a number of health conditions, summarized in Table 17.1. These recommendations are based on significant traditional uses documented in TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (TRAMIL, 2016). Table 17.1  Recommended health conditions across the Caribbean for Momordica charantia Recommended use Common cold Boil (furuncle) Dry skin, burns Itching (pruritus) Lice (pediculosis) Skin rash, burns

Plant part(s) used Aerial parts, decoction, taken orally Aerial parts, decoction, taken orally Aerial parts, crushed or water maceration, bath, friction, and local application Aerial parts, crushed or water maceration, bath, friction, and local application Aerial parts, crushed or water maceration, bath, friction, and local application Aerial parts, bath and compress (poultice)

Reported medicinal uses across the world In addition to its use as a food in many countries, Momordica charantia has represented an important medicinal resource for centuries across countries in Asia, Africa, and Latin America, as well as the Caribbean. The entire plant, aboveground parts, seeds, fruits, leaves, and roots, have been traditionally used to treat cancer, diabetes, dyslipidemia (an abnormal amount of lipids or fats in the blood), gastrointestinal cramps, hypertension, infertility, microbial infections, psoriasis, to aid wound healing, and reduce inflammation, as a mild laxative, emmenagogue (stimulates blood flow and menstruation), and to provoke abortion (Ooi et  al., 2012; Natural Medicines, 2015).

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Clinical efficacy studies in humans The blood sugar lowering activities (glycemic control) of Momordica charantia have been extensively researched in animal studies and in a growing number of clinical studies. In addition to glycemic control, Momordica charantia has also been shown to provide protection for organs that are susceptible to complications related to diabetes, by delaying nephropathy (kidney damage), neuropathy (nerve damage), retinopathy (eye damage), cataract (clouding of the eye lens), gastroparesis (impaired stomach emptying), and atherosclerosis (arterial inflammation and disease). Momordica charantia extracts have shown normalization of blood lipid levels and demonstrated broad-spectrum antimicrobial activities, indicating the protective role that the plant may play against disease-causing organisms (Ooi et al., 2012). The clinical implications for humans from much of this research point to improvements in control of blood sugar levels, insulin resistance, and associated hyperlipidemia (an abnormally high concentration of fats in the blood), and to potential protection from infections and improved wound healing. Additional ­benefits may also come from delaying complications, providing protection of organs in the body (Ooi et al., 2012). One of the early clinical investigations in humans was carried out to evaluate the effect of Momordica charantia on the blood sugar levels of type 2 diabetic patients. The fruit juice was found to significantly improve blood sugar levels in 73% of the patients, while the other 27% failed to respond (Welihinda et al., 1986). Cochrane, an internationally recognized global independent network of researchers, carried out a review of Momordica charantia in the treatment of type 2 diabetes (Ooi et al., 2012). The authors found only four studies that met their quality standards, and even these four showed overall low quality (John et al., 2003; Dans et al., 2007; Purificacion et al., 2007; Fuangchan et al., 2011). A further four studies were identified (Baldwa et al., 1977; Rosales and Fernando, 2001; Inayat-ur-Rahman et al., 2009; Lim et al., 2010), but these were excluded from the review on the basis of poor quality. Three of the four included trials showed no significant differences in the blood sugar response between Momordica charantia and placebo or antidiabetic drugs (glibenclamide and metformin). The duration of treatment ranged from 4 weeks to 3 months, and altogether 479 patients with type 2 diabetes mellitus participated. There are many types of preparations of Momordica charantia, as well as variations in its use as a vegetable. The authors of a review concluded that, although Momordica charantia is extensively used in traditional medicine, and research exists suggesting its use benefits people with type 2 diabetes, the current evidence does not warrant using the plant in treating this disease. Further studies are needed to assess the quality of the various Momordica charantia preparations, as well as to further evaluate their use in the treatment and diet of diabetic people (Ooi et al., 2012). A 2019 systematic review and meta-analysis evaluated the efficacy of Momordica charantia in lowering elevated plasma glucose levels (blood sugar) in prediabetic and type 2 diabetic patients (Peter et al., 2019). The review shortlisted ten randomized and nonrandomized clinical trials, published between 1970 and 2018, which included data on at least 4 weeks of primary and secondary health outcomes and

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quality assessment for levels of bias (Azam et  al., 2016; Cortez-Navarrete et  al., 2018; Dans et al., 2007; Fuangchang et al., 2011; John et al., 2003; Krawinkel et al., 2018; Rahman et al., 2015; Suthar et al., 2016a; Suthar et al., 2016b; Trakoon-osot et al., 2013; Zanker et al., 2012). The authors of the review concluded that unripe fruits, seeds, or fruit pulp preparations of Momordica charantia taken orally at doses of 2–6 g/day for at least 4 weeks lowered elevated levels of fasting plasma glucose, postprandial plasma glucose (blood sugar after a meal), and glycated hemoglobin (HbA1c) in type 2 diabetic patients. High HbA1c levels are associated with a greater risk of developing diabetes-related complications. However, in their analysis, the authors identified the need for further research to standardize Momordica charantia formulations and for high quality clinical trials, to answer specific questions on the safety, efficacy, and specific dose and duration of treatment required to achieve optimal glycemic control in type 2 diabetic patients. By high quality, the authors specified adequate sample size, random sequence generation, allocation concealment (to prevent patient selection bias), and blinding of both participants (patients) and assessors (researchers) (Peter et al., 2019). The conclusions of both these reviews are similar to those of the Natural Medicines database, which states that more evidence is needed to evaluate the effectiveness of Momordica charantia in type 2 diabetes because studies have been small, short-term, and uncontrolled and have sometimes shown conflicting results (Natural Medicines, 2015). The effects of Momordica charantia supplementation was studied in a single-­ blinded, randomized controlled trial in 75 patients diagnosed with primary knee osteoarthritis. Thirty eight and thirty seven patients were given 4.5 g of Momordica charantia (plant part not specified) and placebo capsules, respectively, for a period of 3 months. Rescue analgesia (pain medication) was allowed as needed. After 3 months, body weight, body mass index, and fasting blood glucose reduced significantly in the Momordica charantia group. Based on the results of the study, the authors concluded that Momordica charantia supplementation offers a safe alternative to reducing pain and improving symptoms among the primary knee osteoarthritis patients, while reducing the need for consumption of pain medication (Soo May et al., 2018).

Safety information Side effects Side effects associated with the use of Momordica charantia in some humans include hypoglycemia (low blood sugar), favism (breakdown of red blood cells), and headache, with limited details of the severity and duration of headaches. In animals, Momordica charantia had a negative effect on fertility and formation of sperm cells, induced abortions, and lowered levels of insulin and glucose in blood serum (Natural Medicines, 2015).

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In the Cochrane review of four human clinical studies (see above), 479 participants with type 2 diabetes took various Momordica charantia preparations for periods ranging from 4  weeks to 3  months. Three of the four studies reported side effects, and these were mostly moderate, including diarrhea and abdominal pain (Ooi et al., 2012). A preliminary phase II trial used an open (non-blinded) and nonrandomized design to determine the safety of Momordica charantia supplementation in 42 eligible patients with a clinical diagnosis of metabolic syndrome (21 men and 21 women, with a mean age of 46 years), to provide justification for a large-scale multicenter clinical trial in the future. The patients were supplemented with 4.8 g freezedried whole fruit powder (including seeds) in capsules daily for 3  months. Few adverse effects were reported during the study, and these were generally mild. Throughout the study period, only one subject reported abdominal pain, and two claimed bloating. In a 3-month follow-up period, there were no reports of upper respiratory tract infections, rapid weight gain, edema, or other serious adverse reactions. There were no significant changes in blood parameters (alkaline phosphatase, g-glutamyl transferase, AST, ALT, total bilirubin, creatinine, sodium, and potassium levels) at the end of the trial compared to those at the baseline (Tsai et al., 2012).

Toxicology In animals, the principal toxicity associated with the fruit juice of Momordica charantia is to the liver and to the reproductive system, with antifertility effects. These effects have not been reported in human studies, despite widespread use of the fruit as a medicine and vegetable (Raman and Lau, 1996). Also, changes in levels of important liver enzymes after administration of fruit juice, or an extract of the seeds, were not associated with significant changes in the histopathology of the liver in animals (Natural Medicines, 2015). In humans, the clinical relevance of these results has not been studied, thus caution is warranted in people with liver disease. There have been two cases of hypoglycemic coma and convulsions in small children aged 3 and 4  years after drinking Momordica charantia tea made from the leaves and vine. The tea had been administered early in the morning on an empty stomach. Both the children recovered (Raman and Lau, 1996).

Contraindications Persons with a deficiency in an enzyme called glucose-6-phosphate should not use Momordica charantia because they are at risk of developing favism following ingestion of the seeds. Favism is characterized by the breakdown of red blood cells with symptoms such as headache, fever, stomachache, and coma. Its occurrence is most common in persons of Mediterranean and Middle Eastern descent (Natural Medicines, 2015).

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Use in pregnancy and breastfeeding In animals, Momordica charantia had a negative effect on fertility, induced abortions, and inhibited formation of sperm cells (Natural Medicines, 2015). Pregnant women, therefore, should abstain from taking the plant internally as a medicine. The Caribbean pharmacopeia also recommends against the use of cerasee during pregnancy, due to the risk of abortion, and cautions against its internal use during breastfeeding, and by children under 3 years old (TRAMIL, 2016).

Drug interactions The use of Momordica charantia in combination with drugs that stabilize and control blood sugar levels, such as metformin, insulin, and other medications, is likely to increase the effect of these drugs. Such combined use poses the risk of blood sugar levels becoming too low, an effect called hypoglycemia, with symptoms such as clumsiness, confusion, loss of consciousness, seizures, and ultimately death. When combining plant medicines and drugs, it is strongly recommended that people with diabetes consult with their healthcare provider and closely monitor their blood sugar levels (Delgoda and Picking, 2015; Natural Medicines, 2015). In a Pakistani diabetic woman who took the drug chlorpropamide and ate a curry containing Momordica charantia and Allium sativum (garlic), severe hypoglycemia (low blood sugar) was observed (Izzo and Ernst, 2001). A decoction prepared with the aboveground (aerial) parts of Momordica charantia was tested in the laboratory for its effect on a number of key human enzymes that are responsible for processing many pharmaceutical drugs in the body (cytochromes P450, CYPs 1A2, 2C9, 2C19, 2D6, 3A4). The results showed weak impact against all the enzymes tested, indicating that clinically significant interactions with drugs metabolized by the same enzymes are unlikely (Shields, 2006; Delgoda and Picking, 2015). However, it is advised that the oral consumption of any Momordica charantia preparation, in combination with prescription or over-the-counter (OTC) drugs, is only undertaken with the advice and guidance of a qualified physician or pharmacist.

Recommendations Natural Medicines (2015) considers Momordica charantia possibly safe when the fruit is used orally and short-term. Extracts of the fruit appear to be safe for use up to 3 months. Oral consumption and topical application, using aboveground parts of the plant, is approved by the Caribbean pharmacopeia (TRAMIL, 2016). Efird et al. (2014) concluded that “the use of bitter melon may be warranted in certain individuals, such as patients without health insurance, those living in rural areas far from healthcare,

Selected bibliography

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members of ethnic or religious groups who do not subscribe to conventional medical care or surgery, and non-compliant patients (e.g., those with d­ ifficulty swallowing pills). An increasing prevalence of pre-diabetics has been noted in remote, rural regions, especially those with a high number of elderly residents. Further assessment of the benefits and risks associated with the use of Momordica charantia in these groups is recommended.” Extracts from any part of the plant should not be taken by pregnant women, as it can stimulate menstruation and may cause spontaneous abortion, based on animal data. The oral consumption of Momordica charantia extracts should be avoided during breastfeeding because of lack of information and not given to children under 3 years of age, due to the risk of low blood sugar levels (hypoglycemia).

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Azam M, Saerang CO, Rahayu SR, Indrawati F, Budiono I, Fibriana AI, Azinar M, Sa’dyah NAC, Cahyono EB, Lesmana R (2016) A doubled-blind, crossover-RCT in T2DM for evaluating hypoglycemic effect of P. indicus, M. charantia, P. vulgaris and A. Paniculata in Central Java. Journal of Natural Remedies 16, 108–114. Baldwa VS, Bhandari C M, Pangaria A, Goyal RK (1977) Clinical trial in patients with diabetes mellitus of an insulin-like compound obtained from plant source. Upsala Journal of Medical Sciences 82: 39-41. CABI (2020) Momordica charantia (bitter gourd) [original text by Rojas-Sandoval J, Acevedo-­ Rodriguez P] In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January at https://www.cabi.org/isc/datasheet/34678. Cortez-Navarrete M, Martínez-Abundis E, Pérez-Rubio KG, González-Ortiz M, Méndez-Del Villar M (2018) Momordica charantia administration improves insulin secretion in type 2 diabetes mellitus. Journal of Medicinal Food 21: 672-677. Dans AM, Villarruz MV, Jimeno CA, Javelosa MA, Chua J, Bautista R, Velez GG (2007) The effect of Momordica charantia capsule preparation on glycemic control in type 2 diabetes mellitus needs further studies. Journal of Clinical Epidemiology 60: 554-559. Delgoda R, Picking D (2015) Potential drug interactions for commonly used medicinal plants & foods in Jamaica. Kingston: University of the West Indies, Natural Products Institute, 23 pp. Efird JT, Choi YM, Davies SW, Mehra S, Anderson EJ, Katunga LA (2014) Potential for improved glycemic control with dietary Momordica charantia in patients with insulin resistance and pre-­ diabetes. International Journal of Environmental Research and Public Health 11: 2328-2345. Fuangchan A, Sonthisombat P, Seubnukarn T, Chanouan R, Chotchaisuwat P, Sirigulsatien V, Ingkaninan K, Plianbangchang P, Haines ST (2011) Hypoglycemic effect of bitter melon compared with metformin in newly diagnosed type 2 diabetes patients. Journal of Ethnopharmacology 134: 422-428. Inayat-ur-Rahman, Malik SA, Bashir M, Khan R, Iqbal M (2009) Serum sialic acid changes in non-insulin-dependant diabetes mellitus (NIDDM) patients following bitter melon (Momordica charantia) and rosiglitazone (Avandia) treatment. Phytomedicine 16: 401-405. Izzo AA, Ernst E (2001) Interactions between herbal medicines and prescribed drugs: A systematic review. Drugs 61: 2163-2175. John AJ, Cherian R, Subhash HS, Cherian AM (2003) Evaluation of the efficacy of bitter gourd (Momordica charantia) as an oral hypoglycemic agent—a randomized controlled clinical trial. Indian Journal of Physiology and Pharmacology 47: 363-365. Krawinkel MB, Ludwig C, Swai ME, Yang RY, Chun KP, Habicht SD (2018) Bitter gourd reduces elevated fasting plasma glucose levels in an intervention study among prediabetics in Tanzania. Journal of Ethnopharmacology 216: 1-7.

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Lim ST, Jimeno CA, Razon-Gonzales EB, Velasquez MEN (2010). The MOCHA DM study: The effect of Momordica charantia tablets on glucose and insulin levels during the postprandial state among patients with type 2 diabetes mellitus. Philippine Journal of Internal Medicine 48: 19–25. Natural Medicines (2015) Formerly Natural Standard and Natural Medicines Comprehensive Database. Bitter melon. Accessed 16 December 2015 at https://naturalmedicines.therapeuticresearch.com/. Ooi CP, Yassin Z, Hamid TA (2012) Momordica charantia for type 2 diabetes mellitus. Cochrane Database Systematic Reviews 8: Cd007845. Peter EL, Kasali FM, Deyno S, Mtewa A, Nagendrappa PB, Tolo CU, Ogwang PE, Sesaazi D (2019) Momordica charantia L. lowers elevated glycaemia in type 2 diabetes mellitus patients: Systematic review and meta-analysis. Journal of Ethnopharmacology 231:311-324. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Pons J, Stevenson D (1943) The effects of Momordica charantia L. (“cundeamor”) in diabetes mellitus. The Puerto Rico Journal of Public Health and Tropical Medicine 19: 196–215. Purificacion JM, Cortes-Maramba NP, Ho H (2007) Reinstating ampalaya (Momordica charantia, L.) as scientifically validated herbal medicinal plant. Departmental Circular. Office of the Secretary, Department of Health, Republic of the Philippines, issue 2007–0058. Raman A, Lau C (1996) Anti-diabetic properties and phytochemistry of Momordica charantia L. (Cucurbitaceae). Phytomedicine 2: 349-362. Rahman IU, Khan RU, Rahman KU, Bashir M (2015) Lower hypoglycemic but higher antiatherogenic effects of bitter melon than glibenclamide in type 2 diabetic patients. Nutrition Journal 14, 13. Rosales R, Fernando R (2001) An inquiry to the hypoglycemic action of Momordica charantia among type 2 diabetes patients. Philippine Journal of Internal Medicine 39: 213–216. Shields, M (2006) The effect of Jamaican medicinal plants on the activities of cytochrome P450 enzymes. Kingston, Jamaica: University of the West Indies, MPhil Dissertation. Soo May L, Sanip Z, Ahmed Shokri A, Abdul Kadir A, Md Lazin MR (2018) The effects of Momordica charantia (bitter melon) supplementation in patients with primary knee osteoarthritis: A single-blinded, randomized controlled trial. Complementary Therapies in Clinical Practice 32: 181-186. Suthar AC, Deshmukh A, Babu V, Mohan VS, Chavan MV Kumar D, Chauhan V, Sharma S, Sharma M (2016a) Efficacy and safety of Glycebal (PDM011011) capsules as adjuvant therapy in subjects with type 2 diabetes mellitus: an open label, randomized, active controlled, phase II trial. Clinical Diabetology 5: 88–94. Suthar AC, Pai VG, Kadam Y, Tongaonkar A, Kale S, Deshpande AB, Kolke S, Tanna S, Deshpande SV, Chawla P, Biswas D, Sharma S (2016b) Efficacy and safety of PDM011011 capsules as compared to metformin in subjects with type-2 diabetes mellitus: An open-label, randomized, active-controlled, multicentric, phase III study. Journal of Diabetes Mellitus 6: 38–48. Trakoon-osot W, Sotanaphun U, Phanachet P, Porasuphatana S, Udomsubpayakul U, Komindr S (2013) Pilot study: Hypoglycemic and antiglycation activities of bitter melon (Momordica charantia L.) in type 2 diabetic patients. Journal of Pharmacy Research 6: 859–864. https:// doi.org/10.1016/j.jopr.2013.08.007. TRAMIL (2016) Caribbean pharmacopeia. Momordica charantia. Accessed 27 December 2019 at http://www.tramil.net/en/plant/momordica-charantia. Tsai CH, Chen EC, Tsay HS, Huang CJ (2012) Wild bitter gourd improves metabolic syndrome: a preliminary dietary supplementation trial. Nutrition Journal 11: 4. Welihinda J, Karunanayake EH, Sheriff MH, Jayasinghe KS (1986) Effect of Momordica charantia on the glucose tolerance in maturity onset diabetes. Journal of Ethnopharmacology 17: 277-282. Zanker KS, Mang B, Wolters M, Hahn A (2012) Personalized diabetes and cancer medicine: A rationale for anti-diabetic nutrition (Bitter Melon) in a supportive setting. Current Cancer Therapies Review 8: 66–77. https://doi.org/10.2174/157339412799462521.

Chapter 18

Morinda citrifolia L. (Rubiaceae)

Common names in Jamaica: Noni, hog apple, duppy soursop

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_18

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Botanical characteristics and propagation Evergreen shrub or small tree, reaching up to 10 m in height, with a deep taproot and a wide-spreading lateral root system, that is difficult to eradicate once established. The sapwood is soft and yellow-brown, and the bark gray or light-brown. The simple leaves are opposite and membranous, elliptic to elliptic-ovate in shape, shiny, and deeply veined. The plant bears white, tubular flowers, and egg-shaped fruits all year round (CABI, 2020). The fruit has a strong smell when ripening, often called unpleasant, and turns from green to yellow, then white. The native range of the species is from Southeast Asia to Australia, but its distribution is now pantropical, and it has become naturalized in many islands in the Caribbean (CABI, 2020). It is cultivated in Polynesia, India, the Caribbean, Central and northern South America. Noni is the Hawaiian name (Chan-Blanco et al., 2006). Likely the first naturalist description of the use of noni fruit as a food was in 1769, when one of Captain James Cook’s crew on the ship the Endeavour recorded that people in Tahiti ate noni fruit (West et al., 2006). Noni is propagated by seeds, stems or root cuttings, and air layering (a propagation method for woody plants that allows rooting of branches while they are still attached to the mother plant) (Nelson, 2005; Chandra and Dasari, 2013).

Where to find the plant Noni can be found everywhere since it can tolerate and thrive in harsh conditions (CABI, 2020). In Jamaica, it was observed in people’s yards, near the seashore, and along roadsides.

Part used The leaf and fruit, occasionally the root.

Jamaican cultural uses and beliefs The juice obtained through fermentation of the fruit (called noni wine) is well regarded as a health tonic. Some people reported the smell and taste of the fruit and juice to be unpleasant. The dried leaves are used to prepare a regular tea that “makes you sweat and feel fresh.” Someone in Kingston explained that around the 1980s and 1990s, Jamaican people “got into noni” and that before that time nobody paid much attention to the plant.

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Jamaican medicinal uses The fermented juice from the fruit, and the leaf tea, is popularly used to treat cancer, whereas the leaf is tied to the head for headache.

Major uses (mentioned by more than 20% of people) • Cancer: In Windsor Forest and Kingston, the fruit is drained in a bucket until it melts and the juice is consumed with honey, or a tea of the leaf is drunk. • Headache: In Windsor Forest, people tie the leaf to the head with a cloth and claim it makes the head sweat and draws out the headache. The leaf is also boiled and drunk as a tea.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Arthritis: In Kingston, people tie the leaf to the painful spot. Or, they boil a tea of the leaf, or drain the fruit, and drink the preparation. • Asthma: In Windsor Forest, the juice obtained from draining the fruit is drunk. • Back pain: In Windsor Forest, the well-ripe fruit is drained in a bucket and then juiced, or the leaf is boiled as a tea, and drunk. • Blood cleanser: In Kingston, the fruit is drained for its juice for 8 days, and the juice is mixed with sweet orange juice and honey, bottled and drunk. • Body cleanser: In Windsor Forest and Kingston, the juice is obtained by draining the fruit, after which it is mixed with honey and molasses and drunk three times a week. The leaf is boiled and drunk as a tea. • Common cold: In Windsor Forest and Kingston, the ripe fruit is drained in a bucket or plastic bag, or the fruit is boiled, then the fermented juice is mixed with honey and drunk. Alternatively, a tea is prepared with the leaf. • Diabetes (sugar): In Kingston, the fruit is either boiled or drained for 8 days to 1 month, after which the juice is strained, then sweet orange juice and honey are added, and the tonic wine is bottled and drunk. • High blood pressure: In Kingston, the fruit is drained for 8 days to 2 weeks, a month or longer. People say: “the longer it stays, the more it cures.” Then the juice is strained, sweet orange juice and honey are added, and the preparation is bottled and drunk. Alternatively, a leaf is picked with care so it does not drop on the ground, then wilted (“quailed”) in the sun, and tied to the head. In Windsor Forest and Kingston, the leaf is also boiled as a tea and drunk for blood pressure.

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• Nerves: In Kingston, the fruit is drained for 1 month, or the leaf is boiled as a tea, and the juice or tea are drunk. • Provides energy, strength, and builds the body: In Windsor Forest and Kingston, the fruit is drained to obtain the juice, or the root is added to root tonic, and the fermented preparation is drunk.

Reported medicinal uses across the Caribbean The Caribbean pharmacopeia recommends drinking a decoction of the fresh leaf to treat diarrhea, as well as external application of the fresh leaf for arthritis. These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-Robineau, 2014). In the Caribbean, the leaves are used as a compress on wounds and arthritic joints and applied to the head to relieve pain and fever (Morton, 1992). Across individual countries: • Dominica: The leaves are used as a compress (poultice) to wrap around arthritic joints (Pawlus and Kinghorn, 2007). • Jamaica: A TRAMIL survey undertaken in 2009 identified Morinda citrifolia as the 15th most widely reported medicinal plant for the treatment of illness and maintenance of health (Picking et al., 2015).

Reported medicinal uses across the world Noni is a traditionally important plant that has been used for over 2000  years in Polynesia as a food source, dye, and for its medicinal properties. Early traditional use was primarily as a topical application for boils, ringworm, arthritic pain, neuralgia (nerve pain), bruises, gout, and infections. Modern day uses have now expanded to include antibacterial, antiviral, antifungal, antitumor, anthelmintic (expels ­parasites), analgesic (relieves pain), hypotensive (decreases blood pressure), anti-­ inflammatory (reduces swelling), and immunostimulant (boosts the immune system) (Kuhn and Winston, 2001; Natural Medicines, 2012). Among island people from the South Pacific, noni fruit is traditionally used to treat infertility in women (Wang et al., 2011). Across individual countries: • Andaman and Nicobar Islands (archipelago in India’s Bay of Bengal): The leaves are used for body ache, difficulty breathing, skin injuries, diarrhea, fever, bone fractures, headache, hernia, hypertension, infertility, pain in the eye, scrotal pain, paralysis, snake bite, abdominal pain, dental caries, and weakness (Punnam Chander et al., 2014).

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• Fiji: The young leaves in oil are applied to ringworm and arthritic pains. They are chewed and placed as a compress on any inflammation (Morton, 1992). • Guam: Juice squeezed from the flowers is applied to sore eyes (Morton, 1992). • Guyana: The leaves are macerated alone or mixed with cow foot (Piper peltatum L.), together with coconut oil for an external rub to relieve arthritis (Pawlus and Kinghorn, 2007). • Hawaii: The mashed ripe fruit is used to relieve a painful boil (carbuncle) or a stomach ulcer. The young fruit, mashed with salt, is applied on deep cuts and as a poultice over broken bones (Morton, 1992). The leaves and bark are pounded, cooked, and drunk as a tonic and abortifacient (provokes abortion). The ripe fruit is used for hypertension (high blood pressure) and fatigue of old age. The immature fruit juice is drunk for diabetes, high blood pressure, digestive disorders, menstrual cramps, and as a general tonic. The green fruit is used for skin problems (Pawlus and Kinghorn, 2007). By the 1930s, noni had become a popular ingredient in many compound formulas, usually mixed with ginger, coconut milk, or sugar cane juice and taken orally for tuberculosis, intestinal worms, and sexually transmitted infections and for “purifying the blood” (Kuhn and Winston, 2001). • Malaysia and Southeast Asia: The ripe fruit is gargled for sore throat. In the Philippines, the seeds are given to children and adults as a purgative and to expel worms (Morton, 1992; Kuhn and Winston, 2001). • Mauritius: The leaves of Morinda citrifolia are tied to the leg for pain and to the forehead for headache (Sreekeesoon and Mahomoodally, 2014). • Palau: Morinda citrifolia is a popular remedy to treat overweight and diabetes (Graz et al., 2015).

Clinical efficacy studies in humans No randomized, controlled trials have been conducted to assess the effects of noni in cancer patients (Pilkington, 2016). Natural Medicines (2012) summarizes early research that suggests noni might improve some symptoms associated with cancer, neck pain, high blood pressure, arthritis, and nausea after surgery. Taking 6–8 g of freeze-dried noni fruit (not the juice) daily might improve physical function, fatigue, and pain in people with advanced cancer, but does not seem to reduce tumor size (Issell et al., 2009; Brown, 2012). Taking noni juice during physiotherapy for 4 weeks can reduce neck pain and improve neck flexibility, compared to physiotherapy alone. However, treatment with physiotherapy alone seemed to relieve pain and improve flexibility better than taking noni juice alone. Drinking a juice containing noni, grapefruit, and blackberry for 21 days can increase exercise endurance in distance runners. Drinking 4 oz. of Tahitian noni juice daily for 1 month might reduce blood pressure in people with high blood pressure. Drinking 3  oz. of Tahitian noni juice daily for 90  days can reduce the need for pain relievers and improve quality of life in people with osteoarthritis. Noni fruit reduced nausea after surgery, but did not affect vomiting. On the

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other hand, drinking 4 oz. of noni juice daily for 3 months did not improve hearing in women with hearing problems (Natural Medicines, 2012). A phase I dose-finding trial was carried out in 29 patients with advanced cancer. Patients took capsules containing 500 mg of dehydrated (freeze dried) noni fruit. Doses ranged from 2 to 10 g (4–20 capsules) daily, and a minimum of five patients per dose was observed for 28 days. An effect of noni was observed for several quality of life measures, although these did not reach statistical significance, except for a decrease in pain. No effects of noni were seen on cancer tumors (Issell et al., 2009). Two trials assessed the effects of noni on levels of biomarkers thought to increase the risk of developing cancer. A noni manufacturer-financed, double-blind, placebo-­ controlled trial was conducted to assess antioxidant activity of noni in smokers (Wang et al., 2009a). A total of 285 heavy smokers were randomly given placebo, 29.5 mL (1 oz. fluid) of noni juice, or 118 mL (4 oz) of noni juice, each day for 30 days. Levels of plasma superoxide anion radicals and lipid hydroperoxide were reported to have decreased in the noni groups (Pilkington, 2016). A second, noni manufacturer-funded study assessed the levels of aromatic DNA adducts, a biomarker for risk of lung cancer, in smokers who drank noni juice for a month (Wang et al., 2009b). Of 283 smokers recruited for the trial, 203 completed the study. The results indicated that daily noni juice may reduce cancer risk in heavy cigarette smokers by blocking carcinogen–DNA binding or removing DNA adducts from genomic DNA. Both were preliminary studies. Over 25% of study participants did not complete the trial, yet all patients were included in the analysis. Noni juice and the placebo seemed well-matched but contained a mixture of grape juice and blueberry juice, which could have contributed to the beneficial effects reported (Pilkington, 2016). A third, noni manufacturer-funded study investigated the effect of noni juice on blood serum cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), high-sensitivity C-reactive protein (hs-­ CRP), and homocysteine in 132 adult heavy smokers. In the randomized, double-­ blind, placebo-controlled clinical trial, volunteers drank noni juice, or a fruit juice placebo, for 1 month. Daily consumption was reported to significantly reduce serum cholesterol levels, triglycerides, and hs-CRP. Decreases in LDL (“bad cholesterol”) and homocysteine, as well as increases in HDL (“good cholesterol”), were also observed. The placebo, which did not contain iridoid glycosides, did not significantly influence blood lipid profiles or hs-CRP.  The authors concluded that noni juice was able to mitigate cigarette smoke-induced dyslipidemia (abnormally elevated levels of cholesterol or fats in the blood), which they linked to the presence of iridoids (Wang et al., 2012). A preliminary, prospective, randomized, double-blind, placebo-controlled trial was undertaken in Thailand to evaluate the efficacy of Morinda citrifolia for the prevention of postoperative nausea and vomiting (PONV) in patients following surgery. A plant extract was prepared by boiling dried fruit, and evaporating and encapsulating the resulting powder into dosages of 150, 300, and 600 mg, equivalent to 5, 10, and 20 g of dried fruit, respectively. One hundred patients, aged 18–65 years, and considered at risk for PONV, were randomized to receive 150, 300, or 600 mg

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of extract or a placebo orally, 1 h before surgery. Significantly fewer patients who had received the 600 mg extract experienced nausea during the first 6 h after surgery compared to the placebo group, corresponding to 48% and 80% of patients, respectively. No side effects were reported in any of the groups. The study authors concluded that Morinda citrifolia aqueous extract has antiemetic properties and that the prophylactic use of the extract at 600 mg effectively reduces the incidence of early postoperative nausea up to 6 h (Prapaitrakool and Itharat, 2010).

Safety information Side effects A few case reports have discussed possible links between potential adverse reactions and noni juice. A case of suspected acute hepatitis (inflammation of the liver) in a 45-year-old man, with elevated transaminases and lactate dehydrogenase, was reported at the Medical University of Innsbruck, Austria. The patient’s medical history was unremarkable. He took no medication on a regular basis, and there was no evidence of viral hepatitis, Epstein–Barr virus, cytomegalovirus, autoimmune hepatitis, BuddChiari syndrome, hemochromatosis, or Wilson’s disease. However, the man had been drinking Morinda citrifolia juice during the preceding 3 weeks. Herbal toxicity was subsequently confirmed by liver biopsy, and when he stopped drinking Morinda citrifolia juice, transaminase levels returned to normal after 1  month (Millonig et al., 2005). A direct effect of noni was not established in a case of hyperkalemia (too much potassium in the blood), a case of acquired coumadin resistance (diminished effect of blood thinning medication), and several cases of liver toxicity (Müller et al., 2000). Commercial noni juices may include a wide variety of ingredients, such as other fruit juices, botanicals, and organic acid salts used as preserving agents. For example, further investigation into a case of acute liver toxicity in a 14-year-old boy who drank a product supposedly containing noni revealed that the beverage contained less than 1% noni fruit juice, and included other major ingredients such as Aloe vera (West and Deng, 2011). Therefore, it is recommended that healthcare professionals ascertain the content of a specific brand of noni juice before advising patients (West et al., 2006). The suggested link between ingestion of noni juice, puree or concentrate, and hepatotoxicity (liver damage) has been challenged because it does not correspond with results from organ tissue examination and outcomes of subchronic oral toxicity tests in animals, or with observed laboratory values of clinical safety studies. The European Food Safety Authority (EFSA) investigated four case reports related to the possible association between noni juice consumption and hepatotoxicity and concluded that there was no convincing evidence for a causal relationship (EFSA, 2006). The EFSA

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subsequently reviewed a further six new case reports and concluded that Morinda citrifolia fruit puree and concentrate are considered safe for the general population. However, the EFSA also stated that the increasing number of case reports might indicate that some individuals have a particular sensitivity for the hepatotoxic effects of noni fruit products (EFSA, 2009).

Toxicology There are several studies involving the administration of noni to laboratory animals without perceived toxicity (Pawlus and Kinghorn, 2007). The safety of a water extract of the leaf, in an oral dose of 5 g/kg body weight, was observed in two separate groups of male and female rats for 2 weeks. No changes were observed in the behavior of the rats, nor death. Examination of their organ tissues showed no detectable abnormalities. The authors concluded that the extract may be considered safe in doses consumed in traditional medicine (up to 1 g/day). Studies in animals represent baseline data for further studies in humans (Russo Serafini et al., 2011). Pureed noni fruit from Tahiti (called “Tahitian noni”) was administered orally to rats, in a dose of 15 g/kg body weight. The animals were observed for 2 weeks and showed no signs of toxicity or behavioral changes. All animals appeared healthy, gained weight, and showed no disease during examination of their remains. Therefore, the LD50 or lethal dose at which half the group of test animals died was greater than 15 g/kg body weight for noni fruit. As a general rule, compounds are considered not toxic if the acute oral LD50 is greater than 5 g/kg body weight (West et al., 2006). However, there are reports of liver damage in people who drank noni tea or juice for several weeks, but it remains to be proven that noni was the cause (Natural Medicines, 2012). Malaysian researchers undertook a chronic toxicity evaluation of 6  months in female mice, comparing water extracts of the fruit and leaf of Morinda citrifolia, in doses of 1–2 mg/mL drinking water. The results indicated chronic toxicity for the fruit extracts at the high dose of 2 mg/mL, with deterioration of the liver (hepatocyte necrosis), reduced liver size, increased liver injury marker AST (aspartate aminotransferase) and albumin reduction, injury symptoms, and 40% mortality within 3 months. In contrast, for both the doses of the leaf extract, there were no observable signs of toxicity. The doses of 1 and 2 mg/mL chosen for the study were equivalent to 100 and 200 mg extract/kg body weight of the mice. These doses are the human equivalent of 8 and 16 mg/kg body weight or 0.5 and 1 g for a human weighing around 60 kg. A human drinking 2 L of tea daily would consume about 1–2 g of tea extract depending on the strength, assuming a 200 mL cup of tea contains 2 g of the leaf (Mohamad Shalan et al., 2016). On the other hand, several preclinical safety tests, and a human clinical safety study, have revealed no adverse health effects of noni fruit, even in high doses. The

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available data therefore substantiate its continued use as a safe food (West et al., 2006). The safety of Tahitian noni fruit juice was evaluated in a double-blind, three-dose level, parallel group, placebo-controlled study in 96 healthy subjects (28 men and 68 women). The test groups received a dose of 750 mL placebo (control) or Tahitian noni juice (three different doses) per day, for 28 days. Subjects were evaluated for blood, biochemical, and urological measurements at week 0, 2, 4, and 6. The data showed that drinking up to 750  mL of Tahitian noni juice per day is safe (West et al., 2006). In another clinical safety study, 29 persons ingested capsules of noni fruit extract in doses ranging from 2 to 10 g. No adverse effects were observed. The 10 g dose corresponds to approximately 200 mL (almost one cup) of noni fruit juice (West et al., 2006).

Contraindications Natural Medicines (2012) warns against the consumption of noni by people with liver and kidney diseases. According to Brown (2012), “noni juice is high in potassium and needs to be monitored by patients with kidney, liver or heart problems.” A case was reported of a man who had a long history of kidney insufficiency (not linked to noni) who began to regularly consume noni juice and was subsequently diagnosed with hyperkalemia (elevated levels of potassium in the blood). His condition improved when he stopped consuming noni juice (Müller et  al., 2000). It is therefore recommended that noni is avoided in people with liver problems, hyperkalemia, and kidney problems, people on low potassium diets, or people taking potassium-sparing diuretics or other drugs that increase potassium levels such as ACE inhibitors (Pilkington, 2016). Patients with diabetes should consume noni juice with caution due to its naturally occurring high sugar content. Caution is also urged in patients taking a certain group of drugs that are metabolized (processed in the body) by the human enzyme CYP2C9. Preliminary laboratory screens and two case reports indicated that noni may induce the activity of this enzyme (see drug interactions below). Induction of CYP2C9 could lead to a lowering of drug levels, and a reduced effectiveness of medication. Drugs that are metabolized by CYP2C9 include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen; hypoglycemic agents (to treat diabetes) such as glipizide; angiotensin II blockers (to treat hypertension) such as losartan; phenytoin (to treat epilepsy) and tamoxifen (to treat cancer), warfarin (to treat blood clotting). Patients are urged to consult a qualified healthcare professional before taking noni together with prescription or over-the-counter (OTC) drugs.

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Use in pregnancy and breastfeeding It has been reported that ingestion of a large amount of noni fruit can cause abortion, and the root bark has been used as an abortifacient (provoking abortion) in the Pacific island of Futuna. This activity has not been confirmed experimentally (Pawlus and Kinghorn, 2007). Not enough is known about the safety of ingesting noni during breastfeeding. In mice, 5% Tahitian noni juice in the drinking water showed no adverse effects on fertility and development of pups across three generations and rather seemed to facilitate pregnancy and fetal development. The noni-treated mice had larger litters and less dead pups in the first week after birth (Wang et al., 2011). In rats, freeze-dried noni fruit puree was administered orally for 21 days in doses varying from almost 2 to 7 g/kg body weight. There was no difference between the control group of rats and any noni-treated group in the number of live fetuses, fetal weight, or skeletal abnormalities (West et al., 2008). A water extract of the fruit administered by mouth to pregnant rats for 2 weeks (in doses of 7.5, 75, and 750 mg/kg body weight) showed no influence on the length of pregnancy, number of fetal implants, or litter size. However, the lowest dose (7.5 mg/kg body weight) decreased the number of pregnant females that had pups (parturition index) and decreased the number of live pups as compared to the number of implanted fetuses. Interestingly, the two higher doses showed no such effects (Müller et al., 2009).

Drug interactions Noni juice was tested in the laboratory for its effect on a number of key human enzymes that are responsible for processing many pharmaceutical drugs in the body (cytochrome P450, CYPs 3A4, 2C8, 2C9, 2D6). The results showed that noni juice did not inhibit the enzymes tested, indicating that clinically significant interactions with medications metabolized by these enzymes, which have the potential to lead to dangerous increases in drug levels in the body, are unlikely (Santiago et al. 2010). In spite of these initial findings, further tests indicated that noni juice is a potential inducer of CYPs 3A4, 2C8, 2C9, and 2D6. The clinical implications are that noni juice has the potential to reduce the plasma levels of medications metabolized by CYPs 3A4, 2C8, 2C9, 2D6, and subsequently decrease their effectiveness, by increasing the rate at which these drugs are removed from the body (Santiago et al., 2010). It should be noted that these are preliminary laboratory results and that human clinical studies are necessary to confirm these findings in humans. However, two reported case studies appear to support the laboratory findings of Santiago et  al. (2010). In the first case report, an epileptic 49-year-old male had been successfully treated with the drug phenytoin for 10  years. Over the same period, he had also consumed a noni product, Tahitian Noni® Original Bioactive Beverage™. He was subsequently hospitalized with seizures, and despite maintain-

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ing the normal dose of phenytoin, tests showed that his blood levels of the drug were significantly reduced. His seizures and hospitalization coincided with a doubling of his daily noni juice consumption. Under controlled conditions, the patient stopped taking noni, and his drug levels returned to normal. On resuming the higher dose of noni, his drug levels dropped again. The drug phenytoin is metabolized by the human enzyme CYP2C9. Based on the work of Santiago et al. (2010), the medical team speculated that the patient’s reduction in phenytoin levels, and subsequent seizures, resulted from the induction of CYP2C9 by noni juice (Kang et al., 2015). This mechanism of interaction appears to be ­further supported by an animal experiment, which showed that rats pretreated with noni juice experienced an almost threefold decrease in their blood levels of phenytoin (Harish-Chandra and Veeresham, 2011). The second case report (Carr et al., 2004) is a herb–drug interaction involving the drug warfarin that is commonly used to treat blood clothing. Reduced effectiveness of warfarin was observed in a 41-year-old female following combined ­consumption with noni juice. The authors explained that this could be caused by fortified vitamin K in noni juice (Carr et al., 2004). However, because warfarin is also metabolized by CYP2C9 (like phenytoin), Kang et al. (2015) suspected that a similar mechanism of herb–drug interaction to that with noni juice and p­ henytoin may be at play here. Natural Medicines (2012) states that consuming noni juice along with medications for high blood pressure might spike potassium levels in the blood and might cause blood pressure to go down too low. Noni contains relatively high levels of potassium (similar to levels in orange juice and tomato juice), and the mineral content of commercial noni juices has been shown to vary widely. Since some diuretics (“water pills”) can also increase potassium levels in the body, a combination of noni and water pills can be unhealthy. In addition, Japanese researchers found that ripe noni fruit juice reduced systolic blood pressure in hypertensive rate (rats bred for high blood pressure) in a similar way to a class of pharmaceutical drugs known as ACE inhibitors (Yamaguchi et  al., 2002). In theory, noni might have an additive effect in patients with high blood pressure who are taking ACE inhibitors. In sum, patients with high blood pressure are advised to consult with their healthcare professional about their use of noni juice and other noni products. Finally, taking noni along with medications that affect the liver might increase the risk of liver damage (Natural Medicines, 2012).

Recommendations Morinda citrifolia, commonly called noni, has a long history as a medicinal plant and has been extensively marketed as a botanical dietary supplement over the past decade. Many of the more recent health claims are not based on the traditional use of the plant and are not currently supported by scientific research (Kuhn and Winston, 2001). Natural Medicines (2012) considers noni possibly safe when the fruit is consumed as a food, but warns against taking noni during pregnancy, and against drinking the tea or juice in high medicinal amounts. Data from clinical,

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toxicity, and chemical studies have substantiated the use of noni juice as a safe food. The European Food Safety Authority (EFSA) ruled it unlikely that there was a causal link between noni juice consumption and ten reports of liver toxicity and stated that the noni products tested are considered safe for the general population. However, at the same time, the EFSA cautioned that these cases may indicate that some people have a particular sensitivity for hepatotoxic effects (causing liver damage) of noni products (EFSA, 2006; 2009). It should be noted that a number of published research papers on the safety and efficacy of noni have been undertaken by researchers either employed or funded by commercial noni manufacturers, such as Tahitian Noni Inc., and Morinda Holdings Inc.

Selected bibliography Brown AC (2012) Anticancer activity of Morinda citrifolia (noni) fruit: A review. Phytotherapy Research 26: 1427-1440. CABI (2020) Morinda citrifolia (Indian mulberry) [original text by Rojas-Sandoval J]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/34854 Carr ME, Klotz J, Bergeron M (2004) Coumadin resistance and the vitamin supplement ‘noni’. American Journal of Hematology 7: 103. Chan-Blanco Y, Vaillant F, Perez AM, Reynes M, Brillouet JM, Brat P (2006) The noni fruit (Morinda citrifolia L.): A review of agricultural research, nutritional and therapeutic properties. Journal of Food Composition and Analysis 19: 645-654. Chandra KJ, Dasari DGS (2013) A review on the propagation methods of a miracle fruit Morinda citrifolia L. Indian Journal of Plant Sciences 2: 78-84. EFSA (European Food Safety Authority) (2006) Opinion on a request from the Commission related to the safety of noni juice (juice of the fruits from Morinda citrifolia). The EFSA Journal 376: 1-12. EFSA (European Food Safety Authority) (2009) Opinion on the safety of Tahitian Noni® ‘Morinda citrifolia (noni) fruit puree and concentrate’ as a novel food ingredient. The EFSA Journal 998: 1016. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Graz B, Kitalong C, Yano V (2015) Traditional local medicines in the Republic of Palau and non-­ communicable diseases (NCD), signs of effectiveness. Journal of Ethnopharmacology 161: 233–237. Harish Chandra R, Veeresham C (2011) Herb—drug interaction of noni juice and Ginkgo biloba with phenytoin. Pharmacognosy Journal 2: 33-41. Issell BF, Gotay CC, Pagano I, Franke AA (2009) Using quality of life measures in a Phase I clinical trial of noni in patients with advanced cancer to select a Phase II dose. Journal of Dietary Supplements 6: 347-359. Kang YC, Chen MH, Lai SL (2015) Potentially unsafe herb-drug interactions between a commercial product of noni juice and phenytoin a case report. Acta Neurologica Taiwanica 24: 43-46. Kuhn K, Winston D (2001) Herbal therapy & supplements: a scientific and traditional approach. Philadelphia: Lippincott. Millonig G, Stadlmann S, Vogel W (2005) Herbal hepatotoxicity: acute hepatitis caused by a Noni preparation (Morinda citrifolia). European Journal of Gastroenterology and Hepatology 17: 445-7. Mohamad Shalan NAA, Mustapha NM, Mohamed S (2016) Chronic toxicity evaluation of Morinda citrifolia fruit and leaf in mice. Regulatory Toxicology and Pharmacology 83: 46-53.

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Morton JF (1992) The ocean-going noni, or Indian mulberry (Morinda citrifolia, Rubiaceae) and some of its “colorful” relatives. Economic Botany 46: 241-256. Müller BA, Scott MK, Sowinski KM, Prag KA (2000) Noni juice (Morinda citrifolia): Hidden potential for hyperkalemia? American Journal of Kidney Diseases 35: 310-312. Müller JC, Botelho GGK, Bufalo AC, Boareto AC, Rattmann YD, Martins ES, Cabrini DA, Otuki MF, Dalsenter PR (2009) Morinda citrifolia Linn (noni): In vivo and in vitro reproductive toxicology. Journal of Ethnopharmacology 121: 229–233. Natural Medicines (2012) Formerly Natural Standard and Natural Medicines Comprehensive Database. Noni. Accessed 14 April 2016 at https://naturalmedicines.therapeuticresearch.com/. Nelson S (2005) Noni seed handling and seedling propagation. Fruits and Nuts 10: 1-4. Pawlus AD, Kinghorn AD (2007) Review of the ethnobotany, chemistry, biological activity and safety of the botanical dietary supplement Morinda citrifolia (noni). Journal of Pharmacy and Pharmacology 59: 1587-1609. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Pilkington K (2016) Noni (Morinda citrifolia). CAM-Cancer Consortium. Accessed 27 December 2019 at http://cam-cancer.org/en/noni. Prapaitrakool S, Itharat A (2010) Morinda citrifolia Linn. for prevention of postoperative nausea and vomiting. Journal of the Medical Association of Thailand 93 Suppl 7: S204-9. Punnam Chander M, Kartick C, Gangadhar J, Vijayachari P (2014) Ethno medicine and healthcare practices among Nicobarese of Car Nicobar—An indigenous tribe of Andaman and Nicobar Islands. Journal of Ethnopharmacology 158: 18-24. Russo Serafini M, Moreira de Lima C, Correia Santos R, Azevedo Dória GA, de Jesus JY, Dória de Melo MG, Almeida dos Santos JP, Rabelo TK, Silveira Fortes V, Vieira Fonseca MJ, Cavalcanti de Albuquerque RLJ, Quintans-Júnior LJ, de Souza Araújo AA (2011) Pre-clinical toxicity of Morinda citrifolia Linn. leaf extract. African Journal of Biotechnology 10: 14566-14572. Santiago K, Gaikwad A, Coffer L, Smith JA (2010) Evaluation of the hepatic metabolism and antitumor activity of noni juice (Morinda citrifolia L.) in combination with chemotherapy. Journal of the Society for Integrative Oncology 8: 89-94. Sreekeesoon DP, Mahomoodally MF (2014) Ethnopharmacological analysis of medicinal plants and animals used in the treatment and management of pain in Mauritius. Journal of Ethnopharmacology 157: 181–200. Wang MY, Peng L, Lutfiyya MN, Henley E, Weidenbacher-Hoper V, Anderson G (2009a) Morinda citrifolia (noni) reduces cancer risk in current smokers by decreasing aromatic DNA adducts. Nutrition and Cancer 61: 634-639. [Morinda Holdings Inc.]. Wang MY, Lutfiyya MN, Weidenbacher-Hoper V, Anderson G, Su CX, West BJ (2009b) Antioxidant activity of noni juice in heavy smokers. Chemistry Central Journal 6: 3-13. [Morinda Holdings Inc.]. Wang M, Hurn J, Peng L, Nowicki D, Anderson G (2011) A multigeneration reproductive and developmental safety evaluation of authentic Morinda citrifolia (noni) juice. The Journal of Toxicological Sciences 36: 81-85. [Morinda Holdings Inc.]. Wang, M. Y., Peng, L., Weidenbacher-Hoper, V., Deng, S., Anderson, G., & West, B. J. (2012). Noni juice improves serum lipid profiles and other risk markers in cigarette smokers. ScientificWorldJournal 2012: 594657 [Morinda Holdings Inc.]. West BJ, Deng S (2011) Ingredients other than noni may be culprits in acute hepatotoxicity in a 14-year-old boy. Journal of Pediatric Gastroenterology and Nutrition 53: 469-470. [Tahitian Noni International]. West BJ, Jensen CJ, Westendorf J, White LD (2006) A safety review of noni fruit juice. Journal of Food Science 71: R100–106. [Tahitian Noni International]. West BJ, Su CX, Jensen CJ (2008) Prenatal toxicity test of Morinda citrifolia (noni) fruit. The Journal of Toxicological Sciences 33: 647-649. [Tahitian Noni International]. Yamaguchi S, Ohnishi J, Sogawa M, Maru I, Ohta Y, Tsukada Y (2002) Inhibition of angiotensin I converting enzyme by noni (Morinda citrifolia) juice. Nippon Shokuhin Kagaku Koga ku Kaishi 49: 624-627.

Chapter 19

Petiveria alliacea L. (Phytolaccaceae)

Common names in Jamaica: Guinea henweed, guinea hen weed, guinea hen Other common name in Jamaica: Strong man’s weed (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_19

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Botanical characteristics and propagation Perennial herb or undershrub with tough stems that grows up to 1 m high, emitting a strong smell of garlic when broken. Leaves entire, alternate, simple. Leaf shape elliptical and acuminate (narrowing to a slender point). Small white flowers are born upon a stalk that often droops distally. Its fruits and seeds have projections and hooks that easily attach to animal fur and human clothes (Adams, 1972; CABI, 2020). Sometimes the species is confused with vervine (Stachytarpheta jamaicensis (L.) Vahl and Stachytarpheta cayennensis (Rich.) Vahl) in Jamaica, but these latter two species have small purple flowers and lack the smell of garlic. Petiveria alliacea is native to Florida, Texas, Mexico, Central and tropical South America, and the West Indies (CABI, 2020). It was first described in Jamaica in the eighteenth century (Luz et al., 2016). The plant can be multiplied through stem and root cuttings and from seeds.

Where to find the plant Petiveria alliacea grows in warm and dry to moist climates, from sea level to elevations up to 1300  m (CABI, 2020). It grows wild in the community in Windsor Forest, and people also keep it in their yards. In Kingston, it is cultivated in yards and sold in Coronation Market.

Part used The root, leaf, branch, or the entire plant.

Jamaican cultural uses and beliefs Spiritually, the root is considered very good to break Obeah (when a “disturbing spirit trouble yuh”). In the case of spiritual trouble, Jamaicans break and smell the root, or prepare a bath.

Jamaican medicinal uses Guinea henweed is considered an important bush remedy to treat cancer and headache.

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Major uses (mentioned by more than 20% of people) • Cancer (including prostate problems): It is believed that guinea henweed p­ revents and cures cancer. The bush is either boiled green or steeped dry. Here are a few preparations mentioned by different people in Kingston. Two sprigs of guinea henweed (or a teaspoon of dry bush) are steeped in a cup of hot water and drunk. Alternatively, the bush is bottled together with water, honey, molasses, sugar, and garlic (Allium sativum L.). Two liters of water and guinea henweed are boiled down to 1 L, the remedy is put in the fridge and drunk like water, and four cups are taken per day. Guinea henweed is also boiled as a root tonic with other bush medicines, including blood wiss (different species, such as ­Philodendron hederaceum (Jacq.) Schott, Rourea glabra Kunth, Vitis tiliifolia Humb. & Bonpl. ex Schult., or Paullinia jamaicensis Macfad.), chainy root (Smilax canellifolia Mill.), ironweed (Pseudelephantopus spicatus (B.Juss. ex Aubl.) Rohr ex C.F.Baker), raw moon/ramoon (Trophis racemosa (L.) Urb.), breadnut (Brosimum alicastrum Sw.), cashew (Anacardium occidentale L.), donkey weed (Stylosanthes hamata (L.) Taub.), all-man-strength (Canavalia altipendula (Piper) Standl.), strong back (Desmodium incanum DC.), man back (not identified), sarsaparilla (Smilax ornata Lem.), royal wiss (not identified), soursop (Annona muricata L.), moringa (Moringa oleifera Lam.), and neem (Azadirachta indica A.Juss.). In Windsor Forest, either the entire bush or the aboveground parts, roots, or leaves are boiled for 15  min like coffee, or steeped in hot water, and drunk. Reportedly, guinea henweed is sometimes mixed with soursop leaf, dogblood (Rivina humilis L.), neem, moringa, ginger (Zingiber officinale Roscoe), or pranganat (Punica granatum L.) to treat cancer and prostate problems. • Headache, general pain, back pain: In Kingston, people use the following preparations to treat headache: The bush is broken and inhaled; three leaves are wetted and tied to the head; or the bush is rubbed fresh. Alternatively, the leaf is boiled, or steeped in hot water, and drunk. In Windsor Forest, the leaf, root, branch, or whole bush of guinea henweed is sometimes mixed with ganja (Cannabis sativa L.) to treat headache, general pain and back pain. The fresh leaf is soaked in rum, or bay rum, and tied to the head. Or, the plant parts are either boiled or steeped in hot water, for 5–10 min, and drunk as a tea.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Arthritis: In Kingston, guinea henweed is boiled for 5 min, and the tea is drunk. • Bellyache: In Kingston, the root or bush is boiled as tea, or the bush is steeped in rum, and drunk. • Blood circulation (clogged veins, stroke): In Kingston, the affected area is sapped with the following mixture: the leaf, root, or bush of guinea henweed is steeped

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• • • • •

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19  Petiveria alliacea L. (Phytolaccaceae)

in rum together with a scorpion, a 40 leg, and frankincense. Another preparation is to soak the bush for 3 days in rum, radian B, ammonia, and methylated spirit to apply on the body. Blood pressure: In Kingston, the dry bush is steeped or boiled for 10 min and drunk, or it is tied to the head, to treat high blood pressure. Chikungunya: In Kingston, the root, leaf or bush is used dry (quailed); it is boiled for 15–30 min, sweetened, and drunk. Or, the bush is bottled with water, honey, molasses, sugar, and garlic, and the mixture is drunk regularly. Common cold and flu: In Kingston, the (fresh or dry) root or aboveground parts (leaf and stem) of guinea henweed are boiled for 10 min and drunk. Alternatively, the bush is steeped in boiling water and drunk. Diabetes (sugar): In Kingston and Windsor Forest, the bush, root, or leaf is either steeped or boiled for 5–6 min and drunk. In Windsor Forest, neem is sometimes added to this preparation. Fever: In Kingston, people use the leaf, root, or stem. Guinea henweed is boiled and drunk. Or it is rubbed or steeped in water to bathe. After the bath, the body is covered to sweat. Alternatively, the bush is bottled with water, honey, molasses, sugar, and garlic. It is also put under the sheet in bed to sweat. Sinus problems: In Windsor Forest, people dry and cut the root and leaf of guinea henweed in a bottle and soak them in rum. The remedy is sniffed, rubbed, or drunk, or the bush is inhaled fresh. In Kingston, people smell the root, they soak the leaf and stem in rum to rub or to inhale the mixture, they put the leaves under the pillow, or they boil guinea henweed (fresh or dry) and drink the tea.

Reported medicinal uses across the Caribbean According to the Caribbean pharmacopeia (TRAMIL, 2015), several preparations from the plant are recommended for a number of health conditions, summarized in Table 19.1. These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (TRAMIL, 2015).

Table 19.1  Recommended health conditions across the Caribbean for Petiveria alliacea Recommended use Cold and flu Digestive (stomach pain, gas, slow digestion) Headache Muscle pain Arthritis Skin problems Sinusitis Toothache

Plant part(s) used Leaf and root boiled and drunk Leaf boiled and drunk Leaf and root ground and inhaled Leaf boiled, strained, and added to bath Leaf and root boiled and drunk Leaf boiled for skin wash Root and stem ground and inhaled Leaf steeped and used as a mouthwash

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In Belize, the plant is used for measles, to cleanse the uterus, promote menstruation, and dispel witchcraft, by boiling the leaves or roots, and drinking the tea (Balick and Arvigo, 2015). The most popular use of Petiveria alliacea among the Caribs in Guatemala is inhalation of the powdered root and stem for sinusitis. The Caribs also drink a decoction of the leaves for fever, sinusitis, and digestive disorders, and to fend off bad spirits. They bathe with a decoction of the leaves for muscular pains and skin diseases and burn the leaves as an insect repellent (Girón et al., 1991). A survey of 100 patients attending the oncology and urology clinics at the University Hospital of the West Indies in Kingston, Jamaica, explored the prevalence of concomitant medicinal plant use among this population. Eighty percent of the patients were found to self-medicate with one or more medicinal plants for their cancer, in addition to prescribed biomedical treatments. The use of the leaf, root, and whole plant of Petiveria alliacea, prepared as an aqueous decoction or infusion, was the most common treatment for prostate cancer (Foster et al., 2017).

Reported medicinal uses across the world Across individual countries: • Argentina: In the hot, semi-arid lowlands, a poultice of the root of Petiveria alliacea is used to treat toothache (Martínez, 2010). • Brazil: An ointment of the leaves is applied for arthritis, headache, and skin boils and to treat (unspecified) allergies. Some people reported that the plant should only be used externally (Oliveira et al., 2015). • Nigeria: Traditional healers use a recipe containing the root of Petiveria alliacea and two other plants (leaves of Dysphania ambrosioides (L.) Mosyakin & Clemants and bark of Entandrophragma utile (Dawe & Sprague) Sprague) in the management of sickle cell disease (Adejumo et al., 2011).

Clinical efficacy studies in humans There is currently one published study in humans from 1991. The Brazilian pilot study compared the effectiveness of a Petiveria alliacea tea infusion (plant part not stated) against a placebo tea (that tasted and smelled the same but did not contain guinea henweed) in 14 patients with osteoarthritis of the hip and knee. The study reported no difference between the guinea henweed tea and the placebo tea. However, the authors reported that patients taking both the Petiveria alliacea and placebo tea reported reductions in their levels of pain (Ferraz et al., 1991).

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Safety information Side effects There have been reports of the root and stem causing hypersensitivity reactions in some users (TRAMIL, 2015).

Toxicology A number of studies are listed in the Caribbean pharmacopeia, with no reported cases of toxicity for traditionally made preparations (TRAMIL, 2015). A recent study assessed the toxicity of a suspension of the powder from the dried leaf and stem of the plant in Sprague–Dawley rats by oral administration. The researchers used two tests, the acute toxic class method and the repeated dose 28-day method, following guidelines set by the Organization for Economic Cooperation and Development (OECD). They reported that neither test resulted in deaths. Furthermore, the tests were not associated with negative effects reflected in the general condition or body weight of the rats, nor were there any abnormalities upon histopathological (microscopic) examination of organ tissue (Garcia-Perez et al., 2018). Although a number of animal studies have demonstrated low toxicity under acute and subchronic dosage (Luz et al., 2016), impact on humans from long-­term use, along with variability of plant material introduced by seasonality, plant part, conditions of growing and extraction, is yet to be fully investigated. Healers in Belize warned that “an overdose can be toxic and causes pain, burning and blood in the urine.” They recommended that “a person should not exceed three cups as a complete dosage” (Balick and Arvigo, 2015).

Contraindications None known.

Use in pregnancy and breastfeeding Some extracts of Petiveria alliacea have been shown to cause uterine contractions, which can lead to abortion. The use of the plant is therefore not recommended during pregnancy (Germosén-Robineau, 2014; Balick and Arvigo, 2015).

Selected bibliography

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Drug interactions Traditionally prepared water extracts of the whole plant were tested in the laboratory for their effect on a number of key human enzymes that are responsible for processing many pharmaceutical drugs in the body. The results showed moderate to weak impact, indicating that clinically significant interactions with drugs metabolized by the same enzymes are unlikely (Picking, 2014). Early reports indicated that alcoholic extracts, particularly of the root, may yield the potential for more significant drug interactions with multiple types of medications. Patients are cautioned against combining this herbal remedy with medications without consultation of a physician (Murray et al., 2016). Extracts from the leaf and stem of Petiveria alliacea have demonstrated a hypoglycemic effect in mice, thus lowering blood sugar levels (Lores and Cires Pujol, 1990; TRAMIL, 2015). Therefore, patients with diabetes should avoid consuming preparations of Petiveria alliacea at the same time as insulin or other blood sugarlowering pharmaceuticals, unless under the supervision of a healthcare professional (Taylor, 2005). Petiveria alliacea is reported to contain low levels of the plant chemical coumarin, which has anticoagulant (blood thinning) properties. Patients already taking anticoagulants, such as warfarin, should check with their doctor before using this herb (Taylor, 2005).

Recommendations Petiveria alliacea is a widely used medicinal plant with a long history of traditional use across the Caribbean region. Several preparations with Petiveria alliacea for specific health conditions are currently recommended in the Caribbean pharmacopeia (TRAMIL, 2015). Patients with diabetes and those taking blood thinning medications (such as warfarin) are cautioned to seek the advice of their healthcare professional before taking preparations of this plant. Not for use during pregnancy, as it may provoke abortion (Germosén-Robineau, 2014; Balick and Arvigo, 2015).

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Adejumo OE, Owa-Agbanah IS, Kolapo AL, Ayoola MD (2011) Phytochemical and antisickling activities of Entandrophragma utile, Chenopodium ambrosioides and Petiveria alliacea. Journal of Medicinal Plants Research 5: 1531-1535. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp.

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CABI (2020) Petiveria alliacea (guinea hen weed) [original text by Rojas-Sandoval J, Acevedo-­ Rodriguez P]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/70236. Ferraz MB, Pereira RB, Coelho Andrade LE, Atra E (1991) The effectiveness of tipi in the treatment of hip and knee osteoarthritis—a preliminary report. Memórias do Instituto Oswaldo Cruz 86: 241-243. Foster K, Younger N, Aiken W, Brady-West D, Delgoda R (2017) Reliance on medicinal plant therapy among cancer patients in Jamaica. Cancer Causes & Control 28: 1349-1356. Garcia-Perez ME, Alfonso-Castillo A, Lores OF, Batista-Duharte A, Lemus-Rodriguez Z (2018) Toxicological evaluation of an aqueous suspension from leaves and stems of Petiveria alliacea L. (Phytolaccaceae). Journal of Ethnopharmacology 211: 29-37. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Girón LM, Freire V, Alonzo A, Cáceres A (1991) Ethnobotanical survey of the medicinal flora used by the Caribs of Guatemala. Journal of Ethnopharmacology 34: 173-187. Lores RI, Cires Pujol M (1990) Petiveria alliacea L. (anamu). Study of the hypoglycemic effect. Médecine Interne 28: 347-352. Luz DA, Pinheiro AM, da Silva ML, Monteiro MC, Prediger RD, Ferraz Maia CS, Fontes-Júnior EA (2016) Ethnobotany, phytochemistry and neuropharmacological effects of Petiveria alliacea L. (Phytolaccaceae): A review. Journal of Ethnopharmacology 185: 182-201. Maia CCS (2010) Analysis of fetal and placental development in rats after administration of hydroalcoholic extract from the root of Petiveria alliacea L. (Phytolaccaceae). International Journal of Morphology 28: 165. Martínez GJ (2010) Los remedios naturales en la prevención y cuidado de la salud oral de los Tobas del Chaco Central (Argentina). Boletín Latinoamericano y del Caribe de Plantas Medicinales y Aromáticas 9: 109–122. Murray J, Picking D, Lamm A, McKenzie J, Hartley S, Watson C, Williams L, Lowe H, Delgoda R (2016) Significant inhibitory impact of dibenzyl trisulfide and extracts of Petiveria alliacea on the activities of major drug-metabolizing enzymes in vitro: An assessment of the potential for medicinal plant-drug interactions. Fitoterapia 111: 138-146. Oliveira GL, Oliveira AFM, Andrade LDC (2015) Medicinal and toxic plants from Muribeca Alternative Health Center (Pernambuco, Brazil): An ethnopharmacology survey. Boletín Latinoamericano y del Caribe de Plantas Medicinales y Aromáticas 14: 470-483. Oluwole FS (1998) The uterine contractile effect of Petiveria alliacea seeds. Fitoterapia 69: 3-6. Picking D (2014) The contemporary use of medicinal plants in Jamaica & assessment of potential medicinal plant-drug interactions of select plants. Kingston, Jamaica: University of the West Indies, PhD Dissertation. Taylor L (2005) Anamu. The healing power of rainforest herbs: A guide to understanding and using herbal medicinals. Garden City Park, NY: Square One Publishers, 166 pp. TRAMIL (2015) Caribbean pharmacopeia. Petiveria alliacea. Accessed 27 December 2019 at http://www.tramil.net/en/plant/petiveria-alliacea.

Chapter 20

Pimenta dioica (L.) Merr. (Myrtaceae)

Synonyms: Myrtus pimenta L., Myrtus dioica L., Pimenta officinalis Lindl. (Adams, 1972) Common names in Jamaica: Pimento, allspice

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_20

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Botanical characteristics and propagation Small evergreen tree that grows to a height of 15 m, with a pale whitish-brown bark that peels off in thin sheets. The leathery, opposite leaves are oblong in shape, dark green on the upper surface, and lighter green beneath, with a prominent midrib. The leaves have an aromatic smell when crushed, with hints of nutmeg, cinnamon, black pepper, and cloves. The pyramidal-shaped clusters of small creamy white flowers grow from the leaf axils and develop into berries (CABI, 2020). Although the flowers are structurally bisexual, there are functional “male” and “female” trees. The “male” trees do not bear fruit. The green dried berries (peppercorn-like drupes) serve as a spice and are harvested while immature, to bring out the strongest flavor. The species is native to the tropical forests of South and Central America, southern Mexico, and the West Indies (Zhang and Lokeshwar, 2012), although there is some dispute over its exact origins. Around 1494, Spanish explorers first discovered the species in Jamaica (CABI, 2020). Jamaican farmers sow the seeds if they want to reproduce the tree, or they transplant the suckers that come up under a mother tree.

Where to find the plant The pimento tree is planted and also grows wild after birds disperse the seeds. The tree is maintained on people’s land as a spice tree and for other useful properties (see further). It is commonly found on wooded hillsides and in upland pastures (Adams, 1972).

Part used The fruit (called “seed”), leaf, and bark.

Jamaican cultural uses and beliefs The bark and immature seeds of the pimento tree are used to season meat. These immature green seeds are first dried in the sun before use and turn black. The seed is a spice or condiment that adds flavor to the Sunday dish “rice and peas”. It is used as a preservative in drinks or sauces. The ripe berries make pimento wine. The leaf is used for regular tea. The wood is good to jerk chicken. In Windsor Forest, it was also reported that the leaf, held in the mouth, is a substitute for a cigarette.

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Jamaican medicinal uses Pimento seeds are soaked in rum, and this remedy is commonly taken orally for pain or bellyache, or it is rubbed on the affected area.

Major uses (mentioned by more than 20% of people) • Pain (body, headache, insect sting, after a physical punch called “lick,” period, toothache): In Kingston, people soak 12–30 pimento seeds in rum for 3 days, or up to 1 month, with other ingredients, including a scorpion, a 40 leg, a snake, bitter wood bark (not identified), guinea henweed (Petiveria alliacea L.), bay rum bush (Pimenta racemosa (Mill.) J.W.Moore), physic nut (Jatropha curcas L.), ganja leaf (Cannabis sativa L.), or nutmeg (Myristica fragrans Houtt.). When period pain hits, women take a spoonful of this remedy. It is also used to “sap” the affected area. • Bellyache (gas): In Kingston and Windsor Forest, people soak the seeds in rum and drink a spoonful, or they rub the remedy on the belly. Pimento is sometimes combined with guinea henweed, a scorpion, a snake, bay rum bush, or ganja leaf. Alternatively, people beat the seeds, draw them in boiling water, and drink the tea.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Arthritis (“cold in the joints”) and sprains: In Windsor Forest, people rub the extracted oil on the skin. Alternatively, they beat pimento leaves together with ginger (Zingiber officinale Roscoe), the leaves of custard apple (Annona reticulata L.) and rum, or they rub the leaf directly onto the affected area. • Common cold (and to warm the body): In Kingston and Windsor Forest, people beat and draw the seeds in boiling water, steep or boil the leaves, or they mix the seeds with rum, a scorpion, ganja, or ginger, drink one corkscrew, and rub the mixture.

Reported medicinal uses across the Caribbean The Caribbean pharmacopeia recommends a decoction of the seeds to treat vomiting. This recommendation is based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (Germosén-­Robineau, 2014). Across the Caribbean, Pimenta dioica (plant part not stated) is known for menstrual cramps and abdominal pain (Zhang and Lokeshwar, 2012).

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Across individual countries: • Belize: A paste of the chewed leaves or the green, unripe berries is applied to the gums to relieve toothache. Foot fungus is treated with an ointment of the berries and cow fat, or a soft candle. For arthritis, the berries are crushed, boiled down, and applied as a plaster. Colic of infants, stomachache or gastritis, menstrual cramps, intestinal gas, and indigestion are treated by boiling and drinking the leaves; alternatively, the berries are boiled with garlic, ginger, and sweet orange peel (Citrus × sinensis (L.) Osbeck), and the decoction is drunk. For diarrhea or dysentery, a piece of the bark is boiled, or the seeds are boiled together with the seed of naseberry (Manilkara zapota (L.) P.Royen), and the tea is drunk. Exhaustion or low energy is treated with a bath of the boiled leaves. A tea of the leaves is considered useful for hangover or nervousness (Balick and Arvigo, 2015). • Cuba: Pimenta dioica (plant part not stated) is known to relieve indigestion (Zhang and Lokeshwar, 2012). • Jamaica: The berries, known as allspice, were traditionally used to ease stomach ache, indigestion, constipation, painful menstruation, and uterine problems, and the aromatic leaves were used to make a tea that was “good for the blood.” In addition, the leaves were used as an ingredient for baths and poultices (compresses) for fever and pain and also included in some cold remedies (Asprey and Thornton, 1953). Lindley (2011) wrote in the nineteenth century that the oil, derived from the fruit, was used to relieve toothache and that in mulled port wine, it was once used in the treatment of dysentery (infection of the intestines resulting in severe diarrhea with the presence of blood and mucus). Today, Pimenta dioica is primarily used as a warming agent to stimulate the digestive, circulatory, nervous, and respiratory systems. Teas and decoctions made from the leaves and young twigs are taken to improve appetite and treat digestive complaints such as flatulence, indigestion, nausea, and vomiting. The leaves are put into baths, and pounded green berries and leaves are used as a mash for plasters and poultices (compresses). These are applied to joints and areas of the body suffering from arthritis, muscle cramps, and other painful conditions. Extracts are also taken to relieve coughs, colds, flu, bronchitis, pneumonia, nervous depression, tension, and stress (Warner, 2007).

Reported medicinal uses across the world Pimenta dioica (plant part not stated) is known in Central America for the treatment of high blood pressure, obesity (overweight), and digestive problems (Zhang and Lokeshwar, 2012). Across individual countries: • Costa Rica: The species is used to treat upset stomach and diabetes (Zhang and Lokeshwar, 2012). • Guatemala: The crushed berries are applied to bruises, sore joints, and aching muscles (Zhang and Lokeshwar, 2012). • India: Pimenta dioica (plant part not stated) is used to ease respiratory congestion and toothache (Zhang and Lokeshwar, 2012).

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• Honduras: A decoction of the seeds is drunk to treat abdominal pain during pregnancy (Ticktin and Dalle, 2005). However, TRAMIL warns against its use during pregnancy (Germosén-Robineau, 2014). • Mexico: A tea of the leaves is used to treat diarrhea, back pain, and body aches (Giovannini and Heinrich, 2009).

Clinical efficacy studies in humans Human clinical studies about Pimenta dioica are lacking.

Safety information Side effects Healers in Belize advised against daily consumption of the tea of Pimenta dioica because it is believed that this may lower sexual function; they claim it should not be used too often in cooking, as this may result in rashes and excessive weight loss (Balick and Arvigo, 2015).

Toxicology An alcohol extract of the leaves, administered by mouth to mice, showed a lethal dose at which half the group of test animals died (LD50) of 2.5 g/kg body weight (Lagarto Parra et al., 2001). Another acute toxicity study of a water suspension of Pimenta dioica given orally to mice (plant part not stated) showed neither mortality nor adverse effects up to a dose of 7.5 g/kg body weight (Al-Rehaily et al., 2002).

Contraindications No information is available.

Use in pregnancy and breastfeeding In the United States, Pimenta dioica is classified as GRAS (Generally Recognized As Safe) by the Food and Drug Administration (FDA) when used as a food. However, it is advised to avoid ingestion in excess of amounts found in food because safety has not been established in pregnancy and during breastfeeding.

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The Caribbean pharmacopeia advises against its use during pregnancy because of the risk of provoking abortion (Germosén-Robineau, 2014).

Drug interactions No information is available.

Recommendations Pimenta dioica is widely used as a spice and medicine but lacks scientific studies in humans. The Caribbean pharmacopeia recommends a decoction of the seeds to treat vomiting but advises against its use during pregnancy.

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Al-Rehaily AJ, Al-Said MS, Al-Yahya MA, Mossa JS, Rafatullah S (2002) Ethnopharmacological studies on allspice (Pimenta dioica) in laboratory animals. Pharmaceutical Biology 40: 200-205. Asprey G, Thornton P (1953) Medicinal plants of Jamaica. Part I. West Indian Medical Journal 2: 233–252. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. CABI (2020) Pimenta dioica (allspice) [original text by Jones I]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/ datasheet/42377. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Giovannini P, Heinrich M (2009) Xki yoma’ (our medicine) and xki tienda (patent medicine)— Interface between traditional and modern medicine among the Mazatecs of Oaxaca, Mexico. Journal of Ethnopharmacology 121: 383-399. Lagarto Parra A, Silva Yhebra R, Guerra Sardiñas I, Iglesias Buela L (2001) Comparative study of the assay of Artemia salina L. and the estimate of the medium lethal dose (LD50 value) in mice, to determine oral acute toxicity of plant extracts. Phytomedicine 8: 395–400. Lindley J (2011) Flora Medica: A botanical account of all the more important plants used in medicine, in different parts of the world. Cambridge: Cambridge University Press, 676 pp. Ticktin T, Dalle SP (2005) Medicinal plant use in the practice of midwifery in rural Honduras. Journal of Ethnopharmacology 96: 233-248. Warner M (2007) Herbal plants of Jamaica. Oxford: MacMillan Education, 176 pp. Zhang L, Lokeshwar BL (2012) Medicinal properties of the Jamaican pepper plant Pimenta dioica and allspice. Current Drug Targets 13: 1900-1906.

Chapter 21

Ricinus communis L. (Euphorbiaceae)

Common names in Jamaica: Castor oil, oil nut, whole wife, catcus Other common name in Jamaica: Castor oil plant (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_21

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Botanical characteristics and propagation Evergreen, fast-growing shrub or small tree that grows up to 5 m tall with a strong taproot and noticeable lateral roots. The shoots have a color that ranges from dull grayish-green to red. Stems and branches carry conspicuous nodes and ring-like scars. Leaves spirally arranged, peltate, divided into seven or more coarsely serrate lobes. Male and female flowers found on the same plant, clustered on a terminal spike (CABI, 2020). The spiny fruits (capsules) contain brown-beige speckled seeds that are highly toxic when chewed. The species is probably native to Northeast Africa (Somalia and possibly Ethiopia) and naturalized across the African continent and on the islands in the Indian Ocean (CABI, 2020). The plant is widely cultivated and naturalized in (sub)tropical America and Asia and in temperate regions of Europe. Propagated by seeds.

Where to find the plant Common on waste ground, along roadsides, and as a cultivated plant. The species prolifically produces fruits which explosively release their seeds when mature (CABI, 2020). It grows wild in Downtown Kingston. Older people know how to make castor oil traditionally, by pounding and boiling the seeds during the full moon.

Part used The leaf and the oil derived from the seeds. Caution! Some people have mentioned that “the seed can be chewed,” but the seeds are highly toxic, particularly when chewed or soaked in water, and ingestion, should be avoided at all times. The poisonous substance in the seed is the chemical compound, ricin, a glycoprotein lectin. A significant proportion of reported ricin poisoning involves castor bean ingestion (Audi et al., 2005). The reported levels of ricin content in castor beans vary, but are in the range of 1–5%. Ricin is synthesized and found exclusively in the endosperm of the bean. Following separation of the oil from the bean, ricin is found only in the discarded pulp. No ricin remains in the oil, and, in addition, ricin is inactivated during oil extraction under heated conditions (Audi et al., 2005; Balint, 1974; Musshoff and Madea, 2009). According to the Cosmetic Ingredient Review Expert Panel’s final report on castor oil, one does not have to worry about the oil being contaminated by ricin, and castor oil has been safely added to cosmetic products for many years, without incidents (Cosmetic Ingredient Review Expert Panel, 2007).

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Jamaican cultural uses and beliefs Castor oil has veterinary uses in Jamaica to speed up birth and treat poisoning. In Windsor Forest, someone explained: “If animal cannot pass the afterbirth, you give him castor oil [made] from seeds.” In Kingston, a person said: “If animal cannot give birth, they give it [castor oil] to drink, and rub it on him tail.” To treat a poisoned dog, the animal is given half a seed with some milk, or a teaspoon of castor oil. Castor oil is said to “loosen [the] bowel freely.”

Jamaican medicinal uses Major uses of castor oil are as a body cleanser or “wash out,” and for hair care. Due to serious toxicity, it should be advised to use the oil instead of the seed directly and to be careful with the dosage, since it is a strong laxative.

Major uses (mentioned by more than 20% of people) • Bellyache (cold in the belly or “from something you can not eat”): In Windsor Forest, people dry, pound, and boil the seeds, skim the oil, and take one teaspoon. • Body cleanser (wash out, operation, “run yuh belly,” constipation, expel worms, “cold of the tubes”): People swallow half a seed or more (up to two seeds), but this is very dangerous. Chewing of the seeds should be completely avoided under any circumstances. One woman in Kingston shared her story of how taking two seeds made her end up in the hospital. Another, and safer, recipe is to take a spoonful of castor oil. When taking the oil, please be careful with the dosage. The root, bark, and leaves boiled together and drunk are said to be a gentler laxative. • Hair care (dandruff, grows hair, straightens, gives body, conditioner, no gray hair): The seeds are dried, beaten, and boiled during a special time (the full moon) to extract the oil. The oil is skimmed from the boiling seeds, stored in a bottle, and applied to the scalp.

Minor uses (mentioned by more than 5% of people, but less than 20%) • Blood pressure: To treat high blood pressure, the leaves are tied to the head in Kingston. • Blow or “lick” with blood cloths: In Windsor Forest, two tablespoons of castor oil are mixed with the juice of a young roasted pakee or calabash (Crescentia cujete) and taken orally.

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• Cold (on the chest, cough, runny nose): In Kingston, people extract the oil from the seeds and ingest the oil. • Migraine, headache: In Kingston, three leaves are made wet and tied to the head. • Skin care (dry, rash): The oil is extracted from the seeds and applied like lotion.

Reported medicinal uses across the Caribbean In Jamaica, the leaves of Ricinus communis are used in bush baths and as a compress (poultice) to relieve headache, stomachache, and arthritis. Leaves are heated and, with or without oil, wrapped around affected body parts. Castor oil is traditionally prepared at home, from the seeds, to produce a thick, almost black oil, which does not contain ricin (see section “Toxicology” below), but is made up with a high percentage of ricinoleic acid. It is this substance that gives castor oil its laxative properties, famously given to children after the summer break to purge them of intestinal worms. In other applications, the warmed castor oil is used to soothe ear and eye problems, clean and treat wounds, cure biliousness and constipation, and condition hair and skin (Warner, 2007). Castor oil has been traditionally used as an abortifacient (provokes abortion) in Jamaica (Warner, 2007). Sobo (1996) reports the use of roasted immature calabash fruit (Crescentia cujete), juiced, boiled, cooled, strained, and combined with honey and castor oil as an abortifacient. According to the Caribbean pharmacopeia, several preparations of Ricinus communis are recommended for a number of health conditions, summarized in Table 21.1. These uses are based on the significant traditional uses documented in the TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (TRAMIL, 2016). These recommendations are made with the following instructions: Oral consumption of castor oil should be restricted to a single dose taken away from meals (1–3 spoonfuls or 15–45 mL for adults, 1–3 teaspoonfuls or 5–15  mL for children older than 2  years, and 1–5  mL for children younger than 2 years). Due to the health risks associated with pneumonia, asthma, earache, and ganglion cyst (small, benign, fluid-filled sacs found attached to the joints that present themselves as small lumps under the skin), an initial medical evaluation is recommended, and the use of Ricinus communis should be considered complementary to medical treatment, unless it is contraindicated (TRAMIL, 2016). Only oil that has been hand-made following traditional processes or the oil purchased in a licensed pharmacy or reputable health store should be used. Do not use industrially produced ricin oil as this is a highly toxic product, ingestion of which may lead to life threatening side effects (TRAMIL, 2016).

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Table 21.1  Recommended health conditions across the Caribbean for Ricinus communis Recommended use Asthma Burns Constipation Earache Ganglion cyst (noncancerous lump on wrist, hand, ankle, feet) Headache Arthritis Toothache Trauma Twist (sprain)

Plant part(s) used Seed oil, taken orally Seed oil, applied locally, and dried leaf, powdered, applied locally Seed oil, taken orally Seed oil, instilled in ear Seed oil, applied locally Leaf, mashed or crushed in oil, applied locally Warm leaf, applied locally Leaf decoction, mouthwash and applied locally Leaf, mashed, applied locally, and seed oil, applied locally Leaf, mashed, applied locally and seed oil, applied locally

Reported medicinal uses across the world The use of castor oil (Ricinus communis) can be traced back to some of the earliest written records of medicinal plants surviving today, for example, in the ancient Egyptian medical scrolls, the Ebers Papyrus of c. 1500 BC. Some records indicate even earlier use, dating back 4000 years (Chevallier, 2001). The ancient Egyptians used castor oil as a laxative to cleanse the bowel, and as a scalp rub to encourage hair growth and make the hair shine (Zampieron and Kamhi, 1999). Ricinus communis is also known in some countries as the Palma Christi, or the Hand of Christ, due to the shape of its leaves and its renowned healing properties (Zampieron and Kamhi, 1999). Across individual countries: • China: The crushed seeds are used to treat facial palsy (paralysis or weakness of the muscles on one side of the face due to damage to the nerve) (Chevallier, 2001). • India: Castor oil is massaged into the breasts following childbirth to stimulate milk flow. A compress (poultice) of castor oil seeds is used to relieve swollen and tender joints (Chevallier, 2001). • USA: The American psychic healer, Edgar Cayce popularized the use of castor oil packs in the 1940s, which continue to be used by naturopathic physicians and herbalists today. Castor oil packs are used as external treatments for ovarian fibroids and cysts, breast swelling and cysts, headache, liver problems, constipation, and other ailments (Zampieron and Kamhi, 1999). Castor oil packs are used to “augment detoxification,” stimulate the immune system, and improve circulation in the area to which they are applied. Castor oil acts as a counterirritant that stimulates the body tissues under the pack and attracts immune enhancing cells to the area where it is applied, immediately over the liver being the most

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common. Castor oil packs are administered by soaking a wool or cotton flannel with castor oil (wet but not dripping), heated in a low oven until tolerably hot, and then applied to the abdomen (belly), covered and left in place for at least 1 h and ideally repeated over 3 days (Yance and Valentine, 1999). The external use of castor oil was further popularized in the 1950s by an American physician Dr. D.C. Jarvis in his book Folk Medicine, which recommended its use in the treatment of moles, warts, and skin ulcers to remove or lessen the blemishes, and in small amounts on the hair and eyelashes to make them more shiny (Zampieron and Kamhi, 1999).

Clinical efficacy studies in humans Japanese researchers undertook a randomized, double-blind, placebo-controlled cross-over clinical trial to test the safety, effectiveness, and stability of castor oil eye drops for the treatment of patients with dry eyes caused by lipid deficiency. Twenty patients were assigned randomly to receive castor oil eye drops or placebo, six times daily, for two periods of 2  weeks each. Dry eye symptoms showed significant improvement with castor oil as compared to placebo. No complications attributable to the eye drops were observed. The castor oil eye drops were stable when stored at 4 °C. The researchers concluded that castor oil eye drops are effective and safe in the treatment of dry eyes caused by lipid deficiency. The possible mechanisms of this treatment are improvement of tear stability, prevention of tear evaporation, and the lubricating effect of the castor oil eye drops (Goto et al., 2002). A randomized, double-blind clinical study was conducted to compare the safety and effectiveness of castor oil with the pharmaceutical product diclofenac sodium in patients with knee arthritis. Patients were given either a 0.9 mL castor oil capsule or a capsule of 50 mg diclofenac sodium, three times a day for 4 weeks. They completed an overall evaluation of symptom relief at 2 and 4 weeks of treatment. After 4 weeks, it was observed that both castor oil and diclofenac sodium were effective in the treatment of knee arthritis. Adverse effects were high with diclofenac sodium, whereas with castor oil none were reported. The authors stated that the study indicates that castor oil can be used as an effective therapy in knee arthritis (Medhi et al., 2009). Induction of labor is often necessary in pregnancy where the membranes of the amniotic sac have ruptured prematurely. Castor oil was evaluated as a method to induce labor in uncomplicated patients with prematurely ruptured membranes at full-term gestation. For comparison, a total of 196 patients without castor oil application (only premature rupture of membranes) was studied retrospectively (back in time). Of 107 patients who received castor oil, a significantly higher percentage (75%) went into labor, as compared to 58% of 89 control patients who went into labor spontaneously. The author concluded that castor oil, which is more economical and convenient than the drug oxytocin (the standard pharmaceutical treatment), can be used safely and effectively to stimulate labor (Davis, 1984).

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A prospective evaluation was undertaken into the use of castor oil and the onset of labor in a community hospital in New York. One hundred and three pregnancies at 40–42 weeks were assigned to one of two study groups: Administration of a single oral dose of castor oil (60 mL), or no treatment. Castor oil was considered successful if labor began within 24  h after dosing. The results were that 52 women received castor oil, and 48 were assigned no treatment. More than half (58%) of women receiving castor oil began active labor, compared to 4% receiving no treatment. When castor oil was successful, 83% of the women delivered vaginally. The authors concluded that women who receive castor oil have an increased likelihood of initiation of labor within 24 h, compared to women who receive no treatment (Garry et al., 2000). Iranian researchers conducted a randomized controlled clinical trial on 47 pregnant women between August 2003 and March 2004 to determine the effect of castor oil on initiating labor in term pregnant women. They reported a significant increase in labor initiation in the castor oil group (54% of women) compared with the control group (only 4% of women). The authors concluded that the probability of labor initiation increases during the first 24 h after using castor oil; however, further studies are recommended to improve its efficacy and safety (Azhari et al., 2006). Researchers at the Max-Planck Institute in Germany successfully identified the mechanism by which castor oil exerts its effects on the motility of the gut and uterus. They were able to show that the active component of castor oil, ricinoleic acid, is a selective agonist of two prostaglandin receptors, EP3 and EP4, and that the pharmacological effects of castor oil are mediated by activation of EP3 receptors on smooth-muscle cells. The researchers noted that this remarkable specificity was unexpected, because castor oil had previously been regarded as an agent that exerts its effects nonspecifically (Tunaru et al., 2012).

Safety information Side effects The seeds contain a protein capable of causing allergy (Thorpe, 1988). Case reports of allergic contact dermatitis (an itchy inflammation of the skin), associated with lip care products containing castor oil, have been published, with ricinoleic acid believed to be the main allergen in some reports (Andersen and Nielsen 1984; le Coz and Ball 2000; Lim and Goh 2000; Sánchez-Herrero et al., 2018). When ricinoleic acid, a chemical substance present in castor oil was administered to dogs, it had a laxative effect on the intestine through a reduction in circular smooth muscle activity and inhibition of water absorption (Stewart et al., 1975).

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Toxicology The seeds contain ricin, a glycoprotein lectin, one of the most toxic known proteins. The oral lethal dose of ricin in humans has been estimated at between 1 and 20 mg/ kg body weight (Jackson et al., 2006). Several reports have indicated that ricin can be detoxified by heat treatment; however, the conditions required for inactivation are not well characterized. Ricin heated to 60 °C (140 °F) for 2 h only resulted in a minimal reduction in toxicity. Further heating decreased toxicity. This shows that ricin is a relatively heat stable protein (Jackson et al., 2006). The ingestion of seeds can cause acute gastroenteritis, an inflammation of the lining of the intestines, with the potential to cause death. In addition, ingestion causes neurological (brain) and ophthalmological (sight) symptoms (Al-Tamimi and Hegazi, 2008), loss of fluids and electrolytes, gastrointestinal bleeding, hemolysis (the breakdown of red blood cells), and hypoglycemia (low blood sugar) (Challoner and McCarron, 1990). Mortality (death) rates caused by ricin poisoning in 424 patients were 8% for untreated cases and 0.4% for cases with treatment. The cause of death was hypovolemic shock, an emergency situation in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working (Challoner and McCarron, 1990). Breaking the seed coat appears to be necessary to cause toxicity. Swallowing the seeds whole, without chewing, is less likely to cause toxic effects. However, immediate medical attention is needed after ingestion of a single whole seed. Hulled seeds (i.e., seeds with the seed coat removed) are usually well tolerated without toxic side effects (Jellin et al., 2009).

Contraindications The use of castor oil is contraindicated during pregnancy, during breastfeeding, and for women attempting to conceive (see Use in pregnancy and breastfeeding). Castor oil is contraindicated in patients with intestinal obstruction, unknown abdominal pain, obstruction of the gallbladder tract, or other disorders associated with bile (Jellin et al., 2009).

Use in pregnancy and breastfeeding Adult female rabbits treated orally with pieces of Ricinus communis seeds (7.5 mg/ kg body weight), daily for at least 10 days, experienced a fourfold decrease in pregnancy, compared to an untreated control group of rabbits. All treated female rabbits experienced transient mild diarrhea and loss of body weight. The inhibitory effect of the seeds on pregnancy was reversible (Salhab et al., 1997).

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No changes were found in the length of the estrous (reproductive) cycle in rats or mice that received a diet containing castor oil (Irwin, 1982). No dose-related reproductive toxicity was found in mice fed up to 10% of castor oil for 13  weeks (Cosmetic Ingredient Review Expert Panel, 2007). A specific extract (petroleum ether) of a hulled seed variety called “minor” of Ricinus communis, administered orally to 12 women in single doses of 2.5 g, protected against pregnancy in 7–8 months during which the study was conducted, and showed a high safety margin (Das et al., 2000). However, another study reported on a mother who took castor oil as an oral contraceptive during her 8 weeks of pregnancy and gave birth to an infant with moderate growth retardation, seizures, and deformations (El Mauhoub et al., 1983). Castor oil has been traditionally used as an abortifacient (a substance that provokes abortion) in Jamaica and other countries (Warner, 2007) and to speed delivery after the beginning of labor, at a time when the majority of births took place at home (Sobo, 1996). Therefore, the use of seeds, or seed oil, is contraindicated for pregnant women, those that are breastfeeding, or women wishing to become pregnant (Jellin et al., 2009).

Drug interactions Overuse of castor oil could exacerbate potassium loss induced by diuretics (substances that promote urination). Individuals taking diuretics should seek professional advice before combining this type of medication with castor oil (Jellin et al., 2009). Even though no specific research appears to exist on drug interactions with castor oil, it is generally accepted that laxative herbs can impact the metabolism of a number of drug groups, such as antiarrhythmic agents that are used to suppress abnormal rhythms of the heart (e.g., timolol), cardiac glycosides (e.g., digoxin), and potassium depleting agents (e.g., thiazide diuretics and corticosteroids). It is recommended that excessive doses and prolonged use of castor oil be avoided and that the combined use of this plant and pharmaceutical drugs is discussed with a qualified healthcare provider (Bone and Mills, 2013).

Recommendations A clear distinction should be made between the toxicity of the seeds and castor oil, the latter being the processed product from the seeds. Throughout the world, castor oil is produced by cold pressing the seeds, followed by clarification of the oil by heat. Ricin, a very powerful poison found naturally in the seeds, stays behind in the “mash” (waste material) that is produced during the making of the oil. Castor oil

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appears to be safe for most people when it is used in the short term. An acceptable daily intake of castor oil for humans is reported to be up to 0.7 mg/kg body weight (Cosmetic Ingredient Review Expert Panel, 2007). However, prolonged use at high doses can result in the loss of bodily fluids and potassium. Under no circumstances should the seed be taken orally, because of the presence of ricin in the seed coat (shell). Ricin causes nausea, vomiting, diarrhea, abdominal pain, dehydration, shock, destruction of blood cells, alterations in body fluids and chemicals, and organ damage (of the liver, kidneys and pancreas) and may ultimately lead to death. Chewing as few as 1–6 seeds can kill an adult. Poisoning is less likely when the seed is swallowed whole without chewing, but children are at particular risk, and immediate medical attention must be sought when this happens. The oil may be safe when used to initiate labor in women who are about to give birth, but should always be done under the supervision of a midwife or healthcare professional. The use of the oil is contraindicated in pregnant women who are not about to give birth, as it may cause premature labor (Jellin et al., 2009).

References Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Al-Tamimi FA, Hegazi AE (2008) A case of castor bean poisoning. Sultan Qaboos University Medical Journal 8: 83-87. Andersen KE, Nielsen R (1984) Lipstick dermatitis related to castor oil. Contact Dermatitis 11: 253-4. Audi J, Belson M, Patel M, Schier J, Osterloh J (2005) Ricin poisoning: A comprehensive review. Journal of the American Medical Association 294: 2342–2351. Azhari S, Pirdadeh S, Lotfalizadeh M, Shakeri MT (2006) Evaluation of the effect of castor oil on initiating labor in term pregnancy. Saudi Medical Journal 27: 1011-1014. Balint GA (1974) Ricin: The toxic protein of castor oil seeds. Toxicology 2: 77-102. Bone K, Mills S (2013) Principles and practice of phytotherapy. 2nd Ed. London: Churchill Livingston. CABI (2020) Ricinus communis (castor bean) [original text by Rojas-Sandoval J, Acevedo-­ Rodriguez P]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/47618. Challoner KR, McCarron MM (1990) Castor bean intoxication. Annals of Emergency Medicine 19: 1177-1183. Cosmetic Ingredient Review Expert Panel (2007) Final report on the safety assessment of Ricinus communis (castor) seed oil, hydrogenated castor oil, glyceryl ricinoleate, glyceryl ricinoleate SE, ricinoleic acid, potassium ricinoleate, sodium ricinoleate, zinc ricinoleate, cetyl ricinoleate, ethyl ricinoleate, glycol ricinoleate, isopropyl ricinoleate, methyl ricinoleate, and octyldodecylricinoleate. International Journal of Toxicology 26 (S3): 31-77. Chevallier A (2001) Encyclopedia of medicinal plants (2nd ed.). London: Dorling Kindersley. Campos-Domínguez M, Suárez Fernández R (2018) Allergic contact cheilitis in an adolescent to Ricinus communis seed oil (castor oil) in a lip balm. Contact Dermatitis 79: 176-178. Das SC, Isichei CO, Okwuasaba FK, Uguru VE, Onoruvwe O, Olayinka AO, Ekwere EO, Dafur SJ, Parry O (2000) Chemical, pathological and toxicological studies of the effects of RICOM-­ 1013-­J of Ricinus communis var. minor on women volunteers and rodents. Phytotherapy Research 14: 15-19.

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Davis L (1984) The use of castor oil to stimulate labor in patients with premature rupture of membranes. Journal of Nurse-Midwifery 29: 366–370. El Mauhoub M, Khalifa MM, Jaswal OB, Garrah MS (1983) “Ricin syndrome.” A possible new teratogenic syndrome associated with ingestion of castor oil seed in early pregnancy: A case report. Annals of Tropical Paediatrics 3: 57-61. Garry D, Figueroa R, Guillaume J, Cucco V (2000) Use of castor oil in pregnancies at term. Alternative Therapies in Health and Medicine 6: 77-79. Goto E, Shimazaki J, Monden Y, Takano Y, Yagi Y, Shimmura S, Tsubota K (2002) Low-­ concentration homogenized castor oil eye drops for noninflamed obstructive meibomian gland dysfunction. Ophthalmology 109: 2030-2035. Irwin R (1982) NTP technical report on the toxicity studies of castor oil (CAS no. 8001-79-4) in F344/N rats and B6C3F1 mice (dosed feed studies). Toxicity Report Series 12: 1-5. Jackson LS, Tolleson WH, Chirtel SJ (2006) Thermal inactivation of ricin using infant formula as a food matrix. Journal of Agricultural and Food Chemistry 54: 7300-7304. Jellin JM, Gregory PJ, et  al. (2009) Pharmacist’s Letter/Prescriber’s Letter Natural Medicines Comprehensive Database. 11th ed. Stockton, CA: Therapeutic Research Faculty, 2323 pp. le Coz CJ, Ball C (2000) Recurrent allergic contact dermatitis and cheilitis due to castor oil. Contact Dermatitis 42: 114-5. Lim SW, Goh CL (2000) Epidemiology of eczematous cheilitis at a tertiary dermatological referral centre in Singapore. Contact Dermatitis 43: 322-6. Medhi B, Kishore K, Singh U, Seth SD (2009) Comparative clinical trial of castor oil and diclofenac sodium in patients with osteoarthritis. Phytotherapy Research 23: 1469-1473. Musshoff F, Madea B (2009) Ricin poisoning and forensic toxicology. Drug Testing and Analysis 1: 184-191. Salhab AS, Issa A, Alhougog I (1997) On the contraceptive effect of castor beans. International Journal of Pharmacognosy 35: 63–65. Sánchez-Herrero A, Mateos-Mayo A, Rodríguez-Lomba E, Molina-López I, Campos-Domínguez M, Suárez Fernández R (2018) Allergic contact cheilitis in an adolescent to Ricinus communis seed oil (castor oil) in a lip balm. Contact Dermatitis 79: 176-178. Sobo EJ (1996) Abortion traditions in rural Jamaica. Social Science & Medicine 42: 495-508. Stewart JJ, Gaginella TS, Olsen WA, Bass P (1975) Inhibitory actions of laxatives on motility and water and electrolyte transport in the gastrointestinal tract. The Journal of Pharmacology and Experimental Therapeutics 192: 458-467. Thorpe SC (1988) Allergy to castor bean II. Identification of the major allergens in castor bean seeds. Journal of Allergy and Clinical Immunology 82: 67-72. TRAMIL (2016) Caribbean pharmacopeia. Ricinus communis. Accessed 27 December 2019 at http://www.tramil.net/en/plant/ricinus-communis. Tunaru S, Althoff TF, Nüsing RM, Diener M, Offermanns S (2012) Castor oil induces laxation and uterus contraction via ricinoleic acid activating prostaglandin EP3 receptors. PNAS 109: 9179–9184. Warner M (2007) Herbal Plants of Jamaica. Oxford: MacMillan Education, 176 pp. Yance DR, Valentine A (1999) Herbal medicine, healing and cancer: A comprehensive program for prevention and treatment. New York: McGraw Hill. Zampieron ER, Kamhi E (1999) The Natural Medicine Chest. New York: M. Evans and Company Inc.

Chapter 22

Senna alata (L.) Roxb. (Fabaceae)

Synonyms: Cassia alata L., Herpetica alata (L.) Raf. (Adams, 1972) Common name in Jamaica: King-of-the-forest Other common names in Jamaica: Candlestick, ringworm shrub (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_22

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Botanical characteristics and propagation Short-lived evergreen shrub or small tree, reaching 3 to 4 m high, and often escaping when cultivated. The compound leaves close in the dark. The bright yellow flowers, tinged with conspicuous purple veins, grow together in erect flower spikes (racemes) that resemble the shape of a candle. The dark brown, winged fruits contain triangular, flattened seeds. There exists dispute about the native origin of the species, with some authors claiming it to be native to tropical America and the West Indies, and others that it is only native to Colombia, Venezuela, the Guyanas, and Brazil (CABI, 2020). It has been planted widely for medicinal and ornamental purposes and currently has a pantropical distribution (growing across the tropics of all continents). In many countries, it has become naturalized and is often considered a weed (Bosch, 2007). The species is easily propagated through seeds.

Where to find the plant The plant grows spontaneously along trails and is planted in yards.

Part used The leaf and occasionally the flower.

Jamaican cultural uses and beliefs The bush is drunk as a regular tea. Its flowers are described as “pretty,” and it is considered a “beautification bush.” It is also known as a spiritual bush. People explained in Patois: “When duppy play with pickney dem, [you can] draw it [the bush]. If you plant [the bush] in di yard, it keep[s] spirit out. It strong. When spirit come, it rise[s] up.”

Jamaican medicinal uses King-of-the-forest is a popular remedy for “liver spots,” which people described as “a fungus that changes the complexion of the skin and provokes itching.” The biomedical diagnosis of liver spots is Tinea versicolor, also known as Pityriasis versicolor. The name ringworm shrub also refers to its use as a fungicide (CABI, 2020).

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Major uses (mentioned by more than 20% of people) • Liver spots: Liver spots are caused by a yeast called Tinea versicolor (Pityriasis versicolor). In Kingston and Windsor Forest, the green leaf is juiced and rubbed on the skin like an ointment, with salt or vinegar. Or the leaf is dried, boiled, and drunk. The water can be used to bathe. Occasionally, the dry flowers are rubbed on the affected area with Vaseline. • Common cold: In Kingston, the branches or leaves are boiled green, or steeped dry in hot water (one teaspoon of dry powder for a cup of water), and drunk. • Ringworm (ring and bump on the skin): Ringworm is a highly contagious, fungal infection of the skin or scalp caused by Tinea corporis. In Kingston, the leaves or flowers are boiled, and the water is used to bathe or drink. In Windsor Forest, the juice of the leaf is mixed with vinegar and applied to the skin. • Blood pressure: In Windsor Forest, the leaf or stem is boiled, or steeped in hot water, and drunk to treat high blood pressure.

Reported medicinal uses across the Caribbean According to the Caribbean pharmacopeia, the use of a water extract of the leaves is recommended for the external treatment of a number of skin conditions, including Pityriasis versicolor (liver spots), pimples, Tinea corporis (ringworm), and fungal growth. These recommendations are based on TRAMIL surveys, toxicity studies, scientific validation, and available published scientific information (TRAMIL, 2015). In Belize, the flowers and leaves are boiled and drunk to treat liver problems, kidney ailments, and urinary tract problems and to purge the lymph system. The flower heads are boiled with anise (Pimpinella anisum L.) and chamomile (Chamaemelum nobile (L.) All.) to treat constipation. The root is boiled with garlic and drunk as a uterine cleanser until conception, or the root is soaked in alcohol with anise and consumed to treat infertility (Balick and Arvigo, 2015).

Reported medicinal uses across the world Across Southeast Asia, the plant is known for its laxative properties, and a tea of the leaves is traditionally prepared as a treatment for constipation and intestinal worms. Externally, the leaves are pounded, and in Malaysia and China mixed with lime juice, and rubbed directly on the skin as a treatment for eczema, ringworm, and white spot fungal infections. In addition, the leaves are boiled and simmered in water, and the cooled liquid is applied twice a day to wounds. Because of its antifungal properties, it is a common ingredient in soaps, shampoos, and lotions in the Philippines (ASEAN, 2015).

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Across individual countries: • Ghana: One leaf of Senna alata is boiled in 1 L of water, and only one cup is drunk to treat malaria. It is said that this remedy may cause frequent emptying of the stomach (Asase et al., 2010). • Mali: Senna alata is traditionally used in the treatment of malaria and constipation (Maiga et al., 2005). • Thailand: Senna alata is on the list of herbal medicine products in Thailand for constipation (Saokaew et al., 2011).

Clinical efficacy studies in humans A 10-year-long human study in India, involving 200 persons, reported that Senna alata leaf extract is a reliable treatment for Pityriasis versicolor (liver spots), with no reported side effects (Damodaran and Venkataraman, 1994). In a Nigerian human pilot study, a soap containing 1.5% w/w Senna alata leaf powder cleared the lesions resulting from both Pityriasis versicolor and Tinea corporis in 94% of human subjects. None of the people from the control group who did not receive treatment showed significant improvements. The authors stated that the study clearly confirmed the folkloric claims for the use of Senna alata as an antimicrobial agent for treating fungal skin infections (Oladele et al., 2010).

Safety information Side effects Senna alata was part of a 2-year intensive monitoring program for adverse effects in Thailand. In the country’s national vigilance database of herbal products, there were five reports of adverse reactions for human use of Senna alata between 2000 and 2008, including a decreased therapeutic effect with time, eyelid swelling, nausea, vomiting, headache, and skin rash (the plant part and type of administration were not specified) (Saokaew et al., 2011). In Mali, interviews with more than 100 healers recorded 17 citations of diarrhea as an adverse effect of Senna alata, which ranked the plant fifth out of 19 reported species (Maiga et al., 2005).

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Toxicology Rats fed dried and ground leaves of Senna alata mixed in with their feed for 2 or 4 weeks showed some damage (lesions) to the intestine, liver, and kidney. Rats that were given a 100 mg alcohol extract of Senna alata in their drinking water showed lesions in the liver (Yagi et al., 1998). In contrast, another study in mice and rats investigated the immediate and delayed toxicity of administering a Senna alata leaf extract of water and alcohol directly to the stomach of rats and mice, in doses from 4 to 20 g/kg body weight (only one dose) or in doses from 0.5 to 1 g/kg body weight for 26 days. The study found that the lethal dose at which half the group of test animals died (LD50) was 18.5 g/kg body weight. As a general rule, compounds are considered not toxic if the acute oral LD50 is greater than 5 g/kg body weight. In the 26-day test, no sign of observable toxicity or death was seen in the animals. The authors also found a protective effect of the extract on liver cells and liver architecture. The authors concluded that the use of the extract of Senna alata is safe and that this explains its extensive use in traditional medicine (Pieme et al., 2006). Further studies using alcohol extracts of Senna alata leaves, at 1, 2, or 3 g/kg body weight, administered as a single dose to female mice also showed no toxicity after 14 days. The LD50 dose was higher than 3 g/kg body weight (Priyadarshini et al., 2014).

Contraindications No contraindications have been established for this species. However, for other Senna species with laxative properties, their internal use is contraindicated in cases of gastrointestinal obstruction, acute intestinal inflammation, ulcerative colitis (bowel disease that causes inflammation and sores of the digestive tract), appendicitis, and abdominal pain of unknown origin (WHO, 1999).

Use in pregnancy and breastfeeding Water extracts of leaves of Senna alata were administered orally to pregnant rats in doses of 0.25, 0.5, and 1 g/kg body weight. The highest doses showed abortifacient effects (capable of causing abortion). As such, the use of Senna alata tea prepared with the leaves is not recommended during pregnancy (Yakubu et al., 2010).

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Drug interactions A water extract of the leaves of Senna alata was screened in the laboratory for its inhibitory impact on a number of key drug metabolizing enzymes (CYP450s, CYPs 1A2, 2D6, 2C9, and 3A4) (Appiah-Opong et al., 2008). Such screens provide a useful first step for evaluating potential herb–drug interactions. The results showed moderate to weak inhibition, indicating that clinically significant interactions with drugs metabolized by these enzymes are unlikely (Bone and Mills, 2013). However, laxative herbs such as Senna alata contain substances that are called anthraquinones, which can impact the metabolism of a number of drug groups, such as antiarrhythmic agents that are used to suppress abnormal rhythms of the heart (e.g., timolol), cardiac glycosides (e.g., digoxin), and potassium-depleting agents (e.g., thiazide diuretics and corticosteroids). It is recommended that excessive doses and prolonged use of Senna alata be avoided and that the combined use of this plant and pharmaceutical drugs is discussed with a qualified healthcare professional (Bone and Mills, 2013).

Recommendations A scientific review paper on Senna alata considered the species “safe for short-term oral or topical use” (Hennebelle et al., 2009). TRAMIL has recommended the external use of a water extract of the leaf (applied to the skin) for ringworm and liver spots (TRAMIL, 2015). Internal use of Senna alata is contraindicated in pregnancy based on its ability to provoke abortion in rats.

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Appiah-Opong R, Commandeur JNM, Axson C, Vermeulen NPE (2008) Interactions between cytochromes P450, glutathione S-transferases and Ghanaian medicinal plants. Food and Chemical Toxicology 46: 3598–3603. Asase A, Akwetey GA, Achel DG (2010) Ethnopharmacological use of herbal remedies for the treatment of malaria in the Dangme West District of Ghana. Journal of Ethnopharmacology 129: 367-376. ASEAN (Association of Southeast Asian Nations) (2015) Globinmed. Medicinal Herbs and Plant Database. Malaysian Herbal Monograph. Senna alata (L.) Roxb. Accessed 27 December 2019 at https://bit.ly/2ru6nTY. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. Bone K, Mills S (2013) Principles and practice of phytotherapy. 2nd edition. London: Churchill Livingston.

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Bosch CH (2007) Senna alata (L.) Roxb. [Internet] Record from PROTA4U. In: Schmelzer GH, Gurib-Fakim A (Eds). PROTA (Plant Resources of Tropical Africa/Ressources végétales de l’Afrique tropicale). Wageningen, The Netherlands. Accessed 27 December 2019 at https:// www.prota4u.org/. CABI (2020) Senna alata (candle bush) [original text by Vélez-Gavilán J]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www. cabi.org/isc/datasheet/117090. Damodaran S, Venkataraman S (1994) A study on the therapeutic efficacy of Cassia alata Linn. leaf extract against Pityriasis versicolor. Journal of Ethnopharmacology 42: 19-23. Hennebelle T, Weniger B, Joseph H, Sahpaz S, Bailleul F (2009) Senna alata. Fitoterapia 80: 385-393. Maiga A, Diallo D, Fane S, Sanogo R, Paulsen BS, Cisse B (2005) A survey of toxic plants on the market in the district of Bamako, Mali: Traditional knowledge compared with a literature search of modern pharmacology and toxicology. Journal of Ethnopharmacology 96: 183–193. Oladele AT, Dairo BA, Elujoba AA, Oyelami AO (2010) Management of superficial fungal infections with Senna alata (“alata”) soap: A preliminary report. African Journal of Pharmacy and Pharmacology 4: 98-103. Pieme CA, Penlap VN, Nkegoum B, Taziebou PCL, Tekwu EM, Etoa FX, Ngongang J (2006) Evaluation of acute and subacute toxicities of aqueous ethanolic extract of leaves of Senna alata (L.) Roxb (Caesalpiniaceae). African Journal of Biotechnology 5: 283-289. Priyadarshini L, Mazumder PB, Choudhury MD (2014) Acute toxicity and oral glucose tolerance test of ethanol and methanol extracts of antihyperglycaemic plant Cassia alata Linn. Journal of Pharmacy and Biological Sciences 9: 43-46. Saokaew S, Suwankesawong W, Permsuwan U, Chaiyakunapruk N (2011) Safety of herbal products in Thailand. An analysis of reports in the Thai Health Product Vigilance Center Database from 2000 to 2008. Drug Safety 34: 339-350. https://doi.org/10.2165/11586590-000000000-00000 TRAMIL (2015) Caribbean pharmacopeia. Senna alata. Accessed 27 December 2019 at http:// www.tramil.net/en/plant/senna-alata. WHO (1999) Monographs on selected medicinal plants. Geneva, Switzerland: World Health Organization 1: 241-249. Yakubu MT, Adeshina AO, Oladiji AT, Akanji MA, Oloyede OB, Jimoh GA, Olatinwo AWO, Afolayan AJ (2010) Abortifacient potential of aqueous extract of Senna alata leaves in rats. Journal of Reproduction & Contraception 21: 163-177. Yagi SM, El Tigani S, Adam SEI (1998) Toxicity of Senna obtusifolia fresh and fermented leaves (kawal), Senna alata leaves and some products from Senna alata on rats. Phytotherapy Research 12: 324-330.

Chapter 23

Senna occidentalis (L.) Link (Fabaceae)

Synonyms: Cassia occidentalis L., Ditramexa occidentalis Britton & Rose, Ditremexa occidentalis (L.) Britton & Wilson (Adams, 1972) Common name in Jamaica: Dandelion Other common names in Jamaica: Piss-a-bed, stinking weed, wild coffee (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_23

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Botanical characteristics and propagation Erect shrubby herb with reddish-purple stems that grows up to 2 m high. It emits a characteristic unpleasant (fetid) smell when crushed. Leaves compound, alternate, pale green, with 3–5 pairs of leaflets, and a conspicuous dark-colored gland at the base of the leaf stalk. The pale to bright yellow flowers produce flattened fruit pods that turn brown and woody when mature and contain small dark-brown flattened seeds. The species is native to tropical and subtropical regions of the Americas and the Caribbean and now has a pantropical distribution (CABI, 2020). The plant propagates easily by seed.

Where to find the plant A weed of roadsides, disturbed spaces, grassland, open woodland, coastal environments, and farm land (Adams, 1972).

Part used The seed.

Jamaican cultural uses and beliefs The seed can be drunk like coffee.

Jamaican medicinal uses The seed is a well-known remedy for bladder problems.

Major uses (mentioned by more than 20% of people) • Weak bladder (and kidney problems): In Windsor Forest and Kingston, the seed is pounded, steeped in boiling water, and drunk. The root can be boiled and drunk as well.

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Reported medicinal uses across the Caribbean The Caribbean pharmacopeia recommends external use of the leaf for skin problems, headache, fever, and bad blood and its oral administration for body pain, stomach ache, fever and jaundice (a condition that makes the skin and whites of the eyes turn yellow). Sucking on the leaf and root is recommended for sore throat. The pounded seed is recommended in a bath for body pain and in a compress for skin abscesses and fungal skin infections. Oral administration of the root is ­recommended for stomachache and fever, whereas its application as a compress is recommended for fever (Germosén-Robineau, 2014). Across individual countries: • Belize: The leaves are mashed for heart weakness, mixed with egg and rum, and applied as a compress against the chest. The whole bush, chopped, boiled, and drunk serves as a heart tonic, blood thinner, and as a treatment for depression. For fever and flu, the root is boiled and drunk. For chills, a leaf is warmed with a bit of oil and rubbed over the body. Hepatitis (liver disease) is treated by boiling and drinking the leaf and root, together with the bark of Morinda panamensis. For painful menstruation, the root is boiled and drunk. As a pregnancy test, a woman can urinate on the leaves. When a child has a bad temper, the branches are used for spanking and are then thrown away (Balick and Arvigo, 2015). • Cuba: The root of Senna occidentalis is used in herbal mixtures, but its use is not associated with specific diseases; rather it belongs to a group of herbal remedies that are locally regarded as depuratives (to purify and detoxify the body) and diuretics (to promote urination) (Cano and Volpato, 2004). The leaf juice presumably alleviates the pain of burns. The roasted seeds, boiled as coffee, are taken internally for the chest, liver, and stomach. The root is used as a diuretic and for pain in the abdomen and colic. The water of the boiled root is taken to treat malaria (a disease caused by a Plasmodium parasite in the blood, transmitted by the bite of infected mosquitoes). A cataplasm of the leaves is applied for pneumonia (Roig, 1988). • Jamaica (Portland): The chopped root is boiled for half an hour, and the decoction is drunk for back pain. For kidney problems, inflammation, swelling, and gas (indigestion), the ground fruits are steeped in boiling water, and the preparation is drunk (Austin and Thomas, 2009). Traditional maroon healer Ivelyn Harris (2010) from Portland refers to the plant by its local name “piss a bed,” appropriately named after its treatment for bedwetting in children, and “excess urine” and weak bladder in adults. The same tea, prepared as a decoction from the roasted and ground seeds is also used to clean the urinary tract and is claimed to relax smooth muscle and lower blood pressure. A tea prepared from the dried root is used to treat gallstones and kidney stones. Dandelion is described as a powerful herb, to be used with caution, and not to be taken for more than 2 weeks at a time.

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• Trinidad: The seeds are roasted, ground, and drunk as an infusion for the common cold and cough. A decoction of the root is drunk for cooling and cleansing, asthma, womb infection, and afterbirth (Clement et al., 2015).

Reported medicinal uses across the world Across individual countries: • Angola: The seeds are used as a coffee surrogate, the underground parts to treat bites from snakes and scorpions, and urinary tract conditions, the leaves for cough, the bark for diarrhea, the seed for fever, the bark and underground parts for gonorrhea, and the twigs are considered restorative in pregnancy (Urso et al., 2016). • Benin: The leaves are boiled and drunk for malaria and shivering (Yetein et al., 2013). • Bolivia: The leaf is prepared as a salve (ointment) and applied for arthritis and “pasmo” (a condition that consists of difficulty urinating and passing stool, swelling of the intestines, a whitish face, and dizziness) (Bourdy et al., 2004). The seed is boiled and taken internally for dysentery, whereas the ground root is applied as a bath for fungal and other skin infections (Hajdu and Hohmann, 2012). • Brazil: An infusion of the leaves is taken for weight loss (Cercato et al., 2015). In the Brazilian Amazon, the root is used for malaria (Brandão et al., 1992). The fruit (pod) is administered orally for stroke (Saraiva et al., 2015). • Ethiopia: Fresh or dried leaves of Senna occidentalis are kept in a pocket to prevent snake bites (Giday et al., 2003). • Ghana: Senna occidentalis is included in the country’s herbal pharmacopeia. A decoction of the leaf and seed is used for tapeworm (Agyare et al., 2014). The flower and leaf are prepared as an enema (suppository) for fever in children. A decoction of various plant parts is used to treat high blood pressure, asthma, stomach problems, hernia, and fever (malaria) (Soelberg et al., 2015). The dry seeds are ground, boiled and drunk for malaria (Asase et al., 2010). • Guinea-Bissau: The leaves and roots are used for wounds and burns, fever, malaria, and sexually transmitted infections (Catarino et al., 2016). • India: The leaves are used to treat digestive problems (Choudhury et al., 2015). For “swelling of the nerves,” a paste of the crushed leaves is applied externally and taken internally with water (Rajakumar and Shivanna, 2009). The leaves are used for bone fractures (Xavier et al., 2015). • Mali: The dried leaves of Senna occidentalis are included in a standardized phytomedicine used in the treatment of malaria, called Malarial (Willcox et al., 2012). • Mauritius: A decoction of the leaves is drunk for colds and flu (Suroowan and Mahomoodally, 2016). The seeds are roasted, soaked in hot water, and drunk for hypertension (high blood pressure), whereas the root is boiled and drunk for gangrene (localized death and decomposition of body tissue, resulting from obstructed circulation or bacterial infection) (Mootoosamy and Mahomoodally, 2014).

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• Nicaragua: Senna occidentalis is extensively used in midwifery for healthcare of mother and baby, including to relieve abdominal and back pain, to promote and speed up contractions during childbirth, to reduce nervousness, to stop postpartum abdominal pain, to promote conception, to reduce fever, to alleviate digestive ailments (flatulence, heartburn and stomachache), to treat vaginal infections, to alleviate menstrual pain and constipation, and to promote healing of the navel. The whole plant is either boiled or crushed to extract its juice, and the preparation is administered by mouth or applied topically (Coe, 2008). • Nigeria: A decoction of the leaves, pods, and seeds is used to treat diabetes (Ezuruike and Prieto, 2014). Dried roots and leaves of Senna occidentalis are milled, mixed with black soap and used to bathe for treatment of measles (Sonibare et al., 2009). • Panama: A tea prepared from the leaf is drunk for stomachache, the crushed leaves are used as a poultice (compress) for inflammatory problems, and the leaves are eaten to expel intestinal worms and parasites (Taylor, 2005). • Peru: The roots are considered a diuretic, and a decoction is prepared for fevers. The seeds are brewed into a coffee-like beverage for asthma, and a flower infusion is used for bronchitis (Taylor, 2005). • Somalia: One plant is crushed, boiled, and drunk to treat dull pain located close to the kidneys (probably colic). Against itching on the head, probably scabies, and for the treatment of bruises, a handful of seeds is mixed with vinegar and the liquid applied to the head (Samuelsson et al., 1991). • Suriname: Intestinal problems in young babies are treated with a tea (infusion) of the flowers that is administered to drink. For the “evil eye,” the whole bush is mixed with Lippia alba, and the baby is bathed with this mixture (Ruysschaert et al., 2009). • Togo: The leaf, root, and seed are boiled for liver disease (Kpodar et al., 2016). • Uganda: The root is chewed for snakebite and hernia. To promote childbirth and to treat a retained placenta, an infusion of the root is drunk. Syphilis is treated by boiling and drinking the root. For diphtheria (an infectious disease characterized by a swollen neck and a bacterial film in the throat), the root and leaf are chewed, or an infusion is drunk (Tabuti et al., 2003). • Vanuatu: Juice is extracted from the leaf to induce birth (Bourdy and Walter, 1992).

Clinical efficacy studies in humans Senna occidentalis was one of the three plants in a standardized phytomedicine called Malarial that underwent three clinical studies to establish its safety and effectiveness in the treatment of malaria. The first study was undertaken from 1984 to 1985. The second was a randomized controlled trial comparing Malarial to chloroquine, the latter being a pharmaceutical drug used to prevent and treat malaria. There were 53 patients, of whom 36 were randomized to Malarial and 17 to chloroquine. Fever clearance was similar in both groups, but parasite clearance was better

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in the chloroquine group. Malarial was better tolerated than chloroquine. The concentrations of the three plants in Malarial were slightly altered in an attempt to improve its activity, and the new formula was tested in an observational cohort study on patients with uncomplicated malaria. Thirty patients were included, aged 5 years or older, with a fever (temperature higher than 37.5 °C), and a parasite load of more than 3000 parasites of Plasmodium falciparum per microliter of blood. There was no control group. In the test group, parasite load declined and symptoms improved. Malarial was one of several plant medicines being screened for effectiveness against malaria, and subsequent research focused on a traditional medicine prepared from Argemone mexicana (in Jamaica known as blessed thistle or holy thistle) (Willcox et al., 2012). The seeds of Senna occidentalis are an ingredient of a multi-herbal formulation (containing many different herbs) called Herbolax that is commonly used in treating constipation. A study of 45 patients over 2  weeks showed the laxative effect of Herbolax, with patients reporting smooth evacuation of stool. None of the patients reported purging, griping, abdominal pain, watery stools, weakness, lethargy, or cramps, and there was no recurrence of constipation at the end of the 2  weeks (Reddy and Kulkarni, 2001; Yadav et al., 2010). Senna occidentalis seed extract is also used in another multi-herbal formulation called Liv-52, for the management of hepatitis A. Liv-52 is the flagship product of one of India’s largest herbal drug manufacturing companies, Himalayan Healthcare. A meta-analysis of 50 clinical studies in 4490 patients, undertaken by the manufacturer of Liv-52, concluded that the formulation is effective and safe in the management of hepatitis A (Yadav et al., 2010).

Safety information Side effects An overdose of preparations made with the seeds of Senna occidentalis is reported to be strongly diuretic (increasing urination) and to cause severe stomach upsets (Warner, 2007). Other side effects associated with the excessive use of the seeds of Senna occidentalis in humans include hepatitis (liver disease) and allergic reactions (Teles et al., 2015). Ingestion of a single high dose of the seeds, as well as long-term oral use of small amounts, has been shown to cause toxic reactions, including myodegeneration (muscle disease), and death in animals and young children (Taylor, 2005).

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Toxicology The leaves of Senna occidentalis are claimed to have liver-protective effects and are traditionally used for the treatment of liver disorders (Jafri et al., 1999). A preclinical safety evaluation of the water–alcohol extract of the stem and leaf in rats showed a lethal dose (at which 50% of the test animals died) that was higher than 5 g/kg body weight. Oral administration of the extract in doses of 0.1, 0.5, or 2.5 g/kg body weight per day, for 30 days, failed to demonstrate changes in body weight gain and intake of food and water, or altered profiles of the blood and biochemicals in the body of the rats. In addition, no macroscopic or ­microscopic changes were observed in their organs. The authors concluded that Senna occidentalis leaf and stem are not toxic in rats, suggesting their safe consumption in humans (Silva et al., 2011). However, a case of apparent poisoning with the leaves of Senna occidentalis described liver failure and subsequent death in a 75-year-old woman in India (Ish et al., 2019). The patient was reported to have self-medicated with the leaves for a period of 2 weeks prior to her hospitalization. The published case report does not indicate the preparation method, dose, or whether the plant material was botanically identified as being Senna occidentalis. The seeds of Senna occidentalis are widely used as a coffee substitute. However, ingestion of toxins found in the seeds (or pods) is thought to be the probable cause of acute hepato-myoencephalopathy syndrome in children, indicating toxic effects on the liver, skeletal muscles, and brain. In those children taken to hospital with acute severe poisoning, 75–80% subsequently died (Vashishtha et al., 2009). There are other reports that consumption of Senna occidentalis pods caused dose-dependent poisoning and fatal coma in children of Western Uttar Pradesh, India, and that “the consumption of one or two seed pods by a young child may not have any deleterious impact; [however] a large ‘binge’ can lead to serious disease and death” (Yadav et al., 2010). A study in animals showed that long-term administration of the seeds can promote blood toxicity. Rats were treated with a diet containing no seeds, or with a diet containing 0.5, 1, or 2% of seeds, for a period of 90 days. The highest dose (2% seeds) caused unusual changes in the blood of the rats. Chronic treatment with the seeds affected the bone marrow and spleen (Teles et al., 2015). In another experiment, rats fed 1, 2, and 4% of seeds for 2 weeks showed signs of lethargy, weakness, reclining posture, depression, and emaciation (wasting away). Analysis of their organs showed a dose-dependent degeneration of the liver, kidney, brain, and muscles of the skeleton and heart (Barbosa-Ferreira et al., 2005). Rabbits that received food containing 4% of ground seeds gained less weight and died in the third week; analysis of their organs revealed that the heart and liver were the main organs affected (Tasaka et al., 2000). Poisoning has also been reported in grazing cattle, horses, swine, goats, sheep, chickens, and rabbits. Affected animals continue to eat and remain alert until shortly before death (Tasaka et al., 2000).

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Contraindications No information is available.

Use in pregnancy and breastfeeding The seeds, roots, and leaves have been reported as an emmenagogue (stimulate menstruation), abortifacient (induce abortion), and a labor-inducer (Bourdy and Walter, 1992). Drinking a tea of the roots is contraindicated during pregnancy according to Brazilian people of African descent (Yazbek et  al., 2016); another Brazilian Quilombola community reported that a decoction of the seeds is also contraindicated during pregnancy (Rodrigues, 2007). In Honduras, Senna occidentalis is used for maternal health to speed up contractions during labor (by oral administration of the boiled root) and also to treat nerves during childbirth (by drinking a decoction of the root or of the ground roasted seeds). To encourage conception (pregnancy), the boiled root is drunk together with Matricaria chamomilla L. (Ticktin and Dalle, 2005).

Drug interactions No information is available.

Recommendations The roasted seeds of Senna occidentalis are widely consumed as a coffee substitute, and various parts of the plant are used in traditional medicine. However, toxic effects have been observed from excessive use of the fresh, dried, and roasted seeds or pods in animals and children, even though it is unclear how toxic the pods are as compared to the seeds alone. Adults adhering to the traditional use of the seeds as coffee should practice great care, be vigilant of symptoms, and discuss any possible side effects immediately with their healthcare provider. Although oral consumption of root and leaf preparations is recommended by the Caribbean pharmacopeia, those of the seed and pod are not. Use of any part of the plant is not advisable during pregnancy. Based upon the documented fatalities in children, ingestion of the seeds (or pods) should be avoided at any time by children.

Selected bibliography

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Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Agyare C, Spiegler V, Sarkodie H, Asase A, Liebau E, Hensel A (2014) An ethnopharmacological survey and in vitro confirmation of the ethnopharmacological use of medicinal plants as anthelmintic remedies in the Ashanti region, in the central part of Ghana. Journal of Ethnopharmacology 158: 255–263. Asase A, Akwetey GA, Achel DG (2010) Ethnopharmacological use of herbal remedies for the treatment of malaria in the Dangme West District of Ghana. Journal of Ethnopharmacology 129: 367–376. Austin S, Thomas MB (Eds.) (2009) Common medicinal plants of Portland, Jamaica. Charleston, SC: CIEER, Inc. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. Barbosa-Ferreira M, Zaidan Dagli ML, Maiorka PC, Gorniak SL (2005) Sub-acute intoxication by Senna occidentalis seeds in rats. Food and Chemical Toxicology 43: 497–503 Bourdy G, Chavez de Michel LR, Roca-Coulthard A (2004) Pharmacopeia in a shamanistic society: The Izoceño-Guaraní (Bolivian Chaco). Journal of Ethnopharmacology 91: 189–208. Bourdy G, Walter A (1992) Maternity and medicinal plants in Vanuatu I. The cycle of reproduction. Journal of Ethnopharmacology 37: 179-196. Brandão MGL, Grandi TSM, Rocha EMM, Sawyer DR, Krettli AU (1992) Survey of medicinal plants used as antimalarials in the Amazon. Journal of Ethnopharmacology 36: 175-182. CABI (2020) Senna occidentalis (coffee senna) [original text by Vélez-Gavilán J]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/11450. Cano JH, Volpato G (2004) Herbal mixtures in the traditional medicine of Eastern Cuba. Journal of Ethnopharmacology 90: 293–316. Catarino L, Havik PJ, Romeiras MM (2016) Medicinal plants of Guinea-Bissau: Therapeutic applications, ethnic diversity and knowledge transfer. Journal of Ethnopharmacology 183: 71–94. Cercato LM, White PAS, Nampo FK, Santos MRV, Camargo EA (2015) A systematic review of medicinal plants used for weight loss in Brazil: Is there potential for obesity treatment? Journal of Ethnopharmacology 176: 286–296. Choudhury PR, Choudhury MD, Ningthoujam SS, Mitra A, Nath D, Talukdar AD (2015) Plant utilization against digestive system disorder in Southern Assam, India. Journal of Ethnopharmacology 175: 192–197. Clement YN, Baksh-Comeau YS, and Seaforth CE (2015) An ethnobotanical survey of medicinal plants in Trinidad. Journal of Ethnobiology and Ethnomedicine 11: 67. Coe FG (2008) Rama midwifery in eastern Nicaragua. Journal of Ethnopharmacology 117: 136–157. Ezuruike UF, Prieto JM (2014) The use of plants in the traditional management of diabetes in Nigeria: Pharmacological and toxicological considerations. Journal of Ethnopharmacology 155: 857–924. Germosén-Robineau L (2014) Farmacopea vegetal Caribeña. Tercera Edición. Yucatán, Mexico: Centro de Investigación Científica de Yucatán, 400 pp. Giday M, Asfaw Z, Elmqvist T, Woldu Z (2003) An ethnobotanical study of medicinal plants used by the Zay people in Ethiopia. Journal of Ethnopharmacology 85: 43–52. Hajdu Z, Hohmann J (2012) An ethnopharmacological survey of the traditional medicine utilized in the community of Porvenir, Bajo Paraguá Indian Reservation, Bolivia. Journal of Ethnopharmacology 139: 838–857. Harris I (2010) Healing Herbs of Jamaica. Royal Palm Beach, Florida: AhHa Press, 212 pp. Ish P, Rathi S, Singh H, Anuradha S (2019) Senna occidentalis poisoning: An uncommon cause of liver failure. ACG Case Reports Journal 8: e00035.

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Jafri MA, Subhani MJ, Javed K, Singh S (1999) Hepatoprotective activity of leaves of Cassia occidentalis against paracetamol and ethyl alcohol intoxication in rats. Journal of Ethnopharmacology 66: 355–361. Kpodar MS, Karou SD, Katawa G, Anani K, Gbekley HE, Adjrah Y, Tchacondo T, Batawila K, Simpore J (2016) An ethnobotanical study of plants used to treat liver diseases in the Maritime region of Togo. Journal of Ethnopharmacology 181: 263–273. Mootoosamy A, Mahomoodally MF (2014) Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius. Journal of Ethnopharmacology 151: 413–444. Rajakumar N, Shivanna MB (2009) Ethno-medicinal application of plants in the eastern region of Shimoga district, Karnataka, India. Journal of Ethnopharmacology 126: 64–73. Reddy K, Kulkarni KS (2001) A clinical trial of Herbolax in constipation during post-operative period. The Antiseptic 7: 252–253. Rodrigues E (2007) Plants of restricted use indicated by three cultures in Brazil (Caboclo-river dweller, Indian and Quilombola). Journal of Ethnopharmacology 111: 295–302. Roig JT (1988) Plantas medicinales, aromáticas o venenosas de Cuba. La Habana, Cuba: Ministerio de Cultura. Editorial Cientifico-Tecnica. Ruysschaert S, van Andel T, Van de Putte K, Van Damme P (2009) Bathe the baby to make it strong and healthy: Plant use and child care among Saramaccan Maroons in Suriname. Journal of Ethnopharmacology 121: 148–170. Samuelsson G, Farah MH, CIaeson P, Hagos M, Thulin M, Hedbers O, Warfa AM, Hassan AO, Elmi AH, Abdurahman AD, Elmi AS, Abdi YA, Alin MH (1991) Inventory of plants used in traditional medicine in Somalia. I. Plants of the families Acanthaceae-Chenopodiaceae. Journal of Ethnopharmacology 35: 25-63. Saraiva ME, Ribeiro de Alencar Ulisses AV, Alves Ribeiro D, Souza de Oliveira LG, Gonçalves de Macêdo D, Silva de Sousa FF, Alencar de Menezes IR, Sampaio EVSB, de Almeida Souza MM (2015) Plant species as a therapeutic resource in areas of the savanna in the state of Pernambuco, Northeast Brazil. Journal of Ethnopharmacology 171: 141–153. Silva MGB, Aragão TP, Vasconcelos CFB, Ferreira PA, Andrade BA, Costa IMA, Costa-Silva JH, Wanderley AG, Lafayette SSL (2011) Acute and subacute toxicity of Cassia occidentalis L. stem and leaf in Wistar rats. Journal of Ethnopharmacology 136: 341–346. Soelberg J, Asase A, Akwetey G, Jäger AK (2015) Historical versus contemporary medicinal plant uses in Ghana. Journal of Ethnopharmacology 160: 109–132. Sonibare MA, Moody JO, Adesanya EO (2009) Use of medicinal plants for the treatment of measles in Nigeria. Journal of Ethnopharmacology 122: 268–272. Suroowan S, Mahomoodally MF (2016) A comparative ethnopharmacological analysis of traditional medicine used against respiratory tract diseases in Mauritius. Journal of Ethnopharmacology 177: 61–80. Tabuti JRS, Lye KA, Dhillion SS (2003) Traditional herbal drugs of Bulamogi, Uganda: Plants, use and administration. Journal of Ethnopharmacology 88: 19–44. Tasaka AC, Weg R, Calore EE, Sinhorini IL, Dagli MLZ, Haraguchi M, Gorniak SL (2000) Toxicity testing of Senna occidentalis seed in rabbits. Veterinary Research Communications 24: 573-582. Taylor, L (2005) The Healing power of rainforest herbs 2nd Ed. New York: Square One Publishers, 519 pp. Teles AVFF, Fock RA, Gorniak SL (2015) Effects of long-term administration of Senna occidentalis seeds on the hematopoietic tissue of rats. Toxicon 108: 73–79. Ticktin T, Dalle SP (2005) Medicinal plant use in the practice of midwifery in rural Honduras. Journal of Ethnopharmacology 96: 233–248. Urso V, Signorini MA, Tonini M, Bruschi P (2016) Wild medicinal and food plants used by communities living in Mopane woodlands of southern Angola: Results of an ethnobotanical field investigation. Journal of Ethnopharmacology 177: 126–139.

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Vashishtha VM, John TJ, Kumar A (2009) Clinical and pathological features of acute toxicity due to Cassia occidentalis in vertebrates. Indian Journal of Medical Research 130: 23–30. Warner M (2007) Herbal Plants of Jamaica. Oxford: MacMillan Education, 176 pp. Willcox M, Sanogo R, Diakite C, Giani S, Paulsen BS, Diallo D (2012) Improved traditional medicines in Mali. Journal of Alternative and Complementary Medicine 18: 212-220. Xavier TF, Kannan M, Auxilia A (2015) Observation on the traditional phytotherapy among the Malayali tribes in Eastern Ghats of Tamil Nadu, South India. Journal of Ethnopharmacology 165: 198–214. Yadav JP, Arya V, Yadav S, Panghal M, Kumar S, Dhankhar S (2010) Cassia occidentalis L.: A review on its ethnobotany, phytochemical and pharmacological profile. Fitoterapia 81: 223–230. Yazbek PB, Tezoto J, Cassas F, Rodrigues E (2016) Plants used during maternity, menstrual cycle and other women’s health conditions among Brazilian cultures. Journal of Ethnopharmacology 179: 310–331. Yetein MH, Houessou LG, Lougbégnon TO, Teka O, Tente B (2013) Ethnobotanical study of medicinal plants used for the treatment of malaria in plateau of Allada, Benin (West Africa). Journal of Ethnopharmacology 146: 154–163.

Chapter 24

Solanum torvum Sw. (Solanaceae)

Synonym: Solanum ficifolium Ortega (Adams, 1972) Common names in Jamaica: Susumba, susumber, gully bean Other common name in Jamaica: Turkey berry (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_24

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Botanical characteristics and propagation Spiny shrub or small tree with a deep, woody taproot that grows up to 5 m tall. Stems with scattered hooked prickles. Leaves alternate, broadly ovate, margins entire or lobed. The underside of the leaf is lighter than the upper surface and carries spines along the midrib. White flowers arranged in dense compact heads, carrying bright yellow stamens (CABI, 2020). The fruits are globular berries that grow in clusters and have a bitter taste when cooked. They are green at first, but ripen into a dull yellow. The plant originates in the West Indies (CABI, 2020), although others consider a broader native range, including southern Mexico, Central America, the West Indies, and tropical South America (Acevedo-Rodríguez and Strong, 2007). It grows readily from seeds, although it is not grown as a commercial crop in Jamaica. If farmers want susumba on their land, they scatter the seeds or transplant the suckers.

Where to find the plant The bush grows wild and can be found in yards, on farm land, and in waste areas.

Part used The leaf and fruit (which people call berry or seed), occasionally the root.

Jamaican cultural uses and beliefs Susumba is considered a powerful spiritual bush, and it is claimed that you can “work Science [Obeah] with it.” Jamaicans say: “Haiti people ‘fraid a wi.” Someone in Kingston said in Patois: “if Guzu man [Obeah man] come a yuh yard, him gonna run out.” The leaf can also be used to “scour the pot” because it has a rough texture. Susumba is considered an “all purpose medicine.” The leaf is boiled as a regular tea. The young green berries are much appreciated as a bitter vegetable, and cooked with saltfish and either ackee (Blighia sapida K.D.Koenig) or cho cho (Sechium edule (Jacq.) Sw.), in soup or in rundown (cooked in coconut milk) with mackerel, or the berries are used to season rice. The leaf has a veterinary use, explained in Patois as follows: “When animal has fly, you rub it up, stuff up the hole [in the skin of the animal] and kill the insect.” People also know that “bird like[s] it.”

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Jamaican medicinal uses Susumba leaf and fruit are commonly used as a remedy to treat the common cold and flu and to cleanse the body and the blood.

Major uses (mentioned by more than 20% of people) • Common cold and flu: In Kingston, the green leaf is boiled for 5–10 min or two leaves are steeped in boiling water for 2–3 min; the preparation is drunk and used to bathe. Alternatively, the leaf is put in a cloth and squeezed to extract the juice and drunk; strawberry syrup is sometimes added to the juice. Or, the leaf and seed are boiled in coconut milk and drunk. In Windsor Forest, people boil and drink the leaf or throw hot water on the dry fruit and drink this remedy. • Body cleanser (toxins, bowels): In Windsor Forest, people juice and drink the leaf, pound the young bud and take a teaspoon, parboil (half boil) and drink the root, or cook and eat the berry. This remedy is also taken to improve appetite, the lack of which is associated with having “dirt in the body.”

Minor uses (mentioned by more than 5% of people, but less than 20%) • Blood cleanser (builds the blood): In Kingston, people eat the young green fruit twice a week with fish tea, lunch, or dinner. Or, the fruit is boiled in root tonic or bitters and taken orally.

Reported medicinal uses across the Caribbean Across individual countries: • Belize: The fruit is eaten, either green or boiled. The leaves are used for skin sores and wounds, snakebites, and ringworm (in a bath, poultice, or powder). The fresh fruit juice is used to treat chiggers (infected wounds caused by sand fleas) and athlete’s foot fungus (Balick and Arvigo, 2015). • Cuba: The leaves are commonly used in mixtures for cough (Cano and Volpato, 2004). • Jamaica: Earlier reports note the use of a tea made with the leaves of Solanum torvum to improve appetite and to treat the common cold. When used for the cold, the leaves would often be mixed with other plants, such as the aerial parts

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of John Charles (Hyptis verticillata Jacq.) and cotton (species of Gossypium) (Asprey and Thornton, 1953). A survey undertaken in 2009 identified Solanum torvum as the seventh most widely reported medicinal plant (Picking et  al., 2015).

Reported medicinal uses across the world Across Southeast Asia, a decoction of the fruit is given for cough ailments and is considered useful in cases of liver and spleen enlargement (Siemonsma and Piluek, 1994). Across individual countries: • Cameroon: Solanum torvum is widely used as a traditional African folk medicine to treat fever and high blood pressure (Adjanohoun et al., 1996), stomach complaints, including gastric ulcers (Noumi and Dibakto, 2000), as a diuretic (promotes urination) and sedative (calming medicine) (Mahmood et al., 1983). The leaves are chewed to treat poisoning, and the plant is claimed to have properties to stop bleeding (Noumi, 2004). The fruit is used as a traditional tonic and to support the formation of blood cells, as well as for the treatment of pain. In North-West Cameroon, the fruit juice is used to treat abscesses, chigger (jigger) wounds (caused by sand fleas), skin infections such as ringworm, athlete’s foot in humans, and bacterial skin infections resulting in scabs in animals (dermatophilosis) (Chah et al., 2000). • Ghana: Solanum torvum fruits (and leaves) are boiled and drunk to treat malaria (Asase et al., 2010; Komlaga et al., 2015); alternatively, the fruits are mixed with mango (Mangifera indica L.) stem bark and sugarcane (Saccharum officinarum L.) for the same purpose. Decoctions and infusions of both the unripe fruits and leaves are prepared for the traditional treatment of tuberculosis (TB) (Nguta et  al., 2015). Ground leaves are applied directly on Buruli ulcers, a bacterial infection of the skin caused by Mycobacterium ulcerans (Fokou et al., 2015). • India: Bitter plants like Solanum torvum are generally recommended for stuffy nose, bronchitis, sinusitis, and cough (Mutheeswaran et al., 2011). The Apatani tribe of the Eastern Himalayan region uses the berries (preparation method not stated) to treat cough and skin diseases (Kala, 2005). Traditional healers in Tamil Nadu, the third largest state in India, use the leaf juice to reduce body heat, and consume the unripe fruits to strengthen the body (Muthu et al., 2006). • Papua New Guinea: The juice from the leaves is boiled and then applied to tropical ulcers (Prescott et al., 2015). • Thailand: The edible fruits, commonly available in markets, are used as a vegetable and are regarded as an essential ingredient in Thai cuisine (Arthan et al., 2002).

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Clinical efficacy studies in humans In an uncontrolled study of 30 non-insulin dependent diabetes mellitus patients in India who were on hypoglycemic medication to lower their blood sugar, no changes in fasting blood sugar levels were observed when their medication was supplemented with dry powder of Solanum torvum (7–28 g, plant part not specified but likely to be the berry, administered by mouth for 1 month) (Iyer et al., 1992). A mixed herbal product, registered with the Food and Drug Administration of Ghana for the treatment of uncomplicated malaria, was evaluated for its safety and effectiveness in an open (non-blind), prospective, non-comparative clinical study. The product, a water decoction of four plants, which included the leaves of Solanum torvum and Vernonia amygdalina Delile and the stem bark of Spathodea campanulata P.Beauv. and Bombax buonopozense P.Beauv., was taken at a dose of 60 mL, three times daily for 6 days, by the participants. Forty patients, 25 women and 15 men, with a mean age of 42 years and with a confirmed diagnosis of uncomplicated malaria, were treated and followed up for 28 days. Thirty three (82.5%) participants achieved clearance of all parasites by day 7 of the study, reflecting complete cure. Partial clearance was observed in six patients (15%), and the treatment failed in one patient (2.5%). Resolution of major clinical symptoms was observed in most participants by day 7. There were no adverse effects, and the biochemical profiles of the liver, kidney, and blood were normal. The authors concluded that this mixed herbal product has the potential to be used in cases of uncomplicated malaria (Tetteh et al., 2020).

Safety information Side effects There exist two separate case reports in the United States, both involving couples that shared traditional Jamaican meals that included susumba berries transported from Jamaica. Both couples developed dose-dependent, delayed-onset gastrointestinal and neurological symptoms, respiratory problems, high blood pressure, liver toxicity, and rhabdomyolysis (death of muscle fibers that release a damaging protein into the blood) (Antezana et al., 2012; Willis et al., 2012). Another case study of suspected poisoning was that of a 54-year-old woman who presented with symptoms of a stroke and serum presence of toxic solanaceous compounds following consumption of susumba berries (Glover et al., 2016). Five family members in New  York City prepared a meal containing susumba berries that were harvested in, and transported from, Jamaica. Only the three persons who ate the berries developed symptoms with varying degrees of gastrointestinal distress, dizziness, slurred speech, facial paralysis, and loss of control of body movements. The most seriously affected patient developed high blood pressure,

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confusion, arm muscle weakness, and respiratory failure requiring prolonged mechanical ventilation (Smith et al., 2008). Six other patients in Toronto shared a meal containing unripe susumba berries brought over from Jamaica and encountered adverse effects as well. Fourteen hours after ingestion, only the persons who ate the berries presented with varying degrees of diarrhea, weakness, facial paralysis, slurred speech, loss of control of body movements, hypertension, and muscle weakness. Two patients had respiratory problems; one required intubation (Smith et al., 2008). There was no botanical confirmation that the berries consumed were indeed those of Solanum torvum in any of the case reports.

Toxicology Some authors have stated that poisoning from susumba berries is rare and that normally the berries are edible. However, they have also cautioned that growing conditions of the berries, or post-harvest stress during transport or storage, may contribute to toxicity with gastrointestinal and neurological symptoms, through the formation of solanaceous glycoalkaloids (Willis et  al., 2012). According to other authors, “poisonous berries appeared indistinguishable from nontoxic variants” (Smith et al., 2008). In mice, a water extract of the dried fruits administered orally did not exhibit acute toxicity up to the maximum dose of 8 g/kg body weight. Common side effects such as diarrhea, weight loss, and depression were not recorded within the 7 days of observation. An LD50 (lethal dose at which half the group of test animals die) that is higher than 5 g/kg body weight is considered nontoxic (Nguelefack et al., 2009).

Contraindications No information is available.

Use in pregnancy and breastfeeding No information is available.

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Drug interactions Traditionally prepared water extracts of the dried leaves of Solanum torvum were tested in the laboratory for their effect on a number of key human enzymes that are responsible for processing many pharmaceutical drugs in the body (cytochrome P450, CYPs 1A2, 2C19, 3A4). The results showed moderate to weak impact, indicating that clinically significant interactions with drugs metabolized by the same enzymes are unlikely (Shields, 2006; Delgoda and Picking, 2015). In rats with chemically induced high blood pressure, a water extract of the dried fruit of Solanum torvum, given orally for 30 days in a dose of 0.2 g/kg body weight, potentiated the high blood pressure of the rats and increased their urination. Even though this is an animal study that needs to be verified in humans, one must be vigilant that consumption of susumba fruits might theoretically interact with medications for high blood pressure (Nguelefack et al., 2009).

Recommendations Given its popularity and regular consumption in Jamaica, especially in rural areas, eating Solanum torvum berries appears to be relatively safe. Susumba berry poisoning is a rare event. However, one must keep in mind the possibility that there may exist toxic berries that appear to be indistinguishable from nontoxic berries and that boiling does not seem to eliminate toxicity. If health problems appear after eating susumba berries, one must immediately consult with a healthcare provider. It remains to be resolved if the toxic berries were actually those of Solanum torvum, or if they belonged to another, closely related plant species or lookalike. Researchers have also suggested that toxicity may be associated with other factors, such as the stage of maturity of Solanum torvum, its growing conditions, or post-harvest stressors such as freezing or transportation of the berries. Research involving botanical collections and authentication of plant material is needed to clarify if poisoning is associated with Solanum torvum, or if it involves substitution with closely related species that also exist in Jamaica, such as for example Solanum erianthum D. Don.

Selected bibliography Acevedo-Rodríguez P, Strong MT (2007) Catalogue of the seed plants of the West Indies. Accessed 27 December 2019 at https://naturalhistory2.si.edu/botany/WestIndies/. Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Adjanohoun E, Aboubakar N, Dramane K, Ebot ME, Ekpere J A, Enoworock EG, Wirmum CK (1996) Traditional medicine and pharmacopeia: Contribution to ethnobotanical and floristic

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studies in Cameroon. Lagos, Nigeria: Scientific, Technical, and Research Commission of the Organization of African Unity, 641 pp. Antezana A, Policard J, Sarva H, Vas G (2012) Susumber berries: Unexpected cause of cholinergic poisoning. Neurology Clinical Practice 2: 362-363. Arthan D, Svasti J, Kittakoop P, Pittayakhachonwut D, Tanticharoen M, Thebtaranonth Y (2002) Antiviral isoflavonoid sulfate and steroidal glycosides from the fruits of Solanum torvum. Phytochemistry 59: 459-463. Asase A, Akwetey GA, Achel DG (2010) Ethnopharmacological use of herbal remedies for the treatment of malaria in the Dangme West District of Ghana. Journal of Ethnopharmacology 129: 367-376. Asprey GF, Thornton P (1953) Medicinal plants of Jamaica Part I. West Indian Medical Journal 2: 233–252. Balick MJ, Arvigo R (2015) Messages from the Gods. A guide to the useful plants of Belize. New York: Oxford University Press, 539 pp. CABI (2020) Solanum torvum (turkey berry). In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/50559. Cano JH, Volpato G (2004) Herbal mixtures in the traditional medicine of Eastern Cuba. Journal of Ethnopharmacology 90: 293-316. Chah KF, Muko KN, Oboegbulem SI (2000) Antimicrobial activity of methanolic extract of Solanum torvum fruit. Fitoterapia 71: 187-189. Delgoda R, Picking D (2015) Potential drug interactions for commonly used medicinal plants & foods in Jamaica. Kingston, Jamaica: University of the West Indies, Natural Products Institute. Fokou PVT, Nyarko AK, Appiah-Opong R, Yamthe LRT, Addo P, Asante IK, Boyom FF (2015) Ethnopharmacological reports on anti-Buruli ulcer medicinal plants in three West African countries. Journal of Ethnopharmacology 172: 297-311. Glover RL, Connors NJ, Stefan C, Wong E, Hoffman RS, Nelson LS, Milstein M, Smith SW, Swerdlow M (2016) Electromyographic and laboratory findings in acute Solanum torvum poisoning. Clinical Toxicology 54: 61-65. Iyer UM, Mehta NC, Mani I, Mani UV (1992) Studies on the effect of dry Sundakai (Solanum torvum) powder supplementation on lipid profile, glycated proteins and amino acids in non-­ insulin dependent diabetic patients. Plant Foods for Human Nutrition 42: 175-182. Kala CP (2005) Ethnomedicinal botany of the Apatani in the Eastern Himalayan region of India. Journal of Ethnobiology and Ethnomedicine 1: 11. Komlaga G, Agyare C, Dickson RA, Mensah MLK, Annan K, Loiseau PM, Champy P (2015) Medicinal plants and finished marketed herbal products used in the treatment of malaria in the Ashanti region, Ghana. Journal of Ethnopharmacology 172: 333-346. Mahmood U, Shukla YS, Thakur RS (1983) Non-alkaloidal constituents from Solanum torvum leaves. Phytochemistry 22: 167-169. Mutheeswaran S, Pandikumar P, Chellappandian M, Ignacimuthu S (2011) Documentation and quantitative analysis of the local knowledge on medicinal plants among traditional Siddha healers in Virudhunagar district of Tamil Nadu, India. Journal of Ethnopharmacology 137: 523-533. Muthu C, Ayyanar M, Raja N, Ignacimuthu S (2006) Medicinal plants used by traditional healers in Kancheepuram district of Tamil Nadu, India. Journal of Ethnobiology and Ethnomedicine 2: 43. Nguelefack TB, Mekhfi H, Dongmo AB, Dimo T, Watcho P, Zoheir J, Legssyer A, Kamanyi A, Ziyyat A (2009) Hypertensive effects of oral administration of the aqueous extract of Solanum torvum fruits in L-NAME treated rats: Evidence from in vivo and in vitro studies. Journal of Ethnopharmacology 124: 592-599. Nguta JM, Appiah-Opong R, Nyarko AK, Yeboah-Manu D, Addo PG (2015) Medicinal plants used to treat TB in Ghana. International Journal of Mycobacteriology 4: 116-123. Noumi E, Dibakto TW (2000) Medicinal plants used for peptic ulcer in the Bangangte region, western Cameroon. Fitoterapia 71: s406-412.

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Noumi E (2004) Animal and plant poisons and their antidotes in Eseka and Mbalmayo regions, Centre Province, Cameroon. Journal of Ethnopharmacology 93: 231–241. Picking D, Delgoda R, Younger N, Germosen-Robineau L, Boulogne I, Mitchell S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Prescott TAK, Briggs M, Kiapranis R, Simmonds MSJ (2015) Medicinal plants of Papua New Guinea’s Miu speaking population and a focus on their use of plant–slaked lime mixtures. Journal of Ethnopharmacology 174: 217–223. Shields M (2006) The effect of Jamaican medicinal plants on the activities of cytochrome P450 enzymes. Kingston, Jamaica: University of the West Indies, MPhil Dissertation. Siemonsma JS, Piluek K (Eds.) (1994) Plant resources of South-East Asia. No. 8. Vegetables. The Netherlands: Pudoc Scientific Publishers. Smith SW, Giesbrecht E, Thompson M, Nelson LS, Hoffman RS (2008) Solanaceous steroidal glycoalkaloids and poisoning by Solanum torvum, the normally edible susumber berry. Toxicon 52: 667-676. Tetteh AW, Thomford KP, Mensah ML, Boadu KO, Thomford AK, Amposah IK, Amofa G, Turkson BK, Agyemang MO, Owusu-Ansah EDJ (2020) Ghanaian herbal medicines for malaria: An evaluation of the clinical safety and effectiveness of “Time Herbal Mixture” in uncomplicated malaria. Pharmacognosy Research 12:71-5. Willis J, Garlich FM, Baron BJ, Wiener SW, Hoffman RS, Aluisio AR, Smith SW (2012) “Not-so-­ edible susumber berries” [Meeting Abstract]. Clinical Toxicology 50: 658.

Chapter 25

Turnera ulmifolia L. (Passifloraceae)

Common names in Jamaica: Ramgoat regular, ramgoat dashalong Other common name in Jamaica: Ram-goat dashalong (Adams, 1972)

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_25

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Botanical characteristics and propagation Aromatic herb or small evergreen shrub that grows up to 1 m tall. Leaves opposite, lance-shaped to narrowly elliptic, toothed, with deeply impressed veins, and a strigose (white-haired) underside. Leaves clustered toward the ends of the branches (CABI, 2020). The clear yellow flowers last several hours before closing at night, with new flowers opening the next morning. The species is native to Mexico, Central America, and several islands in the West Indies, including Jamaica. It now has a wide geographic distribution because it has been frequently introduced as an ­ornamental or medicinal plant and easily escapes cultivation (CABI, 2020). It is a wild plant that can be reproduced by seeds, cuttings, and division.

Where to find the plant The species adapts easily to a variety of soils and environmental conditions (CABI, 2020). Often observed growing as a weed along roadsides. It is also found growing in people’s yards, as an ornamental and medicinal plant.

Part used The whole plant.

Jamaican cultural uses and beliefs Ramgoat regular is considered a “serious bush,” one that has important medicinal value.

Jamaican medicinal uses In the countryside, Turnera ulmifolia is known as a medicine for blood pressure.

Major uses (mentioned by more than 20% of people) • High blood pressure: In Windsor Forest, the bush is boiled and drunk. Periwinkle (Catharanthus roseus (L.) G.Don) is sometimes added to the preparation.

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Reported medicinal uses across the Caribbean In Jamaica, an earlier publication stated that the leaf, or the dry powdered herb, is steeped in boiling water and drunk 2–3 times a day (one cup) to lower blood sugar levels, to increase urination, and to treat urinary tract infections. The fresh infusion should not be taken for longer than 2 weeks (Austin and Thomas, 2009). Turnera ulmifolia is a component of Jamaican root tonics (Mitchell, 2011). Traditionally, the leaves of Turnera ulmifolia were used to make tea as a favorite beverage and cold remedy in all parts of Jamaica where the plant was found. It was also used for general weakness, constipation, fever, prickly heat, and uterine disorders and was reputed to cause abortion. The tea, given to small children, was thought to prevent the onset of fever. The tea was also considered to correct “acid stomach” and indigestion (Asprey and Thornton, 1953, 1955). In contemporary Jamaica, young leaves are brewed up to make a golden green solution, taken for many purposes, from a general beverage to fighting colds, depression, digestive problems, and other upsets. Some speculate that the plant also acts as an aphrodisiac, like the well-known damiana (Turnera diffusa Willd. ex Schult.) (Warner, 2007; Szewczyk and Zidorn, 2014). In Middle Caicos (in the West Indies), the leaf and whole plant is used as a carminative (to expel gas), tonic, expectorant (to expel phlegm), and for stomach problems. Across the Caribbean, a leaf decoction serves as a menstrual regulator, abortifacient (induces abortion), and emmenagogue (stimulates menstrual flow) (Szewczyk and Zidorn, 2014).

Reported medicinal uses across the world Across individual countries: • Brazil: Turnera ulmifolia is used for the treatment of gastric and intestinal ulcers (de Souza Gracioso et al., 2002) and as an aphrodisiac, abortifacient (induces abortion), and expectorant (for the latter, the root and leaf, or whole plant, are used). The root and leaves are also used to treat diabetes and disorders of the nervous system. A root decoction is used for uterine inflammation and flu. The whole plant and leaf is recommended for cough, bronchitis, prostate ailments, amenorrhea (absence of menstruation), cancer, inflammation, and as an emollient (skin softener). A maceration of the flower is used against injuries. A decoction and infusion of the root is used for kidney stones and liver disease (Szewczyk and Zidorn, 2014). • India: Turnera ulmifolia is a remedy for joint pain (Szewczyk and Zidorn, 2014). • Marshall Islands: Turnera ulmifolia is used for cleansing and deodorizing purposes (Szewczyk and Zidorn, 2014).

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• Mexico: Turnera ulmifolia is recorded as a medicinal tonic and to treat indigestion and bronchitis. It is listed as a remedy against swellings in the Mexican “Medicinal Herbarium” (Szewczyk and Zidorn, 2014). • Nicaragua: The medicinal uses of the bush include aches and pains, fever, respiratory disorders, and it serves as a purgative and laxative (Szewczyk and Zidorn, 2014).

Clinical efficacy studies in humans There exist no state-of-the-art double-blind clinical studies in humans of Turnera ulmifolia as the ultimate proof of its relevant biological activity (Szewczyk and Zidorn, 2014). In Brazil, persons infected with HIV who were taking antiretroviral drugs reported Turnera ulmifolia as the herbal remedy they most commonly used, without specifying the plant’s therapeutic indications (Almeida et al., 2012).

Safety information Side effects No information is available.

Toxicology No information is available.

Contraindications No information is available.

Use in pregnancy and breastfeeding Oral administration of the leaf is reported to induce abortion (Asprey and Thornton, 1953, 1955). Pregnant rats were given a water extract by mouth, as a maceration of fresh leaves in doses from 0, 1, 2, or 3 g/kg body weight per day, from gestation to day 21

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of pregnancy. The treatment did not induce changes in pregnant rats related to body weight gain, food and water intake, structural changes to organs, impaired gestation, or damage to the exposed offspring (Lopes da Costa et al., 2009).

Drug interactions No information is available.

Recommendations Turnera ulmifolia is used as a traditional medicine in a wide geographic area, but the species is understudied from a biological and clinical perspective, and further studies are urgently needed. It is advisable not to take the plant during pregnancy because of community reports of its abortion-inducing effect.

Selected bibliography Adams CD (1972) The flowering plants of Jamaica. Kingston: University of the West Indies, 848 pp. Almeida FM, Britto e Alves MTSS, Mendonça do Amaral FM (2012) Uso de plantas com finalidade medicinal por pessoas vivendo com HIV/AIDS em terapia antiretroviral. Saúde Sociedad São Paulo 21: 424-434. Asprey GF, Thornton P (1953) Medicinal plants of Jamaica. Part I. West Indian Medical Journal 2: 233–252. Asprey GF, Thornton P (1955) Medicinal plants of Jamaica. Part III. West Indian Medical Journal 4: 69–82. Austin S, Thomas MB (Eds.) (2009) Common medicinal plants of Portland, Jamaica. Charleston, SC: CIEER, Inc. CABI (2020) Turnera ulmifolia (West Indian holly) [original text by Rojas-Sandoval J, Acevedo-­ Rodriguez P]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www.cabi.org/isc/datasheet/55353. De Souza Gracioso J, Vilegas W, Hiruma-Lima CA, and Souza Brito ARM (2002) Effects of tea from Turnera ulmifolia L. on mouse gastric mucosa support the Turneraceae as a new source of antiulcerogenic drugs. Biological and Pharmaceutical Bulletin 25: 487-491. Lopes da Costa LJ, Ribeiro Dantas VC, Souza, TP, Soares LAL, Almeida MG, Brandao Neto J, Schwarz A (2009) Investigation of Turnera ulmifolia effects in pregnant rats and offspring. Pharmaceutical Biology 47: 1071-1077. Mitchell SA (2011) The Jamaican root tonics: A botanical reference. Focus on Alternative and Complementary Therapies 16: 271–280. Szewczyk K, Zidorn C (2014) Ethnobotany, phytochemistry, and bioactivity of the genus Turnera (Passifloraceae) with a focus on damiana—Turnera diffusa. Journal of Ethnopharmacology 152: 424–443. Warner, M (2007) Herbal plants of Jamaica. Oxford: MacMillan Education.

Chapter 26

Zingiber officinale Roscoe (Zingiberaceae)

Common name in Jamaica: Ginger

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4_26

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Botanical characteristics and propagation Perennial herb, usually grown as an annual crop. The “ginger root” is a fleshy subterranean rhizome that has a very aromatic, spicy flavor, due to the presence of ketones, especially the gingerols. The aerial leafy stems (pseudostems) reach up to 1 m high. Leaves distichous, their sheath prominently veined. Flowers fragile, short-­ lived, held in a tight inflorescence at the end of a separate shoot that emerges directly from the rhizome. Originating in India or Southeast Asia (CABI, 2020). The species has been extensively planted in tropical areas, including other parts of Asia, the Caribbean, Central and South America, Australia, and Africa. Jamaican farmers report that it is easy to propagate ginger by first plowing or forking the land, after which a piece of ginger root is sunk flat into the earth and covered with soil.

Where to find the plant Ginger is cultivated in Jamaica. Jamaican ginger is known for its great quality as a culinary spice.

Part used The root (which is actually a rhizome or underground stem).

Jamaican cultural uses and beliefs Ginger is used as a preservative and as an all-purpose ingredient in foods and drinks. It is used to cook meat, in baking, and added to rice and peas.

Jamaican medicinal uses Ginger is mainly used to treat bellyache.

Major uses (mentioned by more than 20% of people) • Bellyache (caused by cold or gas, colic, upset stomach, gripe): The root is consumed raw, juiced, beaten and steeped, or boiled for 15 min, and drunk. As a tea it is sometimes combined with cerasee (Momordica charantia L.), rose-

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mary (Salvia rosmarinus Spenn., formerly known as Rosmarinus officinalis L.), pimento (Pimenta dioica (L.) Merr.), garlic (Allium sativum L.), peppermint (Clinopodium vimineum (L.) Kuntze), or rock rosemary (Croton linearis Jacq.).

Minor uses (mentioned by more than 5% of people, but less than 20%) • Blood circulation (heart, thins the blood): In Kingston, the root is boiled with garlic and drunk. • Blood pressure: In Kingston, scraped ginger root is boiled with garlic and drunk, or it is beaten and chewed for high blood pressure. Alternatively, a tea of ginger root is steeped together with cerasee, or ginger is beaten together with pimento in boiling water and drunk. • Cold, flu: In Kingston, people draw or boil ginger root and drink it. Or they prepare a mixture as follows: In boiling water, beaten ginger is steeped together with pimento seed, tuna (Nopalea cochenillifera (L.) Salm-Dyck) and garlic (Allium sativum L.). This mixture is added to a big bottle of jelly water (coconut water) sweetened with honey, and the bottle is put down for 9  days, after which the remedy is taken by cork or spoon. • Headache: In Kingston, the following preparations were mentioned for headache: Ginger root is scraped, beaten, steeped or boiled, then drunk or chewed. The tea is sometimes prepared together with cerasee or garlic. • Sore throat: People in Windsor Forest boil and drink the root to soothe the throat.

Reported medicinal uses across the Caribbean A TRAMIL survey undertaken in Jamaica in 2009 identified Zingiber officinale as the sixth most widely reported medicinal plant. Among survey respondents who reported using medicinal plants to treat bellyache and gas, 25% identified their use of Zingiber officinale (Picking et al., 2015). The Caribbean pharmacopeia recommends drinking decoctions of the root for asthma, catarrh, cold, cough, whooping cough, fever, flu, vomiting, diarrhea, stomachache, flatulence, and indigestion, based on the significant traditional uses documented in the TRAMIL surveys, toxicity studies, and available published scientific information. Due to the health risks involved with whooping cough, an initial medical evaluation is recommended, and the use of ginger should be considered complementary to medical treatment (TRAMIL, 2016).

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Reported medicinal uses across the world Ginger is one of the most widely used medicinal plants, with documented uses in many countries, primarily for its heating properties, and as a treatment for diseases associated with cold, such as congestion, cough, and diarrhea. In the West, ginger has traditionally been used for congestive chest problems, dyspepsia (upset stomach or discomfort in the upper belly), colic, gastritis, and diarrhea. As a circulatory stimulant, hot infusions of ginger have traditionally been used to treat amenorrhea (absence of menstruation), and topically as a rubefacient, producing redness of the skin. Across individual countries: • China: Ginger has been extensively used in Traditional Chinese Medicine (TCM) for thousands of years, with fresh ginger and dry ginger being used slightly differently. The fresh root is used for damp coughs, colds, flu, diarrhea, and nausea. The dry root is used for deficient (cold) bleeding, joint pain, and cold hands and feet and is considered more effective for digestive upsets, such as nausea, gas, and vomiting (Kuhn and Winston, 2001). • India: Ginger is called “the universal medicine” and is used for digestive complaints, including nausea, diarrhea, flatulence, dyspepsia (upset stomach or discomfort in the upper belly), and gastrointestinal spasms. It is also used for chronic arthritis, venomous bites, colds, influenza, and topically for headache, toothache and to improve circulation to the limbs (Bone and Mills, 2013). • Thailand: In Thai traditional medicine, ginger is used to “sweeten the voice,” enhance appetite, and for dyspepsia (upset stomach or discomfort in the upper belly), flatulence, fever, mouth ulcers, and intestinal infections (Bone and Mills, 2013). • USA: The Eclectics (early American herbalists) used ginger as a stimulating tonic, stomachic (promotes digestion), carminative (expels gas from the digestive tract), and antispasmodic (reduces cramps). They used ginger to treat nausea, gastrointestinal cramping, appetite loss, and poor circulation (Kuhn and Winston, 2001; Bone and Mills, 2013).

Clinical efficacy studies in humans Ginger has undergone extensive studies in humans for a number of specific health conditions, with over 225 clinical studies published to date. A recent paper attempted to summarize the evidence from systematic reviews and meta-analyses evaluating the efficacy of ginger in treating any health condition. Twenty seven such reviews were analyzed, and the health condition studied most was nausea and vomiting. The authors concluded that the most promising evidence for efficacy included the use of ginger for the treatment of nausea and vomiting, metabolic syndrome, and pain (Li et al., 2019).

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The activity of ginger against nausea and vomiting has been tested in more than 42 published clinical studies to date, many of which have been scrutinized in meta-­ analyses and systematic reviews (Jewell and Young 2003; Betz et  al., 2005; Chaiyakunapruk et al., 2006; Jewell and Young 2010; Lee and Oh 2013; Matthews et al., 2015; Tóth et al., 2018; Crichton et al., 2019; Hu et al., 2020). Three of these reports were published by the Cochrane Database of Systematic Reviews (Jewell and Young 2003, 2010; Matthews et al., 2015).

Nausea and vomiting in pregnancy The Cochrane reviews set out to assess the efficacy and safety of treatments for nausea, vomiting, and retching in early pregnancy through a review of randomized controlled trials. In an updated 2015 review, 36 studies were included and systematically reviewed, but it was not possible to complete a meta-analysis due to ­variations in study characteristics, including those related to study participants, interventions, comparison groups, and outcomes measured. The authors concluded that ginger may be helpful to women but that the evidence of effectiveness was limited and not consistent, although the three most recent studies did report statistically significant efficacy compared to placebo (Matthews et al., 2015). In the most recent study of ginger use in pregnancy, a meta-analysis of 13 studies indicated significant effects in improving general symptoms of nausea and vomiting, and relief in the severity of nausea, but not in the reduction of vomiting incidence (Hu et al., 2020).

Postoperative nausea and vomiting (PONV) There have been mixed reviews in the use of ginger for postoperative nausea and vomiting (PONV). A Thai review of five clinical studies demonstrated that a fixed dose of at least 1  g of ginger was more effective than placebo (Chaiyakunapruk et al., 2006; Bone and Mills, 2013). An earlier German review of 24 randomized controlled trials stated that there was no clear evidence for the efficacy of ginger in the treatment of PONV, or motion sickness, but that the results for the treatment of nausea and vomiting in pregnancy were encouraging (Betz et al., 2005; Bone and Mills, 2013). A 2018 meta-analysis of 10 randomized controlled trials reported statistically significant reductions in the severity of PONV, compared to placebo. Results for a decrease in the incidence of PONV and need for antiemetic drugs did not reach statistical significance. The authors, however, noted that a dose exceeding 1  g is clearly required and that further high-quality trials of appropriate patient size, examining the effects of higher doses or standardized extracts of ginger, are needed (Tóth et al., 2018).

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Chemotherapy-induced nausea and vomiting (CINV) A number of studies have shown positive results for the use of ginger in the prevention of chemotherapy-induced nausea and vomiting (CINV) (Levine et al., 2008; Pillai et  al., 2011; Ryan et  al., 2012). Three systematic reviews were carried out between 2013 and 2019. A 2013 systematic review of seven studies reported mixed support for ginger, with three studies demonstrating a positive effect, two in favor but with limitations, and two showing no effect (Marx et al., 2013). A second 2013 systematic review and meta-analysis, this time of five clinical studies, concluded that ginger did not contribute to the control of acute nausea and vomiting and did not influence the severity of acute nausea. However, the limited number of studies, variability in ginger preparation, dose (0.5–3.5 g), and treatment duration (1–6 days) were limiting factors (Lee and Oh, 2013). A 2019 systematic review and meta-analysis of 18 studies reported a 60% reduction in the likelihood of acute vomiting, and an 80% reduction in the likelihood of fatigue associated with CINV. There was no statistically significant association with overall or delayed vomiting, or severity of vomiting. The authors concluded that ginger supplementation can potentially benefit CINV (Crichton et al., 2019). The authors of all three systematic reviews recommended future methodologically rigorous studies to assess the effectiveness of ginger (Lee and Oh, 2013; Marx et al., 2013; Crichton et al., 2019).

Metabolic syndrome Clinical and epidemiological studies appear to indicate that ginger has beneficial effects against obesity, diabetes, cardiovascular disease, and related disorders, referred to collectively as metabolic syndrome. These effects are believed to be mediated through regulation of lipid metabolism, suppression of carbohydrate digestion, modulation of insulin secretion and response, inhibition of oxidative stress, enhancement of anti-inflammatory activities, and antihyperlipidemic, hypotensive, and antiatherosclerotic mechanisms. A review of the beneficial effects of ginger in the treatment of metabolic syndrome identified three clinical studies of obesity, one of cardiovascular diseases, four of diabetes, one of nonalcoholic liver disease, and one study of blood pressure (Wang et al., 2017). A 2017 systematic review and meta-analysis shortlisted nine clinical studies on the effect of ginger on blood glucose and lipid concentrations in subjects with diabetes or hyperlipidemia (an abnormally high concentration of fats in the blood). Ginger supplementation significantly reduced fasting blood glucose (FBG), total cholesterol, and triglycerides and significantly increased HDL cholesterol (“good cholesterol”), compared to controls (Jafarnejad et al., 2017).

Clinical efficacy studies in humans

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A 2018 systematic review and meta-analysis selected 12 clinical trials and identified beneficial effects on levels of LDL (“bad cholesterol”). Low doses of ginger (up to 2 g per day) also significantly lowered levels of triglycerides (the main constituents of body fat) and total cholesterol (TC) (Pourmasoumi et al., 2018).

Gastrointestinal conditions Clinical studies have investigated the reported benefits of ginger in gastrointestinal conditions such as dyspepsia (upset stomach or discomfort in the upper belly) and heartburn. In one double-blind study, ginger accelerated stomach emptying and stimulated stomach contractions in 24 healthy volunteers. The authors concluded that these effects are potentially beneficial in patients with upper gastrointestinal problems (Wu et al., 2008). These findings were further supported by a preliminary, randomized, double-blind study in nine patients with functional dyspepsia. Following an 8-h fast, patients took capsules containing a total of 1.2 g of ginger root powder or placebo (capsules containing an inactive substance). One hour later, they consumed 500 mL of low-nutrient soup. Gastric half-emptying time was significantly less after ginger than placebo (12 versus 21 min), and the frequency of stomach contractions was significantly greater. No significant difference was observed in gastrointestinal symptoms (Hu et al., 2009; Bone and Mills, 2013). An extension of this study included data for 11 patients and yielded similar results with stomach emptying being more rapid following ginger ingestion compared to placebo (12 vs. 16 min) (Hu et al., 2011; Bone and Mills, 2013). A randomized, placebo-controlled, clinical trial evaluated the potential efficacy of ginger in the treatment of patients with ulcerative colitis, an inflammatory bowel disease. Forty six patients with active and mild to moderate ulcerative colitis were randomly assigned to consume either 2  g of dried ginger powder in capsules or placebo capsules, each day for 12 weeks. The ginger group showed a significant reduction in the severity of the disease compared to the control group, and improvement in quality of life variables, such as emotional and social challenges, energy levels, bowel habits, cramps, pain, and flatulence. The authors concluded that ginger can be beneficial to patients with ulcerative colitis (Nikkhah-Bodaghi et al., 2019). A randomized pilot study gave 20 participants (who were identified as being at increased risk for colorectal cancer) either 2  g of ginger, or placebo, daily for 28 days. The results indicated that ginger supplementation might have preventive effects for some patients at increased risk for colon cancer. The authors recommended that further and larger studies are required to confirm any true benefit of ginger supplementation (Citronberg et al., 2013).

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Safety information Side effects In their review of clinical studies concerning vomiting, it was reported that 3% of 777 patients receiving ginger supplementation experienced slight side effects, mainly mild gastrointestinal symptoms and sleepiness, neither requiring treatment nor causing withdrawal from the clinical study (Betz et al., 2005).

Toxicology The acute oral LD50 (lethal dose at which half the group of test animals died) for ginger oil in rats, and the acute dermal LD50 in rabbits, both exceeded 5 g/kg body weight (Bone and Mills, 2013). As a general rule, compounds are considered not toxic if the acute oral LD50 is greater than 5 g/kg body weight. Ginger extract caused no mortality at doses of up to 2.5  g/kg body weight in mice, which is equivalent to approximately 75 g/kg body weight of fresh rhizome. This low acute toxicity was confirmed in a separate study in which ginger extract caused no signs of chronic toxicity at 0.1 g/kg body weight when administered for 3 months (Bone and Mills, 2013).

Contraindications The use of ginger is contraindicated in patients with gallstones, except under close medical supervision. This is due to the action of ginger as a cholagogue (facilitates the expulsion of retained bile from the gallbladder) (Blumenthal, 2003; Bone and Mills, 2013; TRAMIL, 2016). Some authors have observed that the use of ginger in higher concentrations than normal dietary intake should be avoided 2 weeks prior to surgery due to the potential risk for increased bleeding. This is in line with a general caution to avoid herbs that have anti-blood clotting properties due to concerns for perioperative bleeding (Bone and Mills, 2013). However, based on clinical studies in healthy volunteers, and a published case report, the consumption of doses up to the equivalent of 4 g of dried ginger per day seems to pose a low level of risk. Doses equivalent to more than 4 g of dried ginger are contraindicated and should be avoided, unless closely monitored by a qualified healthcare professional (Bone and Mills, 2013).

Recommendations

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Use in pregnancy and breastfeeding Used appropriately, ginger is safe during pregnancy and breastfeeding. For example, one clinical study did not observe adverse effects in 70 pregnant women who were given 1 g of dry ginger in pill form every day for 4 days (Vutyavanich et al. 2001). Observational studies in humans suggest no negative effects of treatments for early pregnancy sickness that included ginger on normal development of the embryo or fetus (Jewell and Young, 2003). These results were confirmed by another study in which ginger was administered from the first trimester of pregnancy onwards and did not appear to increase the rates of major malformations in the embryo or fetus above baseline levels of 1–3% (Portnoi et al., 2003). Another author advised against excessively high daily use of ginger during pregnancy (e.g., dried ginger in doses greater than 2 g) (Blumenthal, 2003), which is also supported by recommendations in Traditional Chinese Medicine (Bone and Mills, 2013).

Drug interactions There is a theoretical concern that ginger may decrease the effectiveness of antacids (medicines that relieve indigestion or heartburn caused by too much stomach acid) based on the proven ability of ginger to increase stomach secretions. However, this is considered to be a low level of risk (Bone and Mills, 2013). The use of ginger preparations (other than in normal food concentrations) is contraindicated and should be avoided in patients taking the pharmaceutical drug nifedipine (prescribed for high blood pressure and for angina or chest pain). This is based on a clinical study with healthy volunteers and hypertensive patients, in which 1 g of dried ginger combined with 10 mg nifedipine significantly increased the antiblood clotting effects of nifedipine (Bone and Mills, 2013).

Recommendations Overall, ginger consumption appears to be safe with very limited side effects (Bode and Dong, 2011). Ginger has a long history of human consumption and topical use, with minimal evidence of harm. Ginger is Generally Recognized As Safe (GRAS) by the United States Food and Drug Administration (FDA). Ginger is possibly unsafe during pregnancy in doses greater than 1 g per day and before surgery because of a theoretical risk of bleeding. Clinical studies have indicated the potential effectiveness of ginger for nausea (associated with pregnancy, chemotherapy, and surgery), metabolic syndrome (obesity, diabetes, cardiovascular diseases, and related disorders), and specific gastrointestinal complaints such as dyspepsia and ulcerative colitis.

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Selected bibliography Betz O, Kranke P, Geldner G, Wulf H, Eberhart LH (2005) [Is ginger a clinically relevant antiemetic? A systematic review of randomized controlled trials]. Forschende Komplementärmedizin und Klassische Naturheilkunde 12: 14-23. Blumenthal M (2003) The ABC clinical guide to herbs. Austin, Texas: American Botanical Council. Bode M, Dong Z (2011) The amazing and mighty ginger. In: (Benzie IFF, Wachtel-Galor S. Eds.) Herbal medicine: Biomolecular and clinical aspects. 2nd edition. Boca Raton, Florida: CRC Press/Taylor & Francis. Bone K, Mills S (2013) Principles and practice of phytotherapy (2nd ed.). London: Churchill Livingston. CABI (2020) Zingiber officinale (ginger) [original text by Kaufman S]. In: Invasive Species Compendium. Wallingford, UK: CAB International. Accessed 12 January 2020 at https://www. cabi.org/isc/datasheet/57537. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C (2006) The efficacy of ginger for the prevention of postoperative nausea and vomiting: A meta-­ analysis. American Journal of Obstetrics and Gynecology 194: 95-99. Citronberg J, Bostick R, Ahearn T, Turgeon DK, Ruffin MT, Djuric Z, Zick SM (2013) Effects of ginger supplementation on cell-cycle biomarkers in the normal-appearing colonic mucosa of patients at increased risk for colorectal cancer: Results from a pilot, randomized, and controlled trial. Cancer Prevention Research 6: 271-281. Crichton M, Marshall S, Marx W, McCarthy AL, Isenring E (2019) Efficacy of ginger (Zingiber officinale) in ameliorating chemotherapy-induced nausea and vomiting and chemotherapy-­ related outcomes: A systematic review update and meta-analysis. Journal of the Academy of Nutrition and Dietetics 119: 2055-2068. Hu ML, Wu KL, Chua SK, Chiu YC, Chiu KW, Changchien CS (2009) Effect of ginger on patients with functional dyspepsia. Journal of Gastroenterology and Hepatology 24 (Suppl. 1). Hu ML, Rayner CK, Wu KL, Chuah SK, Tai WC, Chou YP, Hu TH (2011) Effect of ginger on gastric motility and symptoms of functional dyspepsia. World Journal of Gastroenterology 17: 105-110. Hu Y, Amoah AN, Zhang H, Fu R, Qiu Y, Cao Y, Sun Y, Chen H, Liu Y, Lyu Q (2020) Effect of ginger in the treatment of nausea and vomiting compared with vitamin B6 and placebo during pregnancy: a meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine [Epub ahead of print]. Jafarnejad S, Keshavarz SA, Mahbubi S, Saremi S, Arab A, Abbasi S, Djafarian K (2017) Effect of ginger (Zingiber officinale ) on blood glucose and lipid concentrations in diabetic and hyperlipidemic subjects: A meta-analysis of randomized controlled trials. Journal of Functional Foods 29: 127–134. Jewell D, Young G (2003) Interventions for nausea and vomiting in early pregnancy. The Cochrane Database of Systematic Reviews 4. Jewell D, Young G (2010) Interventions for nausea and vomiting in early pregnancy. The Cochrane Database of Systematic Reviews 9. Kuhn K, Winston D (2001) Herbal therapy & supplements: A scientific and traditional approach. Philadelphia: Lippincott. Lee J, Oh H (2013) Ginger as an antiemetic modality for chemotherapy-induced nausea and vomiting: A systematic review and meta-analysis. Oncology Nursing Forum, 40: 163–170. https:// doi.org/10.1188/13.ONF. Levine ME, Gillis MG, Koch SY, Voss AC, Stern RM, Koch KL (2008) Protein and ginger for the treatment of chemotherapy-induced delayed nausea. Journal of Alternative and Complementary Medicine 14: 545-551. Li H, Liu Y, Luo D, Ma Y, Zhang J, Li M, Yao L, Shi X, Liu X, Yang K (2019) Ginger for health care: An overview of systematic reviews. Complementary Therapies in Medicine 45: 114-123.

Selected bibliography

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Matthews A, Haas DM, O’Mathúna DP, Dowswell T (2015) Interventions for nausea and vomiting in early pregnancy. The Cochrane Database of Systematic Reviews 9. Marx WM, Teleni L, McCarthy AL, Vitetta L, McKavanagh D, Thomson D, Isenring E (2013) Ginger (Zingiber officinale) and chemotherapy-induced nausea and vomiting: a systematic literature review. Nutrition Reviews 71: 245-254. Natural Medicines (2007) Formerly Natural Standard and Natural Medicines Comprehensive Database. Ginger. Accessed 31 December 2007 at https://naturalmedicines.therapeuticresearch.com/. Nikkhah-Bodaghi M, Maleki I, Agah S, Hekmatdoost A (2019) Zingiber officinale and oxidative stress in patients with ulcerative colitis: A randomized, placebo-controlled, clinical trial. Complementary Therapies in Medicine 43: 1-6. Picking D, Delgoda R, Younger N, Germosen Robineau L, Boulogne I, Mitchell S (2015) TRAMIL ethnomedicinal survey in Jamaica. Journal of Ethnopharmacology 169: 314-327. Pillai AK, Sharma KK, Gupta YK, Bakhshi S (2011) Anti-emetic effect of ginger powder versus placebo as an add-on therapy in children and young adults receiving high emetogenic chemotherapy. Pediatric Blood and Cancer 56: 234-238. Portnoi G, Chng LA, Karimi-Tabesh L, Koren G, Tan MP, Einarson A (2003) Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy. American Journal of Obstetrics and Gynecology 189: 1374–1377. Pourmasoumi M, Hadi A, Rafie N, Najafgholizadeh A, Mohammadi H, Rouhani MH (2018) The effect of ginger supplementation on lipid profile: A systematic review and meta-analysis of clinical trials. Phytomedicine 43: 28–36. Ryan JL, Heckle CE, Roscoe JA, Dakhil SR, Kirshner J, Flynn PJ, Morrow GR (2012) Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: URCC CCOP study of 576 patients. Support Care Cancer 20: 1479-1489. Tóth B, Lantos T, Hegyi P, Viola R, Vasas A, Benkő R, Gyöngyi Z, Vincze Á, Csécsei P, Mikó A, Hegyi D, Szentesi A, Matuz M, Csupor D (2018) Ginger (Zingiber officinale): An alternative for the prevention of postoperative nausea and vomiting. A meta-analysis. Phytomedicine 50: 8-18. TRAMIL (2016) Caribbean pharmacopeia. Zingiber officinale. Accessed 27 December 2019 at http://www.tramil.net/en/plant/zingiber-officinale. Vutyavanich T, Kraisarin T, Ruangsri R (2001) Ginger for nausea and vomiting in pregnancy: Randomized, double-masked, placebo controlled trial. Obstetrics and Gynecology 97: 577-582. Wang J, Ke W, Bao R, Hu X, Chen F (2017) Beneficial effects of ginger Zingiber officinale Roscoe on obesity and metabolic syndrome: a review. Annals of the New York Academy of Sciences 1398: 83-98. Wu KL, Rayner CK, Chuah SK, Changchien CS, Lu SN, Chiu YC, Lee CM (2008) Effects of ginger on gastric emptying and motility in healthy humans. European Journal of Gastroenterology and Hepatology 20: 436-440.

Common Plant Name Index

A Ackee, 56, 220 All-man-strength, 175 Allspice, 181, 184 Aloe vera, 13–21, 165 Avocado, 29, 92, 111 B Basley, 46 Bay rum bush, 183 Bees bush, 39 Belly-ache bush, 139 Bissy, 97 Bitter aloes, 13 Bitter melon, 150, 156 Bitter orange, 79, 83–86 Bitter weed, 123 Bitter wood, 98, 183 Black mint, 140 Blessed thistle, 45, 212 Blood wiss, 175 Breadfruit, 7, 55–59, 98 Breadnut, 55–56, 175 C Calabash, 107–110, 112, 189–190 Candlestick, 199 Cashew, 175 Cassada marble, 139 Cassava marble, 139–141 Castor oil, 63, 81, 109–110, 141, 187–196

Catcus, 187 Cerasee, 15, 48, 73, 91, 149–151, 156, 236–237 Chainy root, 175 Chigger nut, 110 Cho cho, 220 Christmas bush, 71 Cinnamon, 97, 142, 182 Coconut, 15, 63, 72, 95–104, 163, 220–221, 237 Coffee, 81, 175, 207–211, 213–214 Coralilla, 39 Coralita, 39 Coriander, 132 Cotton, 29, 192, 222 Cow foot, 163 Cow tongue, 125 Custard apple, 183 D Damiana, 231 Dandelion, 207, 209 Dogblood, 41, 90, 175 Donkey weed, 73, 175 Dreadnut, 95 Duppy soursop, 159 F Fence stake, 73 Fevergrass, fever grass, 73, 115–117, 121 Fitweed, fit weed, 131–132 Fresh cut, 110

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4

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Common Plant Name Index

248 G Ganja, 175, 183 Garlic, 41, 47, 97, 109, 133, 151, 156, 174–176, 184, 201, 237 Ginger, 41, 63, 111, 151, 163, 175, 183–184, 235–243 Gourdy, 107 Guacko, 91 Guava, 30 Guinea hen, 7, 173 Guinea henweed, guinea hen weed, 132, 173–177, 183 Guinep, 57 Gully bean, 219 Gungo pea, 111 H Hedge mustard, 123 Hog apple, 159 Holy thistle, 45–46, 212 I Ironweed, 175 J Jack-in-the-bush, 41, 71–73 Jamaican plum, 41 John Charles, 222 Joseph’s coat, 110

Medina, 15 Mexican poppy, 45 Mexican tea, 123 Milk wiss, 110 Moringa, 15, 30, 48, 175 N Naseberry, 184 Neem, 74, 175–176 Noni, 160, 162–170 Nutmeg, 56, 72, 97, 182–183 O Oil nut, 187 P Pakee, 107, 189 Pear, 41 Pennyroyal, penny royal, 7, 89–91, 93 Peppermint, 237 Periwinkle, 230 Physic nut, 142, 183 Pimento, 91, 181–183, 237 Piss-a-bed, 207, 209 Plantain, 110 Pranganat, 175

L Leaf of life, Leaf-of-life, 61–63, 73 Lemongrass, lemon grass, 115–116, 120, 132 Lignum vitae, 110 Lime, 74, 125, 133, 201 Love grass, 92

R Ramgoat dashalong, ram-goat dashalong, 229 Ramgoat regular, 229–230 Ramoon, 175 Rat ears, 133 Raw moon, 175 Rice and peas, 15, 39, 41, 97, 182, 236 Ringworm shrub, 199–200 Rock rosemary, 237 Rompe saragüey, Rompe zaragüey, 73 Rosemary, 41, 237 Royal wiss, 175

M Man back, 175 Manchineel, 110 Mango, 222 Marigold, 91, 151 Mary ghoule, 91, 151 Mauby, 102

S Sarsaparilla, 175 Sea onion, 110 Search-mi-heart, 63 Semi-conscience, 123 Semi-contract, semicontract, 92, 123–125, 135 Sempervivum, 13

K King-of-the-forest, 6, 30, 73, 199, 200

Common Plant Name Index Seville orange, 79 Sinkle bible, 13–15 Sour orange, 79–80 Soursop, sour sop, 7, 27–29, 31, 35, 125, 159, 175 Spanish needle, 63 Spiritweed, spirit weed, 131–132 Stinking weed, 207 Strong back, 175 Strong man’s weed, 173 Susumba, 219–221, 223–225 Susumber, 219 Sweet orange, 80, 161, 184 Sweetsop, 110 T Tree of life, 61 Tuna, 237 Turkey berry, 219

249 Turmeric, 134, 142 V Vanilla, 56, 97 Vervine, 30, 90–91, 125, 141, 174 W Whole wife, 187 Wild cassava, 139 Wild cerasee, 149 Wild coffee, 207 Wild mint, 141 Worm grass, 125 Wormseed, 123, 126 Y Yellow thistle, 45

Index of Plant Names and Health Conditions

A Abortion, 21, 30, 91, 93, 113, 136, 152, 154, 156–157, 163, 168, 178–179, 186, 190, 195, 197, 203–204, 214, 231–233 Acalypha wilkesiana, 110 Ackee, 56, 220 Acne, 15 Afterbirth, 110, 140, 168, 189, 210 Allium sativum, 41, 47, 97, 133, 151, 156, 175, 237 All-man-strength, 175 All purpose medicine, 220 Allspice, 181, 184 Aloe barbadensis, 13 Aloe perfoliata var. vera, 13 Aloe vera, 13–21, 165 Aloe vulgaris, 13 Alysicarpus vaginalis, 15 Amaranthaceae, 123–129 Amenorrhea, 98, 231, 238 Anacardium occidentale, 175 Andropogon citratus, 115 Anemia, 31, 81, 92, 118, 135, 141–142 Animal, medicine for, 140 Annonaceae, 27–35 Annona muricata, 27–35, 81, 125, 175 Annona reticulata, 183 Anthelmintic, 16, 126–127, 136, 162 Antigonon leptopus, 4, 15, 39–43 Anxiety, 65, 73, 83, 118–119 Aphrodisiac, 99, 231 Apiaceae, 131–136 Appetite, 46–47, 82, 119, 144, 184, 221, 238 Arecaceae, 95–104

Argemone mexicana, 4, 45–51, 212 Arthritic joints, 162 Arthritis, 47, 82, 98, 118, 126, 134, 161–163, 175–177, 183–184, 190–192, 210, 238 Artocarpus altilis, 3, 7, 55–59, 98 Artocarpus communis, 55 Artocarpus incisus, 55 Ascaris, 125, 127 Asphodelaceae, 13–21 Asteraceae, 71–77 Asthma, 8, 16, 41, 48, 57, 63, 65, 91, 97–99, 109–110, 126, 161, 190–191, 210–211, 237 Astringent, 57–58 Athlete’s foot fungus, 221 Azadirachta indica, 74, 175 B Bad blood, 209 Bad luck, 132 Bad temper, 209 Baldness, 16 Bay rum bush, 183 Bedwetting, 209 Bees bush, 39 Bellyache, 30, 63, 97, 117, 125, 150–152, 175, 183, 189, 236–237 Belly-ache bush, 139 Belly cut yuh, 151 Bidens pilosa, 63 Bignoniaceae, 107–113 Biliousness, 151, 190

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020 I. Vandebroek, D. Picking, Popular Medicinal Plants in Portland and Kingston, Jamaica, Advances in Economic Botany, https://doi.org/10.1007/978-3-030-48927-4

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252 Bissy, 97 Bitter aloes, 13 Bitter orange, 79, 83–86 Bitter weed, 123 Bitters, 13, 15–16, 18, 79, 80, 82–86, 98, 123, 150–151, 156, 183, 220–222 Bladder, 64–65, 67, 118, 140, 208–209 Blessed thistle, 45, 212 Blighia sapida, 3, 56, 220 Blocked tubes, 90 Blood circulation, 118, 175, 237 Blood cleanser, 14–15, 151–152, 161, 221 Blood is too sweet, 15, 151 Blood pressure, 57–58, 63, 83, 85, 100–103, 161–163, 169, 176, 189, 201, 209, 230, 237, 240 Blood sugar, 21, 31, 34, 51, 76, 92, 101, 152–154, 156–157, 179, 194, 223, 231 Blow or “lick” with blood cloths, 189 Blow to the back with battered blood, 108–109 Body cleanser, 15, 47, 97, 109, 151–152, 161, 189, 221 Boils, 29, 48, 57, 63–64, 73, 77, 98, 117, 125, 141, 151–152, 161–163, 176–177, 183, 189, 221, 237 Bowels, 15, 17, 20, 126, 151, 189, 191, 203, 221, 241 Breadfruit, 7, 55–59, 98 Breadnut, 55–56, 175 Bronchitis, 29, 63, 73, 109–110, 184, 211–222, 231–232 Brosimum alicastrum, 175 Bryophyllum pinnatum, 61–68, 73 Builds the baby, 47 Builds the blood, 109, 221 Builds the body, 162 Bump, skin, 15, 201 Burns, 16–17, 63, 74, 98, 109, 126, 142, 150, 152, 177, 191, 209–210 C Calabash, 107–110, 112, 189–190 Camphor, 97 Campyloneurum phyllitidis, 125 Canavalia altipendula, 175 Cancer, 17, 20, 29, 30, 32–34, 65–66, 119, 151–152, 161, 163–164, 167, 174–175, 177, 231, 241 Candlestick, 199 Cannabis sativa, 175, 183

Index of Plant Names and Health Conditions Caribbean pharmacopeia, 16, 47, 51, 63, 68, 73, 77, 81, 84, 98, 103, 109, 112–113, 117, 119, 121, 125, 129, 133, 136, 152, 156, 162, 176, 178–179, 183, 186, 190, 201, 209, 214, 237 Carminative, 231, 238 Cashew, 175 Cassada marble, 139 Cassava marble, 139–141 Cassia alata, 199–204 Cassia occidentalis, 207 Castor oil, 63, 81, 109–110, 141, 187–196 Castor oil plant, 187 Catarrh, 16, 110, 126, 237 Catcus, 187 Catharanthus roseus, 230 Cerasee, 15, 48, 73, 91, 149–151, 156, 236–237 Chainy root, 175 Chamaemelum nobile, 201 Chenopodium ambrosioides, 123 Chest cold, 63, 190 Chest congestion, 91 Chest pain, 17, 29, 110, 133, 136, 243 Chicken pox, 151 Chiggers, 110, 221–222 Chikungunya, 176 Chills, 110, 134, 209 Cho cho, 220 Christmas bush, 71 Chromolaena odorata, 6, 41, 71–77 Cinnamomum verum, 97 Cinnamon, 97, 142, 182 Citrus × aurantiifolia, 125, 133 Citrus × aurantium, 79–86, 133 Citrus × sinensis, 184 Citrus × vulgaris, 79 Clean off the chest, 97 Cleanses the belly, bowels, chest, 15, 150, 191, 221 Cleanses the blood, 15, 150–152, 161, 221 Cleansing, 73, 108, 117, 142, 210, 231 Clean the womb, 90, 110 Clinopodium brownei, 7, 89–93 Clinopodium vimineum, 4, 237 Clogged veins, 175 Coconut, 15, 63, 72, 95–104, 163, 220–221, 237 Cocos nucifera, 3, 63, 95–104 Coffea arabica, 81 Cola acuminata, 97 Cold in belly, 63

Index of Plant Names and Health Conditions Cold in the joints, 183 Cold of the tubes, 189 Colds, 16, 49, 74, 77, 91, 109–110, 117, 126, 134, 151, 176, 184, 189–190, 195, 210–221, 231, 236–238 Colic, 20, 81, 91, 133, 184, 209, 211, 236, 238 Colon cleanse, 97 Colubrina arborescens, 102 Common cold, 14–15, 41, 46–47, 62–64, 68, 72–74, 80–81, 91, 97, 109–110, 117, 121, 125, 133, 152, 161, 176, 183, 201, 210, 221 Conditioner, 189 Congestion, 63–64, 109, 184, 238 Conjunctivitis, 48, 81 Constipation, 20, 30, 47, 82, 135, 141–142, 151, 184, 189–191, 201–202, 211–212, 231 Cooling, 109, 117, 210 Coralilla, 39 Coralita, 39 Coriandrum sativum, 132 Cotyledon pinnata, 61 Cough, 29, 46–48, 63–65, 68, 73–74, 81, 86, 109–111, 117–118, 121, 126, 151, 184, 190, 210, 221–222, 231, 237–238 Cow tongue, 125 Crassulaceae, 61–68 Crescentia cujete, 107–113, 189–190 Croton linearis, 237 Cucurbitaceae, 149–157 Custard apple, 183 Cuts, 14–16, 46, 49, 63, 73–74, 110, 118, 142, 163, 176 Cymbopogon citratus, 73, 115–121, 132 D Dandelion, 207, 209 Dandruff, 15, 189 Depression, 73, 184, 209, 213, 224, 231 Depurative, 142, 209 Desmodium incanum, 175 Detox, 15, 118, 194, 209 Diabetes, 17–18, 21, 30–31, 41, 51, 57–58, 64, 74, 76, 92, 97–98, 100, 110–111, 142, 151–156, 161, 163, 167, 176, 179, 184, 211, 223, 231, 240, 243 Diarrhea, 19, 21, 31, 41, 49–50, 57, 74, 81–82, 91–92, 99, 101, 109, 111, 117, 121, 126, 133–135, 142–143, 155, 162, 184–185, 194, 196, 202, 210, 224, 237–238

253 Difficult urination in men, 141 Digestive, 17, 30, 48–49, 81–82, 118, 126, 134, 142, 144–145, 163, 176–177, 184, 203, 210–211, 231, 238 Ditramexa occidentalis, 207–214 Ditremexa occidentalis, 207 Diuretic, 21, 30, 99, 111, 167, 169, 195, 204, 209, 211–212, 222 Dizziness, 30, 75, 119, 128, 144, 151, 210, 223 Dogblood, 41, 90, 175 Donkey weed, 73, 175 Dreadnut, 95 Dropsy, 50, 109 Dry skin, 152 Duppy, 132, 200 Duppy soursop, 159 Dysentery, 48, 57, 74, 82, 109, 133, 184, 210 Dysmenorrhea, 98 Dysphania ambrosioides, 92, 123–129, 135, 177 E Earache, 109–110, 134–135, 190–191 Ear infection, 57–58, 64 Eczema, 15, 151, 201 Emmenagogue, 110, 120, 142, 152, 214, 231 Enema, 65, 81, 210 Energy, 82–83, 141, 162, 184, 241 Eryngium foetidum, 131–136 Eupatorium odoratum, 6, 71 Euphorbiaceae, 139–145, 187–196 Evil, 46, 62, 73, 92, 141, 211 Exhaustion, 184 Expectorant, 82, 231 Expel worms, 124–125, 151, 163, 189 Eye drops, 63, 192 Eye infection, 49, 63 F Fabaceae, 199–204, 207–214 Fainting, 134 Fatigue, 66, 133, 136, 163, 240 Female sterility, 90 Fence stake, 73 Fevergrass, 73, 115–117, 121 Fever, 29–30, 48, 58, 63–64, 73–74, 81–82, 91, 99, 109–111, 115–117, 121, 125–126, 128, 133–136, 155, 162, 176–177, 184, 209–212, 222, 231–232, 237–238 Fits, 97, 110, 131–135

254 Fitweed, 131–132 Flatulence, 30, 81, 91, 117–118, 121, 128, 133, 135–136, 142, 184, 211, 237–238, 241 Flu, 63–64, 74, 81, 98, 111, 117–118, 121, 133–134, 136, 176, 184, 209–210, 221, 231, 237–238 Flushes the system, 15, 47 Flush out infection, 63 Foot, 15, 163, 184, 221–222 Forty leg, 176, 183 Frankincense, 176 Fungal infections, 6, 74, 118, 142, 201–202, 209–210 Fungus, 15, 57, 184, 200, 221 Furuncle, 152 G Gallstone, 209, 242 Ganglion cyst, 190–191 Ganja, 175, 183 Garlic, 41, 47, 97, 109, 133, 151, 156, 174–176, 184, 201, 237 Gas, 15, 63, 117, 126, 128, 133, 151–152, 176, 183–184, 209, 231, 236–238 Ginger, 41, 63, 111, 151, 163, 175, 183–184, 235–243 Gliricidia sepium, 73 Gossypium hirsutum, 29 Gourdy, 107 Gray hair, 189 Gripe, 125–126, 141, 236 Grows hair, 189 Guacko, 91 Guaiacum officinale, 110 Guinea hen, 7, 173 Guinea hen weed, 7, 132, 173–177, 183 Guinep, 57 Gully bean, 219 H Hair, care, 14–15, 189 Hangover, 184 Headache, 57–58, 63, 68, 73–74, 81, 91, 109, 111, 118, 128, 141, 154–155, 161–163, 174–177, 183, 190–191, 202, 209, 237–238 Heart, 17, 21, 30, 40, 50, 67, 81, 83, 85, 98–100, 102, 119, 128–129, 143–144, 167, 194–195, 204, 213, 237 Heart sickness, 98 Heart tonic, 209

Index of Plant Names and Health Conditions Heart weakness, 209 Hedge mustard, 123 Hemorrhage in women, 141 Hepatitis, 19, 21, 141, 165, 209, 212 Herpetica alata, 199–204 High blood pressure, 21, 29–30, 47, 57–59, 63–64, 85, 98, 102, 109, 111, 134, 161, 163, 169, 176, 184, 189, 201, 210, 222–223, 225, 230, 237, 243 Hippomane mancinella, 110 Hog apple, 159 Holy thistle, 45–46, 212 Honey, 49, 63, 74, 81, 110, 161, 175–176, 190, 237 Hookworms, 125, 127–128 Hymenocallis latifolia, 110 Hypertension, 21, 58–59, 64, 102–103, 134, 152, 162–163, 167, 210, 224 Hyptis verticillata, 222 I Indigestion, 48, 82, 117–118, 133–134, 184, 209, 231–232, 237, 243 Infertility, 110, 152, 162, 201 Inflammation, 17, 19–20, 30, 47, 64–65, 74, 81, 99–101, 118, 142, 152–153, 163, 165, 193–194, 203, 209, 231 Insect bites, 91 Insect repellent, 74, 116, 177 Insect sting, 183 Insomnia, 73 Intestinal parasites, 81, 110, 125–127 Intestinal worms, 82, 125–126, 163, 190, 201, 211 Ironweed, 175 Itching, 48, 142, 152, 200, 211 J Jack-in-the-bush, 41, 71–73 Jatropha curcas, 142, 183 Jatropha gossypiifolia, 139–145 Jaundice, 47–49, 64, 142, 209 Justicia pectoralis, 110 K Kalanchoe pinnata, 61 Kidneys, 19–21, 30, 50, 64, 67, 76, 99, 110, 118, 120, 128–129, 135–136, 143–145, 153, 167, 196, 201, 203, 208–209, 211, 213, 223, 231 King-of-the-forest, 6, 30, 73, 199–200

Index of Plant Names and Health Conditions L Labor, 3, 65–67, 134–136, 140, 192–193, 195–196, 214 Lamiaceae, 89–93, 140 Leaf of life, 61–63, 73 Lemongrass, 115–116, 120, 132 Lethargy, 73, 97, 212–213 Lice, 64, 152 Lick (to the body), 183 Lime, 74, 125, 133, 201 Liver, 6, 19, 30, 32, 41, 49–50, 57–58, 66–67, 75, 81, 111, 118–119, 128–129, 134–135, 142, 144–145, 155, 165–167, 169–170, 191, 196, 200–204, 209, 211–213, 222–223, 231, 240 Liver spots, 6, 200–202, 204 Loosen the bowels, 151 Loss of appetite, 47, 144 M Maintenance of health, 162 Malaise, 49, 63 Malaria, 30–31, 47–50, 64, 74–75, 99, 111, 118, 134–135, 141–142, 202, 209–212, 222–223 Manilkara zapota, 184 Marigold, 91, 151 Mary ghoule, 91, 151 Measles, 49, 151, 177, 211 Medina, 15 Melicoccus bijugatus, 57 Menopausal symptoms, 134 Menopause, 65, 67, 83, 134 Menstrual cramps, 91, 117, 163, 183–184 Menstrual flow, 91, 231 Menstruation, 20, 47, 91, 98, 120, 134, 136, 142, 152, 157, 177, 184, 209, 214, 231, 238 Mentha spicata, 140 Mexican poppy, 45 Mexican tea, 123 Micromeria brownei, 89 Migraine, 190 Mikania micrantha, 91 Molasses, 161, 175–176 Momordica charantia, 15, 48, 73, 91, 149–157, 236 Moraceae, 55–59 Morinda citrifolia, 159–170 Moringa, 15, 30, 48, 175 Moringa oleifera, 15, 30, 48, 175

255 Mosquitoes, 48, 80, 97, 126, 209 Musa × paradisiaca, 110 Muscle pain, 176 Myristica fragrans, 97, 183 Myrtaceae, 181–186 Myrtus dioica, 181–186 Myrtus pimenta, 181–186 N Nail jock yuh, 15 Nausea, 20, 31, 91, 118, 143, 163–165, 184, 196, 202, 238–240, 243 Neem, 74, 175–176 Nerves, 28–29, 33, 35, 57, 64, 85, 153, 162, 191, 210, 214 Nervousness, 73, 91, 184, 211 Noni, 159, 160, 162–170 Nopalea cochenillifera, 237 Nutmeg, 56, 72, 97, 182–183 O Obeah, 174, 220 Oil nut, 187 Operation (“wash out”), 189 Osmia odorata, 71 P Pain, body, 209 Pain, general, 73, 175 Pakee, 107, 189 Papaveraceae, 45–51 Passifloraceae, 229–233 Paullinia jamaicensis, 175 Pediculosis, 152 Pennyroyal, 7, 89–91, 93 Peperomia pellucida, 133 Peppermint, 237 Period overflow, 141 Period pain, 183 Periwinkle, 230 Persea americana, 29, 41, 92, 111 Petiveria alliacea, 7, 132, 173–179, 183 Philodendron hederaceum, 175 Physic nut, 142, 183 Phytolaccaceae, 173–179 Pimenta dioica, 97, 181–186, 237 Pimenta officinalis, 181–185 Pimenta racemosa, 183 Pimento, 97, 181–183, 237 Pimpinella anisum, 201

256 Pinkeye, 63 Pinochia floribunda, 110 Piss-a-bed, 207, 209 Pityriasis versicolor, 200–202 Pneumonia, 8, 110, 118, 184, 190, 209 Poaceae, 115–121 Poisoning, 7, 110, 127, 144, 188–189, 194, 196, 213, 222–225 Polygonaceae, 39–43 Poultice, 8, 16, 57, 58, 63, 64, 74, 91, 98, 110–111, 118, 133, 152, 162–163, 177, 184, 190–191, 211, 221 Pranganat, 175 Pregnancy, 7, 20–21, 34, 42–43, 51, 59, 66–68, 76, 85–86, 93, 103–104, 112–113, 120–121, 129, 136, 145, 156, 168–169, 178–179, 185–186, 192–195, 203–204, 209–210, 214, 224, 232–233, 239, 243 Prenatal care, 151 Pretty skin baby, 151 Prickly heat, 231 Prostate, 29–30, 140, 175, 177, 231 Pruritus, 152 Pseudelephantopus spicatus, 175 Punica granatum, 175 Purgative, 48, 57–58, 110–111, 141–142, 163, 232 Purges the blood, 15, 151 R Ram-goat dashalong, 229 Ramgoat regular, 229–230 Ramoon, 175 Rashes, 14–15, 17, 74, 185, 190 Rat ears, 133 Raw moon, 175 Rhytidophyllum tomentosum, 63 Rice and peas, 15, 39, 41, 97, 182, 236 Ricinus communis, 4, 63, 81, 141, 187–196 Ringworm, 48, 118, 162–, 201, 204, 221–222 Ringworm shrub, 199–200 Rivina humilis, 41, 90, 175 Rock rosemary, 237 Rompe saragüey, 73 Rompe zaragüey, 73 Root tonic, 97–98, 162, 175, 221, 231 Rosemary, 41, 236–237 Rosmarinus officinalis, 41, 237 Roundworms, 125, 127–128 Rourea glabra, 175 Rubiaceae, 159–170 Running nose, 190

Index of Plant Names and Health Conditions Run yuh belly, 109, 189 Rutaceae, 79–86 S Salvia occidentalis, 141 Salvia rosmarinus, 41, 237 Santería, 73 Sarsaparilla, 175 Satureja brownei, 89 Satureja khuzistanica, 92 Sciatica, 57 Scorpion, 176, 183, 210 Search-mi-heart, 63 Sechium edule, 220 Sedative, 29, 31, 66, 82, 222 Seizures, 132–133, 136, 156, 168–169, 195 Semi-conscience, 123 Semicontract, 92, 123–125, 135 Sempervivum, 13 Senna alata, 6, 30, 73, 199–204 Senna occidentalis, 141, 207–214 Seville orange, 79 Sinkle bible, 13–15 Sinusitis, 16, 91, 176–177, 222 Sinus problems, 176 Sitodium altile, 55 Skin abscesses, 209 Skin care, 14–15, 98, 190 Skin, dry, 152 Skin problems, 14–15, 64, 74, 151, 163, 176, 209 Skin rash, 16, 29, 99, 142, 151–152, 202 Sleep-inducer, 29 Smilax canellifolia, 175 Smilax ornata, 175 Snakebite, 30, 111, 133, 135, 142, 162, 210–211, 221 Solanaceae, 219–225 Solanum ficifolium, 219–225 Solanum torvum, 6, 219–225 Sores, 21, 48–49, 57, 65, 142, 151, 163, 184, 203, 221 Sore throat, 63, 74, 91, 163, 209, 237 Sour orange, 79–80 Soursop, 7, 27–29, 31, 35, 125, 159, 175 Spanish needle, 63 Speech problems in children, 109 Speed up birth, 112, 189 Sphagneticola trilobata, 91, 151 Spigelia anthelmia, 125 Spirit, evil, 62 Spiritual, 2, 46, 62, 73, 132, 174, 200, 220 Spirit weed, 131–132

Index of Plant Names and Health Conditions Sprains, 15, 57, 110–111, 183, 191 Stachytarpheta cayennensis, 90, 125, 141, 174 Stachytarpheta jamaicensis, 90, 125, 141, 174 Stinking weed, 207 Stomach, 16, 19, 57, 63, 74, 82, 85, 91, 97, 110–111, 118, 126, 133–135, 153, 155, 163, 176, 184, 202–203, 209–210, 212, 222, 231, 241, 243 Stoppage of water, 140–141 Strained muscles, 73 Strength, 47, 142, 162, 166 Stroke, 100, 141, 175, 210, 223 Strong back, 175 Strong man’s weed, 173 Stylosanthes hamata, 73, 175 Sugar, 29, 48, 81, 97, 101, 109–110, 150–151, 161, 163, 167, 175–176 Susumba, 219–221, 223–225 Susumber, 219 Swelling foot, 15 T Tea bush, 40, 46, 72, 116, 150 Teething baby, 132–133 Testicle, 140 Tetanus, 15 Thins the blood, 237 Thrush, 57, 118 Thymus brownei, 89 Tinea corporis, 201–202 Tinea versicolor, 200–201 Tocolytic, 65–67 To keep cool, 81 Tonic, 56, 82, 85, 97–98, 152, 160–163, 175, 209, 221–222, 231–232, 238 Toothache, 48, 74, 91, 176–177, 183–184, 191, 238 Tournefortia hirsutissima, 110 Toxins, 33, 118, 213, 221 Tranquilizer, 29 Trauma, 191 Tree of life, 61 Trophis racemosa, 175 Tuna, 237 Turkey berry, 219 Turnera diffusa, 231 Turnera ulmifolia, 229–233 Twist, 191 U Ulcer, 17, 20, 64, 73–74, 77, 82, 85, 97, 126, 142, 163, 192, 203, 222, 231, 238, 241, 243

257 Upset stomach, 126, 184, 236, 238, 241 Urinary tract, 30, 98–99, 201, 209–210, 231 Urination, 30, 111, 119, 195, 209, 212, 222, 225, 231 Uterus, 82, 110, 112, 120, 177, 193 V Vanilla, 56, 97 Venereal disease, 91, 98, 142 Vermifuge, 82, 126–128 Vervine, 30, 90–91, 125, 141, 174 Veterinary, 14, 189, 220 Vitamin C, 80 Vitis tiliifolia, 175 Vomiting, 19, 20, 50, 97, 128, 133, 136, 142–143, 163–164, 183–184, 186, 196, 202, 237–240, 242 W Warm the body, 183 Wash out, 109, 151–152, 189 Weak bladder, 140, 208–209 Weakness, 63, 98, 128, 144, 162, 191, 212–213, 224, 231 Whole wife, 187 Whooping cough, 237 Wild cassava, 139 Wild cerasee, 149 Wild coffee, 207 Wild mint, 141 Witchcraft, 177 Womb, 90, 110, 210 Worm grass, 125 Worms, 16, 48, 64, 82, 124–128, 135–136, 151, 162–163, 190, 199, 201, 204, 210–211, 221–222 Wormseed, 123, 126 Wound, 14–17, 19, 21, 48–49, 74, 99, 109–111, 142, 152–153, 162, 190, 201, 210, 221–222 Y Yellow thistle, 45 Z Zingiberaceae, 235–243 Zingiber officinale, 41, 63, 111, 151, 175, 183, 235–243