INTRODUCTION
Low back pain (LBP) is a sharp or dull sensation resulting from muscular stiffness in the back. The symptom appears whether isolated in the back area or radiates to the lower limbs (ischialgia) (Al-Salameen et al., 2019). LBP is the second most common reason for doctor visits after headaches. LBP impacts 30%–40% of people each year, and 75%–85% of them will experience back pain at some point in their lives (Gerayeli et al., 2017). Accordingly, LBP is a widespread public health issue in developing countries such as Indonesia. In two decades, LBP was also linked to a 52% increase in living with disability and is responsible for adding disease burden and medical cost. Acute LBP affects nearly 80% of adults, while chronic LBP affects 23% (Cieza et al., 2020; Hoy et al., 2014; Wu et al., 2020).
Various methods are applied to reduce the symptoms of LBP, including the early return of regular physical activity (excluding heavy lifting), nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, support belts, and surgery (Gerayeli et al., 2017; Laudahn and Walper, 2001; Stam et al., 2001). Physicians and patients prefer to use NSAIDs to reduce pain in LBP due to their effectiveness. However, NSAIDs also have many shortcomings reported, including limited long-term efficacy, tolerance issues, and other side effects (Sreekeesoon and Mahomoodally, 2014; Verkamp et al., 2013). Concerning this issue, the community, especially in Asian countries, has used natural remedies for pain management and treatment for generations (Sreekeesoon and Mahomoodally, 2014). Previous studies showed that people with LBP widely use herbal medicine (Foster et al., 2018). Several factors influence people to choose herbal medicine, including psychosocial considerations, ethnic and cultural aspects, accessibility to healthcare resources, and individual perceptions of physical and medical conditions (Yoon and Kim, 2013). Furthermore, the authorities have also produced guidelines that recommend several complementary and alternative medicines for LBP treatment in recent years.
Indonesia has unique flora and fauna that complete its cultural and ethnic diversity (Sreekeesoon and Mahomoodally, 2014). These ethnic groups occupy particular areas in the country. Every ethnic group has its way of life and traditions, including food, medicinal plants, and spices. It is also significantly skilled in using and conserving organic and ecological diversity (Walujo, 2008). For example, the management of LBP in each ethnic group might have different characteristics. The local community uses medicinal plants to treat diseases mainly because of the limitation of health facility access. The indigenous knowledge of using medicinal plants most likely has been passed down from generation to generation (Yaseen et al., 2015). This approach has managed to keep knowledge alive until now. Hence, local knowledge of medicinal plants has always been a source of research to test the effects of plants and develop new therapeutic resources (Bolson et al., 2015).
Ethnobotany research can reveal the indigenous knowledge of communities or ethnic groups, including their resource management and plant ecology. The research result should provide information on essential plant species, conservation potential and function, and impacts on ethnobotany and economics (Batoro and Ekowati, 2017). Another approach aims to use traditional practices in the formal health system. Hence, an ethnopharmacology study can help collect primary data on traditional remedies used by the community. There are several ethnomedicinal plants for treatment of rheumatism (LBP) that have been reported in other countries like Ezhilvalavan et al. (2015), Som (2021), Paudyal et al. (2021), and Ushashee (2021), Mandal and Mahalik (2021), but nothing has been done in Indonesia.
Ethnopharmacology assessments of medicinal plant species are essential for the conservation and protection of and are helpful in developing herbal drugs (Vitalini et al., 2013). The objective of this study was to assess information on the plant species that traditional healers have used to treat LBP in Sumatra, Indonesia. We collected data on preparatory procedures and the delivery of herbal remedies to document traditional healing methods of LBP. This research can help protect the medical knowledge of indigenous peoples and provide baseline data for future research.
MATERIALS AND METHODS
The area of study
Sumatra is an Indonesian island in the Malay Archipelago, the second largest (after Borneo) of the Greater Sunda Islands. It is the world’s sixth-biggest and most significant island within the Indonesian territory (480,847.74 km2) (Badan Pusat Statistik, 2021). The Strait of Malacca separates it from the Malay Peninsula in the northeast, and the Sunda Strait separates it from Java in the south. North Sumatra (Sumatera Utara), Jambi, Riau, West Sumatra (Sumatera Barat), South Sumatra (Sumatera Selatan), Bengkulu, and Lampung—along with the autonomous province of Aceh—are divided into seven propinsi (or provinsi; provinces) (Britannica, 2017).
Data collection
The ethnopharmacological field study was conducted in 2012, 2015, and 2017. Before the interview, each informant gave agreement in verbal informed consent. The key informants and respondents were interviewed in a semi-structured questionnaire. The mentioned medicinal plants were collected for herbarium specimens, and the survey approach determined habitat was done in the field. The questions in the interview were asked to understand traditional uses of medicinal plants, including information on the name of the local plant, the parts of the plant used, and the method of preparation and administration. Taxonomic identification was performed to validate the samples collected during the interviews. A herbarium was also set up to obtain dry specimens that could be used to support taxonomic identification. On the other hand, the herbarium method was only used for unknown species (Jadid et al., 2020). Plants species with unknown scientific names were identified at Herbarium Tawangmanguensis to discover their names.
The survey selected ethnic groups with at least 1,000 individuals living on the local community’s island. The following consideration was if they still have indigenous healing knowledge and live in places with limited access to health services (Mustofa et al., 2021). The Ethics Commission of the Ministry of Health’s National Institute of Health Research and Development approved the protocol and informed consent forms (LB.02.01/5.2/KE.318/2015 and LB.02.02/2/KE.107/2017). The informants were given full facts about the current study and its goals, and they were free to withdraw at any point.
Data analysis
In this research, several quantitative value indexes were measured to find the importance of medicinal plants. The first index is the relative frequency of citation (RFC), which is calculated by dividing a frequency of citation (FC) (the number of respondents who mention the species use) by the total number of respondents in the survey (N). This index ignores the variable use category. It ranges from zero to one. The value of zero indicated that no one thinks the plants are useful, while the value of one meant that everyone thinks they are useful (Mosaddegh et al., 2012).
Use value (UV) was used to assess the ethnobotanical data. UV indicates the relative importance of plants that are known in the area. The following formula was used to calculate it (Phillips et al., 1994):
UV is the use value of a species, “U” is the number of use reports stated by each informant for a specific plant species, and “N” is the total number of informants questioned for a particular plant species. UV is used to identify the most commonly used plants (most frequently advised) in treating a disease.
Family use value (FUV) was used to determine the number of informants who used specific species from a given family. It was determined using the following equation:
The FUV and UV readings above a certain threshold suggest that species were commonly utilized as medications. UVs were used to represent the UVs of all the species in a specific family. Ns denotes the total number of species in a family (Hoffman and Gallaher, 2007)
The informant citation factor (ICF) is produced using the formula below to assess the agreement amongst informants about which plants to utilize for various use categories (Mosaddegh et al., 2012). The ICF describes informants’ understanding of medicinal plant consuming species and assesses diversity in use against ailments stated. Ailments are widely classified into distinct groups before the ICF value is calculated. The highest ICF value, close to 1, shows that most local communities employ well-known species because of their disease authenticity. However, a low ICF score near 0 indicates that the informants use the plants for random diseases (Umair et al., 2017). The ICF value was calculated using the following formula:
RESULTS AND DISCUSSION
Characteristics of the traditional healer
The results of the field surveys are compiled in this section. Traditional healers have an average of 28 years of experience practicing traditional medicine, and they have an average monthly patient load of approximately 87 individuals. Many traditional healers have never obtained formal schooling or completed elementary and junior high school. Half of the informants were > 60 years old (elder group). There were only 3.3% of traditional practitioners from the younger group. The previous study revealed that most informants were uneducated because of the unavailability of educational facilities in the area (Yaseen et al., 2015). In this study, only a few have completed some higher education, despite being literate. The majority of those who took part had completed their primary or secondary education.
The majority of informants have been practicing for at least 28 years. The amount of time a traditional healer has been practicing impacts his ability to diagnose and treat diseases. Meanwhile, many patients in a month indicate that the surrounding community believes in the traditional healer’s quality and skills. The more qualified the traditional healers are, the more reliable the data used in ethnopharmacology research is (Peng et al., 2015).
The herbal healers in the study region used medicinal plants alone or in combination to treat various illnesses. Rural people’s reliance on herbal treatments may be attributed to their lack of access to modern healthcare facilities and services. The elders chose herbal medications over allopathic drugs because they believed in the benefits of herbs. In addition, they believe in sharing their knowledge for the sake of human happiness. Even though Western medicine is available, many individuals still choose traditional herbal remedies (Somashekhara et al., 2015).
Pharmaceutical preparation
In this study, the preparation method of herbal medicine was categorized into oral, topical, and inhalation preparation. As seen in Figure 2, the most common preparation technique was topical preparation. Ethnomedical research in Sumatra shows that traditional healers used 68 plant species to treat LBP. Many therapeutic preparations are made by topical preparation, a common approach. The most commonly used parts of the plant were the leaves (30%), followed by roots (21%), rhizomes (17%), fruits (12%), stems (7%), seeds (6%), tubers (4%), bark (2%), and others (1%) (Fig. 3). Other studies also came up with similar results. The leaves are the primary photosynthetic organs containing photosynthates with therapeutic properties. Compared to roots, and fruits, collecting leaves and then using them as medicine is relatively simple. Another rationale for employing leaves could be for plant conservation, as taking out roots could cause the plant to die, putting the species in serious trouble (Dey et al., 2014). Bradacs et al. (2011) and Leto et al. (2013) mentioned leaves as a standard plant part in herbal medicine used by Islanders and Italians. It has been claimed that using leaves rather than whole plants, roots, and stems might increase the survivability of medicinal plants collected by herbalists, which may pose a severe threat to local flora (Dey et al., 2014).
 | Figure 1. The map of Sumatra Island. [Click here to view] |
 | Figure 2. The proportion of oral and topical herbal medicine preparation for low back pain. [Click here to view] |
 | Figure 3. The proportion of plant parts used. [Click here to view] |
Diversity of medicinal plants and their relative importance in the treatment of LBP
Table 1 shows the information on botanical name, family, plant part used, and relative importance of plants for the treatment of LBP in Sumatra, Indonesia. Their taxonomic group and family determine medicinal plants’ scientific and common names. www.theplantlist.org was used to double-check all of the Latin scientific and families’ terms. In this study, 68 plant species were identified for LBP, which belonged to 32 families. Only the local name was recorded for 49 of the 68 species. Kaempferia galanga L. was the most widely used species, with four use reports from 90 informants, yielding a usage value of 0.04. Citrus aurantiifolia (Christm.) Swingle, Plectranthus amboinicus (Lour.) Spreng, and Zingiber purpureum Roscoe came in second with three use reports each (UV = 0.03). The next rank was occupied by Celosia argentea L., Allium cepa L., Crinum asiaticum L., Fragraea fragrans Roxb., Tinospora crispa (L.), Imperata cylindrica (L.), Oryza sativa L., Nauclea sp., Curcuma domestica Val., and Zingiber zerumbet (L.) Roscoe ex Sm. (UV = 0.02). We also listed toxic plants to discourage the public from using harmful plants, even though locals utilize them to treat various diseases from the survey. The toxic plants are Datura metel L. and Solanum rudepannum. It has been noted that plant species with powerful bioactive chemicals are frequently labeled as both toxic and therapeutic, with the outcome varying depending on the medicine production and administration (Umair et al., 2017). In another study, 25% of medicinal plant users knew nothing about poisonous plants (Eddouks et al., 2002).
In a few cases, the pharmacological effects of medicinal plants mentioned in this study have been confirmed by published data. More research about their chemical composition, pharmacological effects, and toxicity will be required to verify the plant materials’ medical value. Furthermore, animal models must be used to evaluate the cellular and molecular mechanisms of the recorded plants, and thorough information on their use, duration, and dose must be explored before prescription in human healthcare (Eddouks et al., 2002). For example, fever, hemiplegia, rheumatism, arthritis, headaches, earache, muscle discomfort, respiratory illnesses, and digestive problems are treated using the Justicia gendarussa Burm’s leaf in Indian and Chinese traditional medicine (Paval et al., 2009). Still, in this study, these plants had a low UV level.
As presented in Figure 4, we discovered that the informants use 90 medicinal plants from 32 families to treat LBP. The most used family was Zingiberaceae with FUV 0.20, followed by Lamiaceae and Poaceae with FUV 0.09 each, Amaryllidaceae (0.06), Rutaceae (0.06), Arecaceae (0.03), Menispermaceae (0.03), Solanaceae (0.03), Amaranthaceae (0.02), Compositae (0.02), Euphorbiaceae (0.02), Gentianaceae (0.02), Musaceae (0.02), Myristicaceae (0.02), Rubiaceae (0.02), and others with FUV 0.01. The Zingiberaceae family was the most well represented among the 90 plant species found, followed by Lamiaceae and Poaceae, with 10 species mentioned. Many medicinal plants are members of the Lamiaceae family, used for their rich and aromatic essential oils, primarily monoterpenes (Abe and Ohtani, 2013).
There is just one ICF for treating LBP because this study focused on a specific disease. The ICF for medicinal plants to treat LBP was 0.25. The factor represents the degree of shared knowledge among informants about using medicinal plants to treat a specific condition. When plants are chosen randomly, and little or no information is shared among informants, ICF values are low (around 0). If specific criteria have been well defined and information has been well shared, the ICF approaches one (1) (Ferrier et al., 2015; Jaradat et al., 2016; Mustofa et al., 2021; Yaseen et al., 2015). The factor discovered in this study was graded as low. The ICF was assigned low (ranges from 0.0 to 0.3), moderate (ranges from 0.31 to 0.60), and high (ranges from 0.61 to 1.0) values (Achar et al., 2015).
 | Table 1. The diversity of medicinal plants for treatment of LBP in Sumatra, Indonesia, along with quantitative values. [Click here to view] |
 | Figure 4. The Diversity of Famili Use value (FUV) of medicinal plants for treatment LBP in Sumatra. [Click here to view] |
Several properties of the most cited medicinal plants for treatment of LBP
Kaempferia galanga
Analgesic activity of K. galanga extract is the main activity to be applied for LBP. Based on the pain models employed in this work, its activity presumably mediated peripherally and centrally via the nervous system. In the hot plate and tail-flick tests, naloxone reversed the extract’s antinociceptive effect, demonstrating that it works via opioid-mediated processes. Kaempferia galanga extract may bind to opioid receptors. These findings suggest the potential folk medicine usage of K. galanga as an antinociceptive remedy (Ridtitid et al., 2008). Other results reported the traditional use of K. galanga in treating inflammation. The anti-inflammatory activity of ethyl-p-methoxycinnamate from K. galanga is mediated by inhibition of cyclooxygenase enzymes 1 and 2 (Umar et al., 2012). The in vivo analgesic efficacy of the alcoholic K. galanga extract was investigated in Wistar rats using the hot plate method and the tail-flick model. According to the findings, the alcohol extract significantly increased the stress tolerance capacity of rats at doses of 1,200 and 600 mg/kg BW for 60 minutes using the hot plate method and 30 minutes via the tail-flick model (Khairullah et al., 2021).
Kaempferia galanga extract has the same efficacy as meloxicam administration to treat the symptoms and indications of knee OA. These findings suggest K. galanga extract may help with pain relief (Syahruddin et al., 2017).
Citrus aurantium
Citrus aurantium L. blossoms essential oil (neroli) has biologically active constituents that have significant activity against acute and especially chronic inflammation and central and peripheral antinociceptive effects, which supports the ethnomedicinal claims of the plant’s use in the management of pain and inflammation (Khodabakhsh et al., 2015).
Curcuma sp.
Curcuma roots are used to make turmeric spice. Curcumin, a polyphenol extract of turmeric, is widely known for its anti-inflammatory and antioxidant properties. Curcuma’s anti-inflammatory effect has various pathways. Inflammatory mediators such as interleukin-1, tumor necrosis factor-alpha, IL-8, Nitric oxide (NO), and a variety of Matrix metalloproteinases (MMPs) are strongly inhibited by Curcuma via reducing the activation of the Nuclear Factor-kappa B (NF-B), Akt, and mitogen-activated protein kinase (MAPK) signaling pathways.
Curcuma extracts and curcumin have recently been researched for their antiarthritic properties. Over four weeks, C. domestica patients had lower Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores than ibuprofen patients. According to Kuptniratsaikul et al. (2009), curcumin had similar efficacy but more excellent safety and fewer side effects than diclofenac. A randomized, double-blind, placebo-controlled research examined highly bioavailable curcumin (Theracurmin) effects on knee OA. After eight weeks, Theracurmin reduced Visual Analog Scale (VAS) scores for knee pain and celecoxib dependence relative to placebo, but not Japanese Knee Osteoarthritis Measure (JKOM) scores. Curcuminoids (curcumin, demethoxycurcumin, and bisdemethoxycurcumin) coupled with diclofenac exhibited superior pain relief and functional capability in individuals with knee OA (Lindler et al., 2020).
These medicinal plants are significant in any herbal formula because approximately one-fourth of the biologically active plant-derived compounds currently in use worldwide were discovered through research of folk and ethnomedicinal services (Biswajit et al., 2014). In general, drug development research might be employed to extract and describe the bioactive chemicals responsible for these species’ usage to treat LBP.
CONCLUSION
The properties of the most cited medicinal plant for the treatment of LBP are K. galanga, C. aurantium, and Curcuma sp. However, they are chosen randomly, and little or no information is shared among informants. Nonetheless, to acquire a better knowledge of the function of herbal medicine in the treatment of LBP in Sumatra, more research that spans a larger area and diverse population groups is needed. Pharmacological screening of medicinal plants should be evaluated, particularly those commonly referenced and used safely.
ACKNOWLEDGMENT
The authors are very much thankful to the National Institute of Health Research and Development for supporting data. Thanks are also due to the RISTOJA Team, PPI for Medicinal Plant and Traditional Medicines Research and Development Center.
CONFLICT OF INTEREST
The authors declared no potential conflicts of interest in this article’s research, writing, or publishing.
AUTHOR CONTRIBUTIONS
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. All the authors are eligible to be an author as per the international committee of medical journal editors (ICMJE) requirements/guidelines.
FUNDING
There is no funding to report.
DATA AVAILABILITY
All data generated and analyzed are included within this research article.
PUBLISHER’S NOTE
This journal remains neutral with regard to jurisdictional claims in published institutional affiliation.
ETHICAL APPROVAL
The Ethics Commission approved the protocol and informed consent forms of the Ministry of Health’s National Institute of Health Research and Development. The informants were given full facts about the current study and its goals, and they were free to withdraw at any point. The study’s ethical approval codes were LB.02.01/5.2/KE.318/2015 and LB.02.02/2/KE.107/2017.
REFERENCES
Abe R, Ohtani K. An ethnobotanical study of medicinal plants and traditional therapies on Batan Island, the Philippines. J Ethnopharmacol, 2013; 145(2):554–65. CrossRef
Achar SKG, Boosanur V, Shivanna MB. Ethno-medico-botanical knowledge of Tiptur taluk in Tumkur district of Karnataka, India. Indian. J Tradit Knowl, 2015; 14(1):147–54.
Adegbaju OD, Otunola GA, Afolayan AJ. Anti-inflammatory and cytotoxic evaluation of extracts from the flowering stage of celosia argentea. BMC Complement Med Ther, 2020; 20(1):1–7. CrossRef
Ahmad W, Jantan I, Bukhari SNA. Tinospora crispa (L.) Hook. f. & Thomson: A review of its ethnobotanical, phytochemical, and pharmacological aspects. Front Pharmacol, 2016; 7:1–19. CrossRef
Al-Nahain A, Jahan R, Rahmatullah M. Zingiber officinale?: a potential plant against rheumatoid arthritis. Arthritis, 2014; 2014:1–8. CrossRef
Al-Salameen A, Abugad H, Al-Otaibi S. Low back pain among workers in a paint factory. Saudi J Med Med Sci, 2019; 7(1):33. CrossRef
Andriyono RI. Kaempferia galanga L. sebagai antii-Inflamasi dan analgetik. J Kesehatan, 2019; 10(3):495. CrossRef
Asmawi MZ, Arafat OM, Amirin S, Eldeen IM. In vivo antinociceptive activity of leaf extract of Crinum asiaticum and phytochemical analysis of the bioactive fractions. Intern J Pharmacol, 2010; 7(1):125–9. CrossRef
Aszar FDD, Imandiri A, Mustika A. Therapy for low back pain with acupuncture and turmeric. J Vocation Health Stud, 2019; 2(2):74. CrossRef
Badan Pusat Statistik. Jakarta, Indonesia, 2021. CrossRef
Batoro J, Ekowati G. An ethnobotanical tobacco (Nicotiana tabacum L.) in Indonesia. a review. Adv Life Sci, 2017; 7(2):26–9.
Biswajit P, Deenabandhu S, Malaya KM. Ethno-medicobotanical studies of Mohana area of Gajapati district, Odisha, India, Intern. J Herb Med, 2014; 2(4):40–5. CrossRef
Bolson M, Hefler SR, Dall’Oglio Chaves EI, Gasparotto Junior A, Cardozo Junior EL. Ethno-medicinal study of plants used for treatment of human ailments, with residents of the surrounding region of forest fragments of Paraná, Brazil. J Ethnopharmacol, 2015; 161:1–10. CrossRef
Borgonetti V, Governa P, Biagi M, Pellati F, Galeotti N. Zingiber officinale Roscoe rhizome extract alleviates neuropathic pain by inhibiting neuroinflammation in mice. Phytomed, 2020; 78:153307. CrossRef
Borokini TI, Ighere DA, Clement M, Ajiboye TO, Alowonle AA. Journal of Medicinal Plants Studies Ethnobiological survey of traditional medicine practice for Women’ s health in Oyo State. J Med Plants Stud, 2013;1:17–29.
Bradacs G, Heilmann J, Weckerle CS. Medicinal plant use in Vanuatu: a comparative ethnobotanical study of three islands. J Ethnopharmacol, 2011; 137(1):434–48. CrossRef
Britannica. Sumatra. Encyclopedia Britannica, 2017. Available via https://www.britannica.com/place/Sumatra (Accessed 15 December 2021).
Chandran B, Goel A. A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis. Phytother Res, 2012; 26(11):1719–25. CrossRef
Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020; 396(10267):2006–17. CrossRef
NAIR KK, Krupavaram JCB, Singh H, Solomon KA, Jaasminerjiit K, Shopana P. Evaluation of ethanolic root extract of Allium cepa. L for analgesic and anti-inflammatory activities in animal models. World J Curr Med Pharm Res, 2020; 2:11–3. CrossRef
Daily JW, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis of randomized clinical trials. J Med Food, 2016; 19(8):717–29. CrossRef
Dey AK, Rashid MO, Millat S, Rashid M. Ethnobotanical survey of medicinal plants used by traditional health practitioners and indigenous people in different districts of Chittagong division, Bangladesh. Int J Pharm Sci Invent, 2014; 3(7):1–7.
Dimitry MY, Emmanuel PA, Edith DMJ, Armand AB, Nicolas NY. Antioxidant property, anti-inflammatory and analgesic effects of aqueous extracts of two onion bulbs varieties (Allium cepa L.). Clin Phytosci, 2021;7(1):1–8. CrossRef
Eddouks M, Magharani M, Lemhadri A, Ouahidi ML, Jouad H. Ethnopharmacological survey of medicinal plants used for the treatment of diabetes mellitus, hypertension and cardiac disease in the southeast region of Morocco (Tafilalet). J Ethnopharmacol, 2002; 82(2–3):97–103. CrossRef
Ezhilvalavan R, Mayilsamy M, Rajendran A. Ethnomedicinal plants used by the indigenous peoples of palani hills in southern western ghats for treating rheumatism. Intern J Sci Innov Discov Res, 2015; 5(3):23–31.
Fahryl N, Carolia N. Turmeric (Curcuma domestica Val.) as therapy of gout arthritis. Majority, 2019; 8(1):251–5.
Ferrier J, Saciragic L, Traki? S, Chen ECH, Gendron RL, Cuerrier A, Balick MJ, Redzic S, Alikadic E, Arnason JT. An ethnobotany of the Lukomir Highlanders of Bosnia & Herzegovina. J Ethnobiol Ethnomed, 2015; 11(1):1–17. CrossRef
Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 2018; 391(10137):2368–83. CrossRef
Fouda AMM, Berika MY. Evaluation of the effect of hydroalcoholic extract of zingiber officinale rhizomes in rat collagen-induced arthritis. Basic Clin Pharmacol Toxicol, 2009; 104(3):262–71. CrossRef
Gerayeli MV, Abbasian A, Karimi M, Khanlarkhani N, Parvari S. 5 medicinal plants used in iranian traditional medicine for low back pain: a quick review. Eur J Exp Biol, 2017; 07(04):2–6. CrossRef
Gonzal TE, Flore D, Donatien A, William N, Herve T, Vanessa M, Marius M, Gilbert A. In vitro anti-inflammatory, antioxidant and in vivo anti-arthritic properties of stem bark extracts from Nauclea pobeguinii (Rubiaceae) in rats. Asian Pac J Trop Biomed, 2020; 10(2):65–77. CrossRef
Grinberg K. Is curcuma effective for the management of osteoarthritis knee pain?? 2020. Available via https://digitalcommons.pcom.edu/pa_systematic_reviews/542/
Gupta SK, Sharma A. Medicinal properties of Zingiber officinale Roscoe—a review. IOSR J Pharm Biol Scie, 2014; 9(5):124–9. CrossRef
Haque M, Jahan S, Rahmatullah M. Ethnomedicinal uses of Crinum asiaticum?: a review. World J Pharm Sci, 2014; 3(9):119–28.
Haudecoeur R, Peuchmaur M, Pérès B, Rome M, Taïwe GS, Boumendjel A, Boucherle B. Traditional uses, phytochemistry and pharmacological properties of African Nauclea species: a review. J Ethnopharmacol [Internet], 2018; 212(November):106–36. CrossRef
Hoffman B, Gallaher T. Importance indices in ethnobotany. Ethno Res Appl, 2007; 5:201–18; doi: 10.17348/era.5.0.201-218 CrossRef
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis, 2014; 73(6):968–74. CrossRef
Internet citation.link Available via https://gudviral.com
Jadid N, Kurniawan E, Himayani CES, Andriyani, Prasetyowati I, Purwani KI, Muslihatin W, Hidayati D, Tjahjaningrum ITD. An ethnobotanical study of medicinal plants used by the Tengger tribe in Ngadisari village, Indonesia. PLoS One, 2020; 15:1–16. CrossRef
Jaradat NA, Ayesh OI, Anderson C. Ethnopharmacological survey about medicinal plants utilized by herbalists and traditional practitioner healers for treatments of diarrhea in the West Bank/Palestine. J Ethnopharmacol, 2016; 182:57–66. CrossRef
Kanu CL, Owoeye O, Imosemi IO, Malomo AO. A review of the multifaceted usefulness of celosia argentea linn. Eur J Pharm Med Res, 2017; 4(10):72–9.
Kertia N, Asdie AH, Rochmah W, Marsetyawan. Comparison of the effects of curcuminoid from Curcuma domestica Val. rhizome extract and diclofenac sodium on the liver function of patients with osteoarthritis. J Pharmacogn Phyther, 2012; 4(5):62–5. CrossRef
Khairullah AR, Solikhah TI, Ansori ANM, Hanisia RH, Puspitarani GA, Fadholly A, Ramandinianto S. Medicinal importance of Kaempferia galanga l. (zingiberaceae): a comprehensive review. J Herb Med Pharmacol, 2021; 10(3):281–8. CrossRef
Kharat A, Tarkasband Y, Kharat K. Antinociceptive, anti-inflammatory and antidepressant potential of methanolic extract of Celosia argentea Linn. J Drug Deliver. Ther, 2019; 9(2):291–5.
Khodabakhsh P, Shafaroodi H, Asgarpanah J. Analgesic and anti-inflammatory activities of Citrus aurantium L. blossoms essential oil (neroli): involvement of the nitric oxide/cyclic-guanosine monophosphate pathway. J Nat Med, 2015; 69(3):324–31. CrossRef
Koga AY, Beltrame FL, Pereira AV. Several aspects of Zingiber zerumbet: a review. Revista Brasileira de Farmacognosia, 2016; 26(3):385–91. CrossRef
Kumar A. inflammatory and analgesic agents. Ethnomed Source Compl Ther, 2010; 267–93.
Kumar G, Karthik L, Bhaskara Rao KV. A review on pharmacological and phytochemical properties of Zingiber officinale Roscoe (Zingiberaceae). J Pharm Res, 2011; 4(9):2963–6.
Kumar P, Singh S, Kumar N. Plectranthus amboinicus: a review on its pharmacological and pharmacognostical studies. Am J Physiol Biochem Pharmacol, 2020; 10(2):55. CrossRef
Kuptniratsaikul V, Thanakhumtorn S, Chinswangwatanakul P, Wattanamongkonsil L, Thamlikitkul V. Efficacy and safety of Curcuma domestica extracts in patients with knee osteoarthritis. J Altern Complement Med, 2009; 15(8):891–7. CrossRef
Laudahn D, Walper A. Efficacy and tolerance of Harpagophytum extract LI 174 in patients with chronic non-radicular back pain. Phyto Res, 2001; 15(7):621–4. CrossRef
Leto C, Tuttolomondo T, La Bella S, Licata M. Ethnobotanical study in the Madonie Regional Park (Central Sicily, Italy)—Medicinal use of wild shrub and herbaceous plant species. J Ethnopharmacol, 2013; 146(1):90–112. CrossRef
Lindler BN, Long KE, Taylor NA, Lei W. Use of herbal medications for treatment of osteoarthritis and rheumatoid arthritis. Medicines, 2020; 7(11):67. CrossRef
Lukhoba CW, Simmonds MSJ, Paton AJ. Plectranthus: a review of ethnobotanical uses. J Ethnopharmacol, 2006; 103(1):1–24. CrossRef
Mahboubi M. Zingiber officinale Rosc. essential oil, a review on its composition and bioactivity. Clin Phytoscie, 2019; 5(1):1–12. CrossRef
Mahomoodally MF, Sadeer NB, Suroowan S, Jugreet S, Lobine D, Rengasamy KRR. Ethnomedicinal, phytochemistry, toxicity and pharmacological benefits of poison bulb—Crinum asiaticum L. South African J Bot, 2021; 136:16–29. CrossRef
Mandal U, Mahalik G. 2021. Ethnomedicinal plants used in rheumatoid arthritis. In: Devi RS, Kumar S, ed. Medico-Biowealth of India-II. APRF 140–147.
Martani NS, Fatmaria F. Pemanfaatan penawar sampai (Tinospora crispa L.) sebagai tanaman obat tradisional oleh suku Dayak Ngaju’. APRF Publishers City India, J Pharmasci, 2020; 7(2):156. CrossRef
Metrani R, Singh J, Archaya P, Jayaprakasha G, Patil B. Comparative metabolomics profiling of polyphenols. Plants, 2020; 9(9):1–18. CrossRef
Mishra RK, Kumar A, Kumar A. Pharmacological activity of Zingiber officinale. Intern J Pharm Chem Scie, 2018; 1(3):1073–8.
Mosaddegh M, Naghibi F, Moazzeni H, Pirani A, Esmaeili S. Ethnobotanical survey of herbal remedies traditionally used in Kohghiluyeh va Boyer Ahmad province of Iran. J Ethnopharmacol, 2012; 141(1):80–95. CrossRef
Motley TJ. The ethnobotany of Fagraea thunb. (Gentianaceae): the timber of malesia and the scent of polynesia. Eco Botany, 2004; 58(3):396–409. CrossRef
Mustofa IF, Rahmawati N, Saryanto S. Ethnomedicine of medicinal plants used by traditional healers to facilitate bone injury healing in West Kalimantan, Indonesia. J Tumbuh Obat Indones, 2021; 14(1):29–47.
Nguyen MT, Awale S, Tezuka Y, Tran QL, Watanabe H, Kadota S. Xanthine oxidase inhibitory activity of Vietnamese medicinal plants. Biol Pharm Bull, 2004; 27(9):1414–21. CrossRef
Nidavani RB, Mahalakshmi AM, Shalawadi M. Towards a better understanding of an updated ethnopharmacology of Celosia argentea L. Intern J Pharm Pharm Sci, 2013; 5(3):54–9.
Owoyele B V, Ibiyemi AV, Oyeleke MB. Anti-athritic effects of lime , maize husk extract and its co administration on wistar rats’, Adv Herb Medi, 2018; 4(4):58–70.
Padma R, Parvathy NG, Renjith V, Rahate KP. Quantitative estimation of tannins, phenols and antioxidant activity of methanolic extract of Imperata cylindrica. Int J Res Pharm Sci, 2013; 4(1):73–7.
Paramdeep G. Efficacy and tolerability of ginger (Zingiber officinale) in patients of osteoarthritis of knee’, Indian J Physiol Pharmacol, 2013; 57(2):177–83.
Pathak HN. An overview on ethnobotanical knowledge on Oryza sativa L. cultivated in Paiyunpata VDC , Baglung. Himalayan Sci J, 2009; 2:1–5.
Paudyal SP, Rai A, Das BD, Paudel N. Ethnomedicinal knowledge on Rai community of Ramprasadrai rural municipality , Bhojpur district , eastern Nepal. Eur J Biol Res, 2021; 11:367–80.
Paval J, Kaitheri SK, Potu BK, Govindan S, Kumar RS, Narayanan SN, Moorkoth S. Anti-arthritic potential of the plant Justicia gendarussa Burm F. Clinics, 2009; 64(4):357–62. CrossRef
Peng W, Liu YJ, Wu N, Sun T, He XY, Gao YX, Wu CJ. Areca catechu L. (Arecaceae): a review of its traditional uses, botany, phytochemistry, pharmacology and toxicology. J Ethnopharmacol [Internet], 2015; 164:340–56. CrossRef
Phillips O, Gentry AH, Reynel C, Wilkin P, Galvez-Durand BC. Quantitative ethnobotany and amazonian conservation. Conserv Biol, 1994; 8(1):225–48. CrossRef
Preetha TS, Krishnan PN, Thankappan C, Preetha S, Suvarna Preetha T, Sudarsanan Hemanthakumar A. A comprehensive review of Kaempferia galanga L. (Zingiberaceae): a high sought medicinal plant in Tropical Asia. J Med Plants Stu, 2016; 4(3):270–6.
Rakib A, Ahmed S, Islam MA, Uddin MMN, Paul A, Chy MNU, Emran TB, Seidel V et al. Pharmacological studies on the antinociceptive, anxiolytic and antidepressant activity of Tinospora crispa. Phyther Res, 2020; 34(11):2978–84. CrossRef
Refaat J, Kamel M, Ramadan M, Ali A. Analgesic, anti-inflammatory and antimicrobial activities of Crinum augustum Rox. and Crinum asiaticum L. Res J Pharmacogn Phytochem, 2011; 3(6):289–96.
Ridtitid W, Sae-wong C, Reanmongkol W, Wongnawa M. Antinociceptive activity of the methanolic extract of Kaempferia galanga Linn. in experimental animals. J Ethnopharmacol, 2008; 118(2):225–30. CrossRef
Sao A, Panigrahi P, Kumar P, Sahu H. Molecular Distinguishness among rice (Oryza sativa L.) landrace of Central India using microsatellite markers. Int J Chem Stud, 2020; 8(4):1046–50. CrossRef
Sima N. Evaluation of analgesic and anti-inflammatory effects of fresh onion juice in experimental animals. African J Pharm Pharmacol, 2012; 6(23):1679–84. CrossRef
Somashekhara Achar KG, Boosanur V, Shivanna MB. Ethno-medico-botanical knowledge of Tiptur taluk in Tumkur district of Karnataka, India. Indian J Tradit Knowl, 2015;1(1):147–54.
Solomon, Jaasminerjiit K, Shopana P. Evaluation of ethanolic root extract of Allium cepa. L for analgesic and anti-inflammatory activities in animal models. World J Curr Med Pharm Res, 2020; 2:11–3.
Spandana U, Ali SL, Nirmala T, Santhi M, Sipai Babu SD. A review on tinospora cordifolia. Int J Curr Pharm Rev Res, 2013; 4(2):61–8.
Sreekeesoon DP, Mahomoodally MF. Ethnopharmacological analysis of medicinal plants and animals used in the treatment and management of pain in Mauritius’. J Ethnopharmacol, 2014; 157:181–200. CrossRef
Stam C, Bonnet MS, Van Haselen RA. The efficacy and safety of a homeopathic gel in the treatment of acute low back pain: A multi-centre, randomized, double-blind comparative clinical trial. Br Homepath J, 2001; 90(1):21–8. CrossRef
Syahruddin AN, Dahlan CK, Taslim NA. The effects of Kaempferia galanga L . extract on pain , stiffness and functional physic in patient with knee osteoarthritis?: double blind randomized clinical trial. Intern J Sci Healthcare Res, 2017; 2(4):37–43.
Tang Y, Xin HL, Guo ML. Review on research of the phytochemistry and pharmacological activities of Celosia argentea’. Rev Brasil Farmacogn, 2016; 26(6):787–96. CrossRef
Terry R, Posadzki P, Watson LK, Ernst E. The use of ginger (Zingiber officinale) for the treatment of pain: a systematic review of clinical trials. Pain Med, 2011; 12(12):1808–18. CrossRef
Teshika JD, Zakariyyah AM, Zaynab T, Zengin G, Rengasamy KRR, Pandian SK, Fawzi MM. Traditional and modern uses of onion bulb (Allium cepa L.): a systematic review. Crit Rev Food Sci Nutr, 2019; 59(sup1):S39–70. CrossRef
Thirupathi DAT. Analgesic activity of the ethanolic extract of flower parts of Celosia argentea Linn. W J Pharma Res, 2017; 6(5):775–80. CrossRef
Umair M, Altaf M, Abbasi AM. An ethnobotanical survey of indigenous medicinal plants in Hafizabad district, Punjab-Pakistan’. PLoS ONE, 2017; 12(6):1–22. CrossRef
Umar MI, Asmawi MZ, Sadikun A, Atangwho IJ, Yam MF, Altaf R, Ahmed A. Bioactivity-guided isolation of ethyl-p-methoxycinnamate, an anti-inflammatory constituent, from Kaempferia galanga L. extracts. Molecules, 2012; 17(7):8720–34. CrossRef
Varghese S, Nair C. The rice landrace Oryza sativa Linn. cv. Navara in Kerala—a review. SAMAGRA, 2011; 7:8–15.
Verkamp EK, Flowers SR, Lynch-Jordan AM, Taylor J, Ting TV, Kashikar-Zuck S. A survey of conventional and complementary therapies used by youth with juvenile-onset fibromyalgia. Pain Manag Nurs, 2013; 14(4): 244–50. CrossRef
Vitalini S, Iriti M, Puricelli C, Ciuchi D, Segale A, Fico G. Traditional knowledge on medicinal and food plants used in Val San Giacomo (Sondrio, Italy)—an alpine ethnobotanical study. J Ethnopharmacol, 2013; 145(2):517–29. CrossRef
Walujo. Review: research tthnobotany in Indonesia and the future perspectives. Biodiversitas, 2008; 9(1):59–63 CrossRef
Warsinah W, Baroroh HN, Harwoko H. Phytochemical analysis and antioxidant activity of Brotowali (Tinospora crispa L. Mier) stem. Molekul, 2020; 15(2):73–8. CrossRef
Weimer P, Lisbôa Moura JG, Mossmann V, Immig ML, de Castilhos J, Rossi RC. Citrus aurantiifolia (Christm) Swingle: biological potential and safety profile of essential oils from leaves and fruit peels. Food Biosci, 2021; 40:100905. CrossRef
Willcox M, Siegfried N, Johnson Q. Capacity for clinical research on herbal medicines in Africa. J Altern Compl Med, 2012; 18(6):622–8. CrossRef
Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, Blyth FM, Smith E, Buchbinder R, Hoy D. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med, 2020; 8(6):299. CrossRef
Yaseen G, Ahmad M, Sultana S, Suleiman Alharrasi A, Hussain J, Zafar M, Shafiq-Ur-Rehman. Ethnobotany of medicinal plants in the Thar Desert (Sindh) of Pakistan. J Ethnopharmacol, 2015; 163:43–59. CrossRef
Yoon SL, Kim JH. Factors contributing to the use of complementary and alternative medicine in rural older women with chronic pain in South Korea. Appl Nurs Res, 2013; 26(4):186–91. CrossRef
Zhang J, Li Y, Wang Y. The complete chloroplast genome sequence of Fagraea fragrans. Mitochond DNA Part B, 2020; 5(1):711–2. CrossRef