Ethnomedicines used in Trinidad and Tobago for reproductive problems

Validation of practices

A preliminary validation of ethnomedicinal practices ensures that clinical trials are not wasted on plants that are used solely for cultural or religious reasons. The validation of the remedies was conducted with a non-experimental method [11,18,19]. This method consists of:

1. obtaining an accurate botanical identification,

2. determining whether the folk data can be understood in terms of bioscientific concepts and methods,

3. searching the chemical/pharmaceutical/pharmacological literature for the plant's known chemical constituents and to determine the known physiological effects of either the crude plant, related species, or isolated chemical compounds that the plant is known to contain. This information is used to assess whether the plant use is based on empirically verifiable principles or whether symbolic aspects of healing are of greater relevance. If ethnobotanical data, phytochemical and pharmacological information supports the folk use of a plant species it can be grouped into the validation level with the highest degree of confidence.

Four levels of validity were established [19]:

1. If no information supports the use it indicates that the plant may be inactive; or no research has been done on the plant.

2. A plant (or closely related species of the same genus), which is used in geographically or temporally distinct areas in the treatment of similar illnesses, attains the lowest level of validity, if no further phytochemical or pharmacological information validates the popular use. Use in other areas increases the likelihood that the plant is active against the illness.

3. If in addition to the ethnobotanical data, phytochemical or pharmacological information also validates the use in Trinidad, the plant may exert a physiological action on the patient and is more likely to be effective than those at the lowest level of validity.

4. If ethnobotanical [20], phytochemical and pharmacological data supports the folk use of the plant, it is grouped in the highest level of validity and is most likely an effective remedy.

A comparable validation process was used to examine the plants used by traditional healers of ancient Persia to induce abortions [21]. The authors evaluated the validity and the efficacy of the plants used by (1) comparing other reported uses of these plants in traditional medicine, (2) investigating the medical and pharmacological literature on the medicinal properties of the plant species used, and (3) investigating the reported cytotoxic effects of compounds prevalent in these plants.

Plants used for reproductive problems

Forty-two plants are used for reproductive problems of men and women. The term "man's waist pain" was not explained. The plants used for "man's disease" and "man's waist pain" were Catharanthus roseus, Urena sinuata and Clusea rosea. Parinari campestris and Richeria grandis are used for erectile dysfunction. Prostate problems are treated with Ageratum conyzoides, Scoparia dulcis, Cucurbita pepo, Cucurbita maxima, Gomphrena globosa and Justicia pectoralis.

Plants used for abortions are Aristolochia rugosa, Aristolochia trilobata, Ambrosia cumanenesis and Cocos nucifera.

Unspecified female complaints ae treated with Achyranthes indica, Artemisia absinthium, Brownea latifolia, Eleutherine bulbosa, Hibiscus rosa-sinensis, Eupatorium macrophyllum, Justicia secunda, Parthenium hysterophorus, Wedelia trilobata, Abelmoschus moschatus and Ageratum conyzoides. Desmodium canum is used for venereal diseases and Nopalea cochinellifera is used for menopause and hot flashes. The following plants are used for infertility and inflammations: Chamaesyce hirta, Cola nitida, Ruta graveolens, Commelina elegans, Ambrosia cumanenesis and Pilea microphylla.

The plants used for menstrual pain are: Aristolochia rugosa, Aristolochia trilobata

Ruta graveolens, Ambrosia cumanenesis, Capraria biflora, Cordia curassavica, Croton gossypifolius, Entada polystachya, Leonotis nepetaefolia and Eryngium foetidum. Plants used for childbirth, to shorten labour and remove the placenta are Mimosa pudica,

Ruta graveolens, Abelmoschus moschatus, Aristolochia rugosa, Aristolochia trilobata, Coleus aromaticus, Laportea aestuans, Vetiveria zizanioides, Abelmoschus moschatus and Eryngium foetidum. The ethnomedicinal plants used in Trinidad and Tobago for reproductive problems are summarised in Table 1. The validation of the plants is summarised in Table 2.

Non-experimental validation of plants used for reproductive problems

Abelmoschus moschatus plant is used for reproductive purposes in Fiji [22]. Abelmoschus manihot is used for menorrhagia in Vanuatu [23]. Myricetin, a naturally occurring flavonol with antioxidative and cytoprotective proterties is found in Abelmoschus moschatus Medic. This flavonol is used in the treatment of depression and anxiety in traditional Chinese medicine and has potential therapeutic benefit for cardiovascular diseases associated with diabetes mellitus [24].

The use of Achyranthes indica for venereal diseases in Trinidad has been previously recorded [11]. In Nepal Achyranthes aspera is used to facilitate parturition [25]. The benzene extract of the stem bark shows abortifacient activity in the rat [25]. The ethanolic extract of A. aspera caused reproductive toxicity in male rats and the action may result from suppressing the synthesis of androgen [26]. The methanolic leaf extract of Achyranthes aspera possesses significant (p < 0.05) abortifacient activity and increased pituitary and uterine wet weights in ovarectimized rats. The extract did not significantly influence serum concentration of the ovarian hormones and various lipids except lowering HDL at doses tested [26].

Ageratum conyzoides is used for venereal disease in El Salvador [20]. Ageratum conyzoides plant extract inhibited uterine contractions induced by 5-hydroxytryptamine suggesting that the extract exhibited specific antiserotonergic activity on isolated uterus plant extract but had no effect on uterine contractions induced by acetylcholine [28,29]. The results support the popular use of the plant as a spasmolytic [28,29].

The use of Ambrosia cumanenesis for women's problems has been previously recorded [11]. Ambrosia elatior is used as a febrifuge in Tropical America [20]. Dominican healers in New York City use Ambrosia peruviana for uterine fibroids [30]. Synonyms of Ambrosia cumanenesis are A. californica; A. coronopifolia; A. psilostachya and Ambrosia rugelii; these synonyms are provided to guide future researchers to future research; very little is currently available. The sesquiterpene lactone cumanin from Ambrosia psilostachya, exerted a high in vivo anti-inflammatory response, which was equivalent to that of helenalin (ED₅₀ = 6.33 and 13.11 μmol/kg, respectively) [31].

Aristolochia species are used in Mexico, western Panama and Guatemala as analgesics, for stomach pain, female disorders, menstrual pain and as contraceptives [11,20]. At doses of 1000 μg/cm2, the chloroform extract of Aristolochia trilobata, induced oedema reductions ranging between 50 (bark) and 93% (leaves). The methanol extract produced oedema inhibition of 18% (A. trilobata leaves). The chloroform extract of the Aristolochia trilobata leaves showed an anti-inflammatory effect comparable to that of indomethacin [32].

Artemisia absinthium is used together with other plants as fertility regulators in western Panama and Paraguay and this use is ancient [34,11]. Artemisia absinthium is used by the Caribs in Guatemala for fever, vaginitis and stomach pains [11]. Mugwort contains several pain relieving compounds including isothujone, linalool and cineole [35]. These compounds may also relieve premenstrual syndrome. Aqueous extracts of Artemisia contain little thujone and are probably safe to use [35].

Chamaesyce prostrata was used in Barbados prior to 1834 for venereal complaints [11]. The active component(s) in the water extract of Euphorbia hirta leaf have a similar diuretic spectrum to that of acetazolamide [35]. Chamaesyce hirta aqueous extract showed central analgesic properties [36].

The antinociceptive action of 13,118-binaringenin (GB-1a), a biflavonoid isolated from Clusia columnaris was more potent than some well-known analgesic drugs used as references. Its mechanism of action seems unrelated to the opioid receptors [37]. Compounds isolated from the trunk latex of Clusia grandiflora have potent antibacterial activity [38]. A novel antitumoral compound was isolated from Clusia spp. resin [39].

Cocos nucifera shell produces a fluid when hot that is used ethnomedicinally in India [11]. Cocos nucifera is used in complex plant combinations for venereal diseases in Cuba [40]. The fiber husk is rich in catechins with anti-bacterial, anti-viral and anti-proliferative activity on leukaemic cells and normal blood lymphocytes [41].

In vitro crude extracts of kola nuts depress smooth muscle activity. The oestrous cycles of rats treated with hydro-alcohol extracts of Cola nitida, were blocked at the dioestrous II stage. Only 50% of the cycles of rats treated with Cola nitida were disrupted. The extract contains weak antioestrogen-like activity that provokes a blockage of female rat ovulation and oestrous cycle by acting on the hypophysis and/or hypothalamus secretion. This effect was mediated by oestrogen receptors [42].

Coleus aromaticus has been used historically for menorrhagia in Trinidad [11].Coleus barbatus is used to interrupt pregnancy in Brazil and is used as an emmenagogue in other countries [43]. Coleus barbatus showed an anti-implantation effect in the preimplantation period in rats, but after embryo implantation the extract had little effect [43].

Commelina elliptica is used in a bath by the Alteños Indians in Bolivia to reduce high fevers. Commelina pallida and C. cayenensis are used as haemostatics, wound healing and ecbolics in Mexico [11,20]. Commelina communis has level 2 validity for diabetes [44]. Commelina diffusa extract showed antibacterial and antifungal activity against Trichophyton spp., a common dermatophyte [45].

Cordia alba was used by the Aztecs as a diuretic. Cordia spinescens is used in Colombia to relieve postpartum pain [11].Cordia boissieri and C. collococca are used as emollient roots in the Antilles and Mexico [20]. Cordia curassavica has antibacterial activity against bacteria known to cause gastrointestinal problems [46].

Croton nepetaefolius Baill., is used in Brazilian folk medicine as a sedative and antispasmodic agent. Croton draco, C.panamensis, and C.stipulaceus are used in Mexico for kidney ailments [20]. Croton berlandieri bark decoction is used for syphilis in the Yucatan [20]. The essential oil of C. nepetaefolius, administered orally, promotes a dose-dependent antinociceptive effect [11,47]. Active principles could include flavonoids and terpenoid compounds [47]. At a dose of 20 mg/kg, intravenous bolus administration of the ethanolic extracts from Croton schiedeanus showed significant antihypertensive activity when assayed both in SHR and Wistar rats and in rat isolated aortic rings [48].

Cucurbita pepo is used for prostate disorders and urine intermittence in Palestine [11].

Desmodium gangeticum is used as an antipyretic in India [11]. The water decoction of root and aerial parts of Desmodium gangeticum possesses anti-inflammatory and anti-nociceptive activity. These results support the traditional use of the water decoction of Desmodium gangeticum as an analgesic [49].

Eleutherine bulbosa is used in Columbia for menstrual cramps and in Haiti as an antifertility agent [10,50]. Eleutherine species are used in the Malay Peninsula, Bolivia and Peru for vaginal discharge, wounds, dysentery, diarrhoea and anaemia [11]. Eleutherine bulbosa bulb extract showed antifertility and cicatrizant activity and was non-toxic [10].

Eryngium foetidum is used in the Caribbean and South America for the treatment of fevers and antiinflammatory disorders and for venereal diseases [11,50]. The topical antiinflammatory activity of the hexane extract and of stigmasterol was established and stigmasterol is not the only bioactive component [51].

Eupatorium species are used in South America as contraceptives, abortives and emmenagogues [52]. Two species of Eupatorium were used in Trinidad for menstrual problems in 1893 [11]. Eupatorium macrophyllum has been used in Trinidad historically for amenorrhoea, dysmenorrhea, prolapse and womb problems in Trinidad [11]. Chromolaena odorata (synonym Eupatorium odoratum) crude ethanol extract has antioxidant activity that protects fibroblasts and keratinocytes in vitro [53]. The phenolic acids present and complex mixtures of lipophilic flavonoid aglycones protected cultured skin cells against oxidative damage [53].

The glycoside isorhamnetin 3-O-beta-robinobioside was found in Gomphrena boliviana. Upon inoculation of various doses of 5,6,7-trisubstituted flavones on two murine tumour lines, Sarcoma 180 and Ehrlich's carcinoma, a decrease of tumour growth was observed [54]. Gomphrena globosa flowers contain betacyanins which have potential as as food colorants and antioxidants [55].

Hibiscus rosa-sinensis flower decoctions are used in India and Vanuatu as aphrodisiacs, for menorrhagia, uterine haemorrhage and for fertility control [11]. Flower extracts produced an irregular estrous cycle in mice with prolonged oestrus and metoestrus and other indications of antiovulatory effects, androgenicity and estrogenic activity [56-60]. Hibiscus rosa sinensis possesseses anti-complementary, anti-diarrhetic and anti-phologistic activity. Hibiscus rosa sinensis flower showed anti-spermatogenic, androgenic, anti-tumour and anti-convulsant activities [56-60].

Justicia pectoralis showed antinociceptive, bronchodilator and antiinflammatory effects [15,11,61]. These activities might be due to the coumarin in the plant [11,15]. One recent review showed that plant species rich in coumarin compounds have potential antineoplastic or cytotoxic activities that are correlated to their use as abortifacients [21].

The leaf and tem decoction of Leonotis nepetaefolia is used as an abortifacient and emmenagogue in the Caribbean [52].

Mimosa pudica is used in Nicaragua and Mexico for stomach aches, 'cleaning the womb', as a sedative, to stop menstruation and for gonorrhoea [11]. The root is used as a temporary birth control in India [62]. Mimosa pudica produced an antidepressant-like profile similar to two tricyclic antidepressants clomipramine and desipramine [63]. Powdered roots were given to adult cycling female albino rats at dosages of 100 mg and 150 mg/kg body weight, administered intragastrically for 5 consecutive days. There was a significant reduction in the number of normal ova in the experimental rats in the study due to inhibition of steroidogenesis, thus producing an imbalance in oestrogen and/or progesterone levels. Alternatively, the powder may have acted on the hypothalamus and reduced the releasing hormones and/or changed the pituitary gonadotropin levels [62].

Nopalea cochinellifera is used for pain and inflammation in India [11]. An oral glucose tolerance test showed that stems of Nopalea cochinellifera increases blood glucose levels in mice [64].

Parinari species are used for venereal diseases in some African countries [11]. The methanolic extract of the stem bark of Parinari polyandra demonstrated anti-nociceptive and anti-inflammatory effects in mice and rats, justifying the local use of the plant [65].

Parthenium hysterophorus is used as a tonic, analgesic, antipyretic, antiperiodic, febrifuge and emmenagogue in Mauritius, Rodrigues, Mexico, Belize and India [11,20]. It is used for venereal diseases in Cuba [40]. A depolarizing neuromuscular junctional blocking action of Parthenium hysterophorus leaf extracts was found in the rat [66].

Pilea microphylla is used ethnomedicinally in Asia and in Central America [11,20]. The entire plant is given to women in labour in Jamaica. Pilea microphylla was active against Staphyloccocus aureus [67].

Richeria grandis (syn. Guarania ramiflora) is used as an aphrodisiac in Trinidad. Roupala montana is also used in Trinidad and is a documented nervine [68].

Ruta graveolens and closely related species are used as emmenagogues, abortives, antispasmodics, sudorifics and anthelmintics in France, Spain, Brazil, Paraguay, New Mexico, Italy, Madeira and in other cultures and the antifertility uses were documented by Galen and Pliny the Elder [69,70,11]. Ruta species contain different alkaloids and furanocoumarins and may show toxic side effects when used as abortifacients [11,69]. Ruta graveolens has shown weak activity in vitro on excised uterine muscle [70]. The antimicrobial activity of the plant is possibly due to the essential oils or flavonoids [71]. Data collected in Uruguay from 1986 – 1999 of 86 cases of abortion involved 30 different plant species [72]. Ruta chalepensis or Ruta graveolens were among the species most frequently used for abortions [72]. Multiple organ system failure occurred in some patients who had ingested ruda (alone or in combination with parsley or fennel). Deaths occurred in 4 cases of ruda ingestion (2 cases of ruda alone, 2 cases of ruda with parsley and fennel) [72].

Scoparia dulcis is used in Nicaragua for belly pain and to 'clean the blood, kidney and system' [11]. Antitumour-promoting compounds and antiviral agents were found in Scoparia dulcis [22]. It also has antimicrobial and antifungal effects as well as antihyperlipidemic action in normal and experimental diabetic rats in addition to its antidiabetic activity [73].

Urena sinuata plant is used for reproductive purposes in the Pacific, Trinidad, China and India [11,22]. Its synonyms are Urena aculeata Mill., U. lobata ssp. sinuata (L.) Borss. Waalk., Urena morifolia DC., U. muricata DC., U. paradoxa Kunth and U. swartzi. The methanol extract of Urena lobata root exhibited broad spectrum antibacterial activity [74].

Vetiveria zizanioides is used in Pakistan as an emmenagogue and stimulant and is used by the Caribs in Guatemala for stomach pains [11].

Wedelia trilobata has been historically used for amenorrhea in Trinidad [11]. Kaurenoic acid and luteolin in Wedelia paludosa showed antinociceptive action more potent than the standard analgesic drugs (acetyl salicylic acid, acetaminophen, dipyrone and indomethacin) [75]. Wedelia paludosa and Wedelia trilobata contain the diterpene (kaurenoic acid), eudesmanolide lactones and luteolin (in leaves and stems) [11,75]. Kaurenoic acid has antibacterial, larvicidal and tripanocidal activity; it is also a potent stimulator of uterine contractions [75]. Luteolin exerts antitumoural, mutagenic and antioxidant effects, has depressant action on smooth muscles and a stimulant action on isolated guinea pig heart [75].