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Ethnopharmacological survey of herbal remedies used for treatment of various types of cancer and their methods of preparations in the West Bank-Palestine

  • Nidal Amin Jaradat1Email author,
  • Rowa Al-Ramahi1,
  • Abdel Naser Zaid1,
  • Ola Ibrahim Ayesh1 and
  • Ahmad Mustafa Eid1
BMC Complementary and Alternative MedicineBMC series – open, inclusive and trusted201616:93

DOI: 10.1186/s12906-016-1070-8

Received: 25 November 2015

Accepted: 2 March 2016

Published: 8 March 2016

Abstract

Background

Plants have been the primary source of medicines since life on earth; more than 50 % of existing cancer treatments are derived from plants.

Methods

An ethnopharmacological survey of herbal remedies used in cancer treatment was carried out in the West Bank/ Palestine. A questionnaire was distributed to one hundred and fifty herbalists, traditional healers and rural dwellers. Collected information included the names of plants, the used parts, types of cancers for which these plants were used and also their methods of preparation. To identify the most important species used, Factor of informant’s consensus (Fic), Fidelity level (Fl) and the Use-value (UV) were calculated.

Results

Collected data has shown that 72 plants are utilized for treatment of cancer, belonging to 44 families; from them Compositae and Lamiaceae were the most common. Leaves and fruits were the most commonly used parts, while decoctions, infusions and syrups were the main methods of preparation. Lung cancer was the most common type of cancer treated with these plants and Ephedra alata was the most commonly used plant for treatment of cancer in Palestine. The Fic was high for all the plants; Fl was 100 % for many plants, the highest UV (0.72) was for Ephedra alata.

Conclusions

This study showed that many herbal remedies are still used by herbalists in Palestine for treatment of cancer; some of them have been approved scientifically while others are not. A combined effort between informants and scientific institutions working in this field can help in the discovery of new anticancer agents. Moreover, scientists must explore the most suitable method of extraction, formulation and dose determination in order to achieve the best benefits from these herbals.

Keywords

Ethnopharmacology Anticancer Herbal remedies Traditional use Ephedra alata

Background

The Holy Land/ Palestine has miscellaneous ethnic groups (Muslims, Christians, Druze, Jews from East and West and Samaritans), so its characteristic cultures are numerous and varied, including folkloric herbal medicine. However, these traditions in herbal remedies have waned over hundreds of years. Palestine is a unique land, in its ecological diversity due to its geographical location between Africa, Asia and Europe. Different zoogeographic, climatic, and phytogeographic zones covered Palestine, creating great biological multi-diversity [1, 2]. In addition to that it was as an important international trade crossroad from ancient times, between North Africa, East Asia and West Europe; this added to its culture in herbal medicines [35].

Plants provide a continual source of medicines for animals and humans; they have been used since ancient times in crude forms as decoctions, syrups, liniments, powders, infusions and ointments [6, 7]. Evidence of medicinal plant use around 60 000 years ago was found in a cave discovered in 1960 in the Middle East [8, 9]. In recent time, people in both developed and developing countries utilize herbal medicines for improving their health [1012]. According to the World Health Organization (WHO) evaluations, about 80 % of populations in developing countries have utilized ethno-medicines for their health care requirements and more than 60 % of cancer patients have used natural plant products with vitamins in fighting this disease [1315]. While 50 % of modern pharmaceutical medications in clinical practice are derived from plants, many of them have strong anticancer effects [16, 17].

According to the WHO and the American Cancer Society about eight million died from cancer and about fourteen million new cancer cases occurred in 2012. The highest percentages of patients were with lung, breast and colorectal cancers respectively. WHO also estimates a substantive increase up to nineteen million new cases of cancer per year by 2025, due to the growth of global population. More than half of all cancers and cancer deaths occurred in less developed countries, and these proportions may be further increased [1820].

Nowadays, chemotherapeutic anticancer agents are the most common method of treatment, but they may cause serious side effects and toxicity [2123].

Due to the high death rate among patients with cancer and the hazardous side effects and adverse reactions of the radiotherapy and chemotherapy, cancer patients often start seeking alternative methods of treatments, like herbal medicine with or instead of conventional medicine [2426].

Methods

An ethnopharmacological survey on herbal remedies used for treatment of various types of cancer was conducted from March 2015 to June 2015. Areas visited included all regions of the West Bank/Palestine; Nablus, Jenin, Tubas, Toulkarm, Salfeit, Qalqilya, Ramallah, Jericho, Jerusalem, Bethlehem and Hebron (Fig. 1).
Fig. 1

Map of the West Bank/ Palestine showing all surveyed regions

The study aims, protocols and the informed consent forms were approved by the Institutional Review Board (IRB) at An-Najah National University (IRB archived number 25/Jan/ 2015). The study was conducted in accordance with the requirements of the declarations of Helsinki.

The study was carried out by interviews with herbalists, traditional healers and rural dwellers that used herbal remedies in the treatment of different types of cancer. The number of registered herbalists in the West Bank is 222. According to the Raosoft calculator the minimum sample should be 141 participants, so we included 150 [27]. These informants represented most of the practitioners in this field in the West Bank (Sociodemographic characteristics are presented in Table 1).
Table 1

Sociodemographic characteristics of the respondents

Variable

N (%)

Gender

 

Male

128 (85.3)

Female

22 (14.7)

Education level

 

Uneducated

26 (17.3)

Elementary

14 (9.3)

Secondary school

28 (18.7)

High secondary school

53 (35.3)

Undergraduate

27 (18)

Graduate (higher education)

2 (1.3)

Residency

 

Bethlehem

13 (8.7)

Hebron

13 (8.7)

Jenin

21 (14.0)

Jericho

9 (6.0)

Jerusalem

10 (6.7)

Nablus

20 (13.3)

Qalqilya

7 (4.7)

Ramallah

14 (9.3)

Salfeit

18 (12.0)

Tubas

7 (4.7)

Toulkarm

18 (12.0)

Age (mean ± SD) years

54.7 (14.3)

Experience (mean ± SD) years

34.8 (14.3)

A convenience sample of herbalists and practitioners from various regions were met by researchers and asked to answer a face to face questionnaire. They were interviewed in Arabic after getting their verbal consent only once.

Statistical analyses were performed by using Statistical Package for Social Sciences (SPSSversion17.0). Mean ± standard deviation were computed for continuous data. Frequencies and percentages were calculated for categorical variables. Means were compared using Student’s t-test. Categorical variables were compared using Chi-squared and Fisher’s exact tests, as applicable. A p-value of less than 0.05 was considered to be statistically significant for all analyses.

Questionnaires were administered through personal contact discussions. This method is an effective and easy option of data collection. This survey aimed to obtain information on the names of plants commonly used in the treatment of cancer, the type of cancer treated by herbs, the methods of preparing and the parts used for administration. Interviews were conducted in the Arabic language of the informants. Names of plants were translated later to English and Latin. In most cases, the interviews often started in the form of informal discussions to gain the confidence of the interviewees.

All of the 72 plant materials were collected from the interviewees (herbalists, traditional healers and rural dwellers) and kept in special glass frames and later identified by the pharmacognosist Dr. Nidal Jaradat. The identity of each plant species mentioned by the interviewees was confirmed and verified by using photographs and live specimens. A medicinal use was accepted as valid only if it was mentioned by at least three independent herbal practitioners. Samples of these collected herbs were given a herbarium specimen number as shown in Table 2 and voucher samples were kept at the Pharmacognosy Laboratory of the Department of Pharmacy at An-Najah National University, Faculty of Medicine and Health Sciences (Table 2).
Table 2

Medicinal plants used for treatment of cancer in the West Bank regions/Palestine

 

Scientific names/Common names/Arabic names/Voucher specimen code

Family

Part used, method of preparation (herbal formulation) and dosages

Cancer Type

Preparation method and administration

UV

1.

Allium cepa L./Onion / Basal/ Pharm-PCT-2703

Amaryllidaceae

Bulb/About 20–40 ml of the bulb juice is to be given orally 7–8 times daily for four weeks.

Lung and stomach

Fresh bulb (oral)

0.29

2.

Allium sativum L./ Garlic/Thom/ Pharm-PCT-2704

Amaryllidaceae

Bulb/2–3 fresh cloves are eaten raw three times daily with meals.

Lung, Esophageal and breast

Fresh bulb (oral)

0.46

3.

Mangifera indica L./ Mango/ Manga/ Pharm-PCT-2725

Anacardiaceae

Fruits/About 300 ml of fresh fruit juice is to be given orally three times daily.

Colon

Fresh juice (oral)

0.09

4.

Pistacia palaestina Boiss./ Mastic tree, Lentisk/ Sirees/ Pharm-PCT-1870

Anacardiaceae

Leaves/Powdered leaves mixed with goat fat as paste, applied externally twice daily on cancer area.

Skin

Paste (topical)

0.59

5.

Annona muricata L. / Soursop/ Keshta/ Pharm-PCT-2726

Annonaceae

Fruit/One fresh fruit boiled with 100 ml syrup for five minutes; 20 ml of the produced syrup is to be given orally three times daily.

Bladder, prostate and colon

Syrup (oral)

0.32

6.

Daucus guttatus Sm. / Wild Carrot/ Jazar barry/ Pharm-PCT-832

Apiaceae

Seeds/About 100–130 powdered seeds steeped in water for 12 hours; 100 ml from the produced infusion is to be orally given four times daily.

Skin

Infusion (oral)

0.02

7.

Petroselinum crispum (Mill.) Fuss/ Parsley/ Bokdonas/ Pharm-PCT-2739

Apiaceae

Fruits/About 500–600 grams from the ground dry fruits boiled with one liter water for 30 minutes; 300 ml of this decoction is to be given orally three times daily.

Kidney and bladder

Decoction (oral)

0.16

8.

Calotropis procera (Aiton) Dryand./ Apple of Sodom, (mudar)/ A’oshar basek/ Pharm-PCT-472

Apocynaceae

Aerial parts (latex)/ Ten grams from air dried latex from the fruits is boiled with 40 ml water; 20 ml of this decoct is to be given twice daily.

Skin

Decoction (oral)

0.61

9.

Catharanthus roseus (L.) G.Don/ Vinca/ Wanaky/ Pharm-PCT-2728

Apocynaceae

Entire plant/About 25grams from the powdered plant mixed with 30 ml water; this paste is applied topically once daily.

Skin

Paste (topical)

0.47

10.

Nerium oleander L./Oleander/ Dafla/ Pharm-PCT-1636

Apocynaceae

Entire plant/About 20 grams from the powdered plant are mixed with 50 grams lanolin; this cream is applied topically on the skin cancer area directly 4–5 times daily.

Skin

Cream (topical)

0.53

11.

Arum dioscoridis Sm./ Spotted arum/ loof mobarkash/ Pharm-PCT-243

Araceae

Leaves/Boil about 10 grams of the dried leaves with 100 ml water, fifty ml of this decoction is to be given orally before meal.

Liver and stomach

Decoction (oral)

0.66

12.

Arum palaestinum Boiss./ Cuckoo pint / loof/ Pharm-PCT-246

Araceae

Leaves/Boil about 10 grams of the dried leaves with 150 ml water, fifty ml of this decoction is to be given orally three times daily before meals.

Liver, colon, kidney and breast

Decoction (oral)

0.63

13.

Polygonatum multiflorum (L.) All./ David's harp / Khatem Soleyman/ Pharm-PCT-2727

Asparagaceae

Rhizomes/Steep 2 grams from the powdered rhizomes with 100 ml water for 5 hours; 20 ml from this infusion is to be given orally three times daily.

Liver, brain and spinal cord

Infusion (oral)

0.60

14.

Brassica oleracea L./Cabbage/ malfof/ Pharm-PCT-1930

Brassicaceae

Leaves/100 ml from the fresh cabbage leaf juice is to be given 7–9 times daily.

Liver

Fresh juice (oral)

0.46

15.

Sinapis arvensis L./Wild mustard/ Khardal/ Pharm-PCT-2284

Brassicaceae

Seeds/Powdered seeds (2 g) given orally twice daily.

Bone

Powder (oral)

0.47

16.

Capparis spinosa L./Caper bush/ Cobar/ Pharm-PCT-496

Capparaceae

Roots/Crushed fresh roots (100 grams) mixed with 10 ml water, made into paste then applied topically once daily.

Bones cancer

Paste (topical)

0.47

17.

Colchicum hierosolymitanum L./ Colchicum/Lohlah/Pharm-PCT-644

Colchicaceae

Seeds/50 grams from the ground seeds mixed with 100 grams lanolin a are applied topically once daily on the tumor area.

Skin

Cream (topical)

0.53

18.

Achillea aleppica DC./

Yarrow/ Kaysoom/ Pharm-PCT-16

Compositae

Aerial parts/Steep 15grams from the plant with 100 ml water for 2 hours, 10 ml from this infusion is to be given internally twice daily.

Liver

Infusion (oral)

0.11

19.

Cichorium endivia L./Common chicory/ Shokar/ Pharm-PCT-617

Compositae

Flowers/Steep 100 grams from the plant with 100 ml water for 2 hours; 30 ml from this infusion is to be given once daily.

Stomach and colon

Infusion(oral)

0.22

20.

Inula viscosa (L.) Aiton/False Yellow head/ Tayon/ Pharm-PCT-2738

Compositae

Leaves/ Boil about 20 grams from the flowers with 100 ml water; 30 ml of this decoction is to be given orally three times daily before meals.

Kidney and bladder

Decoction (oral)

0.32

21.

Matricaria aurea (Loefl.) Sch.Bip./ Golden Chamomile/Babonaj thahabi/ Pharm-PCT-1519

Compositae

Flowers/ In case of lung cancer: Boil 50 grams flowers with 500 ml water; the vapor is inhaled twice daily for 10 minutes each time.

In case of liver and prostate cancers: Boil 30 grams from the flowers with 300 ml water for 15 minutes; 100 ml from the decoction is to be given orally twice daily.

Lung, liver and prostate

Vapor inhalation

0.47

22.

Onopordum cynarocephalum subsp./Artichoke Cotton-thistle/ kondrees/ Pharm-PCT-1692

Compositae

Flowers/ Steep 50 grams of the dried flowers with 100 ml water for one night; 50 ml from this infusion is to be given three times daily.

Stomach and colon

Infusion (oral)

0.23

23.

Silybum marianum (L.) Gaertn./Milk thistle Khorfeesh/Pharm-PCT-2282

Compositae

Stalk/ 30 drops of celery stalk fresh juice is to be given orally every three hours.

Colon and skin cancer

Fresh juice (oral)

0.32

24.

Taraxacum syriacum Boiss./ Common dandelion/Hindeba/ Pharm-PCT-2396

Compositae

Leaves/ Boil about 60 grams from the dried powdered plant with 100 ml water for 15 minutes; entire decoction is to be given 3–5 times daily.

Pancreatic and gallbladder stomach

Decoction (oral)

0.35

25.

Citrullus colocynthis (L.) Schrad./ Bitter Gourd/Hanthal/Pharm-PCT-628

Cucurbitaceae

Fruits/ About 150 grams from the powdered dried fruits mixed with equal quantity of lanolin; the produced cream applied topically twice daily.

Skin

Cream (topical)

0.13

26.

Cucumis sativus L./cucumber/ kheyar/ Pharm-PCT-2737

Cucurbitaceae

Seeds/ Steep 4grams of the ground seeds with 100 ml water for 12 hours; 10 ml from this infusion is to be given three times daily

Colon

Infusion (oral)

0.07

27.

Ecballium elaterium (L.) A.Rich./ Exploding cucumber / Ketha’ alhemar/ Pharm-PCT-870

Cucurbitaceae

Fruits (juice)/ / One fresh fruit pulp (about 25gram) juice is to be orally given five times daily

Throat and liver

Fresh juice (oral)

0.17

28.

Ephedra alata Decne./ Ephedra/ Alanda/ Pharm-PCT-904

Ephedraceae

Entire plant/ About 100 grams of the powdered plant boiled with 500 ml water for 5 minutes; 100 ml of this decoction is to be given orally twice a day.

Brain, liver and colon

Decoction (oral)

0.72

29.

Arbutus andrachne L./Greek Strawberry Tree/ Kotlob/ Pharm-PCT-213

Ericaceae

Fruits/ Boil 50 grams of the ground fruits with 100 ml water and 100 gram sugar; 20 ml of the produced syrup is to be given orally 5–6 times daily.

Stomach

Syrup (oral)

0.06

30.

Euphorbia hierosolymitana Boiss./ Spurge/Halablabon/Pharm-PCT-988

Euphorbiaceae

Entire plant/ Boil 50 grams from the plant with 150 ml water for 10 minutes; 5 ml of this decoction is to be given each 8 hours.

Ovarian, breast and prostate

Decoction (oral)

0.59

31.

Quercus calliprinos Webb/ Palestine oak/ Baloot/ Pharm-PCT-1978

Fagaceae

Fruits/ Boil about 20 grams from the fruits with 100 ml water, 20 ml of this decoction is to be given four times daily.

Colorectal

Decoction (oral)

0.11

32.

Quercus ithaburensis Decne./ Valonia oak/Sendnyan/ Pharm-PCT-1980

Fagaceae

Bark/ Mix 30 grams of the powdered bark with 100 ml lanolin then apply this cream on the cancer area.

Skin

Cream (topical)

0.13

33.

Hypericum perforatum L./St.John’s Wort/ Oshbat ala’ran/Pharm-PCT-2734

Hypericaceae

Flowers/ About 100 grams of the powdered flowers with 100 ml olive oil then filtered and 20 ml of the produced infusion is to be given orally twice daily.

Brain

Infused in olive oil (oral)

0.05

34.

Crocus sativus L./ Saffron/ Za’faran/ Pharm-PCT-2733

Iridaceae

Flowers/ Two grams of Saffron powder steeped in 300 ml camel milk; this milk infusion is to be given early morning once daily.

Liver and kidney

Infusion (oral)

0.46

35.

Melissa officinalis L./Balm mint/ Torenjan/ Pharm-PCT-1564

Lamiaceae

Aerial parts/ About 10 grams of the fresh leaves are given orally five times daily.

Lung and non-Hodgkin lymphoma

Fresh plant (oral)

0.27

36.

Origanum jordanicum Danin & Kunne/Thyme/Za'atar/Pharm-PCT-1729

Lamiaceae

Leaves/ About 50 grams of the leaves boiled in 500 ml water; inhale vapor three times daily, five minutes each time.

Lung, throat cancer

Vapor inhalation

0.15

37.

Rosmarinus officinalis L./ Rosemary/ Hasa alban/ Pharm-PCT-2732

Lamiaceae

Leaves/ About 20 grams of the leaves boiled in 600 ml water; inhale vapor three times daily, about ten minutes each time.

Lung cancer

Vapor inhalation

0.10

38.

Salvia fruticosa Mill./ Sage/ Maryamya/ Pharm-PCT-2117

Lamiaceae

Aerial parts/ Boil about 70 grams from the leaves with 300 ml water, the decoction is to be given four times daily.

Colon and liver

Decoction (oral)

0.26

39.

Salvia palaestina Benth./Kosa’en(kharna) falestini/ Pharm-PCT-2124

Lamiaceae

Leaves/ Fifteen grams of the leaves steeped with 100 ml water for 12 hours; 10 ml from this infusion is to be given twice a day.

Brain

Infusion (oral)

0.19

40.

Teucrium capitatum L./ Teucrium/ Ja’da/ Pharm-PCT-2407

Lamiaceae

Entire plant/ About 150 grams of the plant boiled for 10 minutes with water; 30 ml from the produced decoction is to be given once daily.

Pancreatic and liver

Decoction (oral)

0.42

41.

Laurus nobilis L. / Bay/ Gaar/ Pharm-PCT-1366

Lauraceae

Leaves/ Ten grams from the dried leaves boiled with 100 ml water; 20 ml of this decoction is to be given before meals 3–4 times daily

Prostate

Decoction (oral)

0.25

42.

Alhagi graecorum Boiss./

Camel-thorn/ ala’alook/ Pharm-PCT-65

Leguminosae

Fruits/ About 50 grams from the dried fruits boiled in 300 ml water; 10 ml of this decoction is to be given orally twice daily.

Glandular

Decoction (oral)

0.13

43.

Glycine soja Siebold & Zucc./ Soy/ Soya/ Pharm-PCT-2731

Leguminosae

Seeds/ About 100 grams of the seeds boiled in 500 ml water; 100 ml of this decoction is to be given orally 5–7 times daily.

Breast, ovarian and Hodgkin lymphoma

Decoction (oral)

0.19

44.

Ononis viscosa subsp. sicula (Guss.) Hub.-Mor./ spiny restharrow/ Shabrak(wassem)/ Pharm-PCT-1686

Leguminosae

Entire plant/ About 20–30 grams from the powdered plant boiled in 350 ml water; 10 ml of this decoction is to be given twice daily.

Prostate, stomach and breast

Decoction (oral)

0.07

45.

Linum usitatissimum L./ Flax/ Ketan/ Pharm-PCT-2735

Linaceae

Seeds/ Ground Seed (10 grams) are to be given orally three times daily.

Ovarian, breast and colon

Powder (oral)

0.19

46.

Lawsonia inermis L./ Henna / Hena/ Pharm-PCT-2736

Lythraceae

Leaves/ A paste from crushed fresh leaves (about 30 grams) are applied externally to affected areas.

Skin

Paste (topical)

0.22

47.

Punica granatum L./ Pomegranate/ Romman/ Pharm-PCT-2730

Lythraceae

Fruits (peels)/ About 500 grams of the fruit peels boiled in 1 liter water with 1000 grams sugar; 50 ml of this syrup is to be given twice daily.

Colorectal

Syrup (oral)

0.27

48.

Ficus sycomorus L./ Sycamore Fig / Jomeez/ Pharm-PCT-1030

Moraceae

Fruits/ One fresh fruit is boiled with 100 ml syrup for five minute; 20 ml of the syrup is to be given orally 4–6 times daily.

Lung

Syrup (oral)

0.19

49.

Psidium guajava L./ Guava /Juafa/ Pharm-PCT-2720

Myrtaceae

Leaves/ A decoction of 100 grams leaves is prepared in one liter water; 2–3 cups are taken orally per day until improvement occurs.

Lung and stomach

Decoction (oral)

0.19

50.

Orobanche aegyptiaca Pers. / Broomrape/ Halook/ Pharm-PCT-1746

Orobanchaceae

Roots/ About 500 grams of the ground roots boiled in one liter water for 30 minutes,; 50 ml of this decoction is to be given orally once daily.

Ovarian and breast

Decoction (oral)

0.21

51.

Trifolium philistaeum var. filifolium Zohary/ Palestine Clover/ Barsem/ Pharm-PCT-2493

Papilionaceae

Flowers/ About 50 grams of the flowers boiled in 60 ml water; 30 ml of this decoction is to be taken internally twice a day.

Ovarian, breast and non Hodgkin lymphoma

Decoction (oral)

0.14

52.

Plantago lanceolata L./ narrowleaf plantain/ Lesan alhamal/ Pharm-PCT-1887

Plantaginaceae

Leaves/ About 500 grams of the leaves boiled in 500 ml water; 100 ml of this decoction is to be taken internally 3–5 times a day.

Throat

Decoction (oral)

0.29

53.

Triticum aestivum L./ Bread wheat/ Kameh/ Pharm-PCT-2540

Poaceae

Seeds (husk)/ Powdered seed husks (10 grams) are given orally three times daily.

Colon

Powder (oral)

0.44

54.

Portulaca oleracea L./ Little Hogweed/ Farfahena/ Pharm-PCT-1935

Portulacaceae

Aerial parts/ About 100 grams of the plant boiled in 500 ml water; 30 ml of this decoction is to be taken 3–5 times a day.

Stomach and esophageal

Decoction (oral)

0.47

55.

Cyclamen persicum Mill./ Cyclamen/ Sapoon alraa’e/ Pharm-PCT-777

Primulaceae

Roots/ Twenty five grams of the ground roots boiled in 350 ml water; 30 ml of this decoction is to be given orally twice daily.

Prostate and bladder

Decoction (oral)

0.21

56.

Nigella arvensis L./ Black cumin / Kezha/ Pharm-PCT-1640

Ranunculaceae

Seeds/ About 100 grams of the ground seeds boiled in 330 ml water for 10–15 minutes; this decoction is to be taken 4–5 times daily

Lung, brain and skin

Decoction (oral)

0.49

57.

Ziziphus spina-christi (L.)Desf./ Christ's Thorn Jujube/ Cedar/ Pharm-PCT-2693

Rhamnaceae

Flowers/ About 100 grams of the flowers boiled in 500 ml water; 50 ml of this decoction is to be given internally 4–7 times daily.

Lung

Decoction (oral)

0.31

58.

Crataegus azarolus L./ Azarole Hawthorn/ Za’ror/ Pharm-PCT-712

Rosaceae

Fruits/ One kilogram of fresh fruit boiled with 1000 ml syrup for 30 minute; 50 ml of the syrup is to be given 5–6 times per day.

Lung

Syrup (oral)

0.41

59.

Galium aparine L./ Stickyweed/ Satoor/ Pharm-PCT-1069

Rubiaceae

Leaves/ Fifty grams of the leaves steeped with 100 ml water for one night; 10 ml from this infusion is to be given twice daily.

Hodgkin Lymphoma

Infusion (oral)

0.11

60.

Salix alba L./ White Salix/ Sofsaf abyad/ Pharm-PCT-2093

Salicaceae

Bark/ About 60 grams from the plant boiled with 500 ml water for 10 minutes; 50 ml of this decoction is to be given orally each 6 hours.

Colon

Decoction (oral)

0.19

61.

Viscum cruciatum Sieber ex Boiss./ Mistletoe/ hedal/ Pharm-PCT-2662

Santalaceae

Leaves/ About 500 grams from the powdered plant boiled with one liter water for 10 minutes; 50 drops of this decoction is to be given three times daily.

Esophageal

Decoction (oral)

0.51

62.

Acer obtusifolium Sm./ Syrian Maple/ Kaikab/ Pharm-PCT-15

Sapindaceae

Fruits/ About 500 grams of the fresh fruits boiled with 100 ml water and 100 gram sugar; 20 ml of the resulting syrup is to be given 6–8 times per day.

Throat and lung

Syrup (oral)

0.21

63.

Verbascum sinuatum L./ Mullein/ A’awarwar/ Pharm-PCT-2604

Scrophulariaceae

Leaves/ Five grams of the leaves boiled with 150 ml water for 30 minutes; 15 ml of this decoction is to be given orally twice daily.

Breast

Decoction (oral)

0.59

64.

Capsicum annuum L/ Chili pepper/ Shatta/ Pharm-PCT-2729

Solanaceae

Fruits/ Four fruits (100 grams) from the plant boiled with 200 ml water for 20 minutes; 5 drops of this decoction is to be given orally each 8 hours.

Skin, bladder

Decoction (oral)

0.16

65.

Lycium europaeum L./ Box thorn/ A’wsaj/ Pharm-PCT-1487

Solanaceae

Fruit/ About half kilogram from the fruit boiled with 500 ml water for one hour; 50 ml of this decoction is to be given once daily.

Bladder, prostate and breast

Decoction (oral)

0.37

66.

Mandragora autumnalis Mill./Mandrake/ Tofah almajan/ Pharm-PCT-1509

Solanaceae

Fruits/ Ten grams from the plant boiled with100 ml water for 30 minutes, 5 drops of this decoction is to be given twice daily.

Lung

Decoction (oral)

0.21

67.

Withania somnifera (L.) Dunal/ Ashwagandha/ A’eba’b monawem/ Pharm-PCT-2678

Solanaceae

Roots/ About 50 grams of the ground roots steeped with 100 ml water for 24 hours; 10 ml from this infusion is to be given twice daily.

Esophageal, skin and prostate

Infusion (oral)

0.19

68.

Camellia sinensis (L.) Kuntze /Green Tea/ Shae akhdar/ Pharm-PCT-2706

Theaceae

Leaves/ About 50 grams from the plant boiled with 300 ml water for 10 minutes; this decoction is to be given 6–8 times daily.

Breast, lung and ovarian

Decoction (oral)

0.31

69.

Daphne linearifolia L./ Mezereon/ Mazeryon/ Pharm-PCT-825

Thymelaeaceae

Fruits/ A decoction is prepared from 7 to 8 fruits (about 100 grams) boiled in 1 liter water and taken orally, 1 ml two times per day and taken for 14 days.

Lung

Decoction (oral)

0.04

70.

Urtica urens L./ Small Nettle/ Korees harek/ Pharm-PCT-2562

Urticaceae

Aerial parts/ About 100–120 grams of the plant boiled with 500 ml water for 30 minutes; 50 ml of the decoction is to be given three times daily.

Bones and stomach

Decoction (oral)

0.51

71.

Curcuma longa L./ Turmeric/ Korkom/ Pharm-PCT-2709

Zingiberaceae

Rhizomes/ About 500 grams from the ground dry rhizomes boiled with one liter water for 30 minutes; 300 ml of this decoction is to be given orally three times daily.

Prostate, bladder and liver

Decoction (oral)

0.53

72.

Zingiber officinale Roscoe/ Ginger/ Zangabil/ Pharm-PCT-2724

Zingiberaceae

Rhizomes/ About 100 grams of the ground dry rhizomes are boiled in 300 ml water for 10 minutes and given twice daily after meals.

Stomach and liver

Infusion (oral)

0.51

Data analysis

All citations were placed into ailment categories for each type of cancer. Factor of informant’s consensus (Fic) was employed to indicate how homogenous the information is. In fact, its main use is to select disease categories where there is consensus on the use of plants among the informants. Fic value is close to 0 if plants are chosen randomly, or if informants do not exchange information about their use. High values of Fic (close to 1) occur when there is a well-defined selection criterion in the community and/or if information is frequently exchanged between informants [28].

The Fic is calculated as in the following equation:
$$ {F}_{ic}=\frac{Nur-Nt}{Nur-1} $$

Where Nur is the number of use citations in each category and Nt is the number of taxa used.

Fidelity level (Fl) was defined as the ratio between the number of informants who independently suggested the use of a species for the same major purpose and the total number of informants who mentioned the plant for any use. Fl is of equal importance to Fic and it can be calculated according to the following equation:
$$ Fl=\frac{Np}{N}*100 $$

Where Np is the number of informants that reported a use of a plant species to treat a particular disease and N is the number of informants that used the plants as a medicine to treat any given disease [29].

The use-value (UV) is a quantitative method that can be used in order to prove the relative importance of species known locally. It is can be calculated according to the following equation:
$$ \mathrm{U}\mathrm{V}-\frac{{\displaystyle \sum U}}{n} $$

Where UV is the use value of a species; U the number of citations per species; n the number of informants [30].

Results of calculated FIC, Fl and UV are shown in Tables 2, 3 and 4.
Table 3

Factor of informant’s consensus (Fic) categorized by the types of cancer

 

Types of cancer

Nt

Nur

Fic

1

Lung

15

350

0.96

2

Colorectal

14

345

0.96

3

Liver

13

364

0.97

4

Skin

13

564

0.98

5

Stomach

11

265

0.96

6

Breast

11

267

0.96

7

Prostate

9

172

0.95

8

Bladder

8

159

0.96

9

Ovarian

6

84

0.94

10

Brain

5

122

0.97

11

Throat

4

74

0.96

12

Kidney

4

96

0.97

13

Esophageal

4

157

0.98

14

Bone

3

194

0.99

15

Hodgkin's lymphoma

2

19

0.94

16

Non-Hodgkin's lymphoma

2

25

0.96

17

Pancreatic

2

57

0.98

18

Spinal cord

1

25

1

19

Gallbladder

1

24

1

Table 4

Fidelity level of herbal medicines mentioned

Medicinal plant

Type of cancer

Np

N

FL,%

Achillea aleppica DC.

Colon

13

13

100.00

Alhagi graecorum Boiss.

Skin

88

88

100.00

Arbutus andrachne L.

Skin

3

3

100.00

Brassica oleracea L.

Skin

91

91

100.00

Calotropis procera (Aiton) Dryand.

Skin

70

70

100.00

Capparis spinosa L.

Skin

79

79

100.00

Catharanthus roseus (L.) G.Don

Liver

69

69

100.00

Citrullus colocynthis (L.) Schrad.

Bone

71

71

100.00

Colchicum hierosolymitanum L.

Bones cancer

71

71

100.00

Crataegus azarolus L.

Skin

79

79

100.00

Cucumis sativus L.

Liver

16

16

100.00

Daphne linearifolia L.

Skin

19

19

100.00

Daucus guttatus Sm.

Colon

10

10

100.00

Ficus sycomorus L.

Stomach

9

9

100.00

Galium aparine L.

Colorectal

17

17

100.00

Hypericum perforatum L.

Skin

20

20

100.00

Laurus nobilis L.

Brain

8

8

100.00

Lawsonia inermis L.

Lung

15

15

100.00

Mandragora officinalis Mill.

Brain

28

28

100.00

Mangifera indica L.

Prostate

37

37

100.00

Nerium oleander L.

Glandular

19

19

100.00

Pistacia palaestina Boiss.

Skin

33

33

100.00

Plantago lanceolata L.

Colorectal

40

40

100.00

Punica granatum L.

Lung

29

29

100.00

Quercus calliprinos Webb

Throat

43

43

100.00

Quercus ithaburensis Decne.

Colon

66

66

100.00

Rosmarinus officinalis L.

Lung

47

47

100.00

Salix alba L.

Lung

61

61

100.00

Salvia palaestina Benth.

Hodgkin's Lymphoma

16

16

100.00

Sinapis arvensis L.

Colon

29

29

100.00

Triticum aestivum L.

Esophageal

77

77

100.00

Verbascum sinuatum L.

Breast

89

89

100.00

Viscum cruciatum Sieber ex Boiss.

Lung

31

31

100.00

Ziziphus spina-christi (L.)Desf.

Lung

6

6

100.00

Origanum jordanicum Danin & Kunne

Lung

18

23

78.26

Psidium guajava L.

Lung

21

29

72.41

Orobanche aegyptiaca Pers.

Breast

23

32

71.88

Urtica urens L.

Bones

52

77

67.53

Zingiber officinale Roscoe

Stomach

52

77

67.53

Arum dioscoridis Sm.

Stomach

99

99

66.67

Allium cepa L.

Stomach

29

44

65.91

Teucrium capitatum L.

Pancreatic

41

63

65.08

Portulaca oleracea L.

Esophageal

42

71

59.15

Salvia fruticosa Mill.

Colon

23

39

58.97

Melissa officinalis L.

Non-Hodgkin's lymphoma

24

41

58.54

Inula viscosa (L.) Aiton

Kidney

28

48

58.33

Crocus sativus L.

Kidney

39

69

56.52

Acer obtusifolium Sm.

Lung

18

32

56.25

Onopordum cynarocephalum subsp.

Colon

19

34

55.88

Petroselinum crispum (Mill.) Fuss

Kidney

13

24

54.17

Capsicum annuum L

Bladder

13

24

54.17

Trifolium philistaeum var. filifolium Zohary

Ovarian

11

21

52.38

Annona muricata L.

Bladder

25

48

52.08

Ecballium elaterium (L.) A.Rich.

Liver

13

25

52.00

Glycine soja Siebold & Zucc.

Ovarian

15

29

51.72

Cyclamen persicum Mill.

Bladder

16

31

51.61

Cichorium endivia L.

Colon

17

33

51.52

Curcuma longa L.

Bladder

41

80

51.25

Results and discussion

Traditional herbal medicine knowledge and their utilization by indigenous cultures are not only useful for conservation of biodiversity and cultural traditions but also useful for the population’s healthcare and drug discovery in the present and in the future [31, 32].

Several studies have shown that around 80 % of rural populations in the developing countries consider herbal remedies as integral parts of treatments available. Recently, the use of natural herbal products is increasing in both developed and developing countries due to many reasons [33, 34].

As shown in (Table 1), most of the respondents who work in this field were males. Most of them had educational level equal or higher than high school. In fact about 19.3 % of the total interviewed were university graduates. The table also showed that the majority of respondents were from areas of the West Bank that mostly depend on agriculture or grazing as a mean of income (Jenin, Nablus, Salfeit and Toulkarem). In fact these areas are geographically close to each other (Fig. 1).

Notably the results of this research have revealed that 72 plant species belonging to 44 families were frequently used for treatment of cancer by the 150 herbalists, traditional practitioner healers, rural dwellers and people of the West Bank, Palestine (Table 2).

Echoing our findings in this research, members of the family Compositae and Lamiaceae were the most commonly used as presented in Table 2. The methods of preparation were decoctions (boiling the plants parts in water), infusions (steeping the plants in water for limited time), syrup (boiling the plants with water and sugar (1:1), creams (mixing the plant powders with goat fat or lanolin), paste, fresh juice, ingested entire plant, powder and vapor inhalations. Decoctions and infusions were the most frequently used methods of preparation as presented in Fig. 2.
Fig. 2

Frequency of methods of preparation from herbals

Leaves, fruits and seeds were reported to be the most frequently used parts of plants for the treatment of cancer, constituting about 56.9 % of the preparations. This was followed by flowers, aerial parts, entire plants, roots, rhizomes, barks, bulb and stalks as presented in Fig. 3.
Fig. 3

Frequency of the used parts of medicinal plants in cancer treatment

The most common cancer type treated with herbal remedies was lung cancer followed by liver, skin, colon and breast cancers as reported in (Fig. 4).
Fig. 4

Cancer types treated with herbals in Palestine

This research shows that the medicinal plants still play a role in the care of cancer patients in Palestine. Ephedra alata, Arum dioscoridis, Arum palaestinum were the most commonly used medicinal plants for treatment of cancer and all of these three plants were prepared as decoctions.

However, Ephedra alata were reported to treat three different types of cancer (brain, liver and colon). Accordingly, three Fl values were calculated. The highest one (40.74 %) was for liver cancer. The same consideration can be raised for Arum palaestinum which was reported to treat four different cancers (Liver, colon, kidney and breast). Breast cancer showed the highest Fl value (45.74 %). According to table 4, only Fl values higher than 50 % were included.

In the Mediterranean region and especially in the Holy land (Palestine), the traditional medicine has been highly appreciated and trusted. Many patients go to herbalists or informants to get benefit from this field. Most practitioners are males and this was confirmed in this study; some of them have university degrees. Complementary and alternative medicines are widely used among cancer patients throughout the world. In a previous study from Palestine, 60.9 % of cancer patients reported using medicinal herbs [35]. Medicinal plants utilized in indigenous health traditional system are gradually becoming wiped out due to over utilization, human overpopulation and from other human impact on the environment. The main problem is destructive harvesting of the subterranean parts of the medicinal plants, or even the entire plant.

Medicinal plants maintain the health and vitality of individuals, and may help in treatment of various diseases, including cancer. In this study, some anticancer medicinal plants of foreign origin have been presented. Many of these medicinal plants possess good immunomodulatory and antioxidant properties, which may lead to anticancer activities. The antioxidant phytochemicals protect the cells from oxidative damage. Thus, consuming a diet rich in antioxidant plant foods (e.g. fruits and vegetables) will provide health-protective effects. In 2013, a traditional practitioner living in Jenin claimed that he could cure a cancer patient completely using Ephedra alata. The local media here were interested in this story and many researchers have started working on this plant.

A multidisciplinary approach combining traditional herbal knowledge with pharmaceutical research is a valuable method for identifying potential herbs with possible clinical significance in cancer care [36].

To achieve a positive response to herbal preparations, the proper part of the plant that contains the active constituents should be chosen. It is well known that not all the plant parts contain the same concentration of the active constituents. The other factors to be considered are the harvesting time of the herb (collection time), the soil, the climate conditions, and the method of drying, processing, and extraction [37, 38]. Methods of preparation were mainly decoction and infusion. This is similar to previous studies in our country conducted by Ali-Shtayeh et al., 2011 and Jaradat, 2005 [35, 39]. In an ethnopharmacological survey of medicinal herbs in Golan Heights and the West Bank region performed by Said et al., 2002, only seven plant species were found to treat cancer among 81 species used for treating 115 different ailments and diseases [40]. In another study conducted in the West Bank, Ali-Shtayeh and Rana, 2011, found only 25 plant species used for treatment in cancer without mentioning which type of cancer they can treat [41]. In another study conducted by Ali-Shtayeh et al., 2011, in Palestine, 58 plant species were collected for cancer treatments [35], while in the survey which was conducted by Hudaib et al., 2008 in Jordan, Mujib Nature Reserve and surrounding area, only six plant species were found for treatment of cancer also without mentioning the type of cancer [42].

The methods of preparation mentioned by the informants are not supported by scientific evidence; this could be suitable for some plants but not for the others. In fact, the boiling process can cause severe degradation of the medicinal components in some plants.

The dosage is another concern. To have the expected benefits, the patients should receive a fixed well defined dosage, but in traditional medicine the suitable doses are not clear [37], so studies are needed to determine the concentration of active ingredients depending on their method of preparation to give the suitable recommended doses.

Table 3 shows the Fic values calculated for the categorized cancers. Fic values obtained for the reported cancers indicate the degree of shared knowledge among informants for the treatment of a cancer by certain medicinal plants. Most cancers had high Fic values; however the highest Fic =1 was scored for spinal cord and gallbladder cancers. Fl was 100 % for many plants; the highest UV (0.72) was for Ephedra alata.

Most of the mentioned plants in Table 2 are edible plants and the most of the non-edible plants were used externally. Therefore minor restrictions could be included as they have minor risk compared to the obtained therapeutic benefits from their use for cancer.

Resulting from this information, scientific practical work is in progress on the phytochemical and pharmacological analysis of the plants. This study is important to preserve the knowledge of medicinal plants used by the people of the West Bank regions. Also, it is of significance to utilize new therapeutic natural plant products in various treatments of diseases. Moreover, clinical studies approved according to international guidelines should be considered in order to prove the safety and efficacy of treatment, especially for the most frequently reported medicinal plants.

Conclusion

Many plant species are still used by herbalists and traditional practitioner healers in Palestine for treating various types of cancer. This article provides the knowledge about anticancer medicinal plants of local and foreign origin, which are used by the people all over the Palestinian area in addition to their method of preparation. Many of the used plants have been approved scientifically to have some anticancer activity. A combined scientific effort between informants and the scientific community working in this field may help in the discovery of new anticancer agents. Moreover, scientists may explore the most convenient method of extraction, formulation and dose determination in order to achieve the best benefit from these plants.

Further scientific laboratory studies are required to explore and to investigate the safety and efficacy of these plants, their potential therapeutic effects as well as probable interactions of these medicinal products with conventional anticancer medicines.

Declarations

Acknowledgements

This study was not funded by any institution. We would like to thank Dr. Cynthia Anderson for her help in language reviewing, all the herbalists and herbal practitioner healers in the West Bank/ Palestine and all participants in the study.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Pharmacy, Faculty of Medicine and Health Sciences, An-Najah National University

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© Jaradat et al. 2016

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