Folk medicine in the northern coast of Colombia: an overview

About 80% of the populations of developing countries continue using traditional resources in health care [1‐6]. The main goal of ethnopharmacology is to identify novel compounds derived from plants and animals for use in indigenous medical systems. This knowledge can be used in the development of new pharmaceuticals. Most of the literature in ethnopharmacology describes medicinal plants used by people who have lived in the same ecological region for many generations. Ethnopharmacologists seek ways to improve the ethnomedical systems of the people whom they study by testing indigenous medicines for efficacy and toxicity. Through this kind of work, ethnopharmacology has contributed to the discovery of many important plant-derived drugs [7].

Colombia accounts for approximately 10% of the world's biodiversity and is home to about 50,000 species of plants [8‐10], of which only 119 are included in the Colombian Vademecum of Medicinal Plants [11]. The diverse topography of the Colombian territory and the country's wide range of climates have favored the formation of varied habitats. Despite the country's natural richness, the status of scientific knowledge on Colombian flora is still incipient in many aspects. The Andean region represents the largest area in the country. It contains a wide variety of biomes, among which are wetlands. The Pacific region has one of the most important pockets of biodiversity in the world, and the tallest costal mountain in the world (18,700 ft above sea level) is in Colombia's Caribbean region. This mountain, the Sierra Nevada de Santa Marta, has a complex variety of flora and fauna since it is completely separated from other ranges mountain, and it contains many different kinds of habitats [10, 12]. It is estimated that only about 70% of the Colombian flora is known, and, on the other hand, there is a worrying number of endangered species. There are also threats due to high levels of water and air pollution and the resulting effects of these on human quality of life and ecosystem health [12‐14]. A similar situation has existed regarding traditional knowledge associated with floristic resources in many regions of the country. At different times in Colombia's history, especially between the Conquest and Colonial periods, when people of different cultures have generated an amalgam of varied customs and beliefs which have in turn contributed to create a diverse and valuable cultural heritage that includes the use of medicinal plants. Many species of plants are still used widely to treat common illnesses in practically the entire Colombian territory [15, 16]. Despite the great importance that floristic resources represent for the population, the country's health authorities have given the resource little attention, and governmental support for research and development of economically viable alternatives in this field has been scarce. Only in recent years, Colombian authorities have begun to focus on the value of the country's biodiversity and to create mechanisms for its use. Laws have been formulated to regulate the commercialization, production, storage, distribution, and use of medicinal plants. In 1994, for example, a listing of medicinal plants and their approved uses was produced by the Comisión Revisora de Productos Farmacéuticos-Colombia (Review Commission for Pharmaceutical Products-Colombia) [11].

The communities that were studied at the north of the department of Bolívar are low-income populations and dedicated mainly to agriculture and ranching. Plantations include grains, fruits, and vegetables, which are the main source of income and employment for men. Large cattle ranches occupy areas that once supported habitats of diverse native plant species that have disappeared and whose number cannot be determined. Handcrafts (hats, mats, musical instruments, tools for agriculture, and others) are made for own consumption or for sale by order. They constitute part of the traditional know-how that is passed from generation to generation. Other sources of income are fishing and forestry, and salt production.

We highlight the community of San Basilio de Palenque investigated in our ethnopharmacological study. San Basilio de Palenque is located in the department of Bolívar, 50 km south of the city of Cartagena de Indias. The community was founded by black slaves who fled and established palenques (villages of fleeing slaves, or cimarrones) in the northern coast of Colombia, beginning in the fifteenth century. Much later, the term palenque became synonymous with freedom. From the many palenques that existed in the Colonial period, San Basilio is the only one that has survived, and it has struggled to maintain its cultural identity. San Basilio de Palenque is the cradle and testimony of the rich African traditions in Colombia.

San Basilio, known also as Palenque, is famous for its symbol, the palenqueras, dark-skinned women dressed in multicolor dresses who carry fresh fruit and traditional candies in large bowls (palanganas) on their heads and sell them in cities such as Cartagena.

The Colombian State, in collaboration with these communities, has formulated and developed plans to preserve, conserve, and protect the different popular expressions and knowledge that constitute the communities' identity. However, factors such as racial discrimination, forced migrations resulting from the violence that has affected Colombia for more than 50 years, acculturation, and the lack of plans for cultural transmission, have affected the expression of traditions that are unique to the regions of northern Colombia, including the passing of knowledge related to traditional medicines, in detriment to the cultural stability of communities and the cultural diversity of the region [12].

The Colombian Caribbean region has a unique combination of geographical and topographical attributes that has given it an extraordinary diversity of flora and fauna. Moreover, considering the cultural diversity of its people, this region has a great pharmacological reserve based on its natural resources. Some characteristic species of this part of Colombia are known commonly as pringamosa (Urera baccifera (L.) Gaudich.), trupillo (Prosopis juliflora (Sw.) DC.), caracolí (Anacardium excelsum (Kunth) Skeels), clemón (Thespesia populnea (L.) Correa), dividivi (Libidibia coriaria (Jacq.) Schltdl), matarratón (Gliricidia_sepium_(Jacq.) Kunth), totumo (Crescentia cujete L.), ají (Capsicum annuum L), ajo (Allium sativum L.), anamú (Petiveria alliacea L.), guayaba (Psidium guajava L.), mamey (Mammea americana L.), tomate (Lycopersicon esculentum Mill.) and orégano (Lippia graveolens Kunth.) [9, 10, 15, 17].

The common interest of many Colombian researchers of preserving this cultural tradition has led to interdisciplinary work among several institutions, for example with the purpose of finding natural-therapy alternatives to several illnesses [10, 18, 19]. For instance, research groups in several disciplines have worked with small communities in the department of Bolívar on the recovery of botanical knowledge in small towns. The location of the main areas can be seen in Figure 1.

The use of medicinal plants as an alternative medicine for the Colombian population has been approved by the government recently, and the Social Protection Department has produced the Colombian Vademecum of Medicinal Plants, which lists the species that have been approved for a specific use and their verified pharmacological activity, main components, instructions for use, toxicity, counter indications, and available pharmaceutical forms [11].

The work presented in this paper can be included into the general context of basic and applied ethnopharmacology because it was conceived to document the traditional knowledge on botanical medicine from Colombia's Caribbean region. Although other valuable investigations have been carried out on indigenous communities, black communities and rural communities in other regions of Colombia with the support of universities and non-government organizations [13], in the Atlantic Coast, and more concretely in the department of Bolivar, the development of ethnobotanical investigations is scant. Considering the enormous floristic wealth of this region and the cultural diversity of its communities, it is crucial keep documented this cultural heritage to avoid dissapearing this valuable knowledge forever. Deforestation and unsustainable farming practices represent additional threats for the medicinal flora and the traditional practices that depend on it.

In our study, a total of 1225 heads of family were interviewed in 8 small towns of the northern department of Bolívar. Many of the interviews were accompanied by supplemental information with specific details of the species studied, such as location, means of collection, disease symptoms, botanical identification, and personal testimonies of the people related to their living experiences.

Men seemed to have less knowledge than women about traditional medicine, probably because they spend less time than women on tasks related to family health. The average age of the participants was 54. Approximately 39 plants were reported by informants as the most used as notable healing remedies, with 33 medicinal uses. In order to analyze the data, all ailments were categorized into 14 major groups based on the system or organ of the human body affected (Table 1). In Table 2 lists the main species used, their botanical and family name (in alphabetical order by scientific name), collection number, common name, popular usage, part plant used, and a simple description of the manner of preparation and administration.

Our results suggest that people have done a coherent use of plants for medicinal goals in the study region. Species with the largest number of reported uses were Allium sativum L. (illness: intestinal parasites), Aloe vera (L.) Burm.f. (flu), Alpinia purpurata K. Schum (headache and common cold), Ambrosia cumanensis Kunth (common cold), Annona muricata L. (fever and inflammation), Annona purpurea Moc. & Sessé ex Dunal (evil eye), Aristolochia anguicida Jacq. (pruritic ailments and snake bite), Chenopodium ambrosioides L. (internal parasites), Crescentia cujete L. (flu), Eucalyptus globulus Labill. (flu), Euphorbia tithymaloides L. (inflammation), Gliricidia sepium (Jacq.) Kunth (pruritic ailments and fever), Guazuma ulmifolia Lam. (inflammation), Heliotropium indicum L. (internal parasites and pruritic ailments), Justicia chaetocephala (Mildbr.) Leonard (Urinary ailments), Luffa operculata Cogn. (Sinusitis), Malachra alceifolia Jacq. (inflammation), Mangifera indica L. (indigestion), Matricaria chamomilla L. (colic, conjunctivitis and nervousness), Mentha sativa L. (nervousness), Momordica charantia L. M. Nee. (intestinal parasites), Murraya exotica L. (toothache), Ocimum basilicum L. (dry skin condition and common cold), Ocimum tenuiflorum L. (Flatulence), Origanum majorana L. (flatulence), Origanum vulgare L. (earache), Petiveria alliacea L. (fever), Plantago major L., R. Liesner (kidney pain and eye injuries), Psidium guajava L. (diarrhea), Ricinus communis L. (Common cold), Russelia equisetiformis Schlecht. & Cham. (kidney stones), Solanum americanum Mill. (toothache), Tabebuia rosea DC. (skin affections) and Terminalia catappa L. (skin affections).

The plant families mostly used by inhabitants were Asteraceae, Lamiaceae, Anacardiaceae, Annonaceae, Bignoniaceae, Cucurbitaceae, Euphorbiaceae, Liliaceae and Myrtaceae. 82% of the plants that are administered internally are prepared as a decoction, infusionor by extraction of the juice of fresh leaves after mashing the plant in some water. For external uses such as dermatological problems, poultice is the preferred form of application.

The highest IAR values (Informant Agreement Ratio, IAR = 0.96), which indicated the major consensus among informants, were established for skin problems like pruritic ailments, boils, dry skin condition and dermatosis presumably caused by fungal or yeast infections and inflammations. Other IAR values were as follows: respiratory tract diseases and cough (0.95), gastro-intestinal system disorders (0.92), central nervous system complaints (0.89), infections (0.85), ear ailments (0.85), and urinary ailments (0.85) (Table 3). Our results showed a great similarity to the corresponding data on morbidity given by the Office of Health of the department of Bolívar for the years 2006-2008 [25, 26].

The observations emanating from the present survey need to be substantiated with other pharmacochemical studies in order to scientifically evaluate or validate their popular uses. However, for some species, there is evidence in the literature that the mode of application being practiced by the local people is likely to be effective. For example, our group reported several furanonaphthoquinones isolated from the bark and stem of Tabebuia sp., and these compounds have been related to antimalarial activity [27‐29]. In 2002, two diterpenoids and aristolochic acid I were isolated from the methanolic extract of the stem of Aristolochia anguicida Jack, and were also associated to some treatments [30]. Other uses have been validated and reported in Farmacopea Vegetal Caribeña for the Tramil group [21, 31] and other important research groups in Colombia [32‐35].

There is a great variety of medicinal plants in the department of Bolívar (Colombia), and they have been used traditionally by the population for the treatment of their illnesses. This knowledge has been passed from generation to generation. The multiple uses reported in this study indicate that scientific investigations are useful in the validation of traditional medicinal practices in this region, which can allow obtaining and developing new therapeutic agents from Colombian plants.

This study showed a high level of coincidence among respondents regarding the use of medicinal plants in the region. The plants used for the most frequent illnesses are Aristolochia anguicida Jacq., Gliricidia sepium (Jacq.) Kunth, Ocimum basilicum L. Tabebuia rosea DC. and Terminalia catappa L. for skin affections and Annona muricata L., Euphorbia tithymaloides L., Guazuma ulmifolia Lam. and Malachra alceifolia Jacq. for inflammation.

Quantitative studies on traditional uses of plants as medicines, such as the one we presented here, are particularly important because they address crucial aspects of a region's biological and cultural diversity.