Introduction

Single-celled protozoan parasites named Plasmodium are the cause of Malaria and it is through the Anopheles mosquito that it is transmitted to man. It is recognised as one of the most important diseases globally, which is considered fatal, more so in the tropics, to add to it. It is endemic in about 102 nations worldwide, which is approximately more than 50 % of total population of the world.  They are all at risk experiencing high death rates of which children belonging to less than five years are part of (Smyth and Walkelin ,1994). Estimated by  WHO there are  every year about 300 to 500 new cases of malaria is recorded, every year, majorly in places like South America, Africa and the islands of south Pacific which contributes to at least 10 lakhs  deaths annually. Despite the management programs in many countries, there has been negligible development in the management of malaria. The infections can be the cause of reduced effectiveness of work and can lead to losses, both financial and human. Controlling malaria is complicated as drug resistant strains of Plasmodium keeps appearing and with the detection that man becomes infested with species of simian (monkey) malaria (Smyth and Walkelin , 1994). It is to be noted that the Anopheles mosquitoes have attained confrontation to many insecticides (Srisilam and Veersha ,2003) . Human Malaria is a fatal disease. It is transmitted through the bite of Anopheles sinensis an infected female mosquito. Most of the time one of four species of the genus Plasmodium namely: P. falciparum, P. vivax, P. ovale, P. malariae causes this disease.

Epidemiology of Malaria

In seven states of India belonging to the north eastern region namely, Tripura , Mizoram,  Assam, Meghalaya , Nagaland and Arunachal Pradesh  the spatial distribution data of P. vivax were examined retrospectively between the years 2008 till 2013(Sharma et al., 2015) . Moreover, cross-sectional surveys of malaria were organised and executed during 1991-2012 in malaria endemic spots across the States of Assam, Arunachal Pradesh, Mizoram, Nagaland, Meghalaya and Tripura to account for the occurrence of P. vivax across diverse age groups (Sharma et al., 2015) . In all north-eastern States vivax malaria prevailed but there was seen a clear separation of two malaria ecotypes following ≤30 and >30 per cent of the total cases of malaria (Sharma et al., 2015). Vivax cases ranging from 60–80% was noted in high proportions in Nagaland and Arunachal Pradesh in the north having an environment which is alpine, 42-67 per cent in the state of Manipur, however it ranged from 23- 31 per cent in Assam with tropical cum sub tropical climate (Sharma et al., 2015) . The least percentage of P. vivax cases were found in Meghalaya, Tripura and Mizoram. All age groups showed the occurrence of malaria cases but a maximum percentage of  P. vivax consistently occurred among  < 5 yr age group compared to P. falciparum (P<0.05 ) . It was throughout the year that P. vivax cases were recorded with the highest record coinciding with rainy season , however , the intensity of transmission and duration varied (Sharma et al., 2015).

Allopathic Medicine in the Treatment of Uncomplicated Malaria

The most commonly used medicine to treat malaria by the physician is chloroquine. It is found that  P ovale , P. vivax and P. malariae are usually responsive to this drug but in some strains of  P. vivax  there is an increasing resistance.

Herbal Plants in the Therapy of  Malaria

It is a well- known fact that humans have been using plants as a source of medicine since ancient times . There was a time when almost all medicines were derived from biological resources. In fact, plants and plant based medicines forms the basis of many modern pharmaceuticals even today for a number of ailments. The two most common drugs used to treat malaria are quinine and artemisinin isolated from Cinchona and Artemisia plants respectively.

Aims and Objective

To discuss the disease malaria and its causative organism.

To collect, elaborate and discuss the treatment of malaria by Traditional medicine which was practiced by various Tribal communities in north east states of India.

To discuss with local residents, traditional practitioners and export from the same field.

To discuss the practical usage of folk herbs in treating malaria.

Materials and Methods

Study Area

The investigation areas picked by the researcher are northeast states ( Sikkim , Assam , Arunachal Pradesh , Mizoram , Manipur and Nagaland ) of  India.  It is a known fact that the above mentioned states are mostly high mountainous territories of which two thirds of the area is mostly covered with mountains and hills having high terrains of height of more than 50 m lying between the valley of Brahmaputra which is above 7000 m in the borders of Himalaya (Sarma et al., 2019). The states lie between 22°00′ to 29°30′ N and 89°40′ to 97°25′ E, and occupy an area of 255,128 Km2 (Sarma et al., 2019). The total northeast states share its International borders of 4600 km with Bhutan (on West ) , Bangladesh ( on South ) , Myanmar (on East) and China (on North) (Sarma et al., 2019). Tropical monsoon humid climates prevail over the north-eastern states (Sarma et al., 2019). The regular temperature throughout winter season ranges between 16 to 20 and 30 °C during summer. The valleys and the mountainous region show a important climatic dissimilarity between them. The northeast region receives extremely heavy-to-heavy rain during June to September which is the South -West Monsoon season, and the region receives maximum rain in the month of June (Sarma et al., 2019). The yearly rainfall is 2000 mm which is also the average rainfall with local differences (1500 to 12,000 mm) (Sarma et al., 2019). More than 50 % , the geological area of all north-east states is afforest excluding Assam. The north east also forms one of the two biodiversity hotspots in India. 45,161,611is the overall population of the given area (2011 census) and it is not homogeneously distributed (Sarma et al., 2019). The northeast states are densely populated with plains of Brahmaputra, Barak river in Assam, the Imphal plain in Manipur and the Western part of Tripura (Sarma et al., 2019).

Table 1: List of Medicinal plant reported from northeast India as Antimalarrial

Figure 1: Image of political boundaries of seven northeast  states. Click here to view figure

The gateway to NE is Assam in India because it joins the Northeast region to the Indian Mainland by 22 km narrow piece known as the “ Chicken Neck ” (Sarma et al., 2019).

Ethnobotanical Survey 

The researchers have used their techniques to gather  information , same as used by (Asase et al., 2005) in their research  about the antimalarial plants in the investigation  area .

Field Interviews

The researcher walked with the local inhabitant  in the area where they generally  collect  their known antimalarial  plants and interviewed them . After identifying one plant used to cure malaria by locals people  , they consulted among themselves the antimalarial properties of the plant . The three to five  local inhabitants  involved in this study were suggested by the management of  Botanical Garden , Howrah , West Bengal as having the maximum information about the use of medicinal plants in the area

Door -to- Door Interviews

For the research , researchers interviewed  21 people by using a questionnaire prepared by them . Researcher took the assistance of a local trained guide for interpretation during the interview. The questionnaire  was prepared with the view of getting all information regarding the plants species , method of medicine preparation , prescription and administration of the medicine .

Interviews with Traditional Practitioners

Seven herbalists were identified with the help of local resource authority   . The researcher arranged for them to collect plants they use in the treatment of material . After collection the herbalists were interviewed about how they use these plants .

The primary data collected for the present research includes the books, journals, article, e books which have been written and published by the Universities and other institutions belonging to the north eastern region in India. The information has been collected on botanical therapies and other plant species which have been used for the treatment of malaria. The local conservative and conventional practitioners were interviewed after proper confirmation and validation from them.  The references and other data related to plants which were used in the present research have been properly placed in the pattern and the botanical name and division were also re analysed and were confirmed with the flora of India. For the purpose for the present study, researchers have interacted with the traditional practitioners with the help of interviews and other ways of communication in the communities residing and staying the states in the north-eastern regions in India.

Duration of Research

The researchers took a total of twenty (25) months to complete the survey work. The researchers stated the survey by the 1^st week of July, 2017 and ended it by the last week of August, 2019.

Result and Discussion

A total of 48 species belonging to 26 families were identified during the ethnobotanical survey as being used in the treatment of malaria. A complete data regarding scientific name of medicinal plants, botanical families name, local name and parts of plants used are given in table no. 01 . The traditional healer or vaids used leaves, roots, bark, stem, rhizome, seeds and sometimes whole plant as antimalarial medicine. Above mentioned parts of plants Leaves , roots and bark are most utilised  as antimalarial medicine by the traditional practitioners  or vaids .

The researcher worked on a total of 26 families named as  Apocynaceae (2) , Acanthaceae (2) , Asteraceae (3) , Berberidaceae (1) ,Betulaceae (1) , Boraginaceae (1) , Brassicaceae (1), Caricaceae (1), Euphobiaceae (2) ,  Fabaceae (1), Gentianaceae (3) ,Lamiaceae (2) , Lauraceae (1) , Malvaceae (1), Menispermaceae (2), Orchidaceae (1), Pasifloraceae (1), Piperaceae (1), Ranaculaceae (2), Rubiaceae (4) , Rosaceae (2) , Rutaceae (4), Saxifragraceae (1) , Scrophulariaceae (2) , Solanaceae (3) , Verbanaceae (5)   .  Among the above mentioned families Verbenaceae (5) , Rutaceae (4), Rubiaceae (4) , Asteraceae (3), Gentianaceae (3) , Solanaceae (3) are principal  in respect  of the number of species utilised  to treatment of  malaria.

During the survey, it is found that the five species of plants namely Copyis teeta , Alstonia Scholaris, Crotolaria occulta, Vitex peduncularis and Acimum sanctum were used by at least one traditional practitioner from others parts of northeast in India. During the survey, it is also found that these four botanical families Apocynaceae , Fabaceae , Lamiaceae and Verbaceae are used by more than one traditional healer or vaids  throughout the northeastern states in India .

This observation was important for further scientific validation of traditional knowledge and is an enduring aspect of ethnobotany in general.

The reported species that was used particularly for the treatment of the given sickness, malaria, were either available around he habitation where the people resided or the same was available in the forest area around the north eastern region. More than twenty scholars have reported that given plants having anti malarial properties and also the researcher himself reported of at least ten plants containing the anti malarial properties in the different regions of Arunachal Pradesh.

The traditional practitioners  used different processes like decoction , infusion , maceration and mechanical crushing to extract the pharmacological agents from different plants The traditional practitioners  or vaids prescribed different oral dose of extract according to  patient conditions .

However, it was not possible to know how these medicinal practitioners or vaids estimated the therapeutic index of the prescribed antimalarial plant based formulations without causing any lethal consequence.

Most traditional practitioners acquired the knowledge about medicinal plants and its uses either by their ancestors or from other resources. During the survey it is found that only 60 % traditional practitioners or vaids are having certificates or done a specified course to practice his profession. Prior to prescription ,the traditional practitioners  were found to enquire about some basic information such as age , gender , pre-medical history , symptom of the malaria , any pre-treatment , since how long  he/she is suffering from it and alcoholic /non-alcoholic .

The plants that were scrutinised for the present research belonged to Manipur, Mizoram, Assam , Arunachal Pradesh and Tripura. The plants have been used as the traditional treatment of malaria and it would also cure the symptoms of the same. Most of the plants that have been used were in the form of decoctions and the some other plants have been used which were externally and internally available in the local regions. Shrubs and other herbs were also utilised in the treatment of malaria however leaves is the most commonly utilised plants in the therapy of malaria.

The percentage for the treatment is as follows:

Leaves is 38 percent

Roots is 33 percent

Whole plants is 07 percent

The great frequency of the use of leaves in the treatment is the traditional method is because of the easy availability of the leaves in the given area and also easy gathering of leaves for the treatment. The knowledge on treatment of malaria by plants in the north eastern regions is a combination of high level of relation which is found in the uses of the mentioned plants. It indicates that the inheritance of the knowledge of our fore fathers is well known all across the countries.

It shows that sometimes when the alternative medium is available in remote areas for the treatment. Four species from the north-eastern regions were found to be present  also as repellents of mosquitoes. The local people used them as an alternative for Dichlorodiphenyltrichloroethane  and other pesticides  too. It is a commonly well – known fact that Dichlorodiphenyltrichloroethane  and other pesticides have great impact on human health and also to the environment at large.

Plants having the properties of antimalarial components such as alkaloids, sesquiterpenes, quassinoids, flavonoids and triterpernoids can be extremely important sources. These compounds have very high, low and moderate in the antiplasmodial actions while some of them remained inactive. They also have an important feature of extraction of crude and essential oils and also other chemical structure from the other plants. These are important properties, which are also anti microbial in nature.

The information gathered, there were also similar properties of the plants analysed such as, some plants showed increased potency when compared to other plants. There were also other plants that were employed for the proper symptoms of malaria such as fever, weakness, failure in the renal area and body pain. Most of the plants that have been taken into consideration have lacked actions against malaria because of the absence of an important aspect vitro activity against the Plasmodium. Some of the scholars have however underestimated the conventional plants and their uses for the treatment of malaria and it is specifically based on low activity against the Plasmodium in animal models and vitro actions. This makes the methodology or the strategy slightly erroneous.

Figure 2: Maximum used families of antimalarial medicinal plants used by traditional practitioners. Click here to view figure

Figure 3: Parts used as medicine along with their percentage. Click here to view figure

Significance in Today’s  Era

It was back in 900 BC when Indian Ayurveda ( Science and knowledge of life ) was discovered and used (Ebbell , 1937) . Prior to the advent of iatrochemistry in the 16th century , plants were the primary source of treatment and prophylaxis (Kelly , 2009) . The beginning of the medicinal plant’s use was instinctive, as is the case similar to animals (Stojanoski, 1999).

The widespread use of medicinal plants is not restricted to India or other developing countries. Other countries such as Canada and Germany have been using the herbal medicine regularly to treat medical problems in the patients such as diabetes and high levels of cholesterol. Thus, it can be said that there is an exponential increase in the use of medicinal plants in the present times. With the relaxation of the rules regarding the use of medicinal plants in certain countries all over the world, the market of medicinal plants has boomed. Over the last couple of years, a very curious thing has happened, instead of losing popularity over medical science and pharmaceutical industry, the medicinal herbs and plants have boomed as because have understood the importance of the same. One very important reason as to why medicinal plants have obtained popularity in the present era as well as in the years to come is because of its inability to cause any side effects which the pharmaceutical drugs have the likelihood of causing. With the increased awareness amongst people about health issues, concerns have been raised continuously and that is why people opt for a more healthy and natural way for curing their illness. There is however no doubt those herbal medicines have been found to have some type of impressive credentials. Another reason as to why medicinal plants shall be gaining more popularity in the years to come is their sure shot cure. This means that it is estimated that most of the patients who have been treated with the use of medicinal plants, the results are effective. For example, the use of penicillin which, replaced mercury in the treatment of syphilis has put to an end many deadly epidemics which came from plant mold. Belladonna continues to provide the chemical which can be used in the treatment of opthalmological preparations and other antibiotics that can be used in the treatment of gastrointestinal problems.

The use of Indian snake root i.e. Rauvolfia serpentine contains, reserpine, which is an active ingredient that can be used for the treatment of many emotional and mental problems too. However, resperine is hardly used in the present times the discovery of the same was a remarkable invention in the field of medicinal plants. Thus, in the coming years as well as in the present era the use and importance of medicinal plants is growing and there is an upsurge in the use of the same in most of the medical issues. However, before medicinal plants is used as a mainstream medicine, it is important that some of its problems gets solved. To attain a stage where the medicinal plants gives best quality and effective treatment it should in the first place become integrated to the mainline treatment and also overcomes the obstacles which may come in the near future.  The present practicing health care professionals do not learn about phytomedicines nor do they hold programs to spread about its awareness. The main problem that should be solved before the herbal medicines join mainstream is to improve the quality of information which is available about them in the form of literature review, journals and articles. With misinformation which can be easily spread because of internet, it becomes very important to make sure that the information which is passed on is highly filtered. Thus, the efficacy, safety and regulations in pursuit of medicinal plants should be well written and well explained before it is available on a public platform. By ensuring these, one can become sure of the increase use of medicinal plants for curing diseases globally.

Conclusion

Based on the above research work, it can be concluded that medicinal plants are powerful sustainable herbs, which are mostly beneficial to humankind.  It is the different chemicals substance, which is lies inside the medicinal plants that produce a particular physiological action on the human body.  Mostly chemical compounds which are present inside the medicinal plants are  phenolic , alkaloids , flavonoids and tannins etc In India , Northeast states ( Tripura, Mizoram , Assam , Manipur , Meghalay , Nagaland and Arunacha Pradesh ) are  under considered geographical location and possesses huge number of valuable medicinal plants .  The current survey found a good number of medicinal plants in northeast states which have significant role in the treatment of Malaria.

During the survey, it is also realised  that most of local people using the above mentioned medicinal plants for treatment of Malaria . However, the widespread use of the medicinal plants is not restricted to developing nations. The rebirth of the herbal medicines, which, has taken place n the developed countries, took place because of the revival of interests in the scientific information of plants. Herbal medicines are not only used for the treatment of Malaria but also for other chronic diseases. The trained physicians cannot ignore the use of herbal medicines. They should realize it that the large number of patients is using the herbal medicines. The disclosure from the patients using herbal medicines may redirect them to use medicinal plants for the treatment too. The patients and the physicians should enter into a discussion and should compare about the appropriateness of herbal medicines over the pharmaceutical drugs.

Patients who are suffering from chronic problem such as AIDS or cancer should be made aware of the benefits that are linked with the usage of medicinal plants for their treatment. The aim of the study was to find out the use of medicinal plants for treatment of malaria by the indigenous people who stay in the north east regions of India have been initiated and handful of plants have been found to cure Malaria. Thus, the aim of the present research has been satisfied. Moreover, the research also deals with the importance or the significance of the study in the present era.

Acknowledgements

First and foremost, I would to thank Allah Almighty for giving me the strength, knowledge, ability and opportunity to undertake this research work and to preserve and complete it satisfactorily. Without his blessings, this achievement would not have been possible.  I take pride in acknowledging the insightful guidance of  Dr. Soma Ghosh , Principal ,  H  M M College for  Women , Kolkata  , West Bengal , India , for sparing her valuable time whenever I approach her and showing me the way ahead .

The author wish to thank the entire team of Mahendra Tamang and his family without whom the project would not have been possible. Furthermore , we would like to thank,  Dr. Amitava Samanta , Associate Professor , Bidhan Chandra Krishi Viswa Vidyalaya , Mohanpur , Kalyani , West Bengal  for his relevant practical and theoretical support .

We also thank the staff of Botanical Garden, Howrah for guiding us to locate the important places in northeast states and authentic identification of a few plants samples used in the study.

I would also like to express my gratitude to my entire colleagues of H M M College for Women , Kolkata who have been so helpful and cooperative in giving their support at all times to help me to achieve my goal .

My acknowledgment would be incomplete without thanking the biggest source of my strength, my family and the blessing of my late parents.

Conflict of Interests

The author declare that there exist no commercial or financial relationship that could , in any way , lead to potential conflict of interest .

Funding Declaration

We would like to thank on behalf of entire research team to SFA Enterprises, New Delhi  , India – 110091 for minor funding ( Rs 51000/- )

References 

1. Asase, A., Oteng-Yeboah, A.A., Odamtten, G.T., Simmonds, M.S., 2005. Ethnobotanical study of some Ghanaian anti-malarial plants. J. Ethnopharmacol. 99, 273–279. doi:10.1016/j.jep.2005.02.020
2. Baruah, S., Borthakur, S.K., Gogoi, P., Ahmed, M., 2013. Ethnomedicinal plants used by Adi-Minyong tribe of Arunachal Pradesh, eastern Himalaya. Indian J Nat Prod Resour 4, 278–282.
3. Biswas, K., 1982 . Common medicinal plants of Darjeeling and the Sikkim Himalayas. Delhi, Soni Reprints Agency.
4. Das, A., Tag, H., 2006. Ethnomedicinal studies of the Khamti tribe of Arunachal Pradesh. Indian J Tradit Knowl 05, 317–322.
5. Ebbell , B., 1937 . The Papyrus Ebers : The Greatest Egyptian Document. Levin & Munksgaard H. Milford Oxford University Press , Copenhagen ; London
6. Kohli YP., 2003. Ethnomedicines in the service of tani tribes. In: Mibang T, Chaudhuri SK, editors. Ethnomedicines of the tribes of Arunachal Pradesh. Itanagar: Himalayan pub.,  2003. pp. 13–7.
7. Kelly , K., 2009. History of medicine . Facts on File , New Yorl , pp . 29-50 .
8. Kumar S.,  2002. The Medicinal Plants of North East. Scientific Publ , Jodhpur, India .
9. Lalfakzuala, R., Lalramnghinglova, H., Kayang, H., 2007. Ethnobotanical usages of plants in western Mizoram. Indian J Tradit Knowl 06, 486–493.
10. Mahanti, N.,1994. Tribal ethno-botany of Mizoram. New Delhi, India, Inter-India Pub.
11.  Pandey, V. N., & Issar, R. K.,  1991. Medico-ethno-botanical explorations in Sikkim Himalayas. CCRAS., New Delhi .
12. Purkayastha, J., Dutta, M., Nath, S., 2007. Ethnomedicinal plants from Dibru-Saikhowa biosphere reserve, Assam. Indian J Tradit Knowl 06, 477–480.
13. Rai, P.K., Lalramnghinglova, H., 2010. Ethnomedicinal Plant Resources of Mizoram , India : Implication of Traditional Knowledge in Health Care System. Ethnobot Leafl 14, 274–305.
14. Shankar, R., Deb, S., Sharma, B., 2012. Antimalarial plants of northeast India: An overview. J Ayurveda Integr Med 3, 10–16. https://doi.org/10.4103/0975-9476.93940
15. Sarma, D. K. et al.,  2019. ‘Malaria in north-east india: Importance and implications in the era of elimination’, Microorganisms, 7(12), pp. 1–22.doi: 10.3390/microorganisms7120673.
16. Sharma, V.P., Dev, V., Phookan, S., 2015. Neglected Plasmodium vivax malaria in northeastern States of India. Indian J Med Res 142, 546–555. https://doi.org/10.4103/0971-5916.159511
17. Shankar, R., Rawat MS.,1996. Medicinal plants and some folklore from East and West Siang district    Arunachal Pradesh and their utilization. Bull Medico Ethno Bot Res. 17, pp. 1-7.
18. Sharma, U. K., 2004. Medicinal plants of Assam..In: BSMPS . Dehradun , India.
19. Shankar, R., Rawat MS., 2007. Medicinal plants vis a vis forest management in Arunachal Pradesh: Ayurveda  and Drugs for all. Himalayan Pub , New Delhi , pp. 110-118
20. Shankar, R., Rawat  M.S., 2008 . Medico-ethno-botany of Arunachal Pradesh : Papum Pare , Lower , Uppar  Subansiri and Kurung Kumey districts , 1^st ed. Regional Research Institute       ( Ayurveda ); New Delhi : CCRAS , Govt. of India ; Itanagar , Arunachal Pradesh
21. Shankar, R., Lavekar, G.S., Deb, S., Sharma, B.K., 2012. Traditional healing practice and folk medicines used by Mishing community of North East India. J Ayurveda Integr Med 3, 124–129. https://doi.org/10.4103/0975-9476.100171
22. Sinha S.C., 1996. Medicinal Plants of Manipur. Manipur Cultural Integ Conf., Palace Compound, Imphal, Manipur, June 31 – July 2, pp. 116-128
23. Singh RK., 2005. Tinospora cordifolia as an adjuvant drug in the treatment of hyper-reactive malicious splenomegaly : case reports. J Vector Borne Dis. 42(1), pp. 36‐38.
24. Smyth, J. D., & Wakelin, D. (1994). Introduction to animal parasitology. Cambridge, Eng, : C.U.P.
25. Srisilam K, Veersham C.,2003. Antimalarials of plant origin. In: Khanum, A Khan IA editors. Role of Biotechnology in Medicinal and aromatic plants. Ukaaz Pub. , Hyderabad, India, pp. 17-47.
26. Stojanoski , N., 1999. Development of health culture in Veles and its region from the past to the end of 20^th century Society of Scince and Arts , Vele , pp. 13-34 .