Introduction

The Chittagong Hill Tracts (CHT) region at the southeast corner of Bangladesh comprises of the districts of Bandarban, Cox’s Bazaar, Khagrachaari and Rangamati. The region consists of forested low hills and is inhabited by a number of tribal people, the Chakma tribe being the largest with the Marma tribe being the second largest. The Marmas are also known as Moghs, and though no accurate population statistics are available, it is estimated that around 200,000 Marma people reside in the CHT region. Although the Marmas have their own language and distinctive culture (including their own medicinal practices and TMPs), in recent years, they have started to attend schools, learn the mainstream Bengali language, discard their TMPs in favor of allopathic doctors, in short becoming merged slowly with the mainstream population.

Human beings possibly needed medicines since their very advent, and it has been postulated that plants, because of their huge diversity and number of species (over 270,000 flowering plants), met the medicinal needs of the early humans [1]. Plants produce secondary metabolites or phytochemicals, which can be toxic, but a number of which can have therapeutic uses [2]. Indigenous peoples can be a valuable knowledgeable source of therapeutic uses of plants, since they have used plant-based medicines for possibly thousands of years, which knowledge has been preserved initially through oral traditions and later on in writing. In fact, many important modern drugs have been discovered from plants or through close observations of the medicinal practices of indigenous peoples [3]. Some of these drugs are morphine, quinine, vincristine, paclitaxel and serpentine, to name only a few [4].

Allopathic medicine, despite its huge success over the last 200 years, has started to face multiple problems. Most allopathic medicines, which are synthetic, are now being seen to cause numerous adverse effects in the body and rapid rise in drug-resistance vectors. Also new diseases like Ebola, bird flu, Nipah and Hanta have emerged to which allopathic medicine does not have any cure. As a result, both the common people and scientists are taking another look at the plant kingdom and the therapeutic practices of the indigenous or tribal people in the quest for discovery of new drugs. Ethno medicinal surveys and documentation have started to play an important role at present.

Bangladesh, although a small country (area 147,610 square kilometers), has more than 5500 floral species, most of them being located in the two hotspots in the southeast (CHT) and the northeast (Sylhet Division). Ethnobotany or ethno medicinal studies are in a very preliminary and rudimentary stage within the country; even then over 1200 medicinal plants have been identified. The country abounds in a number of traditional medicinal systems like Ayurveda, Unani, homeopathy, folk medicine (and tribal medicine), incantations, amulets, to name a few. Among the various systems, folk and tribal medicines are the least known considering the bewildering diversity of folk medicinal and tribal medicinal practitioners. Since without proper documentation, this ethnic knowledge may disappear totally (in fact of the 100 or so tribes, around 30 smaller tribes have totally forgotten their traditional medicinal practices according to our findings), we had been conducting ethno medicinal surveys among the Folk Medicinal Practitioners (FMPs) and TMPs [5-37]. The objective of the present survey was to conduct an interview and document the medicinal practices of a Marma TMP practicing in Camelong Para, Bandarban Sadar town in Bandarban district.

Materials and Methods

The survey was carried out between October 2018 and April 2019. Two visits were made to the Marma TMP, who resided amongst a Marma community settled in a hilly forested area known as Camelong Para (Para means village in this case). The place was about 5 kilometers road distance from Bandarban Sadar town - the main town in Bandarban district, which itself fell in Kuhalong Union of Bandarban Sadar Upazila or sub-district (Figure 1).

Bandarban Sadar town is a small town nestled among forested hills with mainly the mainstream Bengali-speaking administrative personnel residing in the town in buildings. The Marmas resided in tin-roofed houses in forested areas with small agricultural plots cleared of forests besides their residential community. Residential dwellings were clustered together with very little open spaces between dwellings (Figure 2).

The Marmas grew their own rice and vegetables and reared goats and chickens. Camelong Para was besides a stream, where the Marmas can obtain some fish (not much, even though nappi or fermented dried fish was their favorite food). Within the community they spoke in the Marma language, but both young and old were observed to speak the mainstream Bengali language with fluency, but with a strong accent.

The TMP was named Mong Pru Ong, male and about 45 years’ age. Initial contact was made with him through some Marma persons known to the authors in Bandarban district. Prior Informed Consent was obtained from the TMP, who was apprised as to the nature of our visit. Consent was also obtained from the community Headman. In the first visit in October 2018, following some preliminary talks, the TMP started a general discussion on the diminishing of the forests, difficulty that he now faces in obtaining medicinal plants and the lack of respect in recent years on his traditional medicinal knowledge. He also mentioned that in recent years he did not get a single apprentice and so his knowledge was disappearing through lack of transmission to the next generation and adequate practice along with disappearance of many medicinal plant species.

Actual interviews were conducted with the help of a semi-structured questionnaire and the guided field-walk method of Martin [38] and Maundu [39]. In this method, the TMP took the interviewers through forest areas where he obtained his plants (usually) and pointed out the plants. Plant names were mentioned by him on the spot. After returning, he mentioned the uses of the plants (or plant parts) in a leisurely manner. Plants were photographed and plant specimens collected on the spot, dried, and brought back to the University for identification by a competent botanist. Voucher specimens were deposited with the Medicinal Plant Collection Wing of the University of Development Alternative. Interviews were conducted in the Bengali language. It is to be noted that the Marmas themselves used Bengali names for most of the plants. A second visit was made in April 2019 to show the TMP our report and get his affirmation on the contents of the report.

Result

The TMP used phytotherapy, zoo therapy as well as miscellaneous object in his treatment. For his phototherapeutic practices, he used 6 plants distributed into 6 families for treatment of gastrointestinal tract disorders, piles, urinary disorders, pain, dizziness, severe eye irritation, and fever. The results are shown in (Table 1, Part A).

A.                  Phytotherapy

A very interesting part of his treatment was a combination of phytotherapy with zoo therapy, where he treated severe eye irritation with juice from unripe fruits of Piper nigrum along with a dead spider put in the juice and which was also applied to the eyes. According to the TMP there was no specificity to the spider species, any dead spider will suffice. In his other zootherapeutic formulation (Table 1, Part B),

B.                  Zootherapy

the TMP used the skin of a crab, Scylla serrata along with very sour lemon juice (juice from the fruits of Citrus limon) to treat cold which progressed to pneumonia. In his miscellaneous object therapy, the TMP used a blanket soaked in warm water, which was put over the head as treatment for puerperal fever and food poisoning (Table 1, Part C).

C.                  Miscellaneous

Needless to say, it needs to be determined how many of these esoteric practices gave effective results or just acted as placebos. Certainly, lemon juice (juice obtained from the fruits of C. limon) can be useful in colds [40]; steamed lime juice (obtained from steamed fruits of Citrus aurantifolia, a species closes to C. limon) has synergistic antimicrobial effects when taken with honey against Streptococcus pneumonia [41]; the efficacy of adding a crab skin to lemon juice needs to be scientifically determined. Horseshoe crabs may prove useful against bacteria resistant to penicillin and other drugs [42], but the medical benefits of Scylla serrata in treatment of cold remain to be determined. 

Discussion

The in vivo anti-diarrheal activity of ethanol extract of Mikania cordata leaves has been reported [43], thus scientifically justifying the TMP’s treatment of diarrhea with M. cordata leaves. Hypoglycemic effect of hydromethanolic extract of Tamarindus indica seed has been reported in streptozotocin diabetic rats [44]. Aqueous extract of Hibiscus sabdariffa leaves demonstrated analgesic effect in hot plate method in albino rats [45]. Notably, the TMP used seeds of T. indica against diabetes and leaves of H. sabdariffa to treat pain arising from poisonous insect bites. Ethanol extract of fruits of Piper nigrum and its constituent piperine reportedly showed analgesic activity [46], validating the TMP’s use of the fruits to treat headache. Oil from Santalum album reportedly showed anti-pyretic activity against yeast-induced fever [47].

As can be noticed from a perusal of our previous ethno medicinal surveys among folk and tribal medicinal practitioners [5-37], there is an enormous diversity among the practitioners regarding plant selection, formulation ingredients, and mode of treatment for even the same disease. Part of is caused by non-availability of a given plant in a particular area, or non-availability due to the plant’s growth in only a certain season. However, our surveys suggest certain underlying principles for plant selection, which may be followed by a majority of traditional practitioners but not all of them. For instance, bitter plants or plant parts (like Ananas comosus leaves) are generally considered good against helminthes [48], and Momordica charantia fruits, which are bitter in taste are used against diabetes [17]. On the one hand, since traditional practitioners are not registered and their activities monitored or supervised by any regulatory agency, it is difficult to say accurately as to what extent their selection of plants and mode of treatment is valid or how and where they have learned these treatment methods. In our surveys, the TMPs have always mentioned that this medicinal plant knowledge is ancient knowledge handed down orally from generation to generation. What can be safely assumed is that since these treatments have been used over centuries, so possibly trial and error methods have played a large role in ensuring that the treatments work. Otherwise, market and patient factors would have gotten rid of harmful treatments. This explanation can also explain why so many plants used by TMPs are being increasingly validated by science in their therapeutic uses.  

The available scientific reports clearly indicate that there is scientific validation behind the TMP’s selection of plants, even though the TMP may not be aware of the “science”. Traditional medicinal practitioners have honed their phytotherapeutic knowledge over hundreds and thousands of years, so it can be said that most if not all the TMP-selected plants have passed the test of time. This has been noted before with medicinal plants used in traditional medicine in other countries [49]. Thus overall it can be concluded that the plants used by the TMP merits scientific research for their potential towards discovery of lead compounds and new drugs.

Conclusion

The phytotherapeutic practices of the TMP appear to be novel and can be utilized for new drug discoveries. However, some practices like using a warm wet blanket to treat puerperal fever and food poisoning or to use a dead spider for treating severe eye irritation not only borders on the esoteric but may be of no medical value whatsoever.

Conflicts of Interest

The authors declare that there are no conflicts of interest.

Acknowledgement

The authors are grateful to the Marma TMP for his cooperation and providing traditional medicinal information.

Figure 1: Top left: Map of Bangladesh; top right: Bandarban district; bottom left: Bandarban Sadar Upazila map showing Kuhalong Union and place of survey (indicated by arrow).

Figure 2: Came long Para showing Marma agricultural plots, tin-roofed dwellings surrounded by hilly forested areas.

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