Census Ethnobotanical Study of Some Plants Used in Traditional Medicine in the City of Meknes

An ethnobotanical 
survey was conducted in the city of Meknes over a period of two years, from 
2009 to 2011 with 1000 people (615 women, 385 men). Through the questionnaire, 
schedules were established to collect information on the use of therapeutic 
medicinal plants by the local population. This research has focused primarily 
on the general population, herbalists and healers. The present investigation 
has enumerated 194 species distributed in 165 genera and 72 families. The most 
represented families are Lamiaceae (18%), the Aseraceae, (17%), the Apiaceae 
(14%) and the Fabaceae (10%). The results of the survey show that 54% of 
individuals use both herbal medicine and modern medicine, 26% of individuals 
use herbs and 20% use modern medicine. We are interested in the use of plants 
in different ages and sexes. We report that 31% of the population is aged 
between 51 and 60 years, 29% between 41 and 50 years, 23% between 31 and 40 
years, 10% between 21 and 30 years, 3% less than 20 years and 4 % > 60 
years. We note the predominance of women over men. Women use up to 61% against 
39% of men. The analysis of our results shows that herbal medicine takes a 
place in the self-medication of the population studied. However, we emphasize 
an important point: Ignorance of toxic plants, in fact, only 19% of the target 
population recognizes these plants.


Introduction
In recent decades, the use of medicinal plants has grown considerably. In this regard, the human pharmacopoeia F. Moussaoui et al. 2481 has a rich repertoire of no less than 20,000 species of which 50% are widely used in pharmaceutical industry [1]. The use of plants becomes daily in curative and preventive form [2]. Medicinal plants are valuable resources for the vast majority of the rural population in Africa [3]. According to the World Health Organization (WHO), more than 80% of African people resort to traditional medicine and pharmacopoeia to overcome many health problems [4].
Indeed, traditional medicine remains widespread in developing countries. In this context, Morocco remains one of the Mediterranean countries that have a long medical tradition and a traditional herbal [5] expertise. Because its geographical location, Morocco enjoys a natural setting quite original promoting a rich and varied flora. Of the 7000 species and subspecies existing, 537 are endemic to the country, and 1625 are rare or endangered [6]. Meknès-Tafilalet by its Mediterranean climate and its geographical features has favorable conditions for the development of a rich and varied flora plants with medicinal properties. This study of medicinal plants in the region will allow the public to know them better and therefore to use them better. This study is a contribution to the preservation of botanical heritage of the region.

Situation of the Study Zone
The city of Meknes covers a surface of 178,700 Ha. It is bordered to the north by the Province of Sidi Kacem, on the West by the Province of Khémisset, on the South by the Province of El Hajeb and in the East by Zouagha Moulay Yaakoub [7]. Crop production is characterized by a large interannual variability related mainly to climatic conditions; particularly drought that has become structural, sometimes hail and wish Chergui (rising temperatures in the spring). The climate of the area (latitude, 33˚53'36"N, longitude 5˚32'50"W, altitude 548 m) [8] is temperate Mediterranean type understory undergoing continental influences during the summer and winter season.
However, the geographical diversity of the region that each of its natural areas presents particular climatic nuances. During the year, the distribution of rainfall is characterized by heavy rains in autumn, a slight decrease in winter with a relative increase in early spring. Summer is generally dry. Rainwater seeping in reliefs of Atlas average plateau in dolomitic limestones of the Lias powered groundwater. These waters create a free web in the first plateau and along the plain of Meknes-Fez, which then sinks beneath the impermeable ground tertiary and so is the deep confined aquifer in the plain [7]. Surface waters are represented by two main namely networks: Oued R'DOM and network Oued Mikkes. The total population of the prefecture of Meknes amounts to 713,609 inhabitants. This is one of the most populated areas of the Kingdom (340 inhabitants/km²). The rural population represents 20% of the total population of the prefecture against 80% in urban areas. The illiteracy rate is much higher in rural areas than in urban areas with inter-gender disproportions: the rate is 43.8% among women and 22% among men [7] (Figure 1).

Questionnaire
We conducted an ethnobotanical survey in the various districts of the city of Meknes to collect as much information on medicinal plants used.
Our investigation was spread over a period of 2 years (2009-2010 and 2010-2011), during this period, we have achieved 1000 interviews with people of both sexes. We have identified 194 medicinal plants used by local people in traditional medicine and inventory 133 recipes.
This survey was conducted using two questionnaires records: -A card sent to the questionnaire herbalists and healers.
-A survey form sent to users (consumers). Through these questionnaires, we collected all the information regarding the questioned population (age, sex, marital status, level of education...) and plants used in traditional recipes (common identity, part of the plant used, method of preparation, therapeutic and traditional uses, effects, observed and/or expected...).
We present the results obtained regarding the traditional use of medicinal plants, after a comprehensive analysis of data collected over two years and with a data processing by the statistical software SPSS.

Use of Medicinal Plants by Age
Age between the (41 -50) and (51 -60) slices represent the highest percentage of users of plants. This use seems F. Moussaoui et al. 2482 almost non-existent in the age group under 20 years and over 60 years (Figure 2). For young people, this choice could be justified by the lack of information on the importance of plants and also by the lack of confidence in the curative efficacy of traditional medicine. The use of plants is decreasing in the age group over 60 years. This observation could be explained by the fact that the diseases that occur at this age can be complicated and may require extensive treatment.
The results show that medicinal plants are used by almost all age groups. Similar results were observed by [9]- [13]

Use of Medicinal Plants by Sex
The results show that women use medicinal plants (61%) more than men (39%). Since the era of the time, women were interested in plants for medicinal and cosmetic purposes. Their use is acquired following an accumulated knowledge and passed from one generation to another. Women have become custodians of traditional phytotherapy who know much more than men. Note that similar results have been reported by other authors [9] [14] (Figure 3).

Education
Analysis of the results allowed us to distinguish 52% of the population using plants is illiterate. These results are consistent with the work of [13]. The remaining percentages represent the category of educated population up to 23% (primary), 15% (secondary), and 10% (university) (Figure 4). Although traditional medicine has existed since time immemorial, it continues to be used and that over the last ten years its popularity has only increased [10].

Use of Medicinal Plants by Family
It turns out that married people with children increase the use of medicinal plants 72%, against 28% for singles.     The same observation was reported by [13]. People with a family favor the use of medicinal plants. These plants remain in an environment suitable for all family members ( Figure 5).

Monthly income of those surveyed (in dh)
From the results we can see that the category of illiterate population and that a monthly income of less than 1000 dh, are more apt to medicinal plants. This could be explained by the low-cost plants in relation to drugs and the ease of preparation. For this category of the population, the possibility of self-medication is required (or prescription or medical examination) (Figure 6).

First Visited in Case of Health Problem
Of the 1000 people questioned in case of health problems, 26% of the population went first in the herbalist as a first alternative, 20% will visit a clinic or hospital, and 54% try to combine modern medicine and traditional medicine, probably for better efficiency (Figure 7).

The Most Commonly Used Medicinal Plants
The results show that the most used herbs by the population questioned are: Origanum compactum benth, Thymus zygis L, Mentha pulegium L, Rosmarinus officinalis L, Artemisia herba-alba Asso, Lavandula angustifolia Miller, Cleome arabica L, Carum carvi L, Ajuga iva (L.) Schreb, Euphorbia officinalis L, Foeniculum officinale. These plants are used in the composition of several recipes that treat certain diseases, such as diseases of the digestive tract, respiratory diseases, genital diseases, cardiovascular diseases, Rheumatic diseases, urinary diseases… (Figure 9).

The Parts of the Plant Used
The parts of the plant mainly used are the leaves (29%), seeds (21%), all of the aerial part (15%) of the plant. Other parts of the plant (bark, root, stem, flower, seed and rhizome ...) are used occasionally. The study shows that the leaves are mostly used in the preparation of different recipes (Figure 11)      concentration of active ingredients in this organ [11]. Active principles can be found in all parts of the plant, but unevenly. And all the active ingredients in the same plant do not have the same properties [12]. The high use of the leaves can be explained by the fact that the leaves represent the organ specialized for photosynthesis. They are also the site of respiration and transpiration.

Features Recipes Identified
The majority of the people questioned (86%) used a single plant for the preparation of medicinal recipe ( Figure  14). 14% of the population uses plants combined with ingredients from nature plant (82%), or ingredients of animal and mineral in nature (18%).
The nature of the ingredients varies depending on the mode of administration. The ingredients of mineral origin (sulfur, galena, rock salt), are dedicated for external use, while ingredients of animal origin such as milk, pieces of animal organs honey and even insects are for oral administration.

Source of Information Regarding the Therapeutic Use of Medicinal Plants
The results showed that 56% of our respondents refer to the experiences of others to prepare recipes using medicinal plants, 20% of the population refer to herbalists, 18% of people following the media, while 6% people looking at books of traditional medicine. This result is consistent with the results obtained by (Benkhnigue, 2011) (Figure 15).

Knowledge of Poisonous Plants
The survey reveals that few people question (19%) have knowledge about the toxicity of plants. This segment of the population is mostly older people who have some experience in the use of medicinal plants (Figure 16).
The rest of the population (81%) said they had no information on toxic plants and the dangers they can cause to health. This population is more confidence in the herbalists. Identifying poisonous plants remains a crucial factor in the use of plants.   Traditionally deemed safe and plants can be toxic when they are used on a large scale [15]. And plants may contain powerful chemicals, responsible for side effects and toxicity. Their use requires continuous vigilance [16].
The main plant has caused poisoning among the people of the city Meknes are listed in the Table 1.

Treatment of Children by Plants
Diseases are part of life and cannot be avoided despite all the advances in medicine [17]. Diseases affect also children. Herbal medication may be useful to treat or alleviate childhood ailments (diarrhea, constipation, cough, abdominal pain, colic....).
Many women prefer to care for their children without resorting to modern medicine. They know recipes using plants that are useful in the treatment of many problems faced by children since birth, these natural recipes from popular memory and proving highly effective in many years. These revenues continue to be transmitted from grandmothers to mothers and especially from woman to woman through time.

Use of Herbal Medicines in Children
In our study, 57% of those surveyed opting for plants to treat their children. They prefer not to give medicines to their children for fear of side effects, while 43% of the targeted people tend to trust modern medicine (Figure 17).
Natural remedies will strengthen the natural defenses of the child to fight against various diseases. Plants can be highly effective and can help to protect the child.

Age of Medicinal Plants Use in Children
It appears from the survey results that 37% of women give their babies mixtures based on medicinal plants in the early days of birth (7 -40 days). The plant most commonly used is Verbena officinalis, while 63% of women prefer to use plants from 6 months (Figure 18).

The Plants Used to Treat Childhood Diseases
The results obtained show that there are only a few types of plants which are suitable for children. Among the plants most commonly used are: Verbena officinalis L., Cumimum cyminum L., Origanum compactum benth,

Mentha pulegium L., Lavandula angustifolia Miller, Foeniculum officinale, Artemisia herba-alba Asso, Carum carvi L., Thymus zygis L.
It appears that the Verbena officinalis L. is widely used by mothers (46%) (Figure 19). It is an aromatic plant popular infusion proposed to facilitate difficult digestion and in the symptomatic treatment of neurotonic conditions in adults and children [18]. It is also recommended in cases of fever, cough, and insomnia. It is recommended for children of all ages.
Cumimum cyminum L. comes with a percentage of 16% utilization to relieve abdominal pain, colic, indigestion, for both adults and children and even babies.
Mentha pulegium L. is mainly used to aid digestion and fight against the spastic conditions in children. Carum carvi L. has many beneficial effects. It is frequently used to treat bronchitis and cough, particularly among children.
Foeniculum officinale is known for its ability to calm colic of children and babies. It is recommended in the case of digestive disorders and airway inflammation.
The Origanum spp. has a significant effect on the treatment of intestinal worms in children. Artemisia herba-alba Asso helps to expel worms in the stomach, reduce phlegm and to eliminate colic. Lavandula angustifolia Miller is used in particular in the treatment of pain and intestinal colic in children. Lavender is frequently used for its calming properties.
Thymus zygis L. is considered the best treatment against coughs and expels worms in children.

Herbalists and Healers
The interview with healers and herbalists 20 moved to Meknes, which allowed us to collect a set of specific therapists and herbalists' such information.

Healer
Healer is a person who provides health care through the use of plant, animal, and mineral substances using personal recipes herbal. Healer heals the sick by empirical means: remedies or practices resulting from the experience. He knows the different properties of plants and their usefulness. The healer may also have personal resources that enable it to relieve pain and some infections, and reduce the types of fractures... Unlike modern medicine, treatments healers are confidential and are not discussed openly. They can only be passed from generation to generation within the family healer [19].
Used by the healers to cure their sick methods are not always effective. Healers do not master the different diseases and do not fit the recipe and the proper dosage. Worse, some people develop other symptoms that can be severe (renal failure...).

The Herbalist
The herbalist is the most valuable source of information on medicines from plants. He is a plant specialist. His experience has been gained after a period of practice where along transmitted as a legacy of his ancestors. Knowledge of plants and their use to treat a particular condition is timeless. The work of the herbalist is based on experience and learning in a master or a family member doing the same job. Some herbalists update and improve their knowledge over time, others from reading books in the field.
The herbalist is not only a seller of medicinal plants but the professional capacity to recommend to his clients the use of plants. He can also make preparations with several plants according to the requirements that the client The herbalist collected plants either himself or buys from suppliers and farmers in the region and prepares the rest itself. Plants and their essences give excellent results for most diseases, but there are exceptions where herbal becomes useless as in the case of heavy diseases including cancers in an advanced state, cardiovascular diseases and genetic diseases… Some plants have very many medicinal uses (such as Thymus vulgaris is good for all), while others are very specific to specific diseases (such as Citrullus colocynthis used for diabetes).
According to herbalists and healers, there are women-specific diseases (genital problems, menstrual cramps, hair loss, pain pregnancy and childbirth, skin problems...) and those that affect men (bladder problems, prostate, penile inflammation…).