Ethnopharmacological investigation of plants used to treat susto, a folk illness

doi:10.1016/j.jep.2006.08.004

Journal of Ethnopharmacology

Volume 109, Issue 3, 12 February 2007, Pages 380-387

https://doi.org/10.1016/j.jep.2006.08.004 Get rights and content

Abstract

Selected plants used to treat susto, a folk illness recognized by various groups of Latin America, were screened for anxiolytic and/or fear suppression activity in behavioral assays. We found that the plant used by most of the healers interviewed (Adiantum tetraphyllum Humb. & Bonpl. ex Willd.; Adiantaceae) suppressed certain components of anxiety and fear. To our knowledge, this is the first report on the biological activity of Adiantum tetraphyllum. This finding supports the contention that susto may represent what in the Western culture is defined as fear or anxiety, and hence may share the same psychological, biological or neural underpinnings. In light of the available literature, this represents the first experimental investigation of the biological activity of plants specifically in the perspective of their use in treating a culture-bound syndrome.

Introduction

In the realm of ethnopharmacological research, culture-bound syndromes and folk illnesses are seldom investigated. The issue is complex: the classification and etiology of these ailments is often unclear. Moreover, they are typically linked to local belief systems and treatments often rely predominantly on rituals and sensory perceptions (e.g. aromatic plants) (Frei et al., 1998, Leonti et al., 2001). However, a closer examination of treatments used by traditional practitioners can provide unique and important information on the nature of these complex syndromes.

The case of susto, a traditional ethnomedical concept widely recognized by groups of Latin America, is of great importance since it is associated both with strong cultural beliefs and severe health consequences. Indeed, Collado-Ardon et al. (1983) showed that those suffering from susto generally have a higher disease load and likelihood of death than non-sufferers over a 7-year period. However, its underlying causes are ambiguous, having been linked to ailments ranging from intestinal parasitic infestations (Signorini, 1982) to hypoglycemia (Bolton, 1981), social role stress (Rubel, 1964, O’Nell and Selby, 1968, Uzzell, 1974, O’Nell, 1975), and anxiety-related conditions (Gillin, 1948, Kiev, 1968, Gobeil, 1973, Lopez-Ibor, 2003).

According to local descriptions, susto stems from a frightening event involving startle, which causes the loss of the soul, or vital force. This can then lead to sickness involving various general symptoms such as restlessness during sleep, loss of appetite, irritability, inability to urinate, weakness, depression, introversion, fever, muscular pain, nausea, vomiting, diarrhea, and vertigo (Rubel, 1964, Klein, 1978, Signorini, 1982, Crandon, 1983). It is also widely believed that susto can be fatal if uncured (i.e. if the patient's soul is not returned to its body) (Gillin, 1948, Gobeil, 1973, Crandon, 1983).

Although its etiology is an area of active research, both the American Psychiatric Association (APA) and the World Health Organization (WHO) associate susto with mental disorders, including a number of anxiety and fear related conditions (i.e. post-traumatic stress disorder, anxiety disorder, major depressive disorders, somatoform disorders, and other specified neurotic disorders) (WHO, 1993, APA, 1994). Furthermore, evidence from our previous work on rituals performed by Q’eqchi’ Maya healers and plant treatment associations between ailments suggests that susto might have an underlying neurological/psychological component related to anxiety and/or fear (Bourbonnais-Spear, 2005). In the present study, we investigated the pharmacology of selected herbal remedies used by these healers to treat susto, as complimentary information. To our knowledge, this is the first experimental study of the biological activity of selected plants in the perspective of their use in treating a folk illness. We hypothesized that susto has an underlying neurological or psychological component related to anxiety and/or fear and, therefore, that plants used by traditional healers to treat susto would exhibit anxiolytic and/or fear suppressive properties.

Section snippets

Ethical approval

The project was reviewed and accepted by the University of Ottawa Ethics Committee (Approval # H-06-03-01), and the Ministry of Natural Resources of the Government of Belize issued a permit for plant collection in June 2003 (Ref # CD/6-/9/03 (18)). Close attention was paid to the respect of local customs, which was facilitated by working closely with two Q’eqchi’ research collaborators, Pedro Maquin and Victor Cal, and the healers granted their consent individually for participation. Plants and

Plant use

Fourteen plant species belonging to six plant families are used as remedies for susto (Table 1) (another two species mentioned by the healers could not be collected and were therefore excluded from the analyses). Many of the plants collected grow only in the Maya mountains of southern Belize as epiphytes and understory plants of the semi-evergreen tropical forests of the region. Only two tree species were used, Combretum sp. and Guraea grandifolia. DC. Plant families most represented are a fern

Herbal remedies used for susto

The biological activity of plants used by the healers and identified to species has been understudied, apart from Pityrogramma calomelanos (L.) Link, which has shown cytotoxic and anti-tumoral effects (Sukumaran and Kuttan, 1991), and Scoparia dulcis L. which has anti-diabetic (Latha and Pari, 2004) as well as antiviral properties (Hayashi et al., 1988). Of direct relevance, certain compounds found in Piper species exhibit potent activity on the central nervous system (CNS) (Parmar et al., 1997

Acknowledgements

We are extremely grateful to participating healers and their families, and to the communities of Indian Creek, Jalacte and Big Falls. We are also thankful for the technical and logistic support offered by the Belize Indigenous Training Institute. We are also grateful to Maïa Miguelez, Nathalie Lukenbill, John James, Christine Mountney, Judith Hotte-Bernard and Sylvie Emond for their time and input into this project. As well, we would like to thank Luis Poveda and Pedro Sachez for their

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Mirroring its outstanding cultural heritage, Mesoamerica is also one of the world's most biodiverse regions, is among the most eminent centers of plant domestication (Pickersgill, 2016), and has been named a Vavilov center of biodiversity (Hummer and Hancock, 2015). In Mayan medical ethnobotany, there are several herbs used traditionally for treating conditions with an important psychological or spiritual component (Awad et al., 2009; Bourbonnais-Spear et al., 2005, 2007; Castillo-Bautista et al., 2019; Hitziger, 2016; Kufer et al., 2010). Some of these syndromes are recognized universally as central nervous system (CNS) disorders, whereas other ethnopsychiatric interpretations are explained in culture-specific terms.
For thousands of years, different cultural groups have used and transformed natural resources for medicinal purposes focused on psychological or neurological conditions. Some of these are recognized as central nervous system (CNS) disorders and diseases, whereas other ethnopsychiatric interpretations are explained in culture-specific terms. In traditional Mayan medicine, several herbs have been part of treatments and rituals focused on cultural and ethnomedical concepts.
This study aims to provide a comprehensive overview of the medicinal plants used in Mesoamerica by traditional healers and Mayan groups to CNS disorders and associate the traditional use with demonstrated pharmacological evidence to establish a solid foundation for directing future research.
A systematic search for primary sources of plant use reports for traditional CNS-related remedies of Mesoamerica were obtained from library catalogs, thesis and scientific databases (PubMed, Scopus, Google Scholar; and Science Direct), and entered in a database with data analyzed in terms of the usage frequency, use by ethnic groups, plant endemism, and pharmacological investigation.
A total of 155 plants used for ethnopsychiatric conditions in Mesoamerica by Mayan groups were found, encompassing 127 native species. Of these, only 49 native species have reported in vitro or in vivo pharmacological analyses. The most commonly reported ethnopsychiatric conditions are related to anxiety, depression, memory loss, epilepsy, and insomnia. The extent of the scientific evidence available to understand the pharmacological application for their use against CNS disorders varied between different plant species, with the most prominent evidence shown by Annona cherimola, Justicia pectoralis, J. spicigera, Mimosa pudica, Persea americana, Petiveria alliacea, Piper amalago, Psidium guajava, Tagetes erecta and T. lucida.
Available pharmacological data suggest that different plant species used in traditional Mayan medicine may target the CNS, mainly related to GABA, serotonin, acetylcholine, or neuroprotective pathways. However, more research is required, given the limited data regarding mechanism of action at the preclinical in vivo level, identification of active compounds, scarce number of clinical studies, and the dearth of peer-reviewed studies.
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among the most frequently used taxa to treat susto. Ethanolic extracts of A. tetraphyllum (50–300 mg/kg p.o.) showed significant anxiolytic and fear suppression activities in rats in the EPM and CER tests, whereas A. latifolium showed only moderate activity (Bourbonnais-Spear et al., 2007). A methanolic extract of A. latifolium (1–100 mg/kg i.p.) did, however, significantly reduce the nociceptive response of mice in the formalin and writhing tests (Nonato et al., 2011).
The burden of disease caused by mental and neurological disorders is increasing globally, to a disproportionate degree in Latin America. In contrast to the many psychoactive plants with a use history in Mesoamerican cultures, the translation to the wider population of knowledge around numerous botanicals used contemporarily by indigenous Mesoamerican societies to treat psychological and neurological disorders did not receive the same attention.
We used the previously published Mesoamerican Medicinal Plant Database to extract species and associated botanical drugs used as treatments for illnesses associated with the nervous system by Mesoamerican cultures in Belize, Guatemala, and Mexico. With the critical use of published pharmacological literature, the cross-culturally most salient genera are systematically reviewed.
From 2188 plant taxa contained in the database 1324 are used as treatments for illnesses associated with the nervous system. The ethnomedical data was critically confronted with the available biomedical literature for the 58 cross-culturally most salient genera. For a considerable proportion of the frequently used taxa, preclinical data are available, mostly validating ethnomedicinal uses.
This quantitative approach facilitates the prioritization of taxa for future pre-clinical, clinical and treatment outcome studies and gives patients, practitioners, and legislators a fundamental framework of evidence, on which to base decisions regarding phytomedicines.
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Genus Adiantum (Pteridaceae) forms a significant dominant component of many plant communities especially in the tropical and temperate regions. These are commonly known as maidenhair ferns and several have been used medicinally in different parts of the world. They exhibit antidysenteric, antiulcer, antimicrobial, antitumor and antiviral activities. The traditional uses of Adiantum species are known to be for respiratory problems such as cough cold, fever, pneumonia and mucous formation.
This review aims to provide a comprehensive and updated, categorized information on the botanical aspects, traditional uses, phytochemistry, pharmacological activities and toxicological research of Adiantum species in order to explore their therapeutic potential and evaluate future research opportunities.
The available information on various species belonging to the genus Adiantum was collected via electronic search (using Pubmed, SciFinder, Scirus, Google Scholar, JCCC@INSTIRC and Web of Science) and a library search for articles published in peer-reviewed journals.
The literature provided information on several ethnopharmacologically well known Adiantum species, the best studied species being A. capillus-veneris. From these plant species, more than 130 compounds belonging to triterpenoids, flavanoids, phenyl propanoids, phenolics, coumarins, phytosterols, fatty acids and others were identified. Experimental evidences confirmed that the Adiantum species could be used in treating microbial infections, diabetes, liver disorders as well as inflammatory disorders.
Plants belonging to the genus Adiantum have offered bioactive crude extracts as well as pure compounds, thus substantiating their effectiveness in traditional medicine. Although toxicity studies carried out on some Adiantum species have showed them to be non-toxic, further toxicological studies are still required to confirm their safety in humans. Future research should be directed towards implementing an integrated approach through intensive investigations of all the species of Adiantum relating to phytochemical and pharmacological properties, especially bio-assay guided isolation of phytoconstituents, their mechanism of action, as well as their bioavailability and pharmacokinetics, safety and efficacy.
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Tanacetum parthenium, commonly known as “feverfew” is one of the oldest traditional remedies used for the treatment of fever and other inflammatory diseases. The therapeutic virtues of this herb can be traced back to the Materia Medica of the old physician Dioscorides and nowadays feverfew is prescribed for the prophylaxis of migraine. In this chapter, a brief excursus on the botanical, ethnobotanical, and therapeutic virtues of this medicinal plant is presented.
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It is not always possible to correlate the “emic” terms to the “etic” ones during ethnopharmacological surveys, especially regarding those related to Culture-Bound Syndromes (CBS). Nevertheless, it is the role of ethnopharmacology to address these correlations, since they are the basis for the understanding of potential bioactives.
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Fifty-nine healers of different kinds were interviewed: a prayer-maker, medium, natural resource expert, massage therapist, midwife and snakebite healer. The clinical manifestations and healing resources of the following CBS were collected: “mau olhado” (evil eye), “quebrante” (chipping); “espante” (fright or susto); “doença do ar” (air diseases); “vento caído” (fallen wind); “derrame” (leakage); “mãe do corpo” (mother of the body) and “panema” (unlucky). The first three seem to be local variations of other CBSs already described in Latin America. “doença do ar”, “vento caído”, “derrame” and “mãe do corpo” seem to be folk terms for known conventional medical disorders, while “panema” is a yet undescribed Brazilian CBS that is possibly related to dysthymic disorder or depression and deserves further investigation. Treatments included prayer rituals, fumigation, baths and oral remedies using 25 plants and 10 animals.
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Anxiolytic- and antidepressant-like effects of an aqueous extract of Tanacetum parthenium L. Schultz-Bip (Asteraceae) in mice
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Citation Excerpt :
In Mexican traditional medicine, T. parthenium is used to relieve ailments, such as fevers, migraine, headache, rheumatoid arthritis, stomachache, toothache, and as an analgesic, anti-inflammatory, and antispasmodic agent. This species is also employed to treat culture-bound syndromes such as susto (roughly translated as fear), espanto (nervousness), or quemados (burns) (Diccionario enciclopédico de la Medicina Tradicional Mexicana, 2009; Bourbonnais-Spear et al., 2007; Estrada-Reyes et al., 2014). Within this cross-cultural construction of illness, there is an association between beliefs of susto and depression.
Tanacetum parthenium L. Schultz-Bip (Asteraceae) is widely used worldwide in traditional medicine for the treatment of convulsions and culture-bound syndromes such as susto (fear). The aim of this work was to evaluate the anxiolytic- and antidepressant-like effects of an aqueous extract of T. parthenium in behavioral paradigms in mice. The effects of T. parthenium were compared with those produced by anxiolytic and antidepressant drugs. We carried out the chemical characterization of the main constituents of T. parthenium. The involvement with the GABAergic and serotoninergic neurotransmitter systems were explored be means of synergic and antagonist experiments.
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For chemical characterization, High-Performance Liquid Chromatography-Electro Spray Ionization-Mass Spectrometry (HPLC-ESI-MS) analysis was performed.
T. parthenium exerts clear anxiolytic- and antidepressant-like effects in mice, without affecting the ambulatory activity of the experimental subjects.
Anxiolytic- and antidepressant-like T. parthenium effects result, at least part from the involvement of the GABAergic system. Our results support the use of Tanacetum parthenium in traditional medicine and suggest its therapeutic potential in the comorbid anxiety and depression.

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Ethnopharmacological investigation of plants used to treat susto, a folk illness

Abstract

Introduction

Section snippets

Ethical approval

Plant use

Herbal remedies used for susto

Acknowledgements

Fitoterapia

Lancet

European Journal of Pharmacology

Pharmacology & Therapeutics

Journal of Ethnopharmacology

Antiviral Research

Journal of Ethnopharmacology

Neurotoxicology and Teratology

Biological Psychiatry

Phytochemistry

Journal of Neuroscience Methods

Phytomedicine

Journal of Ethnopharmacology

Neuroscience & Biobehavioral Reviews

Phytochemistry

Diagnostic and Statistical Manual (DSM-IV)

Susto, hostility, and hypoglycemia

Ethnology

Pharmacological and phytochemical evaluation of Adiantum cuneatum growing in Brazil

Verlag der Zeitschrift für Naturforschung

Isolation of amentoflavone from Selaginella rupestris and its pharmacological activity on central nervous system, smooth muscles and isolated frog heart preparations

Planta Medica

Why susto

Ethnology

Magical fright

Psychiatry