Ethnobotanical study of medicinal plants used in the management of diabetes mellitus and hypertension in the Central Region of Togo

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1 Pharmaceutical Biology ISSN: (Print) (Online) Journal homepage: Ethnobotanical study of medicinal plants used in the management of diabetes mellitus and hypertension in the Central Region of Togo Simplice Damintoti Karou, Tchadjobo Tchacondo, Micheline Agassounon Djikpo Tchibozo, Saliou Abdoul-Rahaman, Kokou Anani, Koffi Koudouvo, Komlan Batawila, Amegnona Agbonon, Jacques Simpore & Comlan de Souza To cite this article: Simplice Damintoti Karou, Tchadjobo Tchacondo, Micheline Agassounon Djikpo Tchibozo, Saliou Abdoul-Rahaman, Kokou Anani, Koffi Koudouvo, Komlan Batawila, Amegnona Agbonon, Jacques Simpore & Comlan de Souza (2011) Ethnobotanical study of medicinal plants used in the management of diabetes mellitus and hypertension in the Central Region of Togo, Pharmaceutical Biology, 49:12, , DOI: / To link to this article: Published online: 12 Nov Submit your article to this journal Article views: 843 View related articles Citing articles: 19 View citing articles Full Terms & Conditions of access and use can be found at

2 Pharmaceutical Biology, 2011; 49(12): ISSN print/issn online DOI: / RESEARCH ARTICLE Ethnobotanical study of medicinal plants used in the management of diabetes mellitus and hypertension in the Central Region of Togo Simplice Damintoti Karou 1,2, Tchadjobo Tchacondo 1, Micheline Agassounon Djikpo Tchibozo 3, Saliou Abdoul-Rahaman 1, Kokou Anani 1, Koffi Koudouvo 1, Komlan Batawila 4, Amegnona Agbonon 1, Jacques Simpore 2, and Comlan de Souza 1 1 Centre de Recherche et de Formation sur les Plantes Médicinales (CERFOPLAM), Université de Lomé, Lomé, Togo, 2 Centre de Recherche Biomoléculaire Pietro Annigoni (CERBA/LABIOGENE), Université de Ouagadougou, Ouagadougou, Burkina Faso, 3 Laboratoire de Microbiologie et des Technologies Alimentaires (LAMITA), Université d Abomey-Calavi, Cotonou, Bénin, and 4 Laboratoire de Botanique, Faculté des Sciences, Université de Lomé, Lomé, Togo Abstract Context: The Tem tribe in the Central Region of Togo is a population with an extensive knowledge of medicinal plants. However, little is known about their medical practices, principally the use of plants in the management of diabetes mellitus (DM) and hypertension (HTN). Objective: The present study documented the indigenous medicinal plant utilization for the management of DM and HTN in the Togo Central Region. Methodology: From March to October 2010, 55 traditional healers were interviewed about their knowledge on the use of plants for DM and HTN treatment. Results: The results revealed that 35/55 (63.64%) healers had treated at least one case of DM and/or HTN. They highlighted the use of 64 species belonging to 31 families in the treatment of DM and/or HTN. The most used plants against diabetes were Psidium guajava L. (Myrtaceae), Khaya senegalensis A. Juss. (Meliaceae), Sarcocephalus latifolius (Sm.) E.A. Bruce (Rubiaceae), Annona muricata L. (Annonaceae), Bridelia ferruginea Benth. (Phyllanthaceae), and Securidaca longepedunculata Fresen. (Polygalacae), while Allium sativum L. (Liliaceae) and Parkia biglobosa Benth. (Fabaceae), followed by Khaya senegalensis A. Juss. (Meliaceae), Gardenia ternifolia Schumach. (Rubiaceae), and Persea americana Mill. (Lauraceae) were the most commonly cited as antihypertensive. Conclusion: The issue revealed that traditional healers of the above mentioned region have basic knowledge regarding herbal medicine for DM and HTN in comparison with previous published reports. Further pharmacological screening of the identified plants should be conducted to ascertain the effectiveness of these plants. Keywords: Traditional medicine, survey, ethnopharmacology, phytomedicine, herbal concoction, metabolic diseases Introduction Togo is a country located in Western Africa with a border on the Atlantic Ocean in the south. The north of the country belongs to the tropical zone, with one rainy season and one dry season. The vegetation is essentially constituted of tree and bush savannah. The south of the country is in the subequatorial zone, with a long rainy season and short rainy season. The region consists of disparate forests, relics of gallery forests, savannahs, coastal thickets, meadows or halophilic marshy (Kokou & Caballé, 2000). Globally the country benefits from an excellent biodiversity of medicinal plants (Adjanohoun et al., 1986). Address for Correspondence: S.D. Karou, Centre de Recherche et de Formation sur les Plantes Médicinales (CERFOPLAM), Université de Lomé (ESTBA-UL), BP 1515, Lomé, Togo. Tel: Fax: simplicekarou@hotmail.com (Received 21 April 2011; revised 09 July 2011; accepted 04 September 2011) 1286

3 Medicinal plants against diabetes and hypertension in Togo 1287 The majority of the Togolese people living in the rural areas traditionally use plants for food and medicine. As in the other African countries, in recent years, the plants used traditionally for therapeutic purposes have attracted the attention of researchers (Karou et al., 2003, 2005, 2006; Koudouvo et al., 2011; Tchacondo et al., 2011). Although ethnobotanical surveys are essential in providing new leads for pharmacological screenings (Natarajan et al., 2000; Polesna, et al., 2011), very few studies have been conducted in Togo. Consequently, little is known about the medicinal practices of the indigenous people. Hypertension (HTN) or high blood pressure is a chronic medical condition in which the systemic arterial blood pressure is elevated (Carretero & Oparil, 2000). This is one of the most prevalent and important health problems in developed as well as developing countries. About 18 54% of the world s population is hypertensive and 20% of the general population should expect to have high blood pressure during their lifetime (Braunwald, 1992; Haji et al., 1999). In the majority of cases, HTN is associated with diabetes mellitus (DM). The DM is a metabolic disease characterized by high-blood glucose levels resulting from defects in insulin secretion, insulin action, or both (Ortiz-Andrade et al., 2005). This disease is a growing health concern worldwide. Diabetes in adults is estimated to be around 173 million and around two-thirds of these diabetics live in developing countries (Wild et al., 2003). The prevalence of DM is increasing and it is still expected to increase by 5.4% in 2025 (Moller & Flier, 1991). Increase in sedentary lifestyle, consumption of energy-rich diet, and obesity are some of the factors causing the rise in the number of diabetes and cardiovascular disorders, including HTN. However, Asia and Africa are identified as regions with greatest potential where DM and HTN could rise to two- or three-fold above the present level (Abo et al., 2008). As for other diseases, people in the rural places mainly rely on the plants for the management of HTN and DM. However, information is very scanty on the local medicinal plants and the plant parts traditionally used in the Central Region of Togo for the management of DM and HTN. The present study aimed at documenting the plants and the plant parts used exclusively for the management of DM and HTN by the traditional healers (TH) in the targeted region. Methodology Study area Togo is a western African country lying between Burkina Faso in the north, Benin in the east, and Ghana in the west. Togo s coastline in the south stretches for a distance of 54 km. The country is divided into five economic regions from the north to the south: the Savannah Region, Kara Region, Central Region, Plateaux Region, and Maritime Region. The Central Region extends between north and east. It is made up of four prefectures: Tchaoudjo, Tchamba, Sotouboua, and Blitta (Figure 1). It borders the Kara Region, the Republic of Ghana, the Republic of Benin, and the Plateaux Region. The region covers an area of 13,430 sq km which is approximately 23.73% of the total 566,000 sq km land area of Togo mainland. The region belongs to the tropical zone, with one rainy season from April to October and one dry season from October to March. It receives mm total rainfall annually. The annual temperatures are between 20 C and 32 C. The vegetation is mainly constituted of tree and bush savannah with an excellent biodiversity of medicinal plants. The present study was carried out in the Tchaoudjo prefecture. The prefecture is inhabited by 180,400 people, the main ethnic group being the Tem people. They are mainly Muslims. Agriculture and trading are their principal activities. Data collection Direct interviews with THs were conducted between March and October 2010 using a semi-structured questionnaire, after their informed consent. Each TH was asked to sign a consent form certifying his/her agreement with the form which was issued to explain the importance of the information they would provide. All THs were members of the Study and Research in Applied Traditional Medicine Centre of the Central Region in Togo (CERMETRA-RC). The CERMETRA-RC is a nongovernmental organization created in August The organization involves THs of the four prefectures of the Central Region in Togo. The goals of CERMETRA-RC are the training and the counselling of TH on the management of patients and the preservation of the environment, principally the protection of vulnerable species used in traditional medicine (TM). The organization has a center where TH follow-up their patients, and a botanic garden where they grow desired species. The organization works in collaboration with researchers of University of Lomé. The interviewed THs were from the Tchaoudjo prefecture. Questions asked were about (i) the TH identity, i.e. name and surname, sex, age, level of education; (ii) the origin of their knowledge; (iii) the status of the TH, i.e. full-time professional TH or part-time professional TH; (iv) the speciality, i.e. curing diabetes, curing HTN, or curing diabetes and HTN; (v) the disease, i.e. name of the disease in the local language; (vi) the diagnosis, i.e. main symptoms; (vii) the possible confirmation of the diagnosis with laboratory results; and (viii) the remedies, i.e. the number of plants in the remedy, the local names of the plants, the used parts, the period of harvest of the plants materials, the remedy formulation, and the administration route. Plant identification After interviews, preliminary identification of the plants was done in the field by a botanist. Afterward, herbarium specimens were prepared and photographs were taken to aid in the confirmation of the identity of the plants. Plant identities were confirmed

4 1288 S.D. Karou et al. Figure 1. The maps of Togo and Central Region showing the study area. by comparison with available voucher specimens in the Herbarium by Professor Akpagana of the Botany Department, University of Lomé, using taxonomic keys of online databases of PROTA (PROTA4U, Plant resources of Tropical Africa) on the website: www. prota.org. Nomenclature of species was done using the online data base of IPNI website: ipni/plantnamesearchpage.do. Data analysis Excel spread sheet was used to make simple calculations and determine plant frequencies. The use value (UV), a quantitative method that demonstrates the relative importance of species known locally, was calculated according to the following formula (Aburjai et al., 2007; Hudaib et al., 2008): UV = ΣU/n where, UV is the use value of a species; ΣU the total number of citations per species; n the number of informants. Results For the present study, a preliminary survey was carried out with 55 THs in order to select healers who had treated at least one case of diabetes and/or HTN. This preliminary survey enabled the selection of 35 (63.64%) healers, 30 males and 5 females, who were interviewed about the two diseases. Table 1 displays the socioprofessional data of the interviewed TH. The mean age was ± years, minimal age of 26 years and maximal age of 95 years. The THs in the range of up to 50 years accounted for 45.71%. Our results indicated that 37.14% were illiterates and only 22.86% TH attended the secondary school. For the origin of their knowledge, the majority of TH (71.43%) inherited the knowledge from their families, while 17.15% claimed that they received their knowledge through divine revelation and 5.71% learned from a healer outside their family. One TH inherited both from his family and from a TH outside his family, another inherited from his family and from divine gift; they were designated as other in Table 1. For the occupation of the TH, the majority claimed that their main occupation is healing patients and farming is secondary, while one TH said TM is a secondary job. The speciality in the treatment of HTN and/or DM was also surveyed. According to our results, 30.71% and 40% of TH treat exclusively diabetes and HTN, respectively. The rest of the healers claimed they treat the two diseases. Pharmaceutical Biology

5 Medicinal plants against diabetes and hypertension in Togo 1289 Table 1. The socio-professional data of the THs curing diabetes and/or HTN in the Central Region of Togo. Sex Males Females Respondents (%) Ages groups (years) Respondents (%) Educational level Illiterates Primary Secondary University Respondents (%) Origin of the knowledge Familial heritage exclusively Divine revelation exclusively Initiation from a TH exclusively Other Respondents (%) Status of the TH Full-time TH professional Partial TH professional Respondents (%) Speciality DM exclusively HTN exclusively DM + HTN Respondents (%) Basis of diagnostic Only rely only on symptoms Only rely on laboratory results Confirm diagnostic by laboratory results Respondents (%) Season of harvest Dry season (exclusively) Any season (dry or rainy season) Respondents (%) Moment harvest Morning (exclusively) Sunset (exclusively) Morning or sunset Any moment Respondents (%) Table 2. The recorded symptoms of DM and HTN in the Central Region of Togo. DM HTN Symptoms Respondents (%) Symptoms Respondents (%) Polyuria Asthenia Viscous or foamy urine Paralysis Recurrent wounds Giddiness Oedemas Palpitations Asthenia Loss of speech Sweet urines (attraction of ants) Difficulty in breathing Weight loss 8.60 Headache Nauseous urines 5.70 Weight gain 8.60 Fever 5.70 Fever 8.60 Headache 5.70 Tremor 5.70 Difficulty in breathing 5.70 Insomnia 5.70 Polydipsia 5.70 Vomiting (fat-rich after meal) 5.70 Giddiness 2.90 Anger 5.70 Sexual weakness 2.90 Excessive sweating 2.90 Painful urination 2.90 Ringing ears 2.90 Darkening blood 2.90 Itching 2.90 Vomiting (after taking medication) 2.90 Abdominal pains 2.90 Jaundice 2.90 Sudden accidents 2.90 Internal ulceration 2.90 Alternating weight loss/weight gain 2.90 The surveyed TH in this study cited 18 symptoms for DM and HTN. Table 2 displays the symptoms and the percentage of respondents. In the case of DM, Sikiri Kodom in the Tem language, the main symptoms cited by more than 20% of THs were polyuria, viscous or foamy urine, recurrent wounds, and edema. The other symptoms, such as dizziness, sexual weakness, pain on urination, darkening blood, vomiting (after taking medication), jaundice, and internal ulcers were not frequently cited. In the case of HTN, Azima Kodom in the Tem language, asthenia, paralysis, dizziness, and palpitations were the most cited. Most of these symptoms described by the healers could be related to complications of HTN. In fact, accelerated HTN is associated with headache, drowsiness, confusion, vision disorders, nausea, and vomiting symptoms, which are collectively referred to as hypertensive encephalopathy. The majority of surveyed healers confirm their diagnosis by the results of biomedical analysis, less than one-third of TH claimed they only rely on symptoms and their own experience to diagnose the disease. A total of 64 species belonging to 31 families were identified in the present study. Table 3 lists the identified plants, their UVs, and their previous citations in relation with diabetes and/or HTN. According to the table, only 23 species (35.94%) were previously cited in literature for

6 1290 S.D. Karou et al. Table 3. Medicinal plants used in the management of diabetes and/or HTN in the Central Region of Togo. Families Species Voucher specimen number Vernacular names Ailments UVs Diabetes HTN Previous citations Anacardiaceae Anacardium occidentale L. 4692FDS/UL Atchan DM/HTN Ojewole, 2003 Annonaceae Annona muricata L Tg Clt/AK Sabissab DM Lans, 2006 Annona senegalensis Pers. 2179FDS/UL Tchoutchoudè DM/HTN Xylopia aethiopica A. Rich TG Clt/AK Souzi DM Apocynaceae Catharanthus roseus (L.) G. Don Kilakou-sindâzi DM/HTN Lans, 2006 Picralima nitida Th. & H.Dur. 220FDS/UL Ambéri DM/HTN Arecaceae Cocos nucifera L TG Clt/AK Kpakpadirè HTN Lans, 2006 Raphia hookeri G. Mann & H. Wendl. 2179FDS/UL Bambou HTN Aristolochiaceae Aristolochia albida Duch TG Agadayo DM Clt/AK Asteraceae Vernonia amygdalina Del FDS/UL Souwaka HTN Akah and Okafor, 1992; Gbolade 2009; Oni, 2010; Jiofack et al., 2010 Celastraceae Maytenus senegalensis (Lam.) Exell FDS/UL Tchindjinya DM Combretaceae Combretum molle R.Br. ex G. Don FDS/UL Kizizikou HTN Ojewole, 2008 Pteleopsis suberosa Engl. & Diels 8078 FDS/UL Sissinon DM Terminalia glaucescens Planch. ex Benth FDS/UL Souwadâou DM Cucurbitaceae Momordica charantia L FDS/UL Katchalayo DM/HTN Razza et al., 1996; Lans, 2006; Gbolade, 2009 Dipterocarpaceae Monotes kerstingii Gilg FDS/UL Sèrè DM Ebenaceae Diospyros mespiliformis Hochst. ex A.DC FDS/UL Tigbado HTN Euphorbiaceae Ricinus communis L. 351 FDS/UL Dèdèlè HTN Fabaceae Afzelia africana Sm Welou HTN Dichrostachys cinerea (L.) Wight & Arn. 299 FDS/UL Bouvoum DM Lonchocarpus cyanescens Benth FDS/UL Tchèlè DM Millettia thonningii Baker kodoliya HTN Prosopis africana Taub. 848 FDS/UL Kpalou DM Parkia biglobosa Benth FDS/UL Soulou DM/HTN Besançon et al., 2005; Abo et al., 2008 Pericopsis laxiflora (Benth. ex Baker) Meeuwen 2324 FDS/UL Tchamani HTN Phaseolus vulgaris L. Sona DM Piliostigma thonningii (Schumach.) Milne FDS/UL Bakou DM/HTN Redh. Pterocarpus erinaceus Poir. 15 FDS/UL Tem DM Xeroderris stuhlmannii (Taub.) Mendonça FDS/UL Tchalawâri DM/HTN & E. P. Sousa Lamiaceae Hyptis suaveolens (L.) Poit TG Clt/AK Botifadini HTN Ocimum americanum L TG Clt/AK Kozossonya HTN Ocimum gratissimum L FDS/UL Kounozorou DM Aguiyi et al., 2000; Egsie et al., 2006; Gbolade, 2009 Lauraceae Persea americana Mill Paya HTN Lans, 2006; Agbonon et al., 2010 (Continued) Pharmaceutical Biology

7 Medicinal plants against diabetes and hypertension in Togo 1291 Table 3. (Continued) Families Species Voucher specimen number Vernacular names Ailments UVs Diabetes HTN Previous citations Liliaceae Allium cepa L Albassa HTN Eddouks et al., 2002; Tahraoui et al., 2007; Gbolade, 2009 Allium sativum L Ayo DM/HTN Ziyyat etal., 1997; Eddouks et al., 2002; Gbolade, 2009 Aloe vera (L.) Burm.f Fradjo DM Eddouks et al., 2002; Ahmad et al., 2007; Jouad et al., 2001; Haddad et al., 2003; Kareru et al., 2007 Loganiaceae Anthocleista djalonensis A. Chev FDS/UL Assoubo-bissaou DM Gbolade, 2009 Strychnos spinosa Lam FDS/UL Kpengbelé DM Meliaceae Pseudocedrela kotschyi Harms 7719 FDS/UL Ditotoré DM/HTN Khaya senegalensis A. Juss FDS/UL bis Frimou DM/HTN Trichilia emetica Vahl 308 FDS/UL Adjendjegbizou DM Moringaceae Moringa oleifera Lam TG Clt/AK Séguéléguédi DM Nadembega et al., 2010 Myrtaceae Psidium guajava L Goyaba DM Amusan et al., 2007 Opiliaceae Opilia amentacea Roxb FDS/UL Domfadou DM/HTN Phyllanthaceae Securinega virosa (Willd.) Baill. 008 FDS/UL Tchakatchaka DM/HTN Bridelia ferruginea Benth FDS/UL Kolou DM Phyllanthus amarus Schumach. 571 FDS/UL Sèni-sèniyo DM/HTN Ali al., 2006; Abo et al., 2008; Agbonon et al., 2010 Poaceae Cymbopogon citratus Stapf TG Clt/AK Tigbé DM Polygalaceae Securidaca longepedunculata Fresen FDS/UL Fozi DM/HTN Gbolade, 2009 Rubiaceae Gardenia ternifolia Schumach. 27 FDS/UL Kawou HTN Morinda lucida Benth Tg Clt/AK Zanklan (Ewé) HTN 0.04 Adjanohoun et al., 1986; Kamanyi et al., 1994; Abo et al., 2008; Gbolade, 2009; Agbonon et al., 2010 Sarcocephalus latifolius (Sm.) E.A. Bruce 07535TG Clt/AK Kidjitchilou DM/HTN Nworgu et al., 2008: Gidado et al., 2008 Coffea sp Coffi DM Rutaceae Citrus aurantiifolia (Christm.) Swingle 02480TG Clt/AK Akanka HTN Abo et al., 2008; Gbolade, 2009 Sapotaceae Vitellaria paradoxa C. F. Gaertn FDS/UL Somou DM/HTN Solanaceae Nicotiana tabacum L. 278 FDS/UL Assara HTN Gbolade, 2009 Schwenckia americana L FDS/UL Kotoka HTN Lycopersicum esculentum L Timati HTN Sterculiaceae Cola nitida Schott & Endl FDS/UL Goro DM 0.05 Lans, 2006 Theobroma cacao L FDS/UL Coco DM/HTN Taccaceae Tacca leontopetaloides (L.) Oktze Nanitiwou DM Verbenaceae Gmelina arborea Roxb Ansara-tantouna HTN Stachytarpheta angustifolia (Mill.) Vahl 820 FDS/UL Tchoumboulouzou HTN Lippia multiflora Moldenke 09207TG Clt/AK Boufazaou HTN

8 1292 S.D. Karou et al. such purposes. A total of 19 species are used both in the management of diabetes and HTN by the Tem people. For the specific treatment of diabetes, 43 species belonging to 24 families were cited. Among them, Fabaceae, with eight species are the most represented. Three species were recorded for Meliaceae, Phyllanthaceae, and Annonaceae. The rest of the families are represented by one or two species. For the specific treatment of HTN, 40 plant species are used. These species belong to 24 families. The most represented families are the Fabaceae, with four species. Rubiaceae, Solanaceae, and Verbenaceae followed with three species each. The UVs were calculated for the cited plants. These data are helpful in determining the plants with the highest use. Indeed the greatest UV indicated the plants with the highest use. According to the UVs, the plants most used as antidiabetic by the Tem TH are Psidium guajava L. (Myrtaceae), Khaya senegalensis A. Juss. (Meliaceae), Sarcocephalus latifolius (Sm.) E.A. Bruce (Rubiaceae), Annona muricata L. (Annonaceae), Bridelia ferruginea (Benth.) (Phyllanthaceae), and Securidaca longepedunculata Fresen. (Polygalaceae) (all with UV = 0.14), while the most used species for HTN were Allium sativum L. (Liliaceae) (UV = 0.38) and Parkia biglobosa Benth. (Fabaceae) (UV = 0.19), followed by Khaya senegalensis (UV = 0.11), Gardenia ternifolia Schumach. (Rubiaceae) (UV = 0.11), and Persea americana Mill. (Lauraceae) (UV = 0.11). A total of 29 antidiabetic recipes prepared from the 43 plant species were identified (Table 4). Eight recipes were made of one plant. These unique plants were Aloe vera (L.) Burm.f. (Liliaceae) Phaseolus vulgaris L. (Fabaceae), Pterocarpus erinaceus Poir. (Fabaceae), Anacardium occidentale L. (anacardiaceae), Bridelia ferruginea, Catharanthus roseus (L.) G. Don. (Apocynaceae), Annona muricata, and Picralima nitida Th. & H.Dur. (Apocynaceae). Twenty-one recipes were obtained by association of plants. The number of associated plants by recipes varied between two and eight. Indeed, 11 recipes were made of two plants, six recipes made of three plants, two recipes made of four plants, one recipe of five plants, and one recipe of eight plants. Thirty-eight recipes prepared from the 40 plant species were recorded as curing HTN (Table 5). Fourteen recipes were made of unique plants namely Allium sativum, Anacardium occidentale, Lycopersicum esculentum L. (Solanaceae), Morinda lucida Benth. (Rubiaceae), Ocimum americanum L. (Lamiaceae), Gardenia ternifolia, Parkia biglobosa, Table 4. The antidiabetic recipes of the Tem THs. Recipes Plants Used parts Mode of preparation Route of administration Unique plant Antd-1 Aloe vera Juice Oral recipes Antd-2 Phaseolus vulgaris Fruits Powder Oral Antd-3 Pterocarpus erinaceus, stem bark Decoction Oral Antd-4 Anacardium occidentale Stem bark Powder Oral Antd-5 Bridelia ferruginea Stem bark Powder Oral Antd-6 Catharanthus roseus Decoction Oral Antd-7 Annona muricata Decoction Oral Antd-8 Picralima nitida Seeds Powder Oral Recipes made of Antd-9 Pterocarpus erinaceus Stem bark Decoction Oral two plants Bridelia ferruginea Antd-10 Khaya senegalensis Stem bark Powder Oral Parkia biglobosa Stem bark Antd-11 Tacca leontopetaloides Bulb Powder Oral Strychnos spinosa Antd-12 Monotes kerstingii Stem bark Powder Oral Pseudocedrela kotschyi Antd-13 Aristolochia albida et leaves Decoction Oral Xeroderris stuhlmannii et leaves Antd-14 Khaya senegalensis Stem bark Decoction Oral Allium sativum Bulb Antd-15 Tacca leontopetaloides Bulb Decoction Oral Cymbopogon citratus Antd-16 Securidaca longepedunculata Decoction Body bath Sarcocephalus latifolius Antd-17 Bridelia ferruginea Stem bark Decoction Oral Anthocleista djalonensis Antd-18 Phyllanthus amarus Whole plant Decoction Oral Theobroma cacao Antd-19 Psidium guajava Decoction Oral Cola nitida (Continued) Pharmaceutical Biology

9 Medicinal plants against diabetes and hypertension in Togo 1293 Table 4. (Continued) Recipes Plants Used parts Mode of preparation Route of administration Recipes made of Antd-20 Khaya senegalensis Decoction Oral and body bath three plants Sarcocephalus latifolius Pteleopsis suberosa Antd-21 Annona senegalensis Powder Oral Lonchocarpus cyanescens Stem bark Phyllanthus amarus Whole plant Antd-22 Theobroma cacao Decoction Oral Coffea sp Xylopia aethiopica Fruits Antd-23 Psidium guajava Decoction Oral Annona muricata Stachytarpheta angustifolia Antd-24 Sarcocephalus latifolius Decoction Oral Anthocleista djalonensis Trichilia emetica Antd-25 Piliostigma thonningii Stem bark Decoction Oral Momordica charantia Whole plant Annona senegalensis Recipes made of Antd-26 Psidium guajava Decoction Oral four plants Annona muricata Moringa oleifera Piliostigma thonningii Antd-27 Xylopia aethiopica Fruits Powder Poultices Securidaca longepedunculata bark Sarcocephalus latifolius bark Opilia Amentacea bark Recipes made of Antd-28 Parkia biglobosa Stem bark Decoction Oral five plants Aristolochia albida Ocimum gratissimum Whole plant Trichilia emetica Securidaca longepedunculata Recipes made of Antd-29 Securinega virosa Decoction Oral eight plants Prosopis africana Vitellaria paradoxa Parkia biglobosa Maytenus senegalensis Terminalia glaucescens Securidaca longepedunculata Dichrostachys cinerea Table 5. The antihypertensive recipes of the Tem THs. Recipes Plants Used parts Mode of preparation Route of administration dosage Unique plant Anthyp-1 Allium sativum Bulb Crushed maceration + honey Oral recipes Anthyp-2 Anacardium occidentale Stem bark Powder Oral Anthyp-3 Lycopersicum esculentum Maceration Oral Anthyp-4 Morinda lucida Decoction Oral and body bath Anthyp-5 Ocimum americanum Stem and leaves Decoction Oral Anthyp-6 Gardenia ternifolia Decoction Oral Anthyp-7 Parkia bigloboa Seeds Powder Oral Anthyp-8 Phyllanthus amarus Whole plant Decoction Oral Anthyp-9 Vernonia amygdalina Maceration Oral Anthyp-10 Opilia amentacea Decoction Oral and body bath Woods Powder Anthyp-11 Catharanthus roseus Decoction Oral Anthyp-12 Ricinus communis Powder Oral (Continued)

10 1294 S.D. Karou et al. Table 5. (Continued) Recipes Plants Used parts Mode of preparation Route of administration dosage Anthyp-13 Citrus aurantifolia Fruits Juice Oral Anthyp-14 Raphia hookeri Whole plant Wine Oral Recipes made Anthyp-15 Persea americana Decoction Oral of two plants Theobroma cacao Anthyp-16 Hyptis suaveolens Whole plant Decoction Oral Khaya senegalensis Stem bark Anthyp-17 Cocos nucifera Fruits Maceration Oral Nicotiana tabacum Anthyp-18 Gardenia ternifolia Powder Oral Piliostigma Thonningii Anthyp-19 Sarcocephalus latifolius Decoction Oral Picralima nitida Seeds Anthyp-20 Parkia biglobosa Stem bark Maceration Oral Allium sativum Bulb Anthyp-21 Vitellaria paradoxa Stem bark Decoction Oral Millettia thonningii Anthyp-22 Schwenckia Americana Powder Oral Diospyros mespiliformis Maceration Body bath Anthyp-23 Persea americana Decoction Oral Theobroma cacao Anthyp-24 Hyptis suaveolens Whole plant Decoction Oral Khaya senegalensis Stem bark Anthyp-25 Cocos nucifera Fruits Maceration Oral Nicotiana tabacum Anthyp-26 Gardenia ternifolia Powder Oral Piliostigma thonningii Anthyp-27 Sarcocephalus latifolius Decoction Oral Picralima nitida Seeds Anthyp-28 Parkia biglobosa Stem bark Maceration Oral Allium sativum Bulb Anthyp-29 Vitellaria paradoxa Stem bark Decoction Oral Millettia thonningii Anthyp-30 Schwenckia americana Powder Oral Diospyros mespiliformis Maceration Body bath Recipes made Anthyp-31 Piliostigma thonningii Stem bark Decoction Oral of three plants Momordica charantia Whole plant Annona senegalensis Anthyp-32 Pseudocedrela kotschyi Decoction Oral Securinega virosa Combretum molle Recipes made Anthyp-33 Lippia multiflora Powder Oral of four plants Stachytarpheta angustifolia Allium sativum Bulb Persea americana Fruit Anthyp-34 Khaya senegalensis + leaves Decoction Oral Parkia biglobosa Stem bark Pericopsis laxiflora + leaves Gmelina arborea Anthyp-35 Khaya senegalensis Stem bark Powder Oral Sarcocephalus latifolius Pseudocedrela kotschyi Securidaca longepedunculata Pharmaceutical Biology

11 Medicinal plants against diabetes and hypertension in Togo 1295 crushes, wine, and juice (Figure 3). The wine is prepared in the particular case of Raphia hookeri by empirical fermentation of the sap of the plant. The main mode of administration of herbal medicines listed is oral and body bath. For powders, the drugs are often dissolved in porridge or in the sauces. The poultice is less common. Figure 2. The plant portions used in the concoctions of antidiabetic and/or antihypertensive recipes in the Tem TM. Rt, roots; Lv, leaves; Sb, stem bark; Wp, whole plant; Fr, fruits; Bu, bulb; Se, seeds; St, stem; Wo, woods. Figure 3. The formulations of remedies used in the management of diabetes and/or HTM in the Tem TM. Win, wine; FCr, fresh crush; Jui, juice; Mac, maceration; Pow, powder; Dec, decoction. Phyllanthus amarus Schumach. (Phyllanthaceae), Vernonia amygdalina Dedile (Asteraceae), Opilia Amentacea Roxb. (Opiliaceae), Catharanthus roseus, Ricinus communis L. (Euphorbiaceae), Citrus aurantifolia (Christm.) Swingle (Rutaceae), and Raphia hookeri G. Mann & H. Wendl. (Arecaceae). The number of associated plants in the rest of recipes varied between two and four. Sixteen recipes were of two plants, two recipes of three plants, and three recipes of four plants. The Tem TH harvest plant materials at any season of the year, but some of them claimed they preferentially harvest in the dry season according to the availability of the species. The best moment of the day for their harvest is either the morning or the sunset (Table 1). All the plant parts including leaves, roots, stem bark, seeds, woods, and whole plants are used in the concoctions against DM and/or HTN in the Tem TM. According to Figure 2, roots and leaves are the most frequently used organs by the Tem TH in the management of diabetes and HTN, while the stem bark are moderately used. The whole plants and parts, such as fruits, root barks, seeds, and wood are less used. According to our results, the main modes of preparation of drugs are decoction and powder. Other methods of preparation are maceration, Discussion The present study aimed to document the management of HTN and diabetes in the Tem TM. The DM and HTN are two diseases that were pointed out as posing particular challenges, since they were traditionally unknown in most African countries (Heinrich et al., 2009). Accordingly, treating these diseases is not usual for TH. Some of the symptoms might have been recognized, but not the disease as described biomedically today. According to Cooke and Plotnick (2008), the main signs of DM are polyuria, polydipsia, polyphagia, weight loss, and asthenia. Globally the Tem TH cited the main symptoms of DM. Similarly, the main symptoms of HTN were cited by TH. However, each symptom was singularly recognized at the most by 37% of TH. The risk of misdiagnosis remains, since approximately 30% TH do not confirm the diagnosis by laboratory analysis. The surveyed TH highlighted the use of 64 species belonging to 31 families in the treatment of DM and/or HTN. In similar studies, Tahraoui et al. (2007) in Morocco identified 64 medicinal plants belonging to 33 families, 18 species being included in recipes for both DM and HTN. Tahraoui et al. (2007) and Jouad et al. (2001) listed 54 plants grouped into 25 families and 54 plants grouped into 29 families, respectively, while Ziyyat et al. (1997) and Gbolade (2009) recorded 41 plants belonging to 36 families and 49 plants belonging to 33 families, respectively. For these studies, the most cited families were Euphorbiaceae, Apocynaceae, Cucurbitaceae, Asteraceae and Fabaceae. According to our results, herbal concoctions proposed by the TH for the management of DM and HTN may include several plants. Objectively, recipes made of more than three plants should be used with care because of the limitless compounds that could occur in one plant. In our previous study, we reported some adverse effects due to the administration of the herbal medicines. The recipes used in the management of DM and HTN were also incriminated (Tchacondo et al., 2011). All TH in the study recognized that they could not cure definitely the diseases, although some TH in Nigeria claimed to have successfully treated diabetes (Gbolade, 2009). Another concern in this study is the problem of the dose of concoction. This is the main problem with the traditional concoctions. In fact, the TH only rely on their own experience to prepare their recipes. Raw materials or powders are not weighed nor the volume of water measured, so there is a problem for standardization of the preparations. Plants most cited as antidiabetic by the Tem THs were Psidium guajava, Khaya senegalensis, Sarcocephalus

12 1296 S.D. Karou et al. latifolius, Annona muricata, Bridelia ferruginea, and Securidaca longepedunculata, while, the following plants, Catharanthus roseus, Cocos nucifera, and Momordica charantia were found to be the most commonly used in the treatment of diabetes in Trinidad and Tobago (Lans, 2006). In a previous study conducted by Gbolade (2009) in Nigeria, 50 recipes used against DM were recorded. These recipes were mainly made of association of plants, Momordica charantia and Ocimum gratissimum L. (Lamiaceae) being the most used. Eight plants identified in the present study were already cited for same purposes in previous studies conducted in Morocco and in Nigeria (Ziyyat et al. 1997; Jouad et al., 2001; Tahraoui et al. 2007; Abo et al. 2008; Gbolade, 2009). Moreover, the hypoglycemic activity of some of the plants cited in this study has already been demonstrated. These are Ocimum gratissimum (Aguiyi et al. 2000; Egsie et al., 2006) Momordica charantia (Bailey et al., 1985; Raza et al., 1996), Phyllanthus amarus (Ali et al., 2006), Allium sativum (Chang & Johnson, 1980), and Aloe vera (Okyar et al., 2001). Ethnobotanical studies on antihypertensive plants conducted by Tahraoui et al. (2007) and Jouad et al. (2001) identified 36 plants from 21 families and 19 plants from 13 families, respectively, while Ziyyat et al. (1997) reported the use of 18 species classified in 17 families. Several studies have documented unique plants used in the management of HTN. Indeed Allium sativum and Allium cepa L. (Liliaceae) were found to be most frequently used plants in Morocco (Ziyyat et al., 1997; Jouad et al., 2001; Tahraoui et al. 2007), while Vernonia amygdalina and Allimun sativum were commonly used in Nigeria (Abo et al., 2008). Aloe vera, Annona muricata, Cola nitida Schott & Endl. (Sterculiaceae), and Persea americana identified in this study were also documented as used traditionally in Trinidad and Tobago (Lans, 2006). Our results therefore share great similarities with these previous reports. In fact, the most cited plant of the present study, Allium sativum is the species that is widespread among plants mentioned as antihypertensives in several ethnopharmacological studies. Historically, Allium sativum has been designated as a species whose use reduces cardiovascular events by lowering plasma cholesterol levels, blood pressure, and inhibiting platelet aggregation (Rahman, 2001; Lin et al., 2001). Allicin is the compound responsible for such properties (Lin et al., 2001). Moreover, previous experimental studies have demonstrated the antihypertensive activity of some plant species. This is the example of Lycopersicum esculentum (Willcox et al. 2003; Engelhard et al., 2006) and Theobroma cacao (Grassi et al., 2005). Conclusion At this stage of our knowledge, ethnobotanical surveys of medicinal plants used in the treatment of diabetes and HTN in Togo are unknown. The present study enabled the identification of 29 antidiabetic recipes and 38 antihypertensive recipes. These recipes are made from 64 plant species in the flora of Togo. The most cited plants against diabetes were Psidium guajava, Khaya senegalensis, Sarcocephalus latifolius, Annona muricata; Bridelia ferruginea, and Securidaca longepedunculata, while Allium sativum; Parkia biglobosa, Khaya senegalensis, Gardenia ternifolia, and Persea americana were the most commonly cited as antihypertensive. In comparison with previous published reports, the THs of the Togo Central Region have basic knowledge regarding herbal medicine for DM and HTN. The present inventory therefore represents the contribution of natural flora of Togo to the global approach in controlling diabetes and HTN. 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