Key findings:

Key findings of this study on traditional medicinal plants near a catholic church in Iligan City, Philippines, include: identification of 23 plant species from 20 families, with Fabaceae, Meliaceae, and Poaceae being prominent; plants primarily used for digestive, musculoskeletal, and respiratory issues; stem as the commonly used plant part prepared through decoction for oral consumption.

What is known and what is new?

The known aspect in this abstract is the common practice of seeking traditional healing sources in the Philippines due to cost and access issues with modern medicine. The new contribution is the identification of 23 plant species sold near a catholic church in Iligan City, Mindanao, addressing various health concerns, with a focus on digestive, musculoskeletal, and respiratory disorders.

What is the implication, and what should change now?

The implication of this study is the need to regulate the commercialization of traditional medicinal plants in the Philippines to ensure their safe use, despite their extensive utilization by the local community. Changes needed include conducting phytochemical and pharmacological evaluations, establishing quality control measures, and providing education on the proper use of these remedies to protect public health.

Medicinal plants hold significant economic importance and play a crucial role in traditional medicine, being globally commercialized for their accessibility and effectiveness. In Indonesia, for instance, these plants serve both as revenue-generating assets and as effective remedies for various ailments [1]. The diverse organs of these plants are utilized to treat a spectrum of diseases, contributing to human health improvement. According to Katiyar et al. [2], numerous active pharmaceutical ingredients and innovative medications have their origins in plants. The data on commercially available medicinal plants is expanding rapidly. In the Philippines, many of these are sold freely on the sidewalks around catholic churches and even on busy streets. Some plants are claimed to have multiple uses while some are disease-specific and many times more popular and command a better price. To be able to have a clearer idea as to the possible relationships of the commercialized plants with claims of cure for diseases or health concerns, the application of the tool of network analysis may be useful.

Network analysis proves to be a valuable tool in deciphering the mechanisms within vast datasets of medicinal plants concerning their use for treating diseases. Several nations, including Indonesia, Korea, Bangladesh, India, and Myanmar, have conducted extensive research in this domain [3-5]. The resulting graph from such analyses for example illustrates the intricate relationships between the medicinal plants and the concerned health concerns. The visual representations that will be generated by the analysis highlight densely connected network nodes, revealing crucial connection patterns between the plants and concerned health problems or diseases.

While the continued utilization of medicinal plants as an alternative form of treatment is rooted in claims of established efficacy and historical significance, caution must still be necessary when considering the substitution of pharmaceutical drugs with medicinal plants. This is because as traditional knowledge evolves, precise instructions for preparation and administration may be inaccurately conveyed. The exclusive focus on the effectiveness of various commercially available traditional medicinal plants sets the stage for subsequent pharmacological studies aimed at their safe and sustainable utilization. Appropriate information on commercialized traditional medicinal plants requires a better understanding of the interrelationships of their perceived effective cure of the perceived health problem thus providing a good foundation for informed choices in healthcare.

2.1 Collection and Identification of Plant Materials

The research involved surveys, informal interviews, and plant collections in various areas of Iligan City - the sidewalks around the vicinity of the Markets and the church St. Michael's Cathedral. The commercialized plant materials were dried. A semi-structured questionnaire was employed to gather information on the local names of plants, parts used, associated ailments, and methods of preparation, following established methods [6-8]. Photographic documentation focused on the diverse anatomical components of the plants, especially rare species. The identification of plant species was carried out using taxonomic keys, pictorial keys, and relevant botanical and medicinal plant texts. Databases such as Google Scholar, PubMed Central, ScienceDirect, BioMed Central, STUARTXCHANGE, and general Google queries were searched on the taxonomy of the plant taxa and were compiled in Microsoft Excel.

2.2 Network Analysis

Utilizing the dual license CDDL and GNU General Public Version 3 (2008-2023), the network analysis employed the Gephi software (version 0.10.1, released in 2023). The data, in the form of an Edges table, was imported with commas as separators, and the graph type was directed based on an internet search. Gephi was used to assess the network, identify groups, examine nodes, and explore edges statistically. In this study, medicinal plants and ailments were represented as nodes, while the edges depicted the relationships between them. Fruchterman Reingold modified the graph's layout with specific parameters, an area of 10000.0, gravity of 10.0, and speed of 1.0. Nodes were dispersed using an expansion layout with a scale factor of 1.2. Appearance-related dimensions ranked nodes based on degree, with a minimum size of 5 and a maximum size of 10. Nodes were grouped based on the modularity class value.

3.1 Diversity of Plant Species Used

This study collected a diverse array of 28 commercialized medicinal plants, showcasing 23 medicinal plant species, spanning 23 genera and 20 families (Table 1). Interestingly, traditional physicians don't hold exclusive knowledge of medicinal substances; instead, it is the vendors who play a crucial role in this domain. Moreover, the assertion is made that these plants are not unique to Iligan City and their availability might be seasonal, impacting their consistent accessibility. Notable families contributing to the diversity of medicinal plants are Fabaceae (including Adenanthera pavonina and Caesalpinia sappan L.), Meliaceae (including Sandoricum koetjape and Swietenia mahogani Jacq.), and Poaceae (including Setaria italica and Oryza sativa L.). The Fabaceae family stands out as the most widely utilized commercialized group for medicinal purposes, echoing similar practices observed among Ethiopians, who employed it in the treatment of serpent injuries and lesions in various regions [9]. This finding aligns with the results reported by Tantengco et al. [10] and Ragragio et al. [11] in studies involving Ayta communities in Bataan and Pampanga, Philippines. Other prominent plant families like Meliaceae and Poaceae also emerged as widely utilized, contributing significantly to traditional medicine especially for instance, the Maranao, Higaonon, and Ati communities where they employ S. mahogani Jacq. and O. sativa L. for the treatment of gastric pains [12-14]. 

3.2 Medicinal Plants and Therapeutic Treatments

Among the 45 ailments or symptoms documented in this study, digestive disorders, musculoskeletal system, connective tissue issues, and respiratory disorders emerged as the top three most frequently cited (Table 2). Digestive disorders reported by individuals encompassed a range of conditions, including gas pain, ulcer, bruxism, gastritis, vomiting, flatulence, diarrhea, and general discomfort. Consistent with findings from various ethnopharmacological investigations, digestive disorders were identified as the most prevalent ailment [15-16]. Tinospora crispa (L.) Hook. f. & Thomson, a medicinal plant, was notably employed for treating digestive disorders. Across various Filipino ethnic groups, this plant was utilized to address ulcers, dyspepsia, stomachaches, diarrhea, regurgitation, toothaches, and discomfort related to gas. Additionally, it found applications in managing abortifacients, dysmenorrhea, and delayed menstruation [17-18].

Musculoskeletal impairments involve irregularities in adjacent connective tissues, bones, muscles, and joints. Autoimmune imbalances often contribute to musculoskeletal and connective tissue disorders, such as rheumatoid arthritis [19]. The study identified disorders within the musculoskeletal system and connective tissues, including rheumatism, arthritis, back pain, muscle pain, hip pain, and general body pain.

Respiratory diseases, including asthma, wheezing, runny breath, and tuberculosis, were also identified in this investigation. A common respiratory symptom observed in clinical medicine is coughing [20]. The findings of this research illustrated the efficacy of Equisetum hyemale, C. sappan L., and S. mahogani Jacq as remedies for respiratory conditions. In contrast, prior investigations have demonstrated that remedy cough is susceptible to Canarium asperum Benth [14], Hyptis capitata Jacq. [18,13], O. sativa L. [21], and Dendrocnide luzonensis (Wedd.) Chew [22].

Subsequent in order of medicinal utility is Caesalpinia bonduc, S. mahogani Jacq., T. crispa (L.) Hook. f. & Thomson, and Averrhoa bilimbi L. Since only identified species were tabulated, the number of indeterminate species was also recorded. Kidney disease in Mexico is treated with a decoction derived from the stem or aerial portion of E. hyemale [23]. It has been documented that IS. mahogany has therapeutic properties for the following conditions: abortifacient, menstruation syndrome, dysmenorrhea, delayed menstruation, abdominal pain, and tooth decay [12,14,17,18,24, 25,26]. 

Table 1. Commercialized Traditional Medicinal Plants Sold in Iligan City

Table 2. Ailments grouped and the used plants

3.2 Plant Element Utilized

The stem emerged as the most commonly employed plant part, with seeds and roots following closely behind, while bark, bark resin or fluid, and foliage saw comparatively less use. This pattern aligns with the desiccated state of the collected samples, as stems, known for their prolonged display capacity, are often preferred in trade compared to foliage. The survey revealed the simultaneous utilization of multiple plant segments from the same plant. For instance, Lagerstroemia speciosa's stem and leaves were employed in treating urinary tract infections, kidney disease, and postpartum bleeding, while H. capitata Jacq. roots and leaves were applied to address arthritis and postpartum hemorrhage by inducing uterine contraction.

3.3 Network Analysis and Statistical Descriptions

Figure 1 provides a comprehensive view of the connections between medicinal plants, diseases, and their associated medicinal properties. Notably, T. crispa (L.) Hook. f. & Thomson emerges as a key player in the network, boasting the highest out-degree value of 38. This designation as a hub underscores its pivotal role in the network, as it exhibits numerous connections to various maladies and pharmacological activities [27].

Research affirms the diverse pharmacological benefits of T. crispa, encompassing anti-inflammatory, immunomodulatory, antimalarial, antioxidant, cardioprotective, and antidiabetic effects [27]. Locally, in the Philippines, T. crispa is harnessed to address an array of ailments, ranging from malaria and arthritis to fever [18].

In the network, antioxidants assume a central position, evident in the maximum in-degree value of nine. This underscores the importance of antioxidants in the herbal network, with various plants contributing to this antioxidant activity. Notable examples include Coriandrum sativum L., Parameria laevigata, and Heliotropium indicum. The prevalence of antioxidant-active compounds across multiple plants highlights the collective contribution of herbal capsules in promoting antioxidant properties, potentially offering health benefits associated with combating oxidative stress. This emphasis on antioxidants strengthens the understanding of the herbal network's therapeutic potential and underscores the importance of these bioactive compounds in herbal formulations [28-32].

The network analysis reveals a maximum weight of 10, signifying robust connections between nodes. Notably, T. crispa (L.) Hook. f. & Thomson stands out with the highest mass in the network, particularly associated with the ailment of diabetes. This prominence indicates that T. crispa has been extensively studied for its potential applications in diabetes management.

Research in the southern Indian province of Kerala highlights the historical use of T. crispa in treating diabetes [33]. Stem cell infusion, proposed as a therapeutic intervention for diabetes, is explored in Indonesian studies, showcasing the diverse approaches to utilizing T. crispa [34]. In Malaysia, T. crispa is employed for diabetes treatment through oral administration of stem decoctions and aqueous extracts [35-36]. The widespread use of T.crispa in Asia and Africa is attributed to its potent.

 antidiabetic activity [37].

Figure 1. Network of Plants-diseases and Medicinal Properties

Active compounds such as Borapetol B, Borapetoside A, and Borapetoside C found in the stem of T. crispa contribute to its antidiabetic effects. Borapetol B, in particular, is noted for stimulating insulin release, as revealed by Lokman et al. [38]. The multifaceted contributions of T. crispa, especially in the context of diabetes, emphasize its potential as a versatile source of herbal medicines with broad therapeutic applications. The study's Gephi results underscore the significance of T. crispa by clustering it into distinct groups, reflecting its high degree of interconnection within these specific categories (Figure 2-4).

Group A (Fig. 2)

Within this cluster of thirty-three nodes, a diverse array of forty-five medicinal properties associated with plants and diseases is identified. These properties are derived from different plant parts, including seeds, roots, and stems. Notably, Group A stands out with the highest degree of modularity, reaching 31.13%. The combined effects of these plants within Group A demonstrate efficacy against a spectrum of health conditions, encompassing parasitic infections, bacterial infections, blood diseases, and disorders of the nervous system. Specifically, conditions impacting the central nervous system, such as migraines, seizures, and infections like tumors, can trigger symptoms like nausea and vomiting, as elucidated by Kuo and Singh [39]. This highlights the comprehensive medicinal potential of the plants within this group, addressing a range of ailments and reflecting the interconnected nature of their therapeutic properties.

Figure 2. Network Diagram of Group A

Group B (Fig. 3). 

Within this cluster of twenty-five nodes, a diverse spectrum of twenty-four medicinal properties related to plants and diseases is identified. The therapeutic attributes of these plants are derived from various plant components, including roots, stems, and spores. Notably, Group B demonstrates the second-highest modularity in the network, reaching 23.58%. The botanical composition of Group B presents potential remedies for a wide array of conditions, spanning those affecting the integumentary system, musculoskeletal system, menstruation, connective tissue, and endocrine, nutritional, and metabolic processes. While certain maladies, such as toothaches and stomachaches, were not explicitly categorized, research suggests that T. crispa may have efficacy in treating these ailments. This underscores the diverse and interconnected medicinal properties inherent in the plants within Group B, indicating their potential therapeutic relevance across various health domains.

Figure 3. Network Diagram of Group B

Group C (Fig. 4)

Within this particular cluster comprising fifteen nodes, a total of fourteen medicinal properties associated with plants and diseases are identified. The plant components contributing to these medicinal properties include bark, wood, and stem. Group C stands as the third most modular class, boasting a modularity level of 14.15 percent. The combination of plants within Group C holds the potential to address a range of health conditions, including disorders of the digestive system, respiratory infections, veterinary diseases, and poisonings. While diseases explicitly categorized in the above-mentioned groups do not include alternative pharmacological activities like anti-cancer properties, it is worth noting that these may still be relevant, particularly in the context of gastrointestinal cancers associated with digestive issues. This underscores the multifaceted nature of the medicinal properties within Group C, indicating their potential impact on diverse health concerns.

Figure 4. Network Diagram of Group C

Collectively, the revealed groups (Group A through Group C) showcase botanical species known for their notable efficacy against specific strains or categories of ailments. This provides insights into how plants may specialize in addressing particular health conditions. However, it is essential to emphasize that further research is needed to either develop or enhance this guide for the discovery of new treatments.

In conclusion, the local populace in Iligan City relies significantly on commercially available traditional medicinal plants, employing them primarily for respiratory diseases, musculoskeletal and connective tissue issues, and digestive disorders. Various preparation methods highlight the diverse applications of these plants, showcasing the vendors' adherence to traditional knowledge. The network analysis conducted in this study provides meaningful insights into the complex relationships among medicinal plants, diseases, and their corresponding medicinal properties. Notably, T. crispa (L.) Hook. f. & Thomson emerges as a central figure in the network, underlining its importance in traditional herbal practices. Antioxidants also demonstrate robust associations with medicinal plants, emphasizing their significance. This study contributes to the validation of traditional practices by revealing scientific insights into the efficacy of certain botanical species. While some plants have already demonstrated therapeutic properties through scientific research, comprehensive evaluations of various plants are essential to identify new active compounds. The network analysis serves as a valuable tool to support and enhance traditional herbal preparation methods, guiding future pharmaceutical research and development.

Acknowledgements

The authors would like to express their gratitude to DOST-ASTHRDP for the research grant, and we are very grateful to all vendors in the study areas for sharing their oral traditional knowledge during surveys.

Funding: No funding sources 

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Mindanao State University-Iligan Institute of Technology.

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