Journal of Ethnopharmacology,
185
36 ( 1992) 185- 191
Elsevier Scientific Publishers Ireland Ltd.
Review Article
South African traditional herbal medicines used during pregnancy and childbirth D.J.H. Vealea, K.I. Furmana and D.W. Oliverb aDepartment
of Experimental and Clinical Pharmacology, Pharmaceutical Chemistry, Pretoria
University of the Witwarersrand, Johannesburg and bDepartment College of Pharmacy, Pretoria (South Africa)
of
Many black South African women use traditional herbal remedies as antenatal medications or to induce or augment labour. Very little is known about the pharmacology and potential toxicity of the plants used in these herbal remedies. The ethnic background and traditional usage of these remedies was researched and a literature survey revealed that 57 different plants were used in herbal remedies during pregnancy and childbirth. Several of these plants are poisonous and details of their toxicity are given. Key words: herbal medicines; antenatal; childbirth; ethnic usage
Introduction In South Africa, most of the black population use traditional herbal medicines. This applies particularly to the rural areas where modern health care facilities are often lacking. The rural blacks are in many cases able to identify and harvest their own herbal remedies from the veld. The Xhosa, Zulu and Sotho tribes appear to use similar remedies. In urban areas, the black people are able to purchase traditional medicines from herbalist or ‘Muti’ shops. The traditional healers or so-called ‘witch doctors’ still play a very prominent role in black South African society and they possess the most comprehensive knowledge of medicinal plants and prescribe them for their patients. Fertility is a dominant theme in the culture of black South Africans as it ensures the preservation and propagation of the tribe. Children are regarded as an insurance against loneliness and poverty in old age and as a result a sterile woman is treated with contempt and pity (Krige, 1957; Gumedi, 1978; Brindley, 1985). Pregnancy is an event of great importance and many traditions and taboos have to be upheld in order to ensure a successful confinement and the birth of a healthy child. Correspondence to: Ms. D.J.H. Bryanston 2021, South Africa.
Veale, P.O. Box 68275,
Traditional medicine recognizes the value of antenatal medication and, as a result, herbal remedies used in pregnancy and childbirth are numerous. The most common antenatal medication is one known as ‘isihlambezo’ (that which cleanses) which is taken by both the Xhosa and Zulu women (Gerstner, 1941; Krige, 1957; Gumedi, 1978; Broster, 1981; Brindley, 1985). This medicine is taken regularly during the last 3 months of pregnancy in order to ensure an easy confinement and healthy foetal growth. Isihlambezo consists of a number of ingredients, some of them, ‘inembe’, specifically used to facilitate labour (Gerstner, 1941; Bryant, 1967; Conco, 1972). There are many different recipes for isihlambezo and the ingredients are usually a closely guarded secret. A pregnant woman can obtain the recipe from certain old women in the community; if not, an ‘inyanga’ (traditional ‘doctor’) can be consulted or the isihlambezo ingredients can be purchased from a herbalist. Isihlambezo is generally prepared by boiling the herbal ingredients in water for a long time, presumably to extract the active principles. This decoction is then kept in a covered pot and a spoonful is taken regularly by a pregnant woman until the day of her confinement. Brindley (1985) reports that amongst the Zulu, the isihlambezo is sipped by the woman whenever she is thirsty and is also used as a vaginal
0378-8741/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
186
douche. The pot containing the isihlambezo has to be kept covered and the medicine may not be taken by any other woman or looked upon by anyone else except the inyanga. It is believed that if anyone looks into the pot or if he or she leaves a shadow on the isihlambezo, this may become bewitched or the child could be born mentally deranged (Gerstner, 1941; Brindley, 1985). The concentration of the isihlambezo can be increased at term to induce or augment labour. The inembe may also be used alone or in combinations for this purpose (Bryant, 1966; Brindley, 1985). Another remedy called ‘imbelekisane’ may be taken during pregnancy or to facilitate labour (Gumedi, 1978; Broster, 1981; Larsen et al., 1983; Brindley, 1985). Infusions called ‘umsekelo’ (a ‘prop-up’) may also be taken during pregnancy to prevent miscarriages and premature birth (Bryant, 1966, 1967). The thalidomide tragedy (1960- 196 1) demonstrated the susceptibility of an unborn child to the teratogenic effects of drugs taken by a pregnant woman. Astronomical amounts of money are now spent by the pharmaceutical industry in investigating the safety of drugs in pregnancy. Health care professionals and the public alike are
TABLE PLANTS NANCY
educated and continuously reminded about the dangers of taking drugs in pregnancy. It is therefore both ironical and frightening to see that so little research is being done regarding the potential toxicity of the herbal remedies used during pregnancy by so many women in South Africa. Methodology
In order to initiate a study into the pharmacology and toxicology of the plants used by black South African women as traditional herbal remedies during pregnancy and childbirth, a literature survey of such plants was undertaken. The literature was also reviewed regarding the potential toxicity of these plants. Results
The results of the literature survey are presented in Table 1, which lists 57 plants used by black women during pregnancy and childbirth. Table 2 lists the plants which were found to be potentially poisonous and provides details (where available) of their toxic principles and toxicity.
1 USED IN TRADITIONAL AND CHILDBIRTH
Botanical family and speciesa AMARYLLIDACEAE Clivia miniaia Regel
HERBAL
Local nameb
Umayime
(Z)
Crinum bulbispermum (Burm.f) Mime-Redh. et Schweick.
Umduzi
Cyrtanthus obliquus (L. f.) Ait. C. sanguineus (Lindl.) Walp.
Umathunga
Scadoxus puniceus (L.) Friis et Nordal
APOCYNACEAE Rauvolfia caffra Sond.
ASCLEPIADACEAE Asclepias fruticosa L.
REMEDIES
BY BLACK
SOUTH
AFRICAN
Part used
Formulation
Leaf
Isihlambezo,
DURING
ReferenceC
1,4,5,8 11,12,15,17 7,12
Umsekelo
5
Isihlambezo
14
Umphompo (Z), Idumbilikha nhloyile (Z)
Isihlambezo, Inembe
8,9,11,12
Umhlambamanzi (Z), Umjela (X)
Isihlambezo, Inembe
8,12
Isihlambezo, Inembe
8.12
(Z) Bulb, roots soaked in water
Usinga
lwesalukazi
(Z)
PREG-
type
Inembe Isihlambezo, Inembe
(Z)
WOMEN
187
TABLE
1 (continued)
Botanical family and speciesa
Part used
Local nameb
ReferenceC
Formulation type
COMBRETACEAE Combretum erythrophyllum (Bunch.) Sond.
Umdubu (2) Umdubo (X)
lsihlambezo
9
COMPOSITAE Brachylaena elliptica (Thunb.) DC. Callilepis laureola DC.
Iphahle (Z), lsiduti (X) Impila (Z)
Unspecified
12
Isihlambezo, Inembe Prevention of miscarriage Unspecified Inembe Isihlambezo
8.9.12
Gazania pectinata (Thunb.) Spreng. Senecio bupleuroides DC. S. lanceus Ait. Vernonia natalensis Sch. Bip. V. neocorymbosa Hilliard
lsaphete Umkwinti
Root Whole plant
(X)
Ubihli (Z) Isibhara (Z)
Root
Uhlunguhlungu
(Z)
I7 I2 6,12 9
Isihlambezo, Inembe
4,5,8.9, I2
Difficult confinements Unspecified
I7
Imbelekisane, Inembe
3.8
Isihlambezo, lnembe
8.12
lnembe
4
Isihlambezo, Inembe
8,12
Umshekisane (Z) Umgwali (X)
Isihlambezo, Inembe
8.12
FLACOURTIACEAE Gerrardina foliosa Oliv.
Umlulama
Isihlambezo, Inembe
8.12
GENTIANACEAE Chironia krebsii Griseb.
Tjatane
Unspecified
I.17
Isihlambezo, Inembe, expulsion
12.4s 8,9,12,17
CRASSULACEAE Cotyledon cuneata Thunb. Kalanchoe thrysiflora Hat-v.
Seredile (SS) Seredile (SS)
CUCURBITACEAE Cucumis hirsutus Sond.
Uthangazana
CYATHEACEAE Cyathea dregei Kunze
Isikhomakhoma
Root
(Z)
Root
(Z) CYPERACEAE Cyperus spp.
DIOSCOREACEAE Dioscorea dregeana (Kunth) Dur. et Schinz EBENACEAE Euclea undulata Thunb.
HALORAGACEAE Gunnera perpensa L.
Ibhuma (Z) Indawa (X,Z)
Isidakwa
(Z)
(Z)
(S)
Ugobo, Uklenya (Z) Iphuzilomlambo (X)
Rush
Root
placenta
of
1.12.17
188 TABLE
I (continued)
Botanical family and species”
Local name b
ICACINACEAE Pyrenacantha scandens Planch.
Umsekelo
(Z)
Part used
type
Formulation
Root
Inembe,
ex Harv.
IRIDACEAE Gladiolus sericeovillosus Hook.
lsidwa
Huds.
4,5,8,17
Umsekelo
(Z)
Corm
Expulsion
f.
LABIATAE Mentha longifolia (L.)
ReferenceC
of
4,17
placenta
Inzinziniba,
Leaf
Inembe
I,17
Root
Isihlambezo, Inembe
394,577 12,13.15,17
Leaf
Unspecified Isihlambezo, Inembe Unspecified
Inxina (X), Ufuthanelonhlange (Z)
LILIACEAE Agapanthus africanus (L.) Hoffmg. Aloe arborescens Mill. A. cooperi Bak. A. davyana Schonl.
Uhlakahla, Umhlambezo Isilakati (X) Inkalane (Z) Isiphuthumana, Isiphukutwane Kxophane (K,T)
Bowiea volubilis Harv. ex Hook. f. Chlorophytum comosum (Thunb.) Jacq.
Ugibisisila (Z) Umgaqaqana
Eucomis autumnalis (Mill.) Chitt. E. regia
Umathunga
(L.) L’HBrit.
Mathunga
(X)
(Z),
S. natalensis Planch. Urginea physodes (Jacq.) Bak.
Inguduza(Z)
ORCHIDACEAE Eulophia clavicornis Lindl.
Tuber
(Z)
Khapumpu phetola
MORACEAE Ficus natalensis Hochst.
(Z)
Roots soaked water
Ledebouria cooperi (Hook. f.) Jessop
MENISPERMACEAE Cissampelos torulosa E. Mey. ex Harv.
(Z)
Root (SS)
8,11,12
Isihlambezo, Inembe Prevention
8,11,12
Isihlambezo, Inembe Isihlambezo, Inembe
Umahlokoloza (Z)
(Z)
Root
Umthombe (Z,X) Uluzi (X)
Lekzolela, Moisa-teleha, Maholahanya
Tuber
I7
Isihlambezo, Inembe Isihlambezo (Isikakathi)
of premature birth Unspecified
(S)
Umthombo
in
17 8,123
IO
17
12.17 8,11,12 8.1 I,12
Isihlambezo, Inembe
8.12
Isihlambezo, Inembe
8.12
Unspecified
12,17
Unspecified
I2
Isihlambezo,
L&12,
(S)
E. tenella Reichb. f. PLANTAGINACEAE Plantago major L.
Indlebe (Z)
kathekwane
Root
I7
189
TABLE I (continued) Botanical family and specie@
Local nameb
Part used
Formulation type
Referen&
Isihlambezo, Inembe
8.12
Isihlambezo, Inembe, expulsion of placenta
I >378,9712.17
Inembe
17
POLYGALACEAE Polygaia fruticosa
Ithethe (Z)
Berg. RUBIACEAE Pentanisia pruneiioides
(Eckl. et Zeyh.) Walp.
Icimamhlo (Z,X)
Root
RUTACEAE Ruta graveolens L.
SCROPHULARIACEAE Cyenium racemosum
Injanga (X)
I
Root
Benth. T~MELAEACEAE Gnidia capitata L.f.
G. kraussiana
Mofubetswana, Setele (SS), ‘Radix jovis’ Imfuzane (Z)
Meisn.
Unspecified
I7
Isihlambezo, Inembe
8,12
TILIACEAE Grewia occidentalis L. Triumfetta rhomboidea
Jacq.
Iklolo, Ilalanyathi (Z) Inothwane, Indola encane (Z)
Root
Isihlambezo
4,9,17
Root
Inembe
4,12,16,17
Umkhanzi (X) Ibhuma (Z) Mot&la (S)
Root
Isihlambezo, Inembe, expulsion of placenta
1,8,12,17
Umathanjana (Z)
Isihlambezo, lnembe
8,12
Igolo lenkonyane, Ingquza yenkonyane (Z) Isinwazi (Z)
Isihlambezo, Inembe
8,12
Isihiambezo, Inembe
4,8,9,I2, I7
TYPHACEAE Typha capensis
(Rohrb.) N.E. Br.
VERBENACEAE Clerodend~m
tr~hyllum
(Harv.) H.Pearson VITACEAE Cyphostemma natalitium
(Szyszyl.) J.v.d.Merwe Rhoicissus tridentata
(L.f.) Wild et Drum
Root
“The plant nomenclature has been updated following Gibbs Russell et al. (1985, 1987); other Latin binomials original literature. bAbbreviations: K, Kwena; S, Sotho; SS, South Sotho; T, Tswana; X, Xhosa; Z, Zulu.
may be us& in the
c References: 1, Batten and Bokelman (1966); 2, Brindley (1985); 3, Broster (1981); 4, Bryant (1966); 5, Bryant (1967); 6, Gerstner (1938); 7, Gerstner (1939); 8, Gerstner (1941); 9, Gumedi (1978); 10, Hutchings (1986); 1I, Hutchings and Terblanche (1989); 12, Hutchings (1989); 13, Krige (1957); 14, Mbuthama (pers. commun.); 15, Palmer (1985); 16, Osore (1982); 17, Watt and Breyer-Brandwijk (1962).
190
TABLE 2 POTENTIAL TOXICITY OF PLANTS USED IN TRADITIONAL AND CHILDBIRTH” Botanical Family and species
HERBAL REMEDIES TAKEN DURING PREGNANCY
Extent of toxicityb
Main features of poisoning
Toxic principles
Clivia miniata
++
Scadoxus pun&us
Salivation, vomiting, diarrhoea, depression of CNS in severe cases Dizziness, visual disturbances, CNS excitation or depression
Lycorine
(bulb) ++ (bulb, leaf)
AMARYLLIDACEAE
Lycorine, haemanthidine
APOCYNACEAE Rauvoljla caffra
+
Rauvoiiine
ASCLEPIADACEAE Asclepias fruticosa
+
Severe gastrointestinal irritation
Cardiac giycosides
COMBRETACEAE Combretum erythrophyilum
+
COMPOSITAE Caililepis laureola
+++
Senecio bupleuroides
Confusion, vomiting, diarrhoea, convulsions, hypogiycaemia, hepatic failure, renal failure Abdominal pain, nausea, vomiting, ascitis, cirrhosis
Atractyioside
(tuber) ++
+ +
Poisonous to stock Poisonous to stock
Cotyledontoxin Piperidine alkaloids
+ ++
Sap causes severe ulceration of the mouth Severe vomiting and diarrhoea, salivation, cardiac failure Abdominal pain, diarrhoea, renal failure
Pyrroiizidine alkaloids
CRASSULACEAE Cotyyledoncuneata Kalanchoe thyrsifora
LILIACEAE ~ga~anthus africanus Bowiea volubilis Eucomis autumnalis Scilla natalensis Urginea physodes
(tuber) ++ (bulb) ++ (bulb) ++ (whole plant)
Bufadienoiides Haemoiytic saponin
Death of experimental sheep Death of stock
Bufadienoiides
Severe gastrointestinal irritation, death of stock
Mezereine
THYMELAEACEAE Gnidia kraussiana
++ (young leaf, flowering top)
VITACEAE Rhoicissus tridentata
++
CNS paralysis, respiratory arrest
(rootstock} ‘Based on: Watt and Breyer-Brandwijk 1962; Frohne and Pfander, 1983; Veaie, 1987; Munday, 1988; Hutchings, 1989; Hutchings and Terbianche, 1989. ‘Extent of toxicity code: +, potentially poisonous; ++, potentially fatal if taken in large quantities; +++, potentially fatal if taken in small quantities.
191
Discussion
and Conclusions
This literature survey indicates that at least 57 different plants are used by black South African women either as antenatal remedies or, more specifically, to induce or augment labour. Among these, 16 have been reported to be toxic. The uterotonic effects of only a few of these plants have been studied. Mitri et al. (1989) found that foetal meconium passage was more common in black South African women who had recently taken isihlambezo. Caesarean section and low Apgar scores were significantly more common in pregnancies complicated by meconium passage. Foetal meconium passage could indicate foetal distress due to uterine hypertonia. According to P.J. Key, a former medical superintendent of All Saints Hospital, Engcobo, Transkei, as quoted by Broster (1981) taking large quantities of imbelekisane could be the cause of several cases of unexplained foetal death as a result of premature labour. Larsen et al. (1983) who tested an imbelekisane decoction used by Zulu traditional birth attendants to treat prolonged labour, found that the decoction repeatedly produced tonic contractions in isolated rat uterus. Veale et al. (1989) found that an aqueous extract of Clivia miniata, used as isihlambezo or inembe, was pharmacologically active and possessed uterotonic properties. In view of the results of this study, the implementation of a research program to study the pharmacology and toxicology of the plants used in traditional herbal remedies during pregnancy and childbirth should be able to make a very real contribution to the welfare of black South Africans. Acknowledgements
This work was supported by the Levenburg Bequest, University of the Witwatersrand and by the South African Medical Research Council. References Batten, A. and Bokelmann, H. (1966) Wild Flowers of the Eastern Cape Province. Books of Africa, Cape Town. Brindley, M. (1985) Old women in Zulu culture: the old woman and childbirth. South African Journal of Ethnology 8, 98-108. Broster, J.A. (1981) Amagquirha Religion, Magic and Medicine in Transkei. Via Afrika Ltd., Cape Town, pp. 105-107, 121. Bryant, A.T. (1966) Zulu Medicine and Medicine-Men. C. Struik, Cape Town, 64, 87-l 15.
Bryant, A.T. (1967) The Zulu People, 2nd Edn. Shuter and Shooter, Pietermaritzburg, pp. 610-629. Conco, W.S. (1972) The African Bantu traditional practice of medicine. Some preliminary observations. Social Science in Medicine 6, 283-322. Frohne, D. and Pfander, H.J. (1983) A Colour Atlas of Poisonous Plants. Wolfe Publishing Ltd., Stuttgart, pp. 33, 63-65. Gerstner, J. (1938) plants with short Gerstner, J. (1939) plants with short
A preliminary checklist of Zulu names of notes. Bantu Studies 12,215-236, 321-342. A preliminary checklist of Zulu names of notes, Bantu Studies 13, 49-64, 131-149,
307-326. Gerstner, J. (1941) Preliminary checklist of Zulu names of plants with short notes. Banru Studies 15, 277-301, 369-383. Gibbs Russell, G.E., Reid, C., Van Rooy, J. and Smook, L. (1985) List of species of southern African plants. Edition 2, Part 1. Memoirs of the Botanical Survey of South Africa, No. 51. Botanical Research Institute, Pretoria. Gibbs Russell, G.E., Welman, W.G., Retief, E., Immelman, G., Germishuizen, G., Pienaar, B.J., Van Wyk, M. and Nicholas, A. (1987) List of species of southern African plants. Edition 2, Part 2. Memoirs of the Botanical Survey of South Africa, No. 56. Botanical Research Institute, Pretoria. Gumedi, M.V. (1978) Traditional Zulu practitioners and obstetric medicine. South African Medical Journal 53 (21) 823-825. Hutchings, A. (1989) A survey and analysis of traditional medicinal plants as used by the Zulu, Xhosa Bothalia 19 (I), 111-123. Hutchings, A. and Johnson, C. (1986) Glimpses Herbal. Veld and Flora, June, 59-62.
and Sotho. of a Xhosa
Hutchings, A. and Terblanche, S.E. (1989) Observations on the use of some known and suspected toxic Liliiflorae in Zulu and Xhosa medicine. South African Medical Journal 75 (2) 62-69. Krige, E.J. (1957) The Social System of the Zulus, Shuter and Shooter, Pietermaritzburg, pp. 61-65. Larsen, J., Msane, C.L. and Monkhe, M.C. (1983) The Zulu traditional birth attendant. South African Medical Journal 63, 540-542. Mitri, F.F., Hofmeyer, G.J. and Van Gelderen, C.J. (1987) Meconium staining during labour: Self-medication and other associations. South African Medical Journal 71 (7), 431-433. Munday, J. (1988) Poisonous Planrs in South African Gardens and Parks. Delta Books (Pty) Ltd., Craighall. Osore, H. (1982) Ecbolic properties of Triumferfa rhomboidea on the gravid mammalian uterus, East African Medical Journal 59 (1 l), 733-736. Palmer, E. (1985) The South African Herbal. Tafelberg Publishers Ltd., Cape Town, p. 92. Veale, D.J.H. (1987) Poisonous Plants in South African Homes and Gardens. South African Pharmaceutical Journal 54 (2), 45-50. Veale, D.J.H., Oliver, D.W., Arangies, N.S and Furman, K.I. (1989) Preliminary isolated organ studies using an aqueous extract of Clivia miniata leaves. Journal of Ethnopharmacology 27, 341-346. Watt, J.M. and Breyer-Brandwijk. M.J. (1962) The Medicinal and Poisonous Plants of Southern and Eastern Africa, 2nd Edn. E. and S. Livingstone, Edinburgh.
185
36 ( 1992) 185- 191
Elsevier Scientific Publishers Ireland Ltd.
Review Article
South African traditional herbal medicines used during pregnancy and childbirth D.J.H. Vealea, K.I. Furmana and D.W. Oliverb aDepartment
of Experimental and Clinical Pharmacology, Pharmaceutical Chemistry, Pretoria
University of the Witwarersrand, Johannesburg and bDepartment College of Pharmacy, Pretoria (South Africa)
of
Many black South African women use traditional herbal remedies as antenatal medications or to induce or augment labour. Very little is known about the pharmacology and potential toxicity of the plants used in these herbal remedies. The ethnic background and traditional usage of these remedies was researched and a literature survey revealed that 57 different plants were used in herbal remedies during pregnancy and childbirth. Several of these plants are poisonous and details of their toxicity are given. Key words: herbal medicines; antenatal; childbirth; ethnic usage
Introduction In South Africa, most of the black population use traditional herbal medicines. This applies particularly to the rural areas where modern health care facilities are often lacking. The rural blacks are in many cases able to identify and harvest their own herbal remedies from the veld. The Xhosa, Zulu and Sotho tribes appear to use similar remedies. In urban areas, the black people are able to purchase traditional medicines from herbalist or ‘Muti’ shops. The traditional healers or so-called ‘witch doctors’ still play a very prominent role in black South African society and they possess the most comprehensive knowledge of medicinal plants and prescribe them for their patients. Fertility is a dominant theme in the culture of black South Africans as it ensures the preservation and propagation of the tribe. Children are regarded as an insurance against loneliness and poverty in old age and as a result a sterile woman is treated with contempt and pity (Krige, 1957; Gumedi, 1978; Brindley, 1985). Pregnancy is an event of great importance and many traditions and taboos have to be upheld in order to ensure a successful confinement and the birth of a healthy child. Correspondence to: Ms. D.J.H. Bryanston 2021, South Africa.
Veale, P.O. Box 68275,
Traditional medicine recognizes the value of antenatal medication and, as a result, herbal remedies used in pregnancy and childbirth are numerous. The most common antenatal medication is one known as ‘isihlambezo’ (that which cleanses) which is taken by both the Xhosa and Zulu women (Gerstner, 1941; Krige, 1957; Gumedi, 1978; Broster, 1981; Brindley, 1985). This medicine is taken regularly during the last 3 months of pregnancy in order to ensure an easy confinement and healthy foetal growth. Isihlambezo consists of a number of ingredients, some of them, ‘inembe’, specifically used to facilitate labour (Gerstner, 1941; Bryant, 1967; Conco, 1972). There are many different recipes for isihlambezo and the ingredients are usually a closely guarded secret. A pregnant woman can obtain the recipe from certain old women in the community; if not, an ‘inyanga’ (traditional ‘doctor’) can be consulted or the isihlambezo ingredients can be purchased from a herbalist. Isihlambezo is generally prepared by boiling the herbal ingredients in water for a long time, presumably to extract the active principles. This decoction is then kept in a covered pot and a spoonful is taken regularly by a pregnant woman until the day of her confinement. Brindley (1985) reports that amongst the Zulu, the isihlambezo is sipped by the woman whenever she is thirsty and is also used as a vaginal
0378-8741/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
186
douche. The pot containing the isihlambezo has to be kept covered and the medicine may not be taken by any other woman or looked upon by anyone else except the inyanga. It is believed that if anyone looks into the pot or if he or she leaves a shadow on the isihlambezo, this may become bewitched or the child could be born mentally deranged (Gerstner, 1941; Brindley, 1985). The concentration of the isihlambezo can be increased at term to induce or augment labour. The inembe may also be used alone or in combinations for this purpose (Bryant, 1966; Brindley, 1985). Another remedy called ‘imbelekisane’ may be taken during pregnancy or to facilitate labour (Gumedi, 1978; Broster, 1981; Larsen et al., 1983; Brindley, 1985). Infusions called ‘umsekelo’ (a ‘prop-up’) may also be taken during pregnancy to prevent miscarriages and premature birth (Bryant, 1966, 1967). The thalidomide tragedy (1960- 196 1) demonstrated the susceptibility of an unborn child to the teratogenic effects of drugs taken by a pregnant woman. Astronomical amounts of money are now spent by the pharmaceutical industry in investigating the safety of drugs in pregnancy. Health care professionals and the public alike are
TABLE PLANTS NANCY
educated and continuously reminded about the dangers of taking drugs in pregnancy. It is therefore both ironical and frightening to see that so little research is being done regarding the potential toxicity of the herbal remedies used during pregnancy by so many women in South Africa. Methodology
In order to initiate a study into the pharmacology and toxicology of the plants used by black South African women as traditional herbal remedies during pregnancy and childbirth, a literature survey of such plants was undertaken. The literature was also reviewed regarding the potential toxicity of these plants. Results
The results of the literature survey are presented in Table 1, which lists 57 plants used by black women during pregnancy and childbirth. Table 2 lists the plants which were found to be potentially poisonous and provides details (where available) of their toxic principles and toxicity.
1 USED IN TRADITIONAL AND CHILDBIRTH
Botanical family and speciesa AMARYLLIDACEAE Clivia miniaia Regel
HERBAL
Local nameb
Umayime
(Z)
Crinum bulbispermum (Burm.f) Mime-Redh. et Schweick.
Umduzi
Cyrtanthus obliquus (L. f.) Ait. C. sanguineus (Lindl.) Walp.
Umathunga
Scadoxus puniceus (L.) Friis et Nordal
APOCYNACEAE Rauvolfia caffra Sond.
ASCLEPIADACEAE Asclepias fruticosa L.
REMEDIES
BY BLACK
SOUTH
AFRICAN
Part used
Formulation
Leaf
Isihlambezo,
DURING
ReferenceC
1,4,5,8 11,12,15,17 7,12
Umsekelo
5
Isihlambezo
14
Umphompo (Z), Idumbilikha nhloyile (Z)
Isihlambezo, Inembe
8,9,11,12
Umhlambamanzi (Z), Umjela (X)
Isihlambezo, Inembe
8,12
Isihlambezo, Inembe
8.12
(Z) Bulb, roots soaked in water
Usinga
lwesalukazi
(Z)
PREG-
type
Inembe Isihlambezo, Inembe
(Z)
WOMEN
187
TABLE
1 (continued)
Botanical family and speciesa
Part used
Local nameb
ReferenceC
Formulation type
COMBRETACEAE Combretum erythrophyllum (Bunch.) Sond.
Umdubu (2) Umdubo (X)
lsihlambezo
9
COMPOSITAE Brachylaena elliptica (Thunb.) DC. Callilepis laureola DC.
Iphahle (Z), lsiduti (X) Impila (Z)
Unspecified
12
Isihlambezo, Inembe Prevention of miscarriage Unspecified Inembe Isihlambezo
8.9.12
Gazania pectinata (Thunb.) Spreng. Senecio bupleuroides DC. S. lanceus Ait. Vernonia natalensis Sch. Bip. V. neocorymbosa Hilliard
lsaphete Umkwinti
Root Whole plant
(X)
Ubihli (Z) Isibhara (Z)
Root
Uhlunguhlungu
(Z)
I7 I2 6,12 9
Isihlambezo, Inembe
4,5,8.9, I2
Difficult confinements Unspecified
I7
Imbelekisane, Inembe
3.8
Isihlambezo, lnembe
8.12
lnembe
4
Isihlambezo, Inembe
8,12
Umshekisane (Z) Umgwali (X)
Isihlambezo, Inembe
8.12
FLACOURTIACEAE Gerrardina foliosa Oliv.
Umlulama
Isihlambezo, Inembe
8.12
GENTIANACEAE Chironia krebsii Griseb.
Tjatane
Unspecified
I.17
Isihlambezo, Inembe, expulsion
12.4s 8,9,12,17
CRASSULACEAE Cotyledon cuneata Thunb. Kalanchoe thrysiflora Hat-v.
Seredile (SS) Seredile (SS)
CUCURBITACEAE Cucumis hirsutus Sond.
Uthangazana
CYATHEACEAE Cyathea dregei Kunze
Isikhomakhoma
Root
(Z)
Root
(Z) CYPERACEAE Cyperus spp.
DIOSCOREACEAE Dioscorea dregeana (Kunth) Dur. et Schinz EBENACEAE Euclea undulata Thunb.
HALORAGACEAE Gunnera perpensa L.
Ibhuma (Z) Indawa (X,Z)
Isidakwa
(Z)
(Z)
(S)
Ugobo, Uklenya (Z) Iphuzilomlambo (X)
Rush
Root
placenta
of
1.12.17
188 TABLE
I (continued)
Botanical family and species”
Local name b
ICACINACEAE Pyrenacantha scandens Planch.
Umsekelo
(Z)
Part used
type
Formulation
Root
Inembe,
ex Harv.
IRIDACEAE Gladiolus sericeovillosus Hook.
lsidwa
Huds.
4,5,8,17
Umsekelo
(Z)
Corm
Expulsion
f.
LABIATAE Mentha longifolia (L.)
ReferenceC
of
4,17
placenta
Inzinziniba,
Leaf
Inembe
I,17
Root
Isihlambezo, Inembe
394,577 12,13.15,17
Leaf
Unspecified Isihlambezo, Inembe Unspecified
Inxina (X), Ufuthanelonhlange (Z)
LILIACEAE Agapanthus africanus (L.) Hoffmg. Aloe arborescens Mill. A. cooperi Bak. A. davyana Schonl.
Uhlakahla, Umhlambezo Isilakati (X) Inkalane (Z) Isiphuthumana, Isiphukutwane Kxophane (K,T)
Bowiea volubilis Harv. ex Hook. f. Chlorophytum comosum (Thunb.) Jacq.
Ugibisisila (Z) Umgaqaqana
Eucomis autumnalis (Mill.) Chitt. E. regia
Umathunga
(L.) L’HBrit.
Mathunga
(X)
(Z),
S. natalensis Planch. Urginea physodes (Jacq.) Bak.
Inguduza(Z)
ORCHIDACEAE Eulophia clavicornis Lindl.
Tuber
(Z)
Khapumpu phetola
MORACEAE Ficus natalensis Hochst.
(Z)
Roots soaked water
Ledebouria cooperi (Hook. f.) Jessop
MENISPERMACEAE Cissampelos torulosa E. Mey. ex Harv.
(Z)
Root (SS)
8,11,12
Isihlambezo, Inembe Prevention
8,11,12
Isihlambezo, Inembe Isihlambezo, Inembe
Umahlokoloza (Z)
(Z)
Root
Umthombe (Z,X) Uluzi (X)
Lekzolela, Moisa-teleha, Maholahanya
Tuber
I7
Isihlambezo, Inembe Isihlambezo (Isikakathi)
of premature birth Unspecified
(S)
Umthombo
in
17 8,123
IO
17
12.17 8,11,12 8.1 I,12
Isihlambezo, Inembe
8.12
Isihlambezo, Inembe
8.12
Unspecified
12,17
Unspecified
I2
Isihlambezo,
L&12,
(S)
E. tenella Reichb. f. PLANTAGINACEAE Plantago major L.
Indlebe (Z)
kathekwane
Root
I7
189
TABLE I (continued) Botanical family and specie@
Local nameb
Part used
Formulation type
Referen&
Isihlambezo, Inembe
8.12
Isihlambezo, Inembe, expulsion of placenta
I >378,9712.17
Inembe
17
POLYGALACEAE Polygaia fruticosa
Ithethe (Z)
Berg. RUBIACEAE Pentanisia pruneiioides
(Eckl. et Zeyh.) Walp.
Icimamhlo (Z,X)
Root
RUTACEAE Ruta graveolens L.
SCROPHULARIACEAE Cyenium racemosum
Injanga (X)
I
Root
Benth. T~MELAEACEAE Gnidia capitata L.f.
G. kraussiana
Mofubetswana, Setele (SS), ‘Radix jovis’ Imfuzane (Z)
Meisn.
Unspecified
I7
Isihlambezo, Inembe
8,12
TILIACEAE Grewia occidentalis L. Triumfetta rhomboidea
Jacq.
Iklolo, Ilalanyathi (Z) Inothwane, Indola encane (Z)
Root
Isihlambezo
4,9,17
Root
Inembe
4,12,16,17
Umkhanzi (X) Ibhuma (Z) Mot&la (S)
Root
Isihlambezo, Inembe, expulsion of placenta
1,8,12,17
Umathanjana (Z)
Isihlambezo, lnembe
8,12
Igolo lenkonyane, Ingquza yenkonyane (Z) Isinwazi (Z)
Isihlambezo, Inembe
8,12
Isihiambezo, Inembe
4,8,9,I2, I7
TYPHACEAE Typha capensis
(Rohrb.) N.E. Br.
VERBENACEAE Clerodend~m
tr~hyllum
(Harv.) H.Pearson VITACEAE Cyphostemma natalitium
(Szyszyl.) J.v.d.Merwe Rhoicissus tridentata
(L.f.) Wild et Drum
Root
“The plant nomenclature has been updated following Gibbs Russell et al. (1985, 1987); other Latin binomials original literature. bAbbreviations: K, Kwena; S, Sotho; SS, South Sotho; T, Tswana; X, Xhosa; Z, Zulu.
may be us& in the
c References: 1, Batten and Bokelman (1966); 2, Brindley (1985); 3, Broster (1981); 4, Bryant (1966); 5, Bryant (1967); 6, Gerstner (1938); 7, Gerstner (1939); 8, Gerstner (1941); 9, Gumedi (1978); 10, Hutchings (1986); 1I, Hutchings and Terblanche (1989); 12, Hutchings (1989); 13, Krige (1957); 14, Mbuthama (pers. commun.); 15, Palmer (1985); 16, Osore (1982); 17, Watt and Breyer-Brandwijk (1962).
190
TABLE 2 POTENTIAL TOXICITY OF PLANTS USED IN TRADITIONAL AND CHILDBIRTH” Botanical Family and species
HERBAL REMEDIES TAKEN DURING PREGNANCY
Extent of toxicityb
Main features of poisoning
Toxic principles
Clivia miniata
++
Scadoxus pun&us
Salivation, vomiting, diarrhoea, depression of CNS in severe cases Dizziness, visual disturbances, CNS excitation or depression
Lycorine
(bulb) ++ (bulb, leaf)
AMARYLLIDACEAE
Lycorine, haemanthidine
APOCYNACEAE Rauvoljla caffra
+
Rauvoiiine
ASCLEPIADACEAE Asclepias fruticosa
+
Severe gastrointestinal irritation
Cardiac giycosides
COMBRETACEAE Combretum erythrophyilum
+
COMPOSITAE Caililepis laureola
+++
Senecio bupleuroides
Confusion, vomiting, diarrhoea, convulsions, hypogiycaemia, hepatic failure, renal failure Abdominal pain, nausea, vomiting, ascitis, cirrhosis
Atractyioside
(tuber) ++
+ +
Poisonous to stock Poisonous to stock
Cotyledontoxin Piperidine alkaloids
+ ++
Sap causes severe ulceration of the mouth Severe vomiting and diarrhoea, salivation, cardiac failure Abdominal pain, diarrhoea, renal failure
Pyrroiizidine alkaloids
CRASSULACEAE Cotyyledoncuneata Kalanchoe thyrsifora
LILIACEAE ~ga~anthus africanus Bowiea volubilis Eucomis autumnalis Scilla natalensis Urginea physodes
(tuber) ++ (bulb) ++ (bulb) ++ (whole plant)
Bufadienoiides Haemoiytic saponin
Death of experimental sheep Death of stock
Bufadienoiides
Severe gastrointestinal irritation, death of stock
Mezereine
THYMELAEACEAE Gnidia kraussiana
++ (young leaf, flowering top)
VITACEAE Rhoicissus tridentata
++
CNS paralysis, respiratory arrest
(rootstock} ‘Based on: Watt and Breyer-Brandwijk 1962; Frohne and Pfander, 1983; Veaie, 1987; Munday, 1988; Hutchings, 1989; Hutchings and Terbianche, 1989. ‘Extent of toxicity code: +, potentially poisonous; ++, potentially fatal if taken in large quantities; +++, potentially fatal if taken in small quantities.
191
Discussion
and Conclusions
This literature survey indicates that at least 57 different plants are used by black South African women either as antenatal remedies or, more specifically, to induce or augment labour. Among these, 16 have been reported to be toxic. The uterotonic effects of only a few of these plants have been studied. Mitri et al. (1989) found that foetal meconium passage was more common in black South African women who had recently taken isihlambezo. Caesarean section and low Apgar scores were significantly more common in pregnancies complicated by meconium passage. Foetal meconium passage could indicate foetal distress due to uterine hypertonia. According to P.J. Key, a former medical superintendent of All Saints Hospital, Engcobo, Transkei, as quoted by Broster (1981) taking large quantities of imbelekisane could be the cause of several cases of unexplained foetal death as a result of premature labour. Larsen et al. (1983) who tested an imbelekisane decoction used by Zulu traditional birth attendants to treat prolonged labour, found that the decoction repeatedly produced tonic contractions in isolated rat uterus. Veale et al. (1989) found that an aqueous extract of Clivia miniata, used as isihlambezo or inembe, was pharmacologically active and possessed uterotonic properties. In view of the results of this study, the implementation of a research program to study the pharmacology and toxicology of the plants used in traditional herbal remedies during pregnancy and childbirth should be able to make a very real contribution to the welfare of black South Africans. Acknowledgements
This work was supported by the Levenburg Bequest, University of the Witwatersrand and by the South African Medical Research Council. References Batten, A. and Bokelmann, H. (1966) Wild Flowers of the Eastern Cape Province. Books of Africa, Cape Town. Brindley, M. (1985) Old women in Zulu culture: the old woman and childbirth. South African Journal of Ethnology 8, 98-108. Broster, J.A. (1981) Amagquirha Religion, Magic and Medicine in Transkei. Via Afrika Ltd., Cape Town, pp. 105-107, 121. Bryant, A.T. (1966) Zulu Medicine and Medicine-Men. C. Struik, Cape Town, 64, 87-l 15.
Bryant, A.T. (1967) The Zulu People, 2nd Edn. Shuter and Shooter, Pietermaritzburg, pp. 610-629. Conco, W.S. (1972) The African Bantu traditional practice of medicine. Some preliminary observations. Social Science in Medicine 6, 283-322. Frohne, D. and Pfander, H.J. (1983) A Colour Atlas of Poisonous Plants. Wolfe Publishing Ltd., Stuttgart, pp. 33, 63-65. Gerstner, J. (1938) plants with short Gerstner, J. (1939) plants with short
A preliminary checklist of Zulu names of notes. Bantu Studies 12,215-236, 321-342. A preliminary checklist of Zulu names of notes, Bantu Studies 13, 49-64, 131-149,
307-326. Gerstner, J. (1941) Preliminary checklist of Zulu names of plants with short notes. Banru Studies 15, 277-301, 369-383. Gibbs Russell, G.E., Reid, C., Van Rooy, J. and Smook, L. (1985) List of species of southern African plants. Edition 2, Part 1. Memoirs of the Botanical Survey of South Africa, No. 51. Botanical Research Institute, Pretoria. Gibbs Russell, G.E., Welman, W.G., Retief, E., Immelman, G., Germishuizen, G., Pienaar, B.J., Van Wyk, M. and Nicholas, A. (1987) List of species of southern African plants. Edition 2, Part 2. Memoirs of the Botanical Survey of South Africa, No. 56. Botanical Research Institute, Pretoria. Gumedi, M.V. (1978) Traditional Zulu practitioners and obstetric medicine. South African Medical Journal 53 (21) 823-825. Hutchings, A. (1989) A survey and analysis of traditional medicinal plants as used by the Zulu, Xhosa Bothalia 19 (I), 111-123. Hutchings, A. and Johnson, C. (1986) Glimpses Herbal. Veld and Flora, June, 59-62.
and Sotho. of a Xhosa
Hutchings, A. and Terblanche, S.E. (1989) Observations on the use of some known and suspected toxic Liliiflorae in Zulu and Xhosa medicine. South African Medical Journal 75 (2) 62-69. Krige, E.J. (1957) The Social System of the Zulus, Shuter and Shooter, Pietermaritzburg, pp. 61-65. Larsen, J., Msane, C.L. and Monkhe, M.C. (1983) The Zulu traditional birth attendant. South African Medical Journal 63, 540-542. Mitri, F.F., Hofmeyer, G.J. and Van Gelderen, C.J. (1987) Meconium staining during labour: Self-medication and other associations. South African Medical Journal 71 (7), 431-433. Munday, J. (1988) Poisonous Planrs in South African Gardens and Parks. Delta Books (Pty) Ltd., Craighall. Osore, H. (1982) Ecbolic properties of Triumferfa rhomboidea on the gravid mammalian uterus, East African Medical Journal 59 (1 l), 733-736. Palmer, E. (1985) The South African Herbal. Tafelberg Publishers Ltd., Cape Town, p. 92. Veale, D.J.H. (1987) Poisonous Plants in South African Homes and Gardens. South African Pharmaceutical Journal 54 (2), 45-50. Veale, D.J.H., Oliver, D.W., Arangies, N.S and Furman, K.I. (1989) Preliminary isolated organ studies using an aqueous extract of Clivia miniata leaves. Journal of Ethnopharmacology 27, 341-346. Watt, J.M. and Breyer-Brandwijk. M.J. (1962) The Medicinal and Poisonous Plants of Southern and Eastern Africa, 2nd Edn. E. and S. Livingstone, Edinburgh.
