Evidence-Based Complementary and Alternative Medicine
Volume 2015 (2015), Article ID 871675, 23 pages
http://dx.doi.org/10.1155/2015/871675

Research Article

Ethnopharmacological Survey of Medicinal Plants Used by Traditional Healers and Indigenous People in Chittagong Hill Tracts, Bangladesh, for the Treatment of Snakebite

Mohammad Fahim Kadir,1,2 James Regun Karmoker,² Md. Rashedul Alam,¹ Syeda Rawnak Jahan,¹ Sami Mahbub,² and M. M. K. Mia³

¹Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Dhaka, Dhaka 1000, Bangladesh
²Department of Pharmacy, University of Asia Pacific, Dhaka 1209, Bangladesh
³Bangladesh National Herbarium, Bangladesh

Received 27 November 2014; Accepted 15 January 2015

Academic Editor: Rainer W. Bussmann

Copyright © 2015 Mohammad Fahim Kadir et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Snakebites are common in tropical countries like Bangladesh where most snakebite victims dwell in rural areas. Among the management options after snakebite in Bangladesh, snake charmers (Ozha in Bengali language) are the first contact following a snakebite for more than 80% of the victims and they are treated mostly with the help of some medicinal plants. Our aim of the study is to compile plants used for the treatment of snakebite occurrence in Bangladesh. The field survey was carried out in a period of almost 3 years. Fieldwork was undertaken in Chittagong Hill Tracts, Bangladesh, including Chittagong, Rangamati, Bandarban, and Khagrachari. Open-ended and semistructured questionnaire was used to interview a total of 110 people including traditional healers and local people. A total of 116 plant species of 48 families were listed. Leaves were the most cited plant part used against snake venom. Most of the reported species were herb in nature and paste mostly used externally is the mode of preparation. The survey represents the preliminary information of certain medicinal plants having neutralizing effects against snake venoms, though further phytochemical investigation, validation, and clinical trials should be conducted before using these plants as an alternative to popular antivenom.

1. Introduction

Snakebite, caused by a bite from a snake, is an accidental injury, which results in puncture wounds inflicted by the animal’s fangs and sometimes causes envenomation. Snakes are carnivorous vertebrates of the class Reptilia, order Squamata, and suborder Serpentes. Snakes usually kill their prey with constriction rather than venom, though venomous snakes can be found on every continent except Antarctica [1]. 15% of the almost 3000 known species of snakes are venomous [2–4] and, in South Asia, four species were thought to be responsible for causing almost all the deadly cases of venomous snakebites which are referred to as the “big four,” which include the Indian cobra (Naja naja), the common krait (Bungarus caeruleus), Russell’s viper (Daboia russelii), and the saw-scaled or carpet viper (Echis carinatus). However, other venomous snakes may also be found in this area [5–7] and thus represent a major cause of morbidity and mortality to humans [8–11]. Exact numbers on the global prevalence of snakebites and the percentage of severe or fatal cases are largely unknown [12]. However, at least 421,000–1,841,000 envenoming and 20,000–94,000 deaths occur worldwide each year due to snakebite [1]. According to Williams et al. [13] these events surpass the number of deaths from tropical diseases such as hemorrhagic fever, dengue, cholera, leishmaniasis, and the Chagas disease.

Incidence of snakebites in Bangladesh is very high like other tropical countries of Southeast Asia [1]. Here most snakebite victims dwelling in rural areas are farmers, fishermen, and hunters [7–9] and also there are a high number of snakebite occurrences that happened at their homes as most of the snakes are nocturnal animals and poor people have the practice of sleeping on the floor [7]. An epidemiological study estimated about 8000 snakebites per year with 22% mortality which has been identified to be one of the highest in the world [10, 14]. Nonetheless, there are approximately 80 species of snakes found in Bangladesh; among them only few are venomous. These are cobra, krait, Russell’s viper, saw-scaled viper, green snakes, and sea snakes. However, most of the bites are reported by nonvenomous snakes and even as many as 40% bites inflicted by venomous snakes do not produce signs of envenoming [15].

Antivenom is the only therapeutic agent against snake venom available throughout the world. These antivenoms have highly effective neutralizing systemic effects but show some limitations in the inhibition of the local disorders [16, 17] and also a chief drawback of serum therapy is its excessive cost and likelihood that victims are often at some distance away from availability of modern treatment when bitten as antivenom treatment should be sought as soon as possible for their potential efficacy. Moreover, there is a crisis in the quality and supply of antivenom serum in the rural areas where most incidences of snakebites occurred [18]. These problems could be subsided by using traditional plant based treatment since approximately 700 plant species are known to possess potential antivenom [19–22].

Ethnopharmacological survey is important for the conservation and utilization of biological resources [23] since of the 422,000 flowering plants found globally [24] more than 50,000 are used for medicinal purposes [25] and these plants contribute to 33% of drugs produced worldwide [26]. To date approximately more than 6,000 species of indigenous and naturalized plants have been identified out of which more than one thousand contain medicinally useful chemical substances [27, 28]. Due to this rich diversity apparently more than 80% of the Bangladeshi use alternative (Ayurveda, Siddha, Unani, and Homeopathy) medicines for their healthcare and herbs constitute a major source of these alternative systems of medicine [29, 30].

Several ethnobotanical investigations have been carried out at different parts of the world to explore the herbal treatment against snakebite [16, 31–35]. But there are very few ethnobotanical surveys carried out in Bangladesh to explore the medicinal plants used here in the treatment of snakebite. The present study was conducted in order to document the traditional knowledge of the medicinal plants used by the traditional healers of Bangladesh for treating against snakebite.

2. Materials and Methods

2.1. Study Area

The study was conducted in four districts in Chittagong Hill Tracts (Figure 1) in Bangladesh which is located in South Asia and bordered by India and Myanmar and by the Bay of Bengal to the south (latitudes 20° and 27°N and longitudes 88° and 93°E) with population over 162 million having 35 smaller groups of indigenous people. The vegetation type of the study area falls under tropical evergreen and semievergreen forests. More than 3 million people live in this study area and these people mostly depend on the resources coming from the hilly areas [36].

Figure 1: Map of Chittagong Hill Tracts, Bangladesh.

2.2. Informants and Ethnomedicinal Data Collection

The survey was conducted in the official language of Bangladesh, Bengali language, from January 2010 to December 2012. Objectives of the survey were explained to the local communities during social gatherings arranged by local people familiar with well-known traditional health practitioners (THPs). While meeting with indigenous populations who had mother language different from the state language, help from local bilingual translator was taken. Special emphasis was given in seeking out people who had the empirical knowledge on medicinal plants and experience in the use of traditional medicinal plants. Personally administered method was followed during the survey. Open-ended and semistructured questionnaire was used [37, 38] for this survey seeking for the following information: (a) the local name, (b) plants part/s used, (c) the method of preparation, (d) solvent/adjuvant used, (e) mode of application, (f) gastrointestinal and other medicinal uses, (g) voucher specimen number, and (h) dose and dosage forms. After completion of survey, consultation with Botanist Mr. Manzur-ul-Kadir Mia, M.D., Former Principal Scientific Officer and Consultant of Bangladesh National Herbarium, Dhaka, was carried out for getting identification, scientific names, family names, habit, habitat, nature, relative abundance, and preservation of the species. The voucher specimens of the plants were deposited in Bangladesh National Herbarium, Dhaka (DACB).

2.3. Data Analysis

All the species were listed in alphabetical order by their scientific name, family, local name, general name, plants parts used, mode of preparation, habit, habitat, relative abundance, nature, general name, solvent used, and frequency of citation (FC). Here FC is defined as the ratio of “number of times a particular species was mentioned” and “total number of times that all species were mentioned” multiplied by 100. All the data such as frequency distributions were calculated by using SPSS 16.0.

3. Results

3.1. Informants

Among the 110 interviewees, major informants were male (65%), aged (regardless of gender) 50–60 years (31%), mostly with 5 years of institutional education (44%), and having 10–20 years of relevant experience (34%) (Table 1).

Table 1: Demographic data of the informants.

Variable
Categories
Frequency
( = 110)
Percentage

Gender
Male
72
65

Female
38
35

Age (years)
<30
16
15

30–40
25
23

40–50
23
21

50–60
34
31

>60
12
11

Education (years)†

20
18

5
48
44

8
21
19

10
15
14

12
12
11

16
10
10

>16
4
4

Experience‡
<2
18
16

2–5
25
23

5–10
18
16

10–20
37
34

>20
12
11

ProfessionҰ
Traditional health practitioners
42
38

Indigenous people
68
62

These people do not have any formal educational training; †year completed through formal educational institution; ‡relevant to treating people; Ұpeople who acquired medicinal knowledge by themselves and are usually involved in profession not relevant to medicine.

3.2. Plants Using in Treatment of Snakebite and Other Relevant Information

116 plant species belonging to 48 plant families have been identified as being used in the treatment of snakebite by traditional healers in Bangladesh. The largest number of species was noted from the family Fabaceae (10 species), followed by Apocynaceae (8 species), Caesalpiniaceae (7 species), and Euphorbiaceae (6 species) (Figure 2).

Figure 2: Family of the plants with their frequencies.

Leaves (43%) were the most frequently used plant parts, followed by roots (27%) and roots stem (9.4%) (Figure 3). The major mode of preparation is paste (69.3%) followed by juice (21%) and powder (11.23%). Preparations were made with water, honey, wine, lime water, and milk as solvent. The mode of administration was oral (31.9%), topical (56.03%), and oral and topical (12.07%) (Figure 4). 32% of the reported species were herb which was followed by tree (23.3%) and climber (9.5%). Most of the plants are wild (70%) and some are cultivated (18%), whereas others are both cultivated and wild (Table 2). The species Rauvolfia serpentina, Allium cepa, Aristolochia indica, Costus speciosus, Emblica officinalis, Hemidesmus indicus, Leucas aspera, and Vitex negundo were the most frequently cited in study area. The doses of the available plants are presented in Table 3.

Table 2: Scientific names and other relevant information.

S/L number
Scientific name
Bangla/Bengali name
English name
Family
Habit
Habitat
Nature
Plants parts used
Preparation
Solvent/ adjuvant
Mode of application
FC
Voucher specimen

1
Abelmoschus moschatus Medic.
Latakasturi
Musk mallow
Malvaceae
Hf, Rs
W
Fr, L, S
J, Pa
M/sugar, W
O, T
Hf, Rs
0.25
MFK 240 (DACB)

2
Abroma augusta Linn. f.
Ulatkambal
Devil’s cotton
Sterculiaceae
Sh
Hf
W
L, R, St
Pa
H, W
T
1.59
MFK 75 (DACB)

3
Abrus precatorius L.
Kunch, Rati
Indian liquorice
Fabaceae
Cl
Hf, Hs
W
S
P
Andrographis paniculata, lemon juice
O
0.12
JRK 111
(DACB)

4
Acacia farnesiana (L.) Willd., Vachellia farnesiana (L.) W. and A.
Belati babul, Gokul
Needle bush
Mimosaceae
T
G
Cu
R
Pa

T
0.13
JRK 127
(DACB)

5
Acalypha indica L.
Mukta jhuri
Indian nettle
Euphorbiaceae
H
Rs, Wp
Cu, W
Wp
Pa

T
0.21
MSBS 143 (DACB)

6
Achyranthes aspera L.
Apang
Prickly chaff flower
Amaranthaceae
Sh/Wh
Rs, Wp
W
L, S, Wp
P

O, T
2.37
JRK 172
(DACB)

7
Acorus calamus L.
Bach, safed bach, shet bach
Sweet flag
Araceae
H
Mp
Cu
Rh
Pa
W
O
0.15
JRK 97 (DACB)

8
Aegle marmelos (L.) Corr. Serr.
Bel, bela, bilbo
Bael fruit, Bengal quince
Rutaceae
T
Hs
Cu
Wp
Pa
Rice beer
O, T
2.41
JRK 37 (DACB)

9
Ageratum conyzoides L.
Sahadevi
Floss flower, goat weed, white weed
Asteraceae
H
Wp
W
L
Pa

T
0.14
JRK 43 (DACB)

10
Albizia lebbeck (L.) Benth.
Siris, Sirisha
Siris tree
Mimosaceae
T
F
Cu
Fl
Pa

T
0.18
MFK 209 (DACB)

11
Albizia procera (Roxb.) Benth.
Korai
Golden trumpet
Mimosaceae
T
Hf, Hs
Cu, W
R
Pa

T
0.22
JRK 17 (DACB)

12
Allium cepa L.
Palandu, Piyaj
Onion
Liliaceae
H
G
Cu
Bu
J
Mustard oil
O
3.87
JRK 35 (DACB)

13
Alstonia scholaris R. Br.
Chatim
Devil’s Tree, Dita Bark Tree
Apocynaceae
T
Hf
W
B, Fl, G, L, R
D, J
M, W
O
2.32
MFK 110 (DACB)

14
Amaranthus spinosus L.
Kanta note
Amaranthus
Amaranthaceae
H
Hf, Rs, Vt
W
L, R, Wp
I, Pa
W
T
0.30
MSBS 43 (DACB)

15
Andrographis paniculata (Burm. f.) Wall ex Nees., Justicia paniculata Burm. f.
Kalmegh, Maha-tita
Creyat root
Acanthaceae
H
Vt
W
L, R
Pa
H, W
O
0.29
JRK 57 (DACB)

16
Annona squamosa L.
Ata, Sharifa
Custard apple of India, sweet or sugar apple of the W. Indies and America
Annonaceae
T
F
Cu
Fr
J
W
T
0.34
MFK 12 (DACB)

17
Argemone mexicana L.
Baro shial kanta, shial kanta
Mexican or prickly poppy
Papaveraceae
Sh
Hf
W
L, S
Pa

T
0.24
MFK 176 (DACB)

18
Aristolochia indica L.
Isharmul
Indian birthwort
Aristolochiaceae
Wh
F, Hf
W
L, R
Pa
H
O
3.53
MSBS 61 (DACB)

19
Asparagus racemosus Willd.
Satamuli
Chinese gooseberry
Liliaceae
Cl
Hf, Hs
Cu, W
L
Pa

T
2.50
MSBS 79 (DACB)

20
Bacopa monnieri (L.) Pennell
Brahmi sak, adha birni, Dhop chamni
Thyme-leaved gratiola
Scrophulariaceae
Cr
F, Hf
W
L
P
M/black tea
O
0.04
MFK 144 (DACB)

21
Baliospermum montanum L.
Danti mool
Wild croton
Euphorbiaceae
Sc
Hf
W
L
Pa

T
0.06
JRK 10 (DACB)

22
Bauhinia variegata L.
Rokto kanchan, sweet kanchan
Camel’s foot tree, mountain tree, orchid tree
Fabaceae
T
Rs
Cu
B, St
Pa

T
0.11
JRK 28 (DACB)

23
Begonia barbata C.B. Clarke
Bini gach

Bignoniaceae
H
Mp
W
L, St
Pa

T
0.17
JRK 68 (DACB)

24
Bixa orellana L.
Utkana
Monkey turmeric
Bixaceae
T
Hs
Cu
Fr, L, R, S
D
W
O
1.85
JRK 91 (DACB)

25
Bombax ceiba L., B. malabaricum DC., Salmalia malabarica Schott. & Endl.
Simul, Shimul, Rokto simul
Red cotton tree, silk cotton tree
Bombacaceae
T
Hf
Cu
Fr, S
Pa
H/black peppers seed, camphor
O
0.31
MSBS 45 (DACB)

26
Buchanania lanzan Spreng., B. latifolia Roxb.
Piyal, Chikki
Chironji tree
Anacardiaceae
Cl
F
W
B
Pa

T
0.10
MFK 14 (DACB)

27
Butea monosperma (Lamk.) Taub., B. frondosa Koen ex Roxb.
Palas
Butea gum tree, flame of the forest, parrot tree, Bastard teak, Bengal kino
Fabaceae
T
Rs
Cu
Stb
Pa
Z
O
0.18
MFK 65 (DACB)

28
Byttneria pilosa Roxb.
Harjora

Sterculiaceae
Sc
Hf
W
L, St
Pa

T
0.11
MSBS 92 (DACB)

29
Cajanus cajan (L.) Huth.
Arhar
Pigeon pea
Fabaceae
S
Hs
Cu
S
Pa
Leaf juice of Senna tora
T
1.81
MSBS 113 (DACB)

30
Calotropis procera (Ait.) Ait. f.
Choto akanda, sweet akanda
Swallow wort
Asclepiadaceae
Sh
Rs, Wp
W
Fl, La, R
J, P
Black pepper
O, T
0.47
JRK 56 (DACB)

31
Calotropis gigantea (L.) Ait. f.
Baro akanda, Gurtakand, sweet akand
Giant milk weed, swallow wort
Asclepiadaceae
Sh
Rs, Wp
W
R
Pa
M
O
0.55
MFK 169 (DACB)

32
Calycopteris floribunda Lamk.
Guichha Lata
Calycopteris
Combretaceae
Sc
Hf
W
R
J
W
T
1.55
MFK 173 (DACB)

33
Capparis zeylanica L., C. horrida L. f.
Asahia, Baganai, Kalokera

Capparaceae
Sh
Vt
W
Fr, S
P
W
O
0.20
JRK 44 (DACB)

34
Capsicum annuum L.
Marich
Red pepper
Solanaceae
H
G, Hs
Cu
Fr
Pa

T
0.23
MFK 170 (DACB)

35
Cassia fistula L.
Bandar lathi, Gurmata, sonali
Golden shower, Indian laburnum, purging cassia
Caesalpiniaceae
T
Rs
Cu
Fr
P

T
1.63
MFK 149 (DACB)

36
Cassia occidentalis L.
Bara kalkesunde
Coffee senna
Caesalpiniaceae
H
Vt, Wp
W
R
Pa
G
O
0.39
JRK 79 (DACB)

37
Cassia sophera L.
Kalkeshande
Periwinkle
Caesalpiniaceae
H
Hf, Hs
W
R
Pa
Black pepper
O
0.15
JRK 11
(DACB)

38
Cassia tora L.
Chakunda, Panevar
Foetid cassia
Caesalpiniaceae
H
Rs, Wp
W
L, R, S
P

O
0.10
JRK 19 (DACB)

39
Catharanthus roseus G. Don
Noyntara
Madagascar periwinkle
Apocynaceae
H
Hf
W
L
Pa
W
T
2.28
MFK 53 (DACB)

40
Chenopodium album L.
Betu sak, Betua sak
Fat-hen, goose foot, lamb’s quarters
Chenopodiaceae
H
G
Cu
Fr, R
Pa

T
0.61
MSBS 51 (DACB)

41
Cissampelos pareira L.
Akanadi, Eklija, Nemuka
False pareira brava
Menispermaceae
Cl
Hf
W
R
D, Pa
Pepper
O
0.28
MSBS 57 (DACB)

42
Cissus adnata Roxb.
Bhatia lota
Endeavour river vine
Vitaceae
Wc
Hf
W
L
Pa

T
0.37
MSBS 37 (DACB)

43
Cissus javana DC.
Kongngouyen laba
Climbing begonia
Vitaceae
Ch
Hf
W
L, St
Pa
Lw
T
0.12
MSBS 64 (DACB)

44
Clerodendrum viscosum Vent.
Bhant
Clerodendrum
Verbenaceae
Sh
Hf, Rs, Vt, Wp
W
Fl, L
Pa
W
T
0.23
MFK 207 (DACB)

45
Clitoria ternatea L.
Aparajita
Baby watermelon, ivy gourd
Fabaceae
Cl
Hs
Cu
R
P
M
O
0.31
MSBS 114 (DACB)

46
Costus speciosus (J. Koenig) Sm.
Kneu
Costus
Costaceae
H
Hf, Rs
W
Bu, L, S
I, J, Pa
W
O, T
3.01
MSBS 62 (DACB)

47
Curculigo orchioides Gaertn.
Talmuli
Black musale
Hypoxidaceae
H
F, Hf
W
Bu, L
D, I
M, W
O
0.35
MSBS 94 (DACB)

48
Cycas pectinata Griff.

Cycadaceae
T
F
W
Fl
Pa

T
0.49
JRK 18 (DACB)

49
Cynodon dactylon Pers.
Durba, Dubla
Bahama grass, Bermuda, Dhub grass
Poaceae
Gr
G, Vt, Wp
W
Wp
Pa

T
0.12
MFK 201 (DACB)

50
Cyperus rotundus L.
Bada, Mutha
Nut grass
Cyperaceae
Gr
G
W
Bu
P
Butter
T
0.17
JRK 25 (DACB)

51
Datura metel L., D. fastuosa L., D. alba Nees
Dhutura

Thorn apple
Solanaceae
Sh
Rs, Wp
W
L, S
Pa

T
0.81
JRK 64 (DACB)

52
Desmodium gangeticum (L.) DC.
Shalparni
Salpani
Fabaceae
H
F, Hf, Rs
W
Wp
D
M, W
O
2.24
MFK 212 (DACB)

53
Desmodium triflorum (L.) DC.
Tripatri

Fabaceae
Us
Mp
W
Sh
J

O
0.72
JRK 12 (DACB)

54
Eclipta prostrata L., E. alba (L.) Hassk
Kalokesh, Keshori, Keshrangan, Kesuti, Keysuria
False daisy
Asteraceae
H
F, Hf
Cu
L
Pa

T
0.75
MFK 150 (DACB)

55
Emblica officinalis Gaertn., Phyllanthus emblica L.
Amla, Amalaki, Amluki
Emblic myrobalan, Indian gooseberry
Euphorbiaceae
T
F, Hs
Cu
St
I

O
2.84
MFK 51 (DACB)

56
Entada rheedii Spreng.
Gila lata

Mimosaceae
Wc
F, Hf
W
L
Pa

T
0.06
JRK 29 (DACB)

57
Erythrina variegata L., E. indica Lam.
Mandar, Palita mandar
Coral tree
Fabaceae
T
Hs
Cu
Fl, Rb
Pa

O, T
1.42
JRK 13 (DACB)

58
Euphorbia hirta L.
Bara kerui, Baro keruee, dudhia

Euphorbiaceae
H
Vt, Wp
W
R, Wp
J
W
O
0.37
JRK 22 (DACB)

59
Ficus racemosa L.
Jagya dumur, Yajna dumur

Moraceae
T
Vt
W
B, S
D, Pa

O, T
0.38
JRK 50 (DACB)

60
Flacourtia indica (Burm. f.) Merr.
Benchi

Flacourtiaceae
Sh
F, Hf
W
L
Pa

T
0.26
MSBS 207 (DACB)

61
Gmelina arborea L.
Gamar
Indian sarsaparilla
Verbenaceae
T
Hf, Hs
W
R
Pa
H
O
1.37
MSBS 73 (DACB)

62
Hedyotis scandens Roxb.
Bijoma

Rubiaceae
Sc
Mp
W
L, St
Pa

T
0.14
MFK 224 (DACB)

63
Helicteres isora L.
Atmora
East Indian screw tree
Sterculiaceae
Sh
F, Vt
W
R
D

O
0.19
MSBS 233 (DACB)

64
Hemidesmus indicus (L.) R. Br.
Anantamul
Country sarsaparilla, Indian sarsaparilla
Apocynaceae
Cl
Hs, Rs, Vt
W
R
Pa

O
2.75
MFK 218 (DACB)

65
Holarrhena antidysenterica (Heyne ex Roth.) Conessi
Kurchi, indrajab

Apocynaceae
T
F, Hf
W
B, R
Pa
W
O, T
0.38
JRK 14 (DACB)

66
Holarrhena pubescens (Buch.-Ham.) Wall.
Kurchi

Apocynaceae
T
Hf
W
S
Pa

T
0.51
MFK 217 (DACB)

67
Homalomena aromatica (Roxb. ex Sims) Schott.
Gandhabi

Araceae
H
Hf
W
Rh
Pa

T
0.40
JRK 55 (DACB)

68
Hyptis suaveolens (L.) Poit.
Bilati tulsi, Tokmadana
Pignut
Lamiaceae
H
Hf, Mp
W
L
J

T
1.50
JRK 16 (DACB)

69
Ichnocarpus frutescens (L.) Br.
Dudhilata

Apocynaceae
Cl
Hf, Hs
W
R
Pa

O
2.19
MFK 55 (DACB)

70
Ixora cuneifolia Roxb.
Kha muchey

Rubiaceae
Sh
F
W
B
Pa

T
0.03
JRK 20 (DACB)

71
Jatropha gossypifolia L.
Lal verenda
Bellyache nettle spurge
Euphorbiaceae
Sh
F, Rs
W
L, S
D
W
O
0.27
MFK 46 (DACB)

72
Justicia gendarussa Burm.
Jagatmadan
Indian lilac
Acanthaceae
Sh
Hf, Hs
W
L
Pa

O
2.15
MFK 247 (DACB)

73
Lantana camara L.
Kutus kanta

Verbenaceae
Sh
Hf
W
Fl, R, St
D

O
1.46
MSBS 170 (DACB)

74
Leucas aspera (Willd.) Link.
Danda kalas
Litchi
Lamiaceae
H
Hf, Hs
W
L
J, Pa
Black pepper, garlic
In
2.67
MFK 33 (DACB)

75
Mangifera indica L.
Aam
Mango
Anacardiaceae
T
G, Hs
Cu
L
Pa

T
1.76
MSBS 181 (DACB)

76
Melastoma malabathricum L.
Bomang raja
Indian rhododendron
Melastomataceae
Sh
F
W
L
J

T
0.30
MFK 232 (DACB)

77
Melochia corchorifolia L.
Bonpat, Tikiokra
Chocolate weed
Sterculiaceae
T
F, Vt
Cu
L
Pa

T
0.18
MSBS 169 (DACB)

78
Mikania cordata (Burm. f.) Roxb.
Ashamlata
Climbing hemp
Asteraceae
Sc
Hf, Rs, Wp
W
L
Pa

T
0.31
MFK 199 (DACB)

79
Mimosa pudica L.
Lajak, Lajjabati, Lajwati
Sensitive plant
Mimosaceae
Wh
Hs, Rs, Vt
W
L, R
Pa

T
2.11
MFK 94 (DACB)

80
Mirabilis jalapa L.
Krishnakali
Marvel of Peru
Nyctaginaceae
H
G, Mp
Cu
L
J
W
O, T
0.16
MSBS 142 (DACB)

81
Morinda angustifolia Roxb.
Rang gach

Rubiaceae
Sh
F
W
L
J

O
0.09
JRK 15 (DACB)

82
Morinda persicifolia Ham.
Rang gach

Rubiaceae
Sh
F
W
L
Pa

T
2.06
MFK 10 (DACB)

83
Moringa oleifera Lamk.
Sajna

Moringaceae
T
Hs
Cu
R
Pa

T
2.45
MFK 16 (DACB)

84
Mucuna pruriens Baker
Alkushi
Curry leaf tree
Fabaceae
Cl
Hf, Hs
W
S
Pa

T
1.29
JRK 60 (DACB)

85
Mussaenda roxburghii Hook. f.
Ranirtak

Rubiaceae
Sh
F, Mp
W
L
Pa

T
0.27
JRK 41 (DACB)

86
Ocimum basilicum L.
Babul tulsi, Kali tulsi, Pashanbeddie
Common basil, sweet basil
Lamiaceae
H
F, Rs
W
Wp
Pa

T
0.96
MSBS 98 (DACB)

87
Oroxylum indicum Vent.
Nasona, Sona, Sonpatti
Broken bones, Indian trumpet flower, midnight horror
Bignoniaceae
T
F, Hf, Vt
W
B
Pa

T
2.02
MFK 175 (DACB)

88
Oxalis corniculata L.
Amrul shak, Chuka tripati
Indian sorrel, yellow oxalis
Oxalidaceae
H
Mp
W
L
Pa

T
0.86
MSBS 32 (DACB)

89
Peliosanthes teta Andr.
Fuji ghash

Liliaceae
H
F
W
Rt
Pa

T
0.36
MSBS 53 (DACB)

90
Peperomia pellucida (L.) HBK
Luchi pata
Peperomia, shiny bush
Piperaceae
H
Vt
W
Sh
J

O
0.15
JRK 21 (DACB)

91
Piper nigrum L.
Golmorich, Kala morich
Black pepper
Piperaceae
Cl
G
Cu
R
Pa

T
0.57
MFK 181 (DACB)

92
Plumbago zeylanica L.
Chita, Chitrak, Sada chita, Sufaid
Ceylon leadwort, white flowered leadwort
Plumbaginaceae
H/Us
F, G
Cu, W
R
Pa

T
0.28
JRK 155 (DACB)

93
Polygonum chinense L.

Chinese knotweed
Polygonaceae
H
Rs, Vt
W
L
Pa

T
0.15
JRK 2133 (DACB)

94
Pouzolzia indica Gaud.
Bormajal

Urticaceae
H
Mp
W
L
Pa

T
0.16
MFK 69 (DACB)

95
Premna esculenta Roxb.
Lelom pata

Verbenaceae
S
F
W
L
Pa

T
0.06
MFK 77 (DACB)

96
Rauvolfia serpentina (L.) Benth. ex Kurz
Sarpagandha
Snakeroot
Apocynaceae
H
Hf, Hs
Cu, W
L, R, Rh
D, Pa
M
O, T
3.98
MFK 66 (DACB)

97
Senna hirsuta (L.) Irwin & Barneby
Kanduak
Foetid senna
Caesalpiniaceae
H
F, Mp
W
L
Pa

T
0.73
MSBS 17 (DACB)

98
Senna tora (L.) Roxb.
Chakunda, Kalkasham
Metal seed, sickle senna
Caesalpiniaceae
H
Rs, Wp
W
L
Pa

T
0.14
MSBS 144 (DACB)

99
Sida acuta Burm.
Kureta
Country mallow
Malvaceae
Wh
Hf, Hs
W
L
Pa

T
1.98
MFK 61 (DACB)

100
Sida cordifolia L.
Bala, Barela
Country mallow
Malvaceae
H
F
W
L
J

O
0.10
MSBS 191 (DACB)

101
Sida rhombifolia L.
Kureta, Lal berela
Cuba jute, Queensland hemp
Malvaceae
H
Hf, Wp
W
L, St
J, Pa

O, T
0.25
JRK 170 (DACB)

102
Solanum torvum Swartz.
Gota, Titbegun

Solanaceae
Sh
Hf, Hs
W
R
J
Mustard oil, ammonium chloride
O, T
0.31
JRK 112 (DACB)

103
Streblus asper Lour.
Sheowra
Siamese rough bush
Moraceae
T
Hf
W
R
J, P

T
0.21
MFK 117 (DACB)

104
Syzygium cumini (L.) Skeels., Eugenia jambolana Lamk.
Jam, Kalojam
Black plum, Indian black berry
Myrtaceae
T
G, Hs
Cu,
B
Pa

T
1.93
MFK 130 (DACB)

105
Tamarindus indica L.
Tetai, Tetul, Tintil
Tamarind tree
Caesalpiniaceae
T
G, Hs
Cu
Wp
P
H
O
1.68
JRK 57 (DACB)

106
Tephrosia purpurea (L.) Pers.
Ban nil
Fish poison, wild indigo
Fabaceae
Sh
Rs
Cu, W
R
Pa

T
0.07
JRK 30 (DACB)

107
Terminalia arjuna (Roxb.) Wt. & Arn.
Arjun, Arjuna, Kahu

Combretaceae
T
F
Cu
Stb
P, Pa
H, M/black pepper
O
1.89
MSBS 76 (DACB)

108
Tinospora cordifolia (Willd.) Miers
Gulancha, Gurach
Heart leaved moon seed
Menispermaceae
Cl
F, Rs
W
St
J

O
0.22
MSBS 18 (DACB)

109
Trewia nudiflora L.
Bhatam, Betul, Pitali
False white teak
Euphorbiaceae
T
F, Mp
W
L
Pa

T
0.18
MFK 114 (DACB)

110
Trichosanthes tricuspidata Lour.
Makal

Cucurbitaceae
Ch
F
W
R
J

O
0.09
MFK 162 (DACB)

111
Tylophora indica (Burm. f.) Merrill.
Abtomul

Asclepiadaceae
H
F, Vt
W
L
Pa
Urine
In
0.21
JRK 100 (DACB)

112
Urena lobata L.
Ban okra

Malvaceae
H
F
W
R
D

O
0.14
MSBS 06 (DACB)

113
Vitex negundo L.
Nirgundi, Nishinda, Sundubar
Indian privet
Verbenaceae
Sh/T
F, Hf
W
L, R, Rh
Pa

T
2.58
MFK 100 (DACB)

114
Vitis lanata Roxb.

Vitaceae
Sc
F, Hf
Cu, W
L
Pa

T
0.06
MSBS 50 (DACB)

115
Willughbeia edulis Roxb.

Apocynaceae
Cl
F
W
St
Pa

T
0.08
JRK 75 (DACB)

116
Withania somnifera Dunal
Ashwagandha
Spanish bayonet, Spanish dagger
Solanaceae
H
Hs
Cu
R
Pa

T
1.25
JRK 140 (DACB)

THP = traditional health practitioners; habit: Sc = shrubby climber, Wh = woody herb, C = climber, Cr = creeper, Sh = shrub, H = herb, and T = tree; habitat: Hf = hill forest, Hs = homestead, Wp = waste place, Rs = roadside, Vt = village thicket, G = garden, F = forest, and Mp = marshy place; nature: Cu = cultivated, W = wild; plants parts used: B = bark; Bu = bulb, L = leaves, Fr = fruit, Fl = flower, Gp = ground plant, Pe = petioles, R = root, Rh = rhizome, S = seeds, S = shoots, St = stem, Stb = stem bark, Tr = tuberous root, Sy = styles, and Wp = whole plant; preparation: D = decoction, J = juice, I = infusion, C = cook, R = raw, P = powder, and Pa = paste; solvent/adjuvant used: M = milk, H = honey, W = water, and Wi = wine; mode of application: O = oral, T = topical, and V = vaginal; relative abundance: C = common, Lc = least common, and R = rare; conservation status: LC = least common, VU = vulnerable, NT = near threat, UV = use value, and FC = frequency of citation. CITES = endangered commercial plant species; WHO = World Health Organization; FL = fidelity level; Fic = informant consensus factor; RI = relative importance value; FL = fidelity level; ICD = International Statistical Classification of Diseases and Related Health Problems.

Table 3: Doses of the available plants.

S/L number
Name of the plants
Doses

1
Abelmoschus moschatus Medic.
Paste of leaf, fruit, and seed is used on the infected area 2/3 times daily for 2/3 days. Juice of leaf, fruit, and seed is also taken by grinding with milk and sugar.

2
Abroma augusta Linn. f.
Root juice is used after maceration.

3
Abrus precatorius L.
Seed powder is mixed with Andrographis paniculata seed powder to consume with lemon juice.

4
Acacia farnesiana (L.) Willd.
3-4 pieces of fresh root are crushed and squeezed; the extract is taken 3–5 times a day for 1 day.

5
Acalypha indica L.
Whole plant is made into paste, and the paste thus obtained is divided into 4-5 equal parts; each part is given at 6-hour intervals as an antidote.

6
Achyranthes aspera L.
Fresh leaves extract of about 2 teaspoonfuls is given 4–6 times a day.

7
Acorus calamus L.
Fresh rhizome is made into paste. The paste is given with a glass of lukewarm water twice a day for 3 successive days.

8
Aegle marmelos (L.) Corr. Serr.
Whole plants, in tender condition, are made into paste. The paste thus obtained is divided into two equal halves, one half mixed with rice beer applied for cleaning the biting site and the other half again divided into 6 equal portions, and each part is given at an interval of 4–6 hours of time for one day.

9
Albizia procera (Roxb.) Benth.
Fresh root of about one inch long, collected from the plants which are yet not flowered, is given once as an antidote of snakebite.

10
Allium cepa L.
Two teaspoonfuls of bulb juice of the plant mixed with mustard oil and administered to expel poison by vomiting.

11
Andrographis paniculata (Burm. f.) Wall. ex Nees
(1) Fresh root and leaves are mixed in a ratio of 2 : 3 and the whole mixture is made into paste with a little water. The paste thus obtained is divided into 12–16 equal parts (based on the condition of the patient) and each part is given at regular intervals of 1-2 hours for 2-3 days.
(2) Root paste along with honey in equal parts is given 6–8 times a day as an antidote of snake venom.

12
Annona squamosa L.
Incision of snakebite is washed with the juice of plants.

13
Aristolochia indica L.
(1) Fresh root extract mixed with equal amount of root extract of Rauvolfia serpentina is given 4–6 times a day.
(2) Root paste along with honey in equal parts is given 6–8 times a day.

14
Asparagus racemosus Willd.
Leaf extract is applied on the bitten area.

15
Bacopa monnieri (L.) Pennell
Dried plant (except the root portion) powder, about 1 teaspoonful, is given with a cup of warm goat milk or black tea 2-3 times of day as an antidote of snakebite.

16
Baliospermum montanum L.
Paste is prepared with leaf and applied externally twice a day for 4/5 days.

17
Begonia barbata C.B. Clarke
Paste is prepared with stem and leaves and applied once a day for 2/3 days.

18
Bombax ceiba L.
Fresh young shoots (3–5 pieces) are made into paste with black peppers seed (Piper nigrum) and a pinch of camphor (Karpur); the paste thus obtained is given after mixing with a spoonful of honey as an antidote of snake venom.

19
Butea monosperma (Lamk.) Taub.
Stem bark (fresh or dried) about 20 g is made into paste with zinger (rhizome of Zingiber officinale). The whole paste thus obtained is divided into four equal parts. Each of these 4 parts is given 4 times a day.

20
Byttneria pilosa Roxb.
Paste of stem and leaf is applied twice a day until the area is cured.

21
Cajanus cajan (L.) Huth.
Paste is made with seed powder of the plant and the juice of leaf of Senna tora. It is then applied twice a day for 2/3 days.

22
Calotropis gigantea (L.) Ait. f.
Fresh root with milk of cow is ground to a fine paste and taken as an antidote for snakebite.

23
Calotropis procera (Ait.) Ait. f.
About three drops of latex are put on the snake-bitten area and pressed downwards to bleed; root extract is given two cups a day; flower powder is mixed with black pepper and taken.

24
Calycopteris floribunda Lamk.
Root juice is used in infected area.

25
Capparis zeylanica L.
Dried fruits with seeds are made into dust; this dust is given as 1 teaspoonful with a glass of lukewarm water as a snake venom antidote.

26
Cassia fistula L.
As a remedy against snakebite, one teaspoonful fruit powder is taken internally.

27
Cassia occidentalis L.
20–30 gm of root (fresh or dried) is made into paste with 3-4 pieces of   “garlic” (Allium sativum) and a little “gur” (Jaggery); the whole mixture thus obtained is given as an antidote to snakebite.

28
Cassia sophera L.
Root (fresh or dried) of about 20 gm is made into paste with 5–7 pieces of black peepers (seeds of Piper nigrum) and the paste is given as an antidote.

29
Catharanthus roseus D. Don
Leaf is grinded after maceration.

30
Cissampelos pareira L.
Root paste with 10 g long pepper is prescribed once daily for 5 days.

31
Cissus adnata Roxb.
Leaf paste is applied on infected place.

32
Cissus javana DC.
Paste is made with leaf and stem, mixing with lime, and applied externally on the biting place tying a piece of cloth for 3/4 days.

33
Clitoria ternatea L.
Root powder mixed with milk is taken orally immediately after snakebite.

34
Cycas pectinata Griff.
Paste of flower is applied thrice a day for 2/3 days.

35
Cyperus rotundus L.
Bulb powder mixed with cow butter to treat snakebite.

36
Desmodium triflorum (L.) DC.
Juice is prepared with shoots and mixing with shoots of Peperomia pellucida and 2 spoonfuls are taken thrice a day for 4/5 days.

37
Emblica officinalis Gaertn.
Stem infusion is given orally as an antidote.

38
Entada rheedii Spreng.
Paste is prepared with leaf and applied externally once a day for 4/5 days.

39
Erythrina variegata L.
Stamen and root bark are mixed in a ratio of 1 : 3 and then they are made into paste. This paste is applied in both ways externally and internally to reduce the swelling, pain of snakebite.

40
Ficus racemosa L.
A few drops of its decoction are put into the nostrils, resulting into vomiting and relief; bark paste is applied over the injury.

41
Gmelina arborea L.
Inner portion of fresh root (after peeling off the bark) about 20 g is made into paste and this paste is given with a spoonful of honey as an antidote of snakebite.

42
Hedyotis scandens Roxb.
Paste is prepared with leaf and stem and applied in warmed condition externally twice a day for 3/4 days.

43
Hemidesmus indicus (L.) R. Br.
Root paste is applied as an antidote to snakebite.

44
Holarrhena antidysenterica (Heyne ex Roth.) Conessi
The roots were rubbed on a stone with a few drops of water and the paste obtained is given internally and applied externally in snakebite.

45
Holarrhena pubescens (Bach.-Ham.) Wall.
Seed paste is applied locally as antidote and also for reducing the swelling and pain of snakebite.

46
Homalomena aromatica (Roxb. ex Sims) Schott.
Paste of rhizomes is applied until the area is cured.

47
Hyptis suaveolens (L.) Poit.
Juice is extracted from leaf and applied externally twice a day for 3 days.

48
Ichnocarpus frutescens (L.) Br.
Fresh roots (about 100 g) are crushed and squeezed; the aqueous extract thus obtained is given 10–12 times a day as an antidote.

49
Ixora cuneifolia Roxb.
Bark is grinded with water and the paste applied on the biting area twice a day for 4/5 days.

50
Justicia gendarussa Burm.
Fresh leaves extract is given 20–30 mL at every 1-hour interval for up to 18 hours of snakebite as an antidote.

51
Lantana camara L.
Decoction of roots, flowers, and stems is prescribed.

52
Leucas aspera (Willd.) Link.
Leaves with pepper and garlic are chewed and spit into the nostrils.

53
Melastoma malabathricum L.
Juice is prepared with leaf and applied externally twice a day for 3/4 days.

54
Melochia corchorifolia L.
Leaf paste is applied on infected place.

55
Mirabilis jalapa L.
Leaf juice is extracted and 2 spoonfuls are taken twice a day for 2/3 days. Also it is applied topically twice a day in infected areas.

56
Morinda angustifolia Roxb.
4 spoonfuls of extracted leaf juice are taken thrice a day until the area is cured.

57
Morinda persicifolia Ham.
Paste is prepared with leaf and applied externally twice a day for 3/4 days.

58
Mussaenda roxburghii Hook. f.
Paste of leaf is applied on the infected place with tying a piece of cloth.

59
Peliosanthes teta Andr.
Paste is prepared with root tuber and applied externally once a day for 2 days.

60
Peperomia pellucida (L.) HBK
Juice is prepared with shoots and mixing with shoots of Desmodium triflorum and 2 spoonfuls are taken thrice a day for 4/5 days.

61
Polygonum chinense L.
Paste is prepared with leaf and applied externally once a day for 2 days.

62
Pouzolzia indica Gaud.
Paste of leaves is applied twice a day for 2/3 days.

63
Premna esculenta Roxb.
Paste is prepared with leaf and applied externally twice a day for 3/4 days.

64
Rauvolfia serpentina (L.) Benth. ex Kurz
Roots and leaf buds are crushed with milk and made into a paste and used internally and externally on the affected area; rhizome and root decoction is given orally.

65
Senna hirsuta (L.) Irwin & Barneby
Paste of leaf is applied topically on the biting place.

66
Senna tora (L.) Roxb.
Paste is prepared with leaf and applied once a day for 2/3 days.

67
Sida cordifolia L.
Leaf juice is applied to cure snakebite.

68
Sida rhombifolia L.
Paste is prepared with leaf and stem and applied topically once a day to infected areas. Also juice of extracted leaf and stem is 2 spoonfuls which are taken four times a day for 4/5 days.

69
Solanum torvum Swartz.
Root juice is mixed with 250 mL water and 100 mL mustard oil. First, ammonium chloride is rubbed on the snake-bitten area and then the mixture of root juice, water, and oil is given orally. Otherwise, 1 handful of fruit is boiled in 1/2 litre of water. The fruits are then squeezed to get the juice, which is orally given to the snake-bitten person to vomit out the poison.

70
Tamarindus indica L.
To treat snakebite, spoonful powder with honey is consumed thrice a day after every two hours.

71
Terminalia arjuna (Roxb.) Wt. & Arn.
Stem bark powder (about 10 g) is made into paste with a teaspoon full of honey and 5–7 pieces of black pepper (Piper nigrum); this paste is given with a glass of lukewarm goat milk as an antidote to snake venom.

72
Tinospora cordifolia (Willd.) Miers
Stem juice is used to cure snakebite.

73
Trewia nudiflora L.
Paste of leaf is applied topically on the biting place.

74
Trichosanthes tricuspidata Lour.
Root juice is prepared after maceration and 1 spoonful is taken twice a day until the area is cured.

75
Tylophora indica (Burm. f.) Merrill.
Handful of leaves is crushed in urine of snake-bitten person and 2-3 drops of extract are passed through the nostrils.

76
Urena lobata L.
Decoction of root along with leaves of Adhatoda vasica, Alangium salvifolium, and Cocciniagrandis is taken internally.

77
Vitis lanata Roxb.
Paste is prepared with leaf and applied externally once a day for 3/4 days.

78
Willughbeia edulis Roxb.
Latex is collected from stem and applied externally thrice a day for 2/3 days.

Figure 3: Percentage of plant parts used.

Figure 4: Percentage of mode of administration.

4. Discussion

Fabaceae is the most dominant family in the current investigation. This is perhaps because of worldwide prevalence of the species from this family [112, 113]. Leaves were the major plant parts used solely or mixed with other parts in the treatment of snakebite. Ease of collection of leaves is the prime reason compared to roots, flowers, and fruits [114–116]. On the other hand, herbs and trees were the most common habit of the reported plants which might be attributed to the huge number of trees or herbaceous plants naturally abundant in this hilly area [117].

It was very common that blend of different adjuvant including other plant parts was used for the preparation of medication to counteract snake venom. Several researchers also reported this kind of polyherbal treatment [118–121]. The frequent use of multiple plant remedies might be illustrated by the phenomenon of synergistic actions where two or more plants produce an effect greater than the sum of their individual effects [122]. This is particularly true in case of medicinal plant treatment, since each medicinal plant contains numerous pharmacologically active compounds [118].

Among the management options after snakebite, snake charmers (Ozha in Bengali language) were the first contact following a snakebite for more than 80% of the victims in these areas [10]. We also noticed that the field of “snakes and snakebite” has a mythological fragrance in the mind of people living here. The Ozha not only depends on herbal remedies but also recites mantras (magical/mystical words) to enthrall people. There are also potentially harmful approaches reported few of which are making multiple incisions around the bite site, incorrect application techniques in tourniquets (e.g., wrong pressure), and sucking blood orally from the multiple cuts which are practiced in an alarmingly high proportion of cases.

The species with high FC values is a sign of their diverse and numerous medicinal activities and thus it offers further pharmacological, toxicological, and phytochemical analysis for the discovery of potential novel drugs.

Snake venom contains a complex mixture of enzymes, nonenzymatic proteins, carbohydrates, lipids, and other substances [123–126] most of which are extremely toxic. Snakebite envenoming has cytotoxic, hypotensive, neurotoxic, or anticoagulant effects [127]. Cytotoxic enzymes, phospholipases A₂ and metalloproteinases, activate proinflammatory mechanisms that result in edema, blister formation, and local tissue necrosis and facilitate the release of bradykinin, prostaglandin, cytokines, and sympathomimetic amines that cause the intense pain [128]. In addition, there are some venom toxins including aminopeptidases having the ability to alter the physiological function of the victims and ultimately causing systemic hypotension [126]. Many snake venoms have peptides that inhibit angiotensin-converting enzyme causing a slump in arterial blood pressure [129]. Moreover, some toxins such as safarotoxins and endothelins are potent vasoconstrictors of coronary arteries and might be responsible for myocardial ischemia or cardiac arrhythmias [123]. Neurotoxins cause paralysis by affecting the neuromuscular transmission at either presynaptic or postsynaptic levels [130]. Presynaptic neurotoxins, also called b-neurotoxins, include taipoxin, paradoxin, trimucrotoxin, viperotoxin, Pseudocerastes, textilotoxin, and crotoxin [127] which are phospholipase A₂ complexes that inhibit the release of acetylcholine from the presynaptic terminal [131, 132]. On the other hand, postsynaptic neurotoxins including irditoxin [127] called a-neurotoxins cause a reversible blockage of acetylcholine receptors [133–135]. Snake venom toxins may also interfere with blood coagulation and cause hemorrhages or thrombosis [125, 127, 136, 137].

Elucidation of the mode of actions of 116 plants individually is beyond the scope of this study. Research suggests extract of different medicinal plants having antivenom activities such as reducing necrotic and hemorrhagic activity as well as preventing cardiac arrest and reversing the effect of paralysis of skeletal muscle caused by snake venom. Also they might inhibit phospholipase A₂ that causes degranulation of mast cell [138] and consequently they prevent release of platelet activating factors and histamine into circulation, preventing hypersensitive anaphylactic reaction [139].

Several studies have been conveyed in finding of active constituents in the plants used against snake venom. Among the 116 plants in this study, the phytochemical investigations are conducted in most of the plants though the compounds rational for antivenom properties are still unknown for most of them. Extensive phytochemical investigations on the plants mentioned in this study could be another mammoth task. Several plant constituents like flavonoids, quinonoid, xanthene, polyphenols, terpenoids lupeol, gymnemagenin, and pentacyclic triterpenes like oleanolic acid, ursolic, tannins, taraxasterol, amyrin, and so forth are found to be present in varying proportions in surveyed plants. These compounds have also been previously tested in vitro for possessing protein binding and enzyme inhibiting properties [140–142].

These literature studies revealed that the alkaloids (Eclipta prostrate, Rauvolfia serpentina, Strychnos nux-vomica, and Mimosa pudica), esters (Gloriosa superba), phenolic fraction (Hemidesmus indicus), terpenoids (Aristolochia indica, Andrographis paniculata), and flavonoids fraction (Tephrosia purpurea) neutralized the snake venom activities. Flavonoids have been shown to inhibit phospholipases A₂, an important component of snake venoms [143]. The antivenom effects of wedelolactone, a coumestan isolated from the Eclipta prostrate, are well cited for antivenom activities [144]. 2-Hydroxy-4-methoxy benzoic acid, found in Hemidesmus indicus root extracts, was identified as a snake venom neutralizing factor which effectively neutralized viper venom induced lethal, hemorrhagic, coagulant, anticoagulant, and inflammatory activity [145]. This compound seems to act through free radical formation system [146] and is one of the mechanisms of venom inhibition. Caffeic acid is present in Strychnos nux-vomica, and the monomeric caffeic acid is a proven antidote against snake venoms when given as oral and parenteral administration [147]. Marmin in Aegle marmelos, a monoterpenoid substituted fernolin [148], has been mentioned as a remedy against snakebite. Piperine from Piper nigrum inhibits the adhesion of neutrophils to endothelial monolayers. Also it possesses inhibitory activities on prostaglandin and leukotrienes and thus possesses anti-inflammatory activity [149–151]. Quercetin is a potent inhibitor of lipoxygenase, and free quercetin and its glycosides rutin are present in Allium cepa skins [152]. The aristolochic acid content of Aristolochia indica contains a large number of proteins that cluster under native condition. It shows strong gelatinolytic, collagenase, nuclease, and peroxidase activities. It interacts with the components of snake venom and partially inhibits proteolytic and L-amino acid oxidase activities of the venom [12]. Active principle of Bauhinia forficata has thrombin-like enzyme that acts as potent inhibitor of clotting activity that otherwise causes persistent hemorrhage [153].

Most of the plants documented in this study are used for the treatment of versatility of disease. This trend is a possible indication of the tradition of THPs to develop local healing system through trials and errors for optimal treatment practices [154].

There are resemblances in comparative studies of these cited plants to other surveys regarding medicinal plants having antivenin characteristics (Table 4). Using the same plants in different areas by different cultures for the same purpose might be considered as a justification of their pharmacological efficacy [155].

Table 4: Worldwide comparative studies of cited plants of our survey.

Serial number
Scientific name of the plant
Region/country
Reference(s)

1
Abelmoschus moschatus Medic.
West Bengal, India
[39, 40]

2
Abrus precatorius L.
Arunachal Pradesh, India
[41]

3
Acacia farnesiana (L.) Willd.
West Bengal, India; Brazil
[42, 43]

4
Acalypha indica L.
West Bengal, India
[44]

5
Achyranthes aspera L.
West Bengal, India
[39, 43, 44]

6
Ageratum conyzoides L.
Meghalaya, India
[45]

7
Albizia lebbeck (L.) Benth.
Uttar Pradesh, India; Islamabad, Lahore, Pakistan
[46–48]

8
Albizia procera (Roxb.) Benth.
West Bengal, India
[49]

9
Allium cepa L.
Rajasthan, India; Brazil; Kenya
[33, 43, 50]

10
Andrographis paniculata (Burm. f.) Wall. ex Nees
West Bengal, India
[44]

11
Annona squamosa L.
Nicobar, India
[51]

12
Argemone mexicana L.
Rajasthan, India; Brazil
[43, 52]

13
Aristolochia indica L.
Karnataka, Madhya Pradesh, Orissa, Tamil Nadu, West Bengal, India
[53–57]

14
Asparagus racemosus Willd.
Karnataka, India
[58]

15
Bacopa monnieri (L.) Pennell
West Bengal, India
[59]

16
Bauhinia variegata L.
Rupandehi District, Nepal; Islamabad, Pakistan
[47, 60, 61]

17
Bixa orellana L.
West Bengal, India
[59]

18
Bombax ceiba L.
West Bengal, India
[49]

19
Buchanania lanzan Spreng.
Tamil Nadu, Uttar Pradesh, India
[48, 62]

20
Butea monosperma (Lamk.) Taub.
West Bengal, India
[49]

21
Calotropis procera (Ait.) Ait. f.
Rajasthan, Tamil Nadu, India; Balochistan, Pakistan
[57, 63, 64]

22
Calotropis gigantea (L.) Ait. f.
Orissa, India
[65]

23
Capparis zeylanica L.
West Bengal, India
[44]

24
Capsicum annuum L.
India
[66]

25
Cassia fistula L.
Karnataka, Tamil Nadu, Uttar Pradesh, India
[48, 54, 62]

26
Cassia occidentalis L.
West Bengal, India
[59]

27
Cassia sophera L.
West Bengal, India
[39]

28
Cassia tora L.
Uttaranchal, Uttar Pradesh, India; Brazil
[43, 48, 67]

29
Chenopodium album L.
Islamabad, Pakistan
[47]

30
Cissampelos pareira L.
Rajasthan, West Bengal, Tamil Nadu, India; Islamabad, Pakistan
[47, 55, 68, 69]

31
Clitoria ternatea L.
Madhya Pradesh, Meghalaya, Uttar Pradesh, India
[48, 70, 71]

32
Cynodon dactylon (L.) Pers.
India
[72]

33
Cyperus rotundus L.
Madhya Pradesh, India
[71]

34
Datura metel L.
Nicobar, Uttar Pradesh, India
[48, 51]

35
Eclipta prostrata L.
India; Brazil
[43, 72]

36
Emblica officinalis Gaertn.
Maharashtra, India
[73]

37
Ficus racemosa L.
Rajasthan, India
[74]

38
Flacourtia indica (Burm. f.) Merr.
Tamil Nadu, India
[62]

39
Gmelina arborea L.
West Bengal, India
[49]

40
Helicteres isora L.
Uttar Pradesh, India
[48]

41
Hemidesmus indicus (L.) R. Br.
West Bengal, India; Sri Lanka
[55, 75]

42
Holarrhena antidysenterica (Heyne ex Roth.) Conessi
Orissa, India
[65]

43
Holarrhena pubescens (Bach.-Ham.) Wall.
West Bengal, India
[44, 49]

44
Hyptis suaveolens (L.) Poit.
Uttar Pradesh, India
[48]

45
Ichnocarpus frutescens (L.) Br.
West Bengal, India
[44]

46
Lantana camara L.
Madhya Pradesh, India
[71]

47
Mangifera indica L.
Uttar Pradesh, India
[76]

48
Mimosa pudica L.
Nagaland, Uttar Pradesh, India
[48, 77]

49
Moringa oleifera Lamk.
Assam, India
[78]

50
Mucuna pruriens Baker
Uttar Pradesh, India
[48]

51
Ocimum basilicum L.
Uttar Pradesh, India; Brazil
[43, 48]

52
Oroxylum indicum Vent.
Orissa, India
[79]

53
Oxalis corniculata L.
Meghalaya, India; Tehsil Chakwal, Pakistan
[45, 80]

54
Piper nigrum L.
Uttaranchal, India
[81]

55
Plumbago zeylanica L.
Tripura, India
[82]

56
Rauvolfia serpentina (L.) Benth. ex Kurz
Karnataka, Tamil Nadu, Uttar Pradesh, India
[48, 83, 84]

57
Sida acuta Burm.
Madhya Pradesh, India
[71]

58
Sida cordifolia L.
Rajasthan, Tamil Nadu, India
[52, 84]

59
Syzygium cumini (L.) Skeels.
Orissa, India
[85]

60
Tamarindus indica L.
Maharashtra, India; Africa; Sudan
[75, 86]

61
Terminalia arjuna (Roxb.) Wt. & Arn.
West Bengal, India
[49]

62
Tinospora cordifolia (Willd.) Miers
Madhya Pradesh, Tamil Nadu, Uttar Pradesh, India
[62, 76, 87]

63
Tylophora indica (Burm. f.) Merrill.
Karnataka, India
[54]

64
Urena lobata L.
Tamil Nadu, India
[88]

65
Vitex negundo L.
Himachal Pradesh, Kerala, India
[89, 90]

66
Withania somnifera (L.) Dunal
Karnataka, India; Pakistan
[58, 75]

12 of these cited plants had been found to possess possible toxic potentiality (Table 5). However, among those possibly the most toxic one is Abrus precatorius. It contains abrin, a serious toxic compound, which after penetrating the cells of the body inhibits cell protein synthesis. Human fatal dose of abrin is approximately 0.1–1 mg/kg. But toxins are released only if the seed is chewed and swallowed [91]. Another dangerous plant is Ageratum conyzoides which in ingestion can cause liver lesions and tumors [94, 95]. There was a mass poisoning incident reported in Ethiopia as a result of contamination of grain with A. conyzoides [96]. In addition, epidemic dropsy and ocular toxicity have been reported by seed oil of Argemone mexicana [98–101] and latex of Calotropis procera [105], respectively; the rest are toxic only due to high doses of ingestion. However, a number of phytochemical investigations would be required to declare these plants as being toxic.

Table 5: Literature study of the plants surveyed having toxicity.

Scientific name
Toxic part
Toxic compound
Toxic effect
Reference

Abrus precatorius L.
Seed
Abrin, ricin
Abortifacient, inhibiting cell protein synthesis
[91]

Acorus calamus L.
Seed
Beta-asarone
Procarcinogenic
[92, 93]

Ageratum conyzoides L.
Seed
Pyrrolizidine alkaloids lycopsamine, echinatine
Liver lesions and tumors
[94–96]

Annona squamosa L.
Root, seed
Annonastin, squamozin
Roots are drastic purgative and seeds are strong eye irritant, abortifacient
[97]

Argemone mexicana L.
Seed, latex
Sanguinarine, dihydrosanguinarine
Epidemic dropsy
[98–101]

Bacopa monnieri (L.) Pennell
Whole plant

Suppress spermatogenesis and fertility, digestive problem
[102, 103]

Calotropis gigantea (L.) Ait. f.
Root
Calotropin
Inhibit spermatogenesis, abortifacient
[104]

Calotropis procera (Ait.) Ait. f.
Root
Cytotoxin, calotropin, calcilin, gigantin
Ocular toxicity
[105]

Cassia occidentalis L.
Pods and beans
Pyrrolizidine alkaloid
Hepatotoxic
[106–108]

Catharanthus roseus (L.) G. Don.
Root, shoot
Vincristine, vinblastine
Hypotension, neurotoxicity, anaemia, seizure
[109]

Ficus racemosa L.
Bark
Tetracyclic triterpene derivatives
Cause abnormality of liver and kidney
[110]

Lantana camara
Leaf
Triterpene acids
Leaf extracts are cytotoxic
[111]

5. Conclusion

This survey represents the contribution of natural flora of Bangladesh to the global approach in the management of snakebite occurrences. The knowledge documented in this study possibly supports the development of novel plant based treatment. Further investigations should be carried on especially in order to ensure safe therapy concerning medicinal plants. Therefore, snake charmers should be trained on as a priority basis. Again, scarcity of supply of snake antivenin is a major factor which needs to be addressed by local production. And in that case these findings regarding herbal antidote would be useful in planning and formulating strategies and specific interventions to combat snakebite related health problems in Bangladesh.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

Acknowledgments

The authors acknowledge the contribution of all the traditional medicine practitioners and indigenous people for providing relevant information regarding medicinal plants and their practices. The authors also express appreciation to all the government and nongovernment authorities for their help and the administrative facilities during the survey.

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