European folk medicine has a long and vibrant history, enriched with the various documented uses of local and imported plants and plant products that are often unique to specific cultures or environments. In this paper, we consider the medicoethnobotanical field studies conducted in Europe over the past two decades. We contend that these studies represent an important foundation for understanding local small-scale uses of CAM natural products and allow us to assess the potential for expansion of these into the global market. Moreover, we discuss how field studies of this nature can provide useful information to the allopathic medical community as they seek to reconcile existing and emerging CAM therapies with conventional biomedicine. This is of great importance not only for phytopharmacovigilance and managing risk of herb-drug interactions in mainstream patients that use CAM, but also for educating the medical community about ethnomedical systems and practices so that they can better serve growing migrant populations. Across Europe, the general status of this traditional medical knowledge is at risk due to acculturation trends and the urgency to document and conserve this knowledge is evident in the majority of the studies reviewed.
European folk medicine has held a special fascination for ethnographers, anthropologists and ethnobiologists alike. Rooted in a long history of tradition dating back to ancient Greek, Roman, and Arabic medical theories, this folk knowledge has been passed down via both written and oral pathways over the centuries. While some of these medical traditions have survived the passage of time relatively intact, many others have changed or disappeared, while “new” remedies and uses of plants have also emerged.
Today, European traditional medical knowledge is in a state of flux. In many cases, local traditional knowledge regarding the environment, wild food and medicine sources, and human health is in an alarming state of decline. This has prompted researchers to pursue field studies with the aim of documenting, preserving, and comparing data concerning these unique local ethnomedical practices. On the other hand, the mainstream popularization of certain complementary and alternative remedies for human health has promoted common knowledge of some heavily marketed species (many of which are nonnative to Europe). However, herb-drug interactions regarding these popular products are still poorly understood in most cases and present a dilemma for the European allopathic medical community (e.g., see [
Ethnobiological field studies in Europe can enhance our understanding not only of traditional healthcare practices, but also provide insight into human health and offer new solutions for food security. Specifically, ethnobiological data are useful to medical practitioners charged with the care of migrant and other populations that use CAM in that it can provide a basis for understanding folk medical beliefs about sickness, health, and therapies. Moreover, much research into the medicinal and nutritional value of plants that are presently underused in mainstream culture may actually lead to the development of the foods, pharmaceuticals, and CAMs of tomorrow.
Europe represents a melting pot of culture and has a long history of transmission of knowledge of medical practices across geographic, cultural, and linguistic borders. Early
While many of the same plants popular today in European folk medicine have been in use for centuries, if not millennia—the ways in which they are used is often quite different from that documented in historical texts. Furthermore, there is extensive variation in the current day preparation and indication for use of medicinal plants across geographic and cultural planes, and this is clearly supported by the existing ethnobotanical literature concerning Europe.
This review is based on an exhaustive survey of medicoethnobotanical field studies conducted in Europe over the last two decades (1992–2012) that have been indexed by Scopus [
Representation of medicoethnobotanical studies included in our analysis as they relate to the (a) involved countries, (b) ethnic groups and, (c) biogeographical regions.
For the purposes of this review, we have defined Europe to include the European continent plus Cyprus, Turkey, the Caucasus, and the Azores/Madeira/Canary Isles. We did not consider reviews or meta-analyses of preexisting data. Our criteria for the inclusion and exclusion of studies considered are detailed in Table
Criteria considered for the inclusion or exclusion of studies in our analysis of medical field ethnobotany in Europe.
Inclusion criteria | Exclusion criteria |
---|---|
Medical ethnobotanical field studies | Meta-analyses were excluded if based on the data collected by others |
Indexed in Scopus from 1992–2012 | Works conducted on a single species or group of related species |
Reports must provide precise details about the folk medicinal uses of plants | Field market surveys (unless the study involves folk-studies/TK of local or small-scale herb gathering and trade) |
Works written in English (or have an English abstract) | Reports on large-scale trade of medicinal plants (i.e., commodities studies) |
Here, we have divided our discussion of medical ethnobotanical field studies in Europe into three general geographic regions: SW Europe, SE Europe, and the rest of Europe. We have placed the most emphasis in our discussion of the European literature on SW Europe in order to provide a detailed discussion with specific case studies and examples of the relevance of traditional knowledge recorded in field studies to future European CAM therapies.
The Iberian Peninsula can be considered a small continent of around 600,000 km2. It is separated from the rest of Europe by the Pyrenees, a mountainous barrier that has contributed to its relative isolation. It has a striking climatic, geological, geographical, biological, cultural, and linguistic diversity. Its vascular plants flora, with around 7,500 taxa, is one of the richest of Europe [
Until the 1950s, Iberian society was mainly agrarian and rural. Most people were subsistence farmers and markets were weakly developed. There were exceptions such as some industrial regions in Catalonia or the Basque Country and big cities such as Madrid, Barcelona, Lisbon, or Porto. Many remote places remained isolated and only local markets, livestock fairs, the annual visit of transhumance herders, or an incipient tourism interrupted their isolation [
Deep transformations in the lifestyle of rural societies began in the 1960s with the process of industrialization and mechanization of the farms and the shift from a rural, agriculturally based, subsistence economy to a market oriented one [
Though not as common as in the past, there are still people who remember how life was when they mainly relied on the plants, animal, and materials found in their surroundings for food, medical, and other basic needs. However, the lack of direct contact with nature while tending animals, agricultural fields or home gardens has led to a strong erosion of this traditional ecological knowledge (TEK) and it is essential to record it before it is too late [
The rich traditional lore of the Iberian Peninsula has attracted many folklorists, ethnographers, and medical anthropologists and ethnobotanists since the end of the nineteenth century [
More than 30 Ph.D. theses have been fully or partially devoted to the study of medical ethnobotany of Spanish and Portuguese territories (e.g., see [
Number and most important species (determined by highest consensus) in a selection of Iberian medical ethnobotany studies.
Study site | Number of medicinal plants | Reference | Most relevant species |
---|---|---|---|
Pallars |
437 | [ |
|
Montseny (Catalonia, Spain) | 351 | [ |
|
Cabo de Gata (Andalusia, Spain) | 253 | [ |
|
W Granada province (Andalusia, Spain) | 244 | [ |
|
Alta Vall del Ter (Catalonia, Spain) | 220 | [ |
|
Middle Navarra (Spain) | 216 | [ |
|
Arrabida |
176 | [ |
|
Northern Navarra (Spain) | 174 | [ |
|
Montesinho (Tras-os-Montes, Portugal) | 169 | [ |
|
Campoo (Cantabria, Spain) | 160 | [ |
|
Vall del Tenes (Catalonia, Spain) | 153 | [ |
|
São Mamede (Portalegre, Portugal) | 150 | [ |
|
Serra da Açor (Central Portugal) | 124 | [ |
|
Piloña (Asturias, Spain) | 107 | [ |
|
Sierra Mágina (Andalusia, Spain) | 103 | [ |
|
Riverside Navarra (Spain) | 90 | [ |
|
Segarra |
92 | [ |
|
Chaves, Montalegre (Tras-os-Montes, Portugal) | 88 | [ |
|
Gorbeialdea (Basque Country, Spain) | 82 | [ |
|
Many of these surveys have been published only locally (e.g., see [
This rich level of production is reflective of the increasing social, political and scientific interest in traditional knowledge and specifically medical ethnobotany and the need to promote and conserve it. In fact, the Spanish legislation has assumed the principles of the Convention on Biological Diversity (CBD) in the law on Natural Heritage and Biodiversity [
According to a recent review of medicinal plants popularly used in Spain [
In Iberia, more than 400 plants were used in the richest area, Pallars, a territory of the Catalan Pyrenees [
Medicinal plants were mainly used for common disorders such as catarrh, pneumonia, fever, diarrhea, stomach and intestinal disorders, high blood pressure, wounds, bruises, or muscular pains. Many surveys concluded that digestive, respiratory, and skin disorders were among those most commonly treated with home remedies [
Households commonly kept a few species for treating the most common disorders, serving as a sort of traditional First Aid Kit. Their contribution was essential to the families’ well-being [
Apart from those plants whose knowledge was shared by most people, there were also plants and remedies known only by specialists, such as healers or local experts with a wider extensive knowledge of herbs. Particular recipes made of plant mixtures, some herbal extracts, and special lotions and ointments were prepared by healers or wise women who provided them on request [
Some of these local experts were incredibly wise and had a precious store of extensive traditional knowledge. For instance, Palacín found in his ethnobotanical survey of Aragon, in which he interviewed more than 1,500 informants, that three women knew more than hundred medicinal plants [
Lamiaceae, Asteraceae, and Rosaceae are always among the most important families referred in these territories [
Despite the fact that many of these plants have been widely used, they are abundant and have not suffered overexploitation. These species have the essential characteristics for being used in elementary healthcare: they are widespread, easily gathered, and have a vast array of medicinal properties and pharmacological effects [
On the other hand, there are also species that have suffered overexploitation. For example, in the case of
The Italian peninsula and islands (including Sardinia and Sicily) comprise a land mass of roughly 300,000 km2. The vascular flora includes 6,711 species [
Like the field studies conducted throughout the Iberian Peninsula, recent ethnobotanical studies undertaken over the past five years in Italy have also revealed a rich traditional pharmacopoeia that utilizes both local flora and fauna. Indeed, a multisite study of the zootherapeutic practices in select rural communities in several countries—including Italy (Basilicata), Spain, and Albania—revealed the use of 21, 11, and 34 animal species used in multiple ways as ingredients in the treatment of 50 (etic) categories of disease or illness [
In other regions of Italy, traditional knowledge of medicinal plants is also still quite resilient. For example, in Campania, a study examining a broad range of medicinal applications of plants recorded traditional knowledge concerning 95 medicinal species, representing roughly 24% of the entire local flora [
Quite similarly to the examples presented of SW Europe, the SE regions have been subject to political and economic shifts that have heavily influenced local lifeways, economies, foodways, connectivity with nature, and as a consequence, transmission of traditional knowledge regarding health and local CAM practices. The rural regions of SE Europe represent some of the most vibrant scenarios for conducting medical ethnobotanical studies (see, e.g., field studies in Croatia [ This mountainous area is a hotspot for both biodiversity and cultural/ethnic diversities. The area has historically provided the botanical materials that are sold in the Western European herbal market (especially during the last few centuries). The majority of dried medicinal plants and an impressive number of locally gathered medicinal plants are still widely used in many households for local healthcare. Medicinal plants are central to many economic initiatives and programs devoted to rural development.
Moreover, medical ethnobotany studies in the Western Balkans (e.g., see [
The ethnopharmacopeia of SE Europe shares some similarities with that of SW Europe, especially with regards to some of the most common medicinal species, including
Number and most important species (determined by high consensus) in a selection of south European medical ethnobotany studies.
Study site | Number of medicinal plants | Reference | Most relevant species |
---|---|---|---|
Inland Marches, Italy | 70 | [ |
|
Dolomiti Lucane (Basilicata), Italy | 103 | [ |
|
Arbëreshë (ethnic Albanians in N. Basilicata), Italy | 120 | [ |
|
Gollak region, Kosovo | 92 | [ |
|
Prokletije Mountains (Montenegro) | 94 | [ |
|
Pešter Plateau, Sandžak, SW Serbia | 62 | [ |
|
Sivrice (Elaziğ), Turkey | 81 | [ |
|
Maden (Elaziğ), Turkey | 88 | [ |
|
In the other regions of Europe (i.e., in Central and Northern Europe), modern medical ethnobotanical studies are quite rare, due to the remarkable erosion of TK related to home-made plant-based remedies. In these countries, scholars have shifted their focus mainly to historical studies, using both scholarly and folkloric sources of information for their analyses (see, e.g., [
On the other hand, CAM therapies of migrant communities in Northern Europe have presented an interesting topic of study, but most of these are dependent upon import of dried medicinal species from their cultural homeland (i.e., Africa, Asia, South America, Middle East, and etc.) and do not commonly incorporate the local flora [
Local knowledge is not static; rather it is highly adaptive. It is open to adopt new species and techniques and to reject others. Transhumant shepherds, schoolteachers, monks, nuns, or migrants who return to small communities after periods away all help to introduce new plants and therapies. Moreover, the tragic events of wars and forced migrations also lead to the movement of both plants and sets of traditional knowledge from one cultural terrain to another. For example, remnants of ancient Albanian medicinal plant uses and names can still be found today amongst the Arbëreshë diaspora in Italy, who are descendants of Albanians that fled to southern Italy following the Ottoman Turk invasion of their homeland about 500 years ago (e.g., see [
People are highly likely to experiment with “new” remedies that had been previously used and praised by friends or relatives [
Many researchers have described a deep erosion of traditional medical knowledge following the deep social and economic changes of the past few decades (e.g., [
Yet, on the other hand, researchers have observed an opposite trend with regards to a revitalization of traditional medical practices by youth and adult populations stemming from their concerns about the health risks of consuming industrial foods and pharmaceuticals [
Despite this general trend of abandonment of local medicinal species, especially in urban populations, recent medicoethnobotanical and epidemiological studies have shown that botanicals do still play a critical role in rural healthcare. In particular, composites like
Although there is an overall trend of decline of local medicinal plant use in urban areas, there are still examples of these practices, especially in southern Europe. For example, in Spain, city dwellers use medicinal plants such as
Some of these practices are even becoming more popular. As a result of tourism market that demands local authenticity, there are herbal infusions, such as
Despite the fact that many of these species are well known in the scientific phytotherapy literature, there are highly valued plants that do not appear in modern phytotherapy treatises. For example, this is the case for both
However, health policies cannot ignore the risks of an unsafe use of herbs. For example, in the case of
Our review of the recent literature concerning medical ethnobotany in Europe highlights the dynamic nature of traditional knowledge concerning medicinal plants and traditional medical practices. While in some cases a resilience of local CAM practices has been observed, especially when ecotourism plays a role in creating a demand for authenticity of local products, this is not representative of most regions. In fact, alarmingly, many of the studies reviewed comment on the growing erosion of existing TK of folk medical practices that has accompanied acculturation processes and loss of linguistic diversity. In general, the younger generations are no longer able to identify the local flora that are useful as wild foods and medicines. In urban areas, those interested in continuing the incorporation of such products in their diet and lifestyle most often purchase them, or use other mainstream CAM products that are imported from other global sources. Likewise, migrant populations often import foreign medicinals to meet their health needs.
Pluralistic and culturally appropriate approaches, which include “emic” views of newcomers' health seeking strategies, are increasingly considered crucial in our public health policies. In fact, these are often considered the only approaches that can build a genuine understanding of the holistic essence of health as a composite of physical, psychological, and social aspects of well-being. Understanding migrants' medical ethnobotanies can, therefore, offer a unique arena for fostering this aim, and for implementing the safe use of CAMs within the multicultural framework of diversity in the new Europe.
Traditional knowledge of local health seeking strategies, including the use of local medicinal flora, can serve as a foundation for understanding small-scale uses of CAM natural products and allow us to assess the potential for the sustainable expansion of these practices into the larger European market as commercial CAMs. Medical ethnobotanical field studies can provide useful information to the allopathic medical community as they seek to reconcile existing and emerging CAM therapies with conventional biomedicine. This is of great importance not only for phytopharmacovigilance and managing risk of herb-drug interactions in mainstream patients that use CAM, but also for educating the medical community about ethnomedical systems and practices so that they can better serve growing migrant populations. Acculturation trends and economic shifts away from rural, agriculture-based local economies have contributed to a decline in knowledge of traditional health practices and TEK at large. All of these issues underline the critical importance of documenting the remaining traditional knowledge of local medicinal plants, especially in southern Europe, where it is still present and used in local health strategies.
A review of the literature concerning field studies of medical TK in Europe would not have been possible without the dedicated work of the numerous ethnobiologists that have contributed to the body of literature on this subject. We also wish to acknowledge the many local communities, collaborators, and study participants throughout Europe who have so generously shared their traditional knowledge with the researchers who conducted the studies reviewed here.