Ethnobotanical Study of Effective Medicinal Plants as Laxative (Anti-constipation): A Case Study in Arasbaran Forests, Northwest Iran

ABSTRACT


Intorduction
Constipation is a common complication that a wide range of healthy and sick people suffer from (Daniali et al., 2020).It has been estimated that constipation has a high prevalence equal to 16% all over the world.However, statistics from Western industrial countries show prevalence of constipation near 30% (Salari et al., 2023;Klaschik et al., 2003).Constipation is a phenomenon that is experienced by the majority of people throughout their lives at least one time, regardless of age or health status (Salari et al., 2023).There are many causes, including diseases, lifestyle and the use of drugs such as narcotics, in the occurrence of constipation (Klaschik et al., 2003;Xu et al., 2021).Constipation could be an emergency condition that may lead to serious gastrointestinal complications such as hemorrhoids, anal fissure, rectal bleeding, and rectal prolapse eventually (Faghihi et al. 2022).Constipation is an unpleasant condition that needs appropriate assessment and immediate treatment.Constipation treatment is a multi-method process that requires changes in behavior, lifestyle, nutritional status and drug therapy with laxatives for faster and more stable treatment (Camilleri et al., 2017).Changing the behavior, lifestyle and nutritional status of a person with constipation through increasing physical activity, increasing fluid intake, increasing consumption of vegetables and fiber-rich foods are effective approaches in managing constipation (Klaschik et al., 2003).Laxative therapy is the selective pharmacotherapy of constipation.Bulk-forming laxatives, stimulant laxatives, osmotic laxatives, and lubricating agents are most common used laxatives agents to treat constipation (Bassotti et al., 2023).The numerous side effects of synthetic laxatives have increased the desire of researchers to use natural alternatives (Khan et al., 2020).Previous studies have demonstrated the beneficial effects of medicinal plants on constipation.Medicinal plants are well known for their various therapeutic effects including antioxidant, antimicrobial and anti-inflammatory properties (Sulaiman et al., 2022;Amiri et al., 2023;Zangeneh et al., 2023;Baharvand Ahmadi et al., 2023;khajehpour A, Javadian, 2020).In addition to the use of medicinal plants as remedies, they have been recognized as a reliable food sources.Medicinal herbs can improve health status because of their phytochemical constituents.For instance, it has been reported that medicinal plants relieve constipation because they are rich in fiber (Sharma et al., 2021;Jasim et al. 2023;Eftekhari et al., 2022;Baniesmaeeili et al. 2023).Hence, the aim of this study was to identify effective medicinal plants as laxative in Arasbaran Forests, East Azerbaijan Province, and Northwest Iran.

Area of Study
The present ethnobotanical study was performed in Arasbaran Forests, East Azerbaijan Province, Northwest Iran.

Data Collection
The current study was a cross-sectional systematic and ethnobotanical research that was conducted in the period from February 2021 to May 2021.First, standard questionnaires were prepared and these questionnaires were administered to 20 traditional medicine doctors (five women and 15 men).The questionnaire was distributed among traditional medicine doctors.The results obtained from the traditional information of the studied subjects were recorded directly in the questionnaire tables and finally the data were analyzed using Excel software (Baharvand Ahmadi et al., 2015).

Discussion
Numerous studies have documented the role of medicinal herbs as laxative to treat constipation (Akram et al., 2022).In Iranian traditional medicine, it is recommended to use herbs as laxatives to solve the problem of constipation (Karami et al., 2020).Therefore, the present ethnobotanical study that we know was the first to investigate the effect of medicinal plants of Arasbaran forests as a laxative on constipation.Euphorbiaceae, Grossulariaceae, Polygonacea, Polypodiaceae, and Rosaceae families were recognized as potent laxative, respectively.Our work also demonstrated that fruit, leaves, aerial parts, bark, root, and rhizome were the most usable part of the mentioned plants.Furthermore, we found that these medicinal plants were administrated in the form of decoction and infusion.In recent decades, researchers have focused on the use of natural agents to treat various diseases.Herbal plants have a long history in the treatment of gastrointestinal diseases.In fact, medicinal plants with various phytochemicalcompounds, including flavonoids, phenolic compounds, terpenoids (or isoprenoids), saponins, and vitamins cause multiple therapeutic properties such as antioxidant, antimicrobial, anticancer and anti-inflammatory properties.Medicinal plants, with their anti-inflammatory and antimicrobial properties, deal with inflammation and pathogenic microbes in the digestive system, which are the cause of many diseases in these organs.On the other hand, the presence of high amounts of plant fibers in them increases the volume of feces, increases intestinal movements, and thus prevents constipation (Karami et al., 2020;Hashem et al., 2015).In a similar ethnobotanical study conducted by Karami N et al.,  ), Rheum ribes L., pink cotton lamb's ear (Stachys lavandulifolia), Plantago major, Alcea spp., licorice (Glycyrrhiza glabra L.), wild rue (Peganum harmala L.), Pistacia atlantica Desf.and common basilisk (Prangos ferulacea L.) showed a potent anticonstipation effect (Karami et al., 2020).The results of this study in line with the results of our study documented the therapeutic effects of medicinal plants on constipation as laxative.In another similar study, Hashem Dabaghian F et al. reported that Iranian traditional medicinal plants such as golden shower tree (Cassia fistula), Cotoneaster nummularia Fisch., tamarind (Tamarindus indica), camelthorn (Alhagi camelorum), and Damask rose (Rosa damascene) and almond oil were used to treat constipation especially during pregnancy (Hashem et al., 2015).

Conclusions
Our findings revealed that medicinal plants used in Arasbaran have potent therapeutic effect constipation as laxative.The chemical compounds found in medicinal plants are the main factor in helping to treat constipation by increasing bowel movements and volume.Therefore, studying more about the role of herbal compounds in improving digestive problems such as constipation can be a factor in reducing the side effects of chemical drugs.

Figure 1 .
Figure 1.The percentage of plant organs used traditionally as laxative in Arasbaran forests

Table 1 .
Medicinal plants used as laxatives in Arasbaran, Iran The number of people who stated in this study that this plant has laxative effects; %: The percentage of people who stated in this study that this plant has laxative effects; -: Not announced.