Ethnomedicinal and traditional uses of the Ferns of Khyber Pakhtunkhwa, Pakistan

Ferns are often used by indigenous people in Khyber Pakhtunkhwa, Pakistan. This study was designed to collect the ethnomedicinal and traditional knowledge of these locals about this group of vascular plants. Forty taxa belong to nineteen genera and ten families are used in the treatment of different diseases. The Pteridaceae was the most representative family with twelve taxa (30%), followed by Athyriaceae and Dryopteridaceae with six taxa each (30%), and Thelypteridaceae with five taxa (12.5%). Regarding the genera, Adiantum , Asplenium and Dryopteris ranked first with four taxa each (30%), followed by Aleuritopteris, Diplazium, Pteris and Equisetum with three taxa each (30%), followed by Athyrium, Oeosporangium, Polystichum and Pseudophegopteris with two taxa each (20%). These taxa were commonly used in the treatment of respiratory disorders i.e. asthma, bronchitis, emphysema, pneumonia; intestinal ulcer, stomach, urinary ailments and skin disorders by the methods of decoction and infusion. Traditional knowledge about ethnomedicinal plants is a valuable and essential source for the discovery of allopathic, herbal and homeopathic medicines.


Introduction
All living organisms depend upon food and medicines (Irfan et al., 2017a, b). Plants are ethnomedicinally used in different communities of the world since centuries ago (Irfan et al., 2018a;Ullah et al., 2018). Now a day's modern medicines are replacing the ethnomedicinal uses of the plants around the world (Iftikhar et al., 2019;Irfan et al., 2018bIrfan et al., , 2019. Until now 70% inhabitants around the world depends upon the ethnomedicinal uses of plants (Irfan et al., 2018c). Most of the population of poor and developing countries relies upon traditional medicines (Attaullah et al., 2017;Irfan et al., 2018d;Singh and Upadhyay, 2014). In Pakistan about 700 plant species are method from the local inhabitants; herbal practitioners, Hakeem's, medicinal plants traders, wound healers and aged women from March 2018 to August 2019. A total of 150 questionnaires were conducted from informers at different districts of Khyber Pakhtunkhwa, Pakistan, i.e. Abbottabad, Buner, Chitral, Dir Lower, Dir Upper, Khyber, Kurram, Malakand, Mansehra, Swabi, Swat, Shangla and Torghar. During field trips the potential indigenous knowledge about its use were documented. Plant specimens were collected, photographed, tagged, pressed, preserved and mounted on exsiccates and later deposited at the herbarium of Abdul Wali Khan University, Mardan, Khyber Pakhtunkhwa, Pakistan. Plant specimens were identified by Mr. C. R. Fraser-Jenkins and were classified according to (PPG-I, 2016).
The fidelity level is the percentage of respondents mentioning the uses of a specific plant to treat particular disease. Ip is the number of informants independently suggested the use of various taxa for a specific disorder, while Iu is the total number of informants suggested various taxa for the ethnomedicinal purpose. Use value (UV) was calculated according to Equation 2 (Phillips et al., 1994).
Use value (UV) is a numerical method that proves the relative importance regarding medicinal uses of plant species; UV is the number of individual use species, Ui is the number of uses recorded for each species and Ni is the total number of informants. Use value reflects the relative importance of reported plant species in an area. High use value shows that plant species have many use reports and is important in the region, whereas low use value (approach to 0) shows that species have few use reports related to its use. However, use report is not meaningful to differentiate whether a plant species is used for single or manifold purposes (Kayani et al., 2014). Relative frequency was calculated according to Equation 3 (Ali-Shtayeh et al., 2016).
Relative frequency of citation (RFC) presents the local importance of each species in a study area. To calculate RFC, number of respondents citing a useful species (FC) is divided by total number of respondents in the field survey (N). RFC value varies from 1 (when all the respondents refer to a plant as a useful one) to 0 (when nobody refers to a plant as a valuable species). FC is the number of informants using the plant species, N is the total number of informants . Jaccard index (JI) was calculated according to Equation 4 (González-Tejero et al., 2008). medicinally used in rural and tribal areas due to high cost on modern medicines and poverty (Ahmad et al., 2016;Irfan et al., 2018e).
Worldwide there are about 11916 taxa with 337 genera, 51 families, 14 orders and two classes of ferns and lycophytes (PPG-I, 2016). A total of 168 taxa with 45 genera and 19 families are currently reported from Pakistan with greater wealth in Azad Jammu and Kashmir, Khyber Pakhtunkhwa and Gilgit-Baltistan, Pakistan (Fraser-Jenkins et al., 2016, 2020Irfan et al., 2021d).

Materials and Methods
Ethnomedical and traditional uses of the ferns in Khyber Pakhtunkhwa were investigated through questionnaire "a" is the total number of taxa used in Khyber Pakhtunkhwa, Pakistan, "b" is the total number of taxa previously published in each article from India, while "c" is the total number of taxa common to both A and B.
The similarity of knowledge between different communities was determined by comparing the findings of the current study with already published articles from India by applying Jaccard index. The studies conducted on the areas with similar, vegetation, climatic condition, and culture was considered for comparison.

Results
The current research found 40 taxa of ferns belongs to 19 genera and 10 families with ethnomedicinal and traditional used in the prophylaxis of different ailments (Table 1). Amongst 10 ferns plant families Pteridaceae was  largest with 12 taxa (30%), followed by Athyriaceae and Dryopteridaceae with 6 taxa each (30%), Thelypteridaceae with five (12.5%), followed by Aspleniaceae presenting 4 (10%) and Equisetaceae with 3 taxa (7.5%). Blechnaceae, Hypodematiaceae, Marsileaceae and Woodsiaceae presented 1 taxon each (10%) (Figure 1, Table 1). Adiantun, Asplenium and Dryopteris were the most representative genera with 4 taxa each (30%), followed by Aleuritopteris, Diplazium, Pteris and Equisetum were second with 3 taxa each (30%), Athyrium, Oeosporangium, Polystichum and Pseudophegopteris with 2 taxa each (20%), and Ampelopteris, Christella, Cystopteris, Hypodematium, Marsilea, Phegopteris, Woodsia and Woodwardia with 1 taxon each (20%) (Figure 2, Table 1). All of these taxa were used in the treatment of different diseases, i.e. healing of wounds, general tonic, asthma, bronchitis, pneumonia, skin infections, ulcer, sterility in women, diabetes, hepatitis, gonorrhea, common cold, as an anthelmintic, rheumatism, epilepsy and osteoporosis while two taxa of Diplazium were used as a vegetable. Different parts of ferns were used by local inhabitants, i.e. young leaves of twenty one taxa (52.5%), rhizome of nine taxa (22.5%), young frond of seven taxa (17.5%), cones of two taxa (5%), while whole plant of only one taxa (2.5%) were used. Seven taxa was used for skin infections (17.5%), followed by female sterility and general tonic with 4 taxa each (20%), followed by intestinal disorders and wound healings with 3 taxa each (15%), lungs, bones, stomach disorders have 2 taxa each (15%), while remaining disorders, i.e. antivenom, rheumatism, migraine, diabetes, epilepsy and as an expectorant etc have only 1 taxon each (32.5%) were used for treating them (Table 1). The effectiveness of the treatments described has not been tested, as the present study aimed to rescue and record the knowledge contained in traditional populations regarding ferns and how they are used by these inhabitants. Frequency and percentage of different ethnic groups in the area resulted that Pashto was the dominant language (98%) followed by Gujars (2%).
Gender wise men had more information about vernacular names and uses of taxa (70%) followed by women (30%). Hakims, wound healers, medicinal plant traders and farmers presented more information on the use of these taxa. Locality wise rural and hilly areas (81.33%) people have more knowledge about the ethnomedicinal uses of taxa, followed by suburban and urban areas (19.67%).

Conclusion
Ethnomedicinally ferns taxa were utilized by the local inhabitants in the curing of various ailments, i.e. diabetes, hepatitis, hair loss, bones disorders, female infertility, stomach, urinary and intestinal disorders, bronchial disorders, wound healings, general tonic, epilepsy, hair care, inflammation of skin, antivenom, anthelmintic, and fair complexion to treat skin problems with strong potential. These taxa may be utilized commercially for drug discovery, keeping in view of their availability and sustainable supply. Cultivation of these taxa for medicine and ornamental purpose is highly needed. Education plays a key role in awareness about the uses of medicinal plants at scientific basis which can leads to drug discovery.