RESEARCH ARTICLES

Traditional use of medicinal plants to heal wounds: implications for nursing

Manuelle Arias PirizI; Adriana Roese^II; Caroline Vasconcellos LopesI^II; Marcelo Melo Silva^IV; Rita Maria Heck^V; Rosa Lia Barbieri^VI

^I Nurse. Master degree in Nursing. Ph.D. student by the Graduate Program in Nursing by the Federal University of Pelotas. Rio Grande do Sul, Brazil. E-mail: manuelle.piriz@hotmail.com
^II Nurse. Ph.D. in Nursing. Assistant Professor in the Nursing School at the Federal University of Rio Grande do Sul. Porto Alegre, Rio Grande do Sul, Brazil. E-mail: adiroese@gmail.com
^III Nurse. Master degree in Nursing. Ph.D. at the Graduate Program in Nursing of the Federal University of Pelotas. Rio Grande do Sul, Brazil. E-mail: carolinevaslopes@gmail.com
^IV Nurse. Graduated by the Federal University of Pelotas. Rio Grande do Sul, Brazil. E-mail: marcello_melo@yahoo.com.br
^V Nurse. Ph.D. in Nursing. Associate Professor of the Nursing School at the Federal University of Pelotas. Coordinator of the Graduate Program in Nursing. Pelotas, Rio Grande do Sul, Brazil. E-mail: rmheckpillon@yahoo.com.br
^VI Biologist. Ph.D. in Genetics and Molecular Biology. Researcher of the Brazilian Company of Agricultural Research. Pelotas, Rio Grande do Sul, Brazil. E-mail: barbieri.cpact@emprapa.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.5624

ABSTRACT

A qualitative and quantitative, descriptive study was conducted in four cities in southern Brazil to identify the me­dicinal plants indicated by folk informants for treating wounds, and the implications for professional nursing practice. Between September, 2009 and August, 2011, semi-structured interviews of ten informants were recorded, medicinal plant collection sites were georeferenced, with systematic observation, and photographic records were made. Results showed that 19 medicinal plants were being indicated for treating wounds. Of these, the healing effects of 16 are reported in the scientific literature. Accord­ingly, nursing, a profession that appreciates the importance of caring for wounds, should understand how this care is provided traditionally, in order for nurses to become active subjects in restoring health in the population served.

Keywords: Phytotherapy; nursing care; traditional medicine; healing.

INTRODUCTION

The use of medicinal plants for the wound healing process is mentioned since prehistory, in which plants and plant extracts were used for human care. The aim was to stop bleeding and promote healing, and many of these plants were ingested to work in a systemic way¹.

Today, it is of great importance to recognize forms of care the individuals perform in their daily lives, revealing the need for a greater domain of this knowledge by nursing professionals. Once the community is a space of popular knowledge that can be used as a proximity instrument, autonomy and appreciation of the culture of each cared human being².

The professional nurse, especially, should pay attention to these cultural issues of the community, considering the commitment to care, which can favored not only for diagnoses, results and nursing interventions, but all the practice planning, socializing people with less painful wound and paying attention to the multidimensional nature of human beings³.

In this way, through the approach and understanding of everyday life care universe of the farmer and informant folk (people with great knowledge on plants and can also be called healers or herbalists), it will be possible to establish a therapeutic effective to assist in the care provided. The popular knowledge must be understood and increased of knowledge and attitudes backed by scientific knowledge, expanding research on the use of medicinal plants to ensure full and welcoming assistance from professionals of the Unified Health System (SUS)⁴.

The important thing is that knowledge about medicinal plants can contribute effectively in health, meeting basic needs of the population, especially about wound care, very familiar nursing practice⁵. The objective of this study was to identify medicinal plants indicated by folk informants in southern Brazil for the treatment of wounds, explaining the implications for nursing professional practice.

LITERATURE REVIEW

For interpretive anthropology, culture is built by the subjects to interact in everyday life, emerging values, forms of care, knowledge exchange about medicinal plants, beliefs and norms that are part of the practice. Thus, culture can be conceptualized as a system of shared symbols that people use to perceive, interpret and organize the world in which they live.⁶
From this perspective, it can be understood the specificity of the given group to identify a plant which by experience is used to alleviate a particular symptom. In another group, it may be that this same plant is used in health care to another symptom. Thus, the medicinal plant is a shared symbol that has meaning only from its visual recognition, olfactory and healing accumulated and passed on between generations.

Thus, it is understood that, to discuss the care, it is essential to be closer to the culture, emphasizing that health care systems are culturally and socially constructed. These care systems are ways to play the social reality that gives meaning to interactions between people^7,8.

Thus, there is an explanatory model of health care that aims that within the same society there are different health systems, with a multiplicity of conceptions about the disease, including etiology, pathophysiology, definition of severity, treatment and diagnosis. In this context, the three basic systems of care to health are differenciated⁷:

. Professional care system (official) - which is the medical system established and accepted as formal in Western societies - the biomedical model. This system has the practices and knowledge which consist of a scientific knowledge or a specific tradition of health care, such as biomedicine, homeopathy and Chinese medicine.

. Popular care system (familiar) - composed of lay knowledge, referring to knowledge and daily practices that are related to the health and disease phenomenon. In this context, the first health care and disease are adopted.

. Folk care system (popular) – it is the healing specialists not recognized legally, using resources such as medicinal plants, manipulative treatments, special exercises, and considered as sacred when they involve shamanism and healing rituals. These specialists are legitimized by society and are strongly linked to family care system. Most folk caregivers share the same cultural values and the same worldview of communities where they live, offering explanations of the illness more accessible to understanding the individuals and their family^7,8.

Thus, this study sought to approach the folk care system in order to enhance the popular culture and learn about the care practices to wounds used by representatives/informal health care specialists, bringing this knowledge to the professional contemporary nursing practice.

METHODOLOGY

There was conducted a quantitative, qualitative, descriptive study⁹ which is part of the research project called Bioactive plants for human use by families of ecological farmers of southern Rio Grande do Sul region, focusing on the use of medicinal plants used in wound healing indicated by people reference the knowledge of medicinal plants in rural communities. There were 10 people interviewed, indicated by organic farmers and by the Rio Grandense Association of Technical Assistance Projects and Rural Extension (Emater) or even by the teams of the Family Health Strategy of the localities. Of these, seven were addressed at home and the others at the place where public treatment was provided in the cities of Pelotas, Canguçu, Morro Redondo and São Lourenço do Sul, which are located in southern Rio Grande do Sul.

During the first visit to the informants, the formal invitation to participate in the research was done and a meeting agenda was established, ranging from 2 to 12. The research instruments for data collection were recorded in semi-structured interviews and systematic observation⁹.

Only a folk informant did not agree with the use of the recorder. In this case, the approach was carried out with at least two people to assist the notes of records.

Photographic record was held in place of medicinal plants cited for later taxonomic identification. When there was doubt in the correct identification of some plants, with the permission of folk informant, branches in reproductive phase were collected for preparation of herbarium specimens. The locations of the interviews and the aforementioned plants were georeferenced through Global Positioning System (GPS) navigation. Data collection took place between September 2009 and August 2011. For this article, medicinal plants indicated for the treatment of wounds for at least three informants were selected. For data analysis, literature review for each medicinal plant used was carried out, seeking to confront their indications with existing scientific studies.

All ethical and legal precepts of Nursing Research and the Resolutions No. 196/96 and 466/12 of competence of the National Health Council emanating guidelines for research with human beings were respected¹⁰.

Research participants signed the Informed Consent Form in two ways. And the project was approved by a Research Ethics Committee of healthcare.

RESULTS AND DISCUSSION

According to the 10 participants, 19 medicinal plants can be used in wound care because they have healing effects. With this information, the authors of this study have developed Figure 1, complementing the required specifications, with supporting literature.

n.i. = not informed
FIGURE 1: Herbal medicines indicated for the treatment of wounds. Pelotas, Rio Grande do Sul, in 2015.

In the scientific literature reports of specific healing activity for 16 of the 19 medicinal plant species mentioned folk by informants, or most of them were found. The Allium sativum (garlic) has proven effect on wound healing¹¹. Several species of the genus Aloe also have healing effects ¹², most notably for Aloe Vera¹³. Antibacterial activities have been demonstrated in endodontics for Arctium lappa species (burdock)^14,15. The topical gel elaborated starting from Calendula officinalis oil (marigold), showed re-epithelization and wound healing capability¹⁶. The ointment prepared with Melia azedarach extract (white cedar) showed antibacterial action and anti-inflammatory in incisional wounds which have healed in about 15 days¹⁷.

The local action of Symphytum officinale (cultivated comfrey) is due to the presence of Allantoin - substance proven healing action. In a study of 161 patients with pressure ulcers, the ointment cream with comfrey extract obtained a percentage of 90.4% healing in four weeks¹⁸.

Healing action evidences were found for Polygonum barbatum and Polygonum cuspidatum (water smartweed)^19,20. Compared the efficacy and safety of using Solanum americanum (nightshade), this has not been tested in scientific studies, and its use has been made based on the popular knowledge²¹.

Maytenus (maiten) has a protective effect against gastric lesions by inhibiting secretion of gastric juice²². In addition, it operates in the healing of stomach injury and is a source of antioxidants²³.

For Bryophyllum pinnatum (life plant) an experimental study in rats was conducted, and it has proven its anti-inflammatory and antinociceptive effectiveness²⁴. An experimental study in rats showed that the hydroalcoholic extract of Stachytarpheta cayennensis has properties anti- inflammatory and antinociceptive for external or internal use²⁵. Additionally, it has proven its antibacterial potential²⁶.

For Citrus sinensis (orange), the extract from the bark of administered orally plant known significant effects on wound healing in rats with induced diabetes, due to the high concentration of vitamin C and carotenoids²⁷.

Malva sylvestris plant (mallow) showed effective results in wound healing²⁸. Pharmacological studies with the species Achyrocline satureioides (Marcela) have shown anti-inflammatory, analgesic, immunostimulant, antiviral, antimicrobial, hypoglycemic and antioxidant effects^29,30.

Specific studies of use of Senecio brasiliensis species (flower of souls) on human health were found. However, a study conducted in Africa with other species of the same genus Senecio serratuloides concluded that the plant extract has good tissue regeneration capacity in deep wounds ³¹.

It has been demonstrated antimicrobial activity, anti-inflammatory, antioxidant and analgesic for Piper umbellatum (West African pepper) ³². In addition, this species has a high concentration of polyphenols and antioxidant activity, with actions against free radicals³³.

The species Alternanthera dentata (penicillin) showed significant cytotoxicity in tumors and considerable anti-tumor effects¹⁷, but there are no studies proving its healing effects.

The essential oil of Schinus molle (Peruvian pepper) demonstrated antimicrobial properties, antifungal, anti-inflammatory and healing effects ³⁴.

The pharmacological analysis of hydroalcoholic extracts of leaves, roots and seeds of Plantago australis (common plantain) proved its analgesic and anti-inflammatory effects³⁵. Another related species, Plantago ovata, has antiseptic action in cleaning wounds, anti-inflammatory and anti-allergic³⁶. Polyphenols extracted from leaves and seeds of Plantago major, other species of the same genus, showed effects in wound healing, in addition, provides antiulcer, anti-inflammatory, antioxidant, anticarcinogenic activity and antiviral capacity^37,38.

The National Health Surveillance Agency (ANVISA), through the Collegiate Board Resolution (RDC) No. 10, regulates the use of 66 plants in the care of human health. Among these, seven (Polygonum punctatum, Maytenus ilicifolia, Arctium lappa, Malva sylvestris, Calendula officinalis, Achyrocline satureioides and Plantago major), from the 19 plants cited by informants are indicated having healing effect³⁹.

In this perspective, the results show that of the 19 plants analyzed as healing, 16 (84.21%) of them have experimental or pharmacological studies that demonstrate its healing effect. Six of these had direct effect on wound healing and 10 act in healing through their anti-inflammatory or antimicrobial potential, considering the infected or inflamed wounds take more time to wound healing.

Thus, it can be seen that most of the plants indicated by folk informants to treat wounds has healing effects reported in the scientific literature. However, for three plants, there are no studies reporting healing action, which somehow means they do not have this effect. It may happen that scientific studies investigating this action have not yet been conducted.

Regarding nursing, among its actions, it is highlighted the care of wounds and control of the healing process. Nursing professionals, either in primary care services, secondary or tertiary, should pay attention to the research of local, systemic and external factors that contribute to the onset and chronicity of injury, interfering with the healing process and seeking a comprehensive approach⁴⁰.

To occur this comprehensive and contextual approach, it is necessary that nursing link their knowledge with popular knowledge about the medicinal plants used as healing. Thus, a new perspective of care arises, which values cultural systems and develops new knowledge and skills to improve this health practice.

CONCLUSION

This study allowed to know the practices for the care of wounds used by professionals in the informal health system in southern Rio Grande do Sul. The main findings are highlighted that the majority of the plants have scientific proof of their effectiveness in healing. Among the limitations of the study, there is the importance of continued work in the communities, which is not done effectively, as well as the articulation between users of medicinal plants and University in the form of return of scientific publications on the topic to socialize knowledge and experience.

Brazilian Southern folk informants surveyed indicate correctly, in most cases, medicinal plants, which improves our plans to look at the importance of the rescue of this knowledge by the nursing profession that values the care of wounds.

Thus, allying to the popular care and those references in this matter, the nurse extends their care skills and can become an active subject in the recovery and promotion of health of individuals.

REFERENCES

1.Dealey C. Caring for wounds: a guide for nurses. São Paulo: Atheneu; 2008.

2.Badke MR, Budó MLD, Silva FM, Ressel LB. Medicinal plants: the knowledge sustained by daily life practice. Esc Anna Nery. 2011; 15: 132-9.

3.Silva RS, Matos LSL, Araújo EC, Paixão GPN, Costa LEL, Pereira A. Popular practices in health: self-care to wounds of users of medicinal plants. Rev enferm UERJ. 2014; 22: 389-95.

4.Piriz MA, Ceolin T, Mendieta MC, Mesquita MK, Lima CAB, Heck RM. Health care with the use of medicinal plants: a cultural perspective. Ciênc cuid saúde. 2014; 13(2): 309-17.

5.Sena J, Soares MCF, Cezar-Vaz MR, Sena A, Mucillo-Baisch AL. The vision of educators on medicinal plants as a knowledge and on its use as a medication. Rev enferm UERJ. 2006; 14: 196-201.

6.Geertz C. The interpretation of cultures. Rio de Janeiro: LTC; 2011.

7.Kleinman A. Patients and healers in the context of culture: an exploration of the bordeland between anthropology, medicine and psychiatry. California (USA): Regents; 1980.

8.Kleinman A. Concepts and a model for the comparison of medical systems as cultural systems. Soc Sci Med. 1978; 12(2B): 85-95.

9.Minayo MCS. The challenge of knowledge: qualitative health research. 12ª ed. São Paulo: HUCITEC; 2010.

10.Ministry of Health (Br). National Health Council. Resolution No. 466/12: Regulatory standards for research involving human subjects. Brasília (DF): Ministry of Health; 2012.

11.Ejaz S, Chekarova I, Cho JW, Lee SY, Ashraf S, Lim CW. Effect of aged garlic extract on wound healing: a new frontier in wound management. Drug Chem Toxicol. 2009; 32: 191-203.

12.Zillmer JGV, Arrieira IC, Ceolin T, Heck RM, Barbieri RL. Use of Aloe in the daily life of patients with cancer. RBSP. 2010; 34: 773-82.

13.Hashemi SA, Madani SA, Abediankenari S. The review on properties of Aloe Vera in healing of cutaneous wounds. Biomed Res Int. 2015; 2015: 1-6.

14.Gentil M, Pereira JV, Sousa YT, Pietro R, MD Neto, Vansan LP, de Castro França S. In vitro evaluation of the antibacterial activity of Arctium lappa as a phytotherapeutic agent used in intracanal dressings. Phytother Res. 2006; 20(3): 184-6.

15.Pereira JV, Bergamo DC, Pereira JO, França SC, Pietro RC, Silva-Sousa YT. Antimicrobial activity of Arctium lappa constituents against microorganisms commonly found in endodontic infections. Braz Dent J. 2005; 16: 192-6.

16.Okuma CH, Andrade TA, Caetano GF, Finci LI, Maciel NR, Topan JF, et al. Development of lamellar gel phase emulsion containing marigold oil (Calendula officinalis) as a potential modern wound dressing. Eur J Pharm Sci. 2015; 71: 62-72.

17.Nazar AK, Khalaf FH, Al-Zuhairi AH, Al-Ezzy AI. Evaluation of the Performance of Melia Azedarach for skin wound healing in donkeys: clinical and histopathological study. AJPCT. 2015; 3: 1-9.

18.Stepán J, Ehrlichova J, Hladikova M. Efficacy and safety of symphytum herb extract cream in the treatment of pressure ulcers. Z Gerontol Geriatr. 2014; 47: 228-35

19.Wu XB, Luo XQ, Gu SY, Xu JH. The effects of Polygonum cuspidatum extract on wound healing in rats. J Ethnopharmacol. 2012; 141: 934-7.

20.Hitesh HK, Gupta MK. Wound healing activity of Polygonum barbatum Linn. J Pharm Pharmaceut Sci. 2012; 1: 1084-91.

21.Lorenzi H, Matos FJA. Medicinal plants in Brazil: native and exotic. São Paulo: Instituto Plantarum; 2008.

22.Baggio CH, Freitas CS, Otofuji GM, Cipriani TR, Souza LM, Sassaki GL, at al. Flavonoid-rich fraction of Maytenus ilicifolia Mart. ex. Reiss protects the gastric mucosa of rodents through inhibition of both H+, K+ -ATPase activity and formation of nitric oxide. J Ethnopharmacol. 2007; 113: 433-40.

23.Cipriani TR, Mellinger CG, de Souza LM, Baggio CH, Freitas CS, Marques MC, et al. A polysaccharide from a tea (infusion) of Maytenus ilicifolia leaves with anti-ulcer protective effects. J Nat Prod. 2006; 69: 1018-21.

24.Ojewole JAO. Antinociceptive, anti-inflammatory and antidiabetic effects of Bryophyllum pinnatum (Crassulaceae) leaf aqueous extract. J ethnopharmacol. 2005; 99: 13-9.

25.Schapoval EE, Vargas MR, Chaves CG, Bridi R, Zuanazzi JA, Henriques AT. Antiinflammatory and antinociceptive activities of extracts and isolated compounds from Stachytarpheta cayennensis. J Ethnopharmacol. 1998; 60: 53-9.

26.Okoye TC, Akah PA, Okoli CO, Ezike AC, Mbaoji FN. Antimicrobial and antispasmodic activity of leaf extract and fractions of Stachytarpheta cayennensis. Asian Pac J Trop Med. 2010; 3: 189-92.

27.Ahmad M, Ansari MN, Alam A, Khan TH. Oral dose of citrus peel extracts promotes wound repair in diabetic rats. Pak J Biol Sci. 2013; 16: 1086-94.

28.Pirbalouti AG, Azizi S, Koohpayeh A, Hamedi B. Wound healing activity of Malva sylvestris and punica granatum in alloxan-induced diabetic rats. Acta Pol Pharm. 2010; 67: 511-6.

29.Barata LES, Alencar AAJ, Tascone M, Tamashiro J. Brazilian medicinal plants: I. Achyrocline satureioides (Lam.) DC. (Macela). Rev Fitos. 2009; 4: 120-5.

30.Simões CMO. Pharmacognosy: the plant to medicine. 6ª ed. Porto Alegre (RS): Editora UFRGS; 2007.

31.Gould AN, Penny CB, Patel CC, Candy GP. Enhanced cutaneous wound healing by Senecio serratuloides (Asteraceae/Compositae) in a pig model. S Afri J Bot. 2015; 100: 63-8.

32.Roersch CM. Piper umbellatum L.: a comparative cross-cultural analysis of its medicinal uses and an ethnopharmacological evaluation. J Ethnopharmacol. 2010; 131: 522-37.

33.Nwauzoma AB, Dawari SL. Studies on the phytochemical properties and proximate analysis of Piper umbellatum (linn) from Nigeria. AJRC. 2013; 1(7): 165-77.

34.Marongiu B, Alessandra PSP, Casu R, Pierucci P. Chemical composition of the oil and supercritical CO2 extract of Schinus molle L. Flavour Fragr J Flora. 2004; 19: 554-8.

35.Palmeiro NS, Almeida CE, Ghedini PC, Goulart LS, Baldisserotto B. Analgesic and anti-inflammatory properties of plantago australis hydroalcoholic extract. Acta farm bonaer. 2002; 21(2): 89-92.

36.Westerhof W, Das PK, Middelkoop E, Verschoor J, Storey L, Regnier C. Mucopolysaccharides from psyllium involved in wound healing. Drugs exp clin res. 2001; 27(5-6): 165-75.

37.Zubair M. Genetic and environmental effects on polyphenols in Plantago major. Balsgård: Swedish University of Agricultural Sciences; 2010 [cited in 2013 jan 12]. Available from: http://pub.epsilon.slu.se/5468/1/zubair_m_101022.pdf.

38.Chiang LC, Chiang W, Chang MY, Lin CC. In vitro cytotoxic, antiviral and immunomodulatory effects of Plantago major and Plantago asiatica. Am J Chin Med. 2003; 31(225): 225-34.

39. National Health Surveillance Agency (Br). Resolution - RDC No. 10 of March 9, 2010 [access in 12 Oct 2014]. Available from: http://www.brasilsus.com.br/legislacoes/rdc/103202-10.

40.Morais GFC, Oliveira SHS, Soares MJGO. Nurse wound evaluations in public hospital institutions. Texto contexto - enferm. 2008; 17: 98-105.