Medicinal Plants Traditionally used for Blood Sugar Lowering in the Kabul and Parwan regions of Afghanistan

Abstract

This article discusses the traditional use of medicinal plants for lowering blood sugar levels in the Kabul and Parwan regions of Afghanistan. It explores various plants historically utilized by local communities in these regions to manage and regulate blood sugar. The article covers the cultural and historical context of these traditional practices, as well as any potential scientific evidence or research that supports the effectiveness of these plants in managing blood sugar levels.

Full text

Hamdard Medicus Vol. 66, No. 2, 2023
19
Medicinal Plants Traditionally used for Blood Sugar Lowering in the Kabul and Parwan
regions of Afghanistan
Abdul Ghani Karimi
1,2
and Keusgen M.
2
1
Kabul University, Faculty of Pharmacy, 1006 Kabul, Afghanistan.
2
Philipps-Universität Marburg, Institut für Pharmazeutische Chemie, Marbacher Weg 6-10, 35037 Marburg, Germany.
Corresponding author: Abdul Ghani Karimi
Email : karimiabg@gmail.com
Abstract
Diabetes is one of the biggest public health
problems in our days, considered as silent epidemic
of the 21st century. The number of diabetes cases
in the world is increasing, and according to official
statistics, this disease accounts for 3% of all
deaths in Afghanistan. Before the discovery of
insulin, medicinal plants were widely used to treat
diabetes.
To collect data regarding the use of medicinal
plants in the treatment of diabetes, experienced
people who dealt with medicinal plants were
interviewed using a structured questionnaire.
This survey showed that 53 medicinal plants
belonging to 30 different plant families are used in
the management of diabetes in the study area.
The plants used as antidiabetic agent were mainly
represented by Lamiaceae (>13%), Asteraceae
(>9%), Solanaceae (>7%), Apiaceae, Fabaceae,
and Rosaceae (each, >5%). The most often used
parts of the plants were fruits and seeds (39%),
and the most common method of preparation was
infusion (24%). A literature review of the plants
showed that most of them have antidiabetic
potential proved in preclinical or even clinical
studies.
To validate the therapeutic effects of
medicinal plants and to introduce new medicinal
natural product candidates for pharmaceuticals,
phytochemical and pharmacological studies are
needed to elucidate the effective biomarkers and
their safety and efficacies as well as their
mechanism of action.
Keywords
Afghanistan medicinal plants, antidiabetic
activity, traditional use, Kabul province, Parwan
province.
1. INRODUCTION
Diabetes is a chronic disease that progressi-
vely threatens various body organs and gradually
the symptoms appear several years after the
onset of this disease. It leads to several problems
such as hypertension, hypercholesteremia, and a

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20
obesity (“metabolic syndrome”), which contribute
to the pathogenesis of cardiovascular diseases. It
is estimated that the risk of cardiovascular diseases
increases twice for patients who have both
diabetes and hypertension. In addition, most
diabetic patients have hyperlipidemia, which is
more related to early coronary heart disease.
Insulin resistance is typically increased in patients
with hyperlipidemia. In addition, obesity is also
associated with insulin resistance as an important
risk factor for heart disease. Moreover, diabetes
complications lead to higher financial charges and
reduce the quality of life for patients and their
families. Therefore, awareness of the symptoms
and risk factors could reduce mortality. Type 2
diabetes is the most common form, accounting for
about 90%-95% of all diabetes cases. It has
dramatically increased in recent decades world-
wide. With the progress and emergence of comp-
lications such as kidney and eye damage, patients
become aware of their condition (WHO,
“Diabetes,” 8 7 2021. [Online] ; B. Ahmadi et al.,
2016).
According to the statistics of the World
Health Organization (WHO), 422 million people
in the world are suffering from diabetes, which
causes the death of 1.6 million people every year,
most of whom are from countries with low and
medium economic levels(WHO, “Diabetes,” 8 7
2021. [Online]). Based on the official statistics in
Afghanistan, the number of deaths caused by
diabetes contributes 3% of the total number of
deaths in the country (WHO, WHO, Geneva:
WHO, 2018.), but since the disease and death
registration system in Afghanistan is very poor
and incomplete, the statistics maynot mirror reality
and data are suggested to be too low.
Medicinal plants are used traditionally all
over the world. Many of these plants used in the
treatment of diabetes have considerable blood su-
gar-lowering effects and are considered useful
for the treatment of type 2 diabetes. New research
on the antidiabetic effects of medicinal plants has
led to an increase in their use to control diabetes,
and so far, more than 1200 medicinal plant species
have been identified with regard to antidiabetic
efects (B. Ahmadi et al., 2016).
The traditional use of medicinal plants in
Afghanistan has played a crucial role in the
healthcare system for centuries. Afghanistan is
home to a diverse range of flora with medicinal
properties, and its people have developed an
extensive knowledge of their uses. However, the
ongoing conflict in the country, coupled with a
lack of formal regulation and documentation, has
led to a decline in the availability and quality of
medicinal plants. Therefore, there is a need for
increased efforts to conserve and sustainably use
medicinal plants in Afghanistan, while also ensuring
that traditional knowledge is preserved and passed
on to future generations. By doing so, the country
can promote its cultural heritage, provide
affordable health care to its people, and contribute
to the global knowledge of medicinal plants. As
mentioned traditional ethnomedicinal knowledge
and inventory of medicinal plants in the country
have poorly been investigated and data regarding
the traditional use of medicinal plants for the
management of diabetes is lacking.The complete
inventory of the medicinal plants of Kabul and
Parwan regions of Afghanistan is given in Karimi
& Keusgen (A. Karimi and M. Keusgen.,
2022).This paper includes an inventory of medicinal
plant species that have traditionally been used by
local people in the management of diabetes.
1.1. Data collection
Study area
Kabul and Parwan provinces cover an ar-

Hamdard Medicus Vol. 66, No. 2, 2023
21
ea of 10, 239 km
2
and lie between 34°322 to 35°
North latitude and 69° to 69°10’ East longitude in
the southern parts of the Hindukush Mountains.
Their climate is arid continental with annual
precipitation of approximately 400 mm and an
average temperature of 32°C in summer and -
5°C in winter (A. Karimi and M. Keusgen.,
2022). The study area is inhabited by18.3% of the
whole population of the country. Ghorband Valley,
which forms almost two-thirds of Parwan
province, is a mountainous area. Here dependence
on medicinal plants is very high.
2. MATERIALS AND METHODS
Data were collected from the informants
through structured ethnobotanical interviews
conducted from 2015 – 2019. Plants were
primarily identified by the author or with the help
of informants, and the identified species were
verified using relevant literature (S. W. Breckle
et al., 2013 ; S. W. Breckle et al., 2010 ; M. Alam
et al., 2011). Then specimens were matched and
compared with authentic virtual specimens at
Kabul University, the Faculty of Sciences (KUFS)
Herbarium, and the virtual herbarium of the Royal
Botanical Gardens (R. Kew et al., 2021). Finally,
the doubtful specimens were confirmed by
professional botanists; Prof. S.-W. Breckle,
University Bielefeld, Germany, and Dr. R. M.
Fritsch, IPK Gatersleben, Germany, using
photographs or live specimens. Nomenclature
and taxonomy were confirmed using the Plants of
the World Online database. Voucher specimens
are kept at the Herbarium of the Faculty of Phar-
macy, Kabul University, Afghanistan.
3. RESULTS AND DISCUSSION
The survey of traditionally used medicinal
plants in Kabul and Parwan regions of Afghanistan
focused on identifying plants that have been
traditionally utilized for their medicinal properties
medicinal properties. Out of 271 medicinal plants
recorded, a total of 53 species reveald antidiabetic
use. These species belonging to 30 different fami-
lies are listed in Table 1 along with their scientific
name, plant family, local name, parts used, modes
of preparation, and frequency of citation (mentoin
in brackets).
Tab le1. M edici nal pl ants applied for the treatme nt of d iabetes in the re gions of
Kab u l an d Par wan of A fghanistan.
Preparation s
2
and
frequency of
citati on
Parts
used1
L ocal name
Family/ Sci en tific n ame
#
Dy
) 2(
FU
Unab Anacardiac eae/ Z i ziphus jujuba M ill .
1
Pw (2), In (1)
FU
Shibit Api aceae/ Anethum gr aveolens L. 2
Pw (3)
RO
B urbu
Api aceae/ Ferula sp. (not fur the r
identif ied)
3
Pw (1), D e (1)
HE , RO
Karafs
Api aceae/ Levisticum offic inale
W.D.J . Koch.
4

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Co (2)
RO
Kachaluimisry
Asteraceae/ Heli anthus petiolaris Nutt.*
5
De (1) RO Laruk Asteraceae/ Cousinia buphthalmoides
Regel*
6
In (23) HE Mastar Asteraceae/ Artemisia absinthium L.* 7
In (12)
FL
Talkhak-alaf
Asteraceae/ Centaurea pulchella Ledeb.*
8
In (1), Pw (2) INF Shulukbuteh Asteraceae/ Artemisia sieberi Besser 9
Co (4) RO Shalgham Brassicaceae/ Brassica rapa L. subsp.
rapa
10
Fr (1)
FU
Anari zamini
Cactaceae/ Opuntia stricta (Haw.) Haw.
var. dillenii (Ker Gawl.) L.D. Benson*
11
De (1), Pw ) 5( FU Tarbozi Abojihl Cucurbitaceae/ Citrullus colocynthis (L.)
Schrad.*
12
Co (1) FU Karileh Cucurbitaceae/ Momordica charantia L.*
13
Dy (3)
FU
Sinjid
Elaeagnaceae/ Elaeagnus angustifolia L.
14
In (1) FU Qaraqat Syah Ericaceae/ Vaccinium macrocarpon
Aiton*
15
Mc (4) RO Shutur Khar Fabaceae/ Alhagi pseudalhagi (M. Bieb.)
Desv.
16
Mc (1) FU Flus Fabaceae/ Cassia fistula L. 17
Pw (5) FU Hulbeh Fabaceae /Trigonella foenum-graecum L. 18
De (1) FU Qaraqat Grossulariaceae/ Ribes orientale Desf.* 19
Dy (9) FU Charmaghz Juglandaceae/ Juglans regia L. 20
In (1) HE Astukhudus Lamiaceae/ Lavandula angustifolia Mill. 21
Pw (3)
HE
Podineh
Lamiaceae/ Mentha longifolia (L.) L.
22
Pw (1) HE Kakuti Lamiaceae/ Nepeta bracteata Benth. 23
In (2) FL Ahzdum Lamiaceae/ Nepeta glutinosa Benth. 24
Pw (1)
HE
Ganda Baghal
Lamiaceae/ Sal via rhytidea Benth.
25
De (2) HE Paduleh Lami aceae/ Stachys parviflora Benth. 26

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Pw (1)
HE
Kakuti
Lamiaceae/ Ziziphora tenuior L.
27
Pw (1) BA Darchini Lauraceae/ Cinnamomum verum J.Presl 28
In (1) FL Saffron Iridaceae/Crocus sativus L. 29
De (1)
RO
Zanbaq
Iridaceae/ Iris germanica L.
30
Co (3) FU Bameh Malvaceae/Abelmoschus esculentus ( L.)
Moench
31
Dy (1), Fr (1) FU Toot Moraceae/Morus alba L.* 32
Fr (1) FU Sha h toot Moraceae/ Morus nigra L. 33
In (1) LE Gaitis Myrtaceae/ Eucalyptus globulus Labill. 34
De (2)
FL
Mikhak
Myrtaceae/ Syzygium aromaticum (L.)
Merrill & Perry
35
In (3) LE Zaitone Oleaceae/ Ol ea europaea L. 36
De (1) RO Kabal Poaceae/ Agropyron repens (L.) P. Beauv.
37
In (3)
ST
Jawari
Poaceae/ Zea mays L.
38
Fr (3) SM, PE Chukri Polygonaceae/ Rheum ribes L. 39
Co (1) HE Khurfeh Portulacaceae/ Portulaca oleracea L. 40
Fr (1) FU Anar Punicaceae/ Punica granatum L. 41
Pw (7) SE Syahda neh Ranunculaceae/ Nigella sativa L. 42
Co (2)
FO
Qar ghaneh
Rosaceae/ Amygdalus koelzii Browicz *
43
Fr (1) FU Tooti-zamini Rosaceae/ Fragaria × ananassa
(Duchesne) Duchesne*
44
Co (1) FO Badam Talkh Rosaceae/ Amygdalus communis L. var.
amara (Duhamel) Willd.
45
Fr (1) FU Naronj Rutaceae/ Citrus × aurantium L. [var.
amara (Link) Kostel.]
46
In (1) FL Goshi Kharak Scrophulariaceae/ Verbascum thapsus L. 47
Fr (1), Pw (2) FU Murch Solanaceae/ Capsicum annuum L.* 48
Fr (1)
FU
Badinjanirumi
Solanaceae/ Solanum lycopersicum L.
49

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De (1)
FU
Panirband
Solanaceae/ Withania coagulans (Stocks)
Dunal
50
Fr (2) FU Murchishirin Solanaceae/ Capsicum annuum (another
cultivar group)
51
In (1) LE Chai Sabz Theaceae/ Camellia sinensis (L.) Kuntze 52
In (3) LE Sokhtanak Urticaceae/ Urtica dioica L. 53
1
BA: bark; FU: fruit; FL: flower; FO: fatty oil; He:
herb; INF: inflorescence; Le: leaves; PE: petiol;
RO: roots; Se: seeds; SM: stem; ST: stigmat.
2
Be: beverage; Co: cooked; De: decoction; Dy:
dry eat; Fr: fresh eat; In: infusion; Mc: maceration;
Pw: powder.
*The most important traditionally antihyper-
glycemic plants.
Diabetes is the seventh leading cause of death in
the world, killing more than 1.5 million people
every year (WHO, “Diabetes,” 8 7 2021). Today,
interest in the use of medicinal plants has increased
and medicinal plants are considered the main part
of alternative and complementary medicine. A
wide range of medicinal plants are used to treat
diabetes in different regions of the world.
In this study, we found that the local
inhabitants used 53 medicinal plant species for the
management of highblood sugar. These medicinal
plants not only used for high blood sugar but offer
a wide range of traditional uses, with 13 species
including Helianthus petiolaris, Cousinia
buphthalmoides, Ar t e mi s i a absinthium,
Centaurea pulchella, Cactus dillenii, Citrullus
colocynthis, Momordica charantia, Vaccinium
macrocarpon, Ribes orientale, Amygdalus
koelzii, Fragaria × ananassa, and Capsicum
annuum are being particularly recognized for th-
eir potential in managing diabetes in the study
area. The rich diversity of these plants, combined
with their long history of use in traditional medicine,
highlights their importance in providing alternative
approaches to diabetes management. Species
such as Nigella sativa, Citrullus colocynthis,
Anethum graveolens, Juglans regia, Mentha
longifolia, Cinnamomum verum, Urtica dioica,
and Ziziphora, have also been reported to be
usedfor the treatment of diabetes in the traditional
medicine of Iran (B. Ahmadi et al.,2016), which
areconsistent to our study.
A literature review on phytochemical and
pharmacological investigations of all these species
shows that the anti-diabetic effects of the majority
of medicinal plants recommended for the
treatment of diabetes in our study area have been
investigated and proven by modern pharma-
cological studies that are discussed in the following
paragraphs.
Ziziphus jujubais grown in the western
and northern parts of Afghanistan and its dried
fruits are eaten as a snack and called “Onab” or
“Chilaan”. Recent studies reveal that the
po l ysacc h arides fr om th e fruits p o ssess
antioxidant, hepatoprotective, and hypoglycemic
ac tiviti es (X. Ji et al., 2017). Aneth um
graveolens, a common spice in the Shamali plain
of Afghanistan,has been reported to have many
useful effects, including among others hypolipide-

Hamdard Medicus Vol. 66, No. 2, 2023
25
mic, hypoglycemic, and antioxidant activities that
might reduce the risk of diabetic complications
(M. Goodarzi et al., 2016). Citrullus colocy-
nthis,a well-known traditional purgative in the
country, is reported that extracts of different plant
parts exhibited antidiabetic properties in animal
diabetic models (W. Olejarz, et al., 2014).
Levisticum officinale is native to high altitudes of
the mountainous area of Parwan province and
grows near the springs and rivulets. Its aerial
parts are used by households as a spice for
buttermilk and other dishes since ancient times.
Besides this use, in recent decades its roots have
also been used as a remedy for cardiovascular
disorders by traditional healers. Literature data
reveals that the plant contains essential oil with
monoterpenes, showing also a high abundance of
phthalides. Also, phenolic compounds in the
decoction and hydroethanolic extracts of the
plant are reported. The plant is used due to its
carminative, spasmolytic, and diuretic effects. It
is being approved by the German Commission E
for lower urinary tract infections (R. Spréa et al.,
2020). Elaeagnus angustifolia owns hypoli-
pidemic, antioxidant, wound healing, carminative,
gastroprotective, antitumor, and anti-inflammatory
activities (M. Farzaei et al., 2015).Cassia fistula,
used asa laxative in our study area, is reported to
contain anthracene derivatives responsible for a
laxative effect. Preparations from the fruit have
demonstrated antimicrobial and antiviral effects
in vitro. Aqueous and alcoholic extracts of the
leaves exhibited hypoglycemic activities (Mont-
vale, NJ et al., 2007 ; P. Sudha et al., 2011). The
biological activitiesof Artemisia absinthium and
Trigonella foenum-graecum, common spices in
Shamali plain,are well documented,and their
antidiabetic properties are proven Montvale, NJ-
et al., 2007). Juglans regiais a common nut-
producing economic plant in the study area. Its
dried kernelsare used as a nutritive snack and a
hypolipidemic agent in our study area. It has been
reported to contain fatty oil with oleic, linoleic, and
linolenic acids as its main constituents and is
therefore considered a rich source of poly
unsaturated fatty acids. These acids play a vital
role in the prevention of beta-cell destruction and
insulin resistance. Moreover, it increases insulin
secretion and reduces blood lipids and glucose
concentration in type II diabetes patients (A. Al-
Snafi et al., 2018 ; H. Baynes et al., 2018).
Cinnamomumverumis a well-known traditional
Indian medicine used since ancient times in the
study area. Scientific investigations reveal that it
significantly reduces blood sugar, cholesterol,
LDL, and triglycerides, and increases HDL levels
(R. Allen et al., 2013) . Crocus sativus,an eco-
nomic crop that is mostly cultivated in Herat
province, produces the best saffron spice in the
world. Its antioxidative, memory-enhancing,
antidiabetic, and antitumor activities were repor-
ted (M. Keusgen et al., 2020) . Abelmoschus
esculentus, besides its use in culinary, is used as
an antidiabetic and lipid-lowering medicinal plant
in our study area.It has been reported to have
antioxidant, anti-inflammatory, gastroprotective,
hy polipidemi c , an t i d i a b e t i c, an t i c a ncer,
immun omodulatory, and neurop r otective
properties (D. Esmaeilzadeh et al., 2020). Morus
albais commonly planted in the study area for its
edible berries. Scientific studies reveal that the
consumption of berries decreases triglycerides,
cholesterol, and VLDL in animal models, and
increases the â-cell number in diabetic islets (P.
Sudha et al ., 2011). Leaves of Eucalyptus
globulusand Olea europaea, cultivated and na-
turalized trees in the eastern part of Afghanistan,

Hamdard Medicus Vol. 66, No. 2, 2023
26
thapsus were found to be the most uncommon
species for blood sugar lowering, and scientific
studies to support their claims are widely missing.
Although various phytochemicals such as phenols,
tannins, saponins, and alkaloids have been repor-
ted to have antidiabetic properties, flavonoids and
phenolic compoundsare known as the main
sources of hypoglycemic activity (B. Ahmadi et
al., 2016). Therefore, medicinal plants with
phenolic compounds and antioxidant activity mi-
ght be useful for the management of diabetes.
However, studies onthe mechanisms of the
antihyperglycemic activity of these species are
limited. Therefore, more investigations are needed
to elucidate the effective pharmacologically active
ingredients as well as their mechanism of action.
4. CONCLUSION
This study presents a large number of a
medicinal plants used in the management of
diabetes in the Kabul and Parwan regions of
Afghanistan and is the the first of its kind for the
country. The rich heritage of traditional medicine
in the region has provided a wealth of knowledge
and remedies that have been used for generations.
These plants offer a wide range of traditional uses
with some species that are marked by stars in
Table 1 being particularly recognized for their
potential in diabetes management. This could be
the first stage in pharmaceutical bio-prospection
to introduce new natural productsas candidates
for the treatment of diabetes. The antidiabetic
effects of the majority of thesespecies have been
investigated in actual pharmacological studies,
for e x a mple, sp e c i e s such as A rtemisia
absinthium, Trigonellafoenum graecum, Mim-
ordica charantia, and Centaurea pulchella.
While scientific research is needed to fully un-
derstand and validate the effectiveness of those
have been reported to have antidiabetic effects
(J. Wainstein et al., 2012 ; M. Keusgen et al.,
2020) Portulacaoleracea is reported to have
anti-inflammatory, anti-diabetic, skeletal muscle
relaxant, antitumor, hepatoprotective, anticancer,
an t i o x i dant, anti-i n s omnia, analgesic,
gastroprotective, neuroprotective, wound healing,
and antiseptic properties (A. Kumar et al., 2022).
Nigella sativa has been reported to have a
significant influence on blood glucose and insulin
resistance and causes a rise in serum insulin.
Researchers suggested that the plant could be
used as a comedication for oral antidiabetics in
diabetes control (A. Kumar et al., 2022). A
review study on Capsicum annum reveals that it
might be useful for the control of metabolic
syndromes including obesity, lipidemia, diabetes,
and its complications (S. Sanati et al., 2018). A
recent study also supports our informant claim
regarding the antidiabetic potancial of Centaurea
pulchella (S. Fattaheian et al., 2021).
In addition, a review on the antidiabetic
potential of medicinal plants by Salehi et al.
(2019) reveals that Syzygium aromaticum, Citrus
aurantium, Mentha longifolia, Camelliasine-
sis, Rheum ribes, Solanum lycopersicum,
Withania coagulans, and Urtica dioica have
significant antidiabetic effects. Their pharmaco-
logical effects are proven in animal diabetic
models (B. Salehi et al., 2019).
Artemisia sieberi, Brassica rapa subsp.
rapa, Cousinia buphthalmoides, Ferula sp.,
Vaccinium macrocarpon, Alhagi pseudalhagi,
Ribes orie ntal e, Lavand ula angustifolia,
Nepeta bracteata, Nepeta glutinosa, Salvia
rhytidea, Stachys parviflora, Ziziphora tenuior,
Iris germanica, Morus nigra, Zea mays, Punica
granatum, Amygdalus koelzii, Fragaria × ana-
nassa, Amygdalus communis, and Verbascum

Hamdard Medicus Vol. 66, No. 2, 2023
27
plants, which are highlighted by our informants in
lowering blood sugar without the support of
scientific studies. It is crucial to combine this
traditional knowledge with modern medical
practices and consult healthcare professionals to
ensure safe and effective integration into diabetes
management strategies in the local context.
Acknowledgments
The Authors would like to thank Hessen
Fonds and DAAD for thier long-lasting financial
support. Thanks are due to all Afghanistan project
partners, especially to Prof. S. Breckle, Bielefeld,
Germany, and to Dr. R. M. Fritsch, IPK
Gatersleben, Germany, for critically reading the
manuscript and verifying scientific plant names.
Authors’ Contributions
A.G. Karimi conceived and designed the
study, interpreted and analyzed the data, and
prepared the original draft. Prof. Keusgen provided
critical revisions to the manuscript. All authors
approved the final version of the manuscript.
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