Sociodemographic profile of the participants

The survey of this study indicated that only 2 informants did not have information about the use of the MPs. Thus, most of the Aseer inhabitants (98.67%) used MPs’ conventional medicine combined or not with modern drugs. A comparison with earlier surveys, conducted in other regions of Saudi Arabia, which reported values ranging between 67 and 93% [27, 30], indicated that the traditional knowledge in Aseer province has been maintained and diffused despite the modern lifestyle, the public health facilities, and the presence of modern hospitals. The knowledge of MPs was also owed to the plant biodiversity in the various topographical features of the Aseer province. Arab people other than Saudis are attached differently to the traditional heritage related to the use of MPs in folk medicine. For example, 92.4% of participants in Bahrain [21] and 80.2% in Jordan [38] affirmed that they use herbal medicine. In Morocco, only 68.08% of respondents claimed using MPs for disease treatment [39]. Humadi et al. [40] reported that 66.9% of Iraqi people use herbal treatment. However, the United Arab Emirates is less attached to the herbal folk medicine, since only 35% of its population indicated their use of MPs [41].

The number of the cited MPs was correlated with gender (p-value = 0.000) (Table 2). However, it was predisposed neither by age (p-value = 0.114) nor location (p-value = 0.059). Also, the cited species number was not correlated with the education level (p-value = 0.787). Therefore, gender was the main factor influencing the local MP’s knowledge of the respondents. Also, females exhibited a more significant understanding of the MPs’ properties than males. Such dissimilarity may be due to the gender roles within the communities in Aseer province, where women are considered as primary health care for their families. Similarly, women were shown to be experts in MP species in many continents such as Asia, Africa, Europe, and South America [42, 43]. In the North African Arab country Algeria, women used plants more than men to treat diseases [44]. This was explained by the fact that Algerian women trust natural remedies and take preserving good health seriously, even in the case of ordinary illness. In Morocco, women possess much more knowledge about MPs than men due to their household tasks that allow them to prepare herbal soups and infusions to treat many diseases [45]. A comparable result was found in Tunisia, which was explained by the fact that knowledge of traditional medicine has been passed down through generations by mothers to daughters, which created the best vigilance of women for the best nutrition and healthcare of their families [46].

Our survey revealed that the respondents acquired knowledge about the MPs from different sources. The family and friends, and the Internet were the most important sources of MPs’ knowledge (Table 3). The source of MPs’ knowledge was correlated with location (p-value = 0.001) and educational level (p-value = 0.000) (Table 3). 87.50% of rural communities and those who had no formal education got knowledge of MPs from families and friends. This was due to the plant’s biodiversity in the Aseer province or the availability of MPs at home. It is worth noting that, despite the considerable changes in the livelihoods of the Saudi people, rural people in Aseer province are still somehow implicated in agro-pastoral activities and have conserved a substantial knowledge of nature [47]. Our results highlighted that rural people in Aseer province, as in many other cities in the Arab countries, preserved their traditional ecological knowledge and spread it among the different families of their community. Bailey and Danin [48] showed that traditional medicine was very popular among pastoral nomads in the Middle East for many centuries. Pasture for goats and camels allowed Bedouin tribes in Egypt to discover MPs and use them for many illnesses [48]. In Tunisia, the ancestral nomadic roots of the Southern region inhabitants offered a unique and relevant MPs knowledge compared to ethnobotanical bibliography data [49]. Furthermore, in accordance with our results, Karous et al. [49] showed that in the rural localities in the Southern region of Tunisia, informants who had no formal education exhibited a more significant understanding of the ethnobotanical properties of the local flora than educated people. In the neighboring country, Sudan, illiterates were described as having much experience in curing diseases by MPs. Their knowledge was orally transmitted from one generation to another in the same family or community [50, 51].

Table 3 Source of knowledge about MPs by age, gender, location, and educational level

In the present work, it is shown that 37.30% of the urban communities and 44.55% of the highly educated informants knew MPs from the Internet and social media (Table 3). Indeed, the population of the Aseer province was strongly connected to the Internet and involved in social media. The Internet is also one of the main sources that provides information on how to use herbs for educated people in neighboring countries such as Jordan [52] and Bahrain [21].

Furthermore, our findings indicated that 71.33% of the participants took the MPs directly from herbalists or used commercially available plants. Similar behavior was observed in Jordan, Iraq, and Qatar, where most consumers obtained herbal medicines from herbalists [38, 40, 53]. Saudi in Aseer province and other Arab people still trust the wisdom of the herbalists who have contributed significantly to the development of the traditional Arab medicine for many centuries. Indeed, Abu AlAbbas and other ancient Arab herbalists published several books and dictionaries on the use of MPs and the treatment procedure of certain diseases, many of which are still used nowadays [54]. The other proportion of the informants (28.67%) preferred to take the MPs from their wild sources. Indeed, the cultivation and domestication of MPs were uncommon in the studied area. In the Aseer province, cultivation of MPs would be difficult on the mountain terraces; however, in the coastal plains, most farmers grow only crop plants. Consequently, conserving the natural flora in the Aseer province is more than requested to protect such species and avoid the loss of traditional knowledge.

Vernacular and scientific plant names

Most of the vernacular names of plants given in the present work were found to arise from the Arabic language. Some MPs reported in the Aseer province had one, two, or three names (Table 4). The well-known MPs in the old Arab medicine have one name, such as ‘Naanaa’ for Mentha spicata L., ‘Sedr’ for Ziziphus spina-christi (L.) Desf., and ‘Zeytoun’ for Olea europaea L. People in the Aseer province give additional regional names for some MPs such as Origanum majorana L. called ‘Bardakouch’ or ‘Alwazab’. ‘Mardakouch’ is the common Arabic name for O. majorana in the Middle East and North Africa, and ‘Bardakouch’ or ‘Alwazab’ are the local names of the same species. This herbaceous and perennial plant is native to southern Europe and the Mediterranean countries [55]. O. majorana has likely made its way to the Arabian Peninsula through trade and cultural exchanges during antiquity and the early Islamic period [56]. Zingiber officinale Roscoe also has two names, ‘Zanjabil’ and ‘Hawar’. Some MP species have different but close names depending on the local pronunciations, such as ‘Chatheb’, ‘Chetheb’, and ‘Chedeb’ for Ruta Montana (L.) L. The Latin names of some MPs species are derived from old Arabic names, such as ‘mahaleb’, the Arabic name of Prunus mahaleb L. More examples of MPs'names and uses are presented in Table 4.

Table 4 List of the medicinal plants used in Aseer regionMedicinal plants used in the Aseer province

For a long time, Aseer communities have used herbs as an alternative medicine against routine maladies and chronic diseases. In the present study, a total of 80 MPs, used for curative and preventive purposes, were identified. The scientific nouns, the families, the used parts, the preparation, and the administration methods of the mentioned MPs are summarized in Table 4. In the Aseer province, people used MPs for treating several ailments such as dermatological problems, GIT diseases, stress and insomnia, cold and respiratory tract diseases, skeletomuscular aches, mouth inflammation, toothache, hypertension, diabetes, and insect bites. This could be explained by the large diversity of the MPs and the folk medicine, which was well preserved in the Aseer province. The mentioned MPs (Table 4) belonged to 38 families of angiosperms [57]. The informants took these herbs from the wild, herbalists, and local markets. The most frequent plant families cited by the informants were Lamiaceae (12.5%), Apiaceae (10%), Asteraceae (6.3%), Rosaceae (6.3%), Fabaceae (5%), Rubiaceae (5%), Brassicaceae (3.8%), Malvaceae (3.8%), Amaryllidaceae (2.5%), Burseraceae (2.5%), Cucurbitaceae (2.5%), Lauraceae (2.5%), Lythraceae (2.5%), Myrtaceae (2.5%) and Zingiberaceae (2.5%) (Fig. 2). Comparable results were found in Al-Baha city located in West Saudi Arabia, where the most cited families were Lamiaceae, Apiaceae, and Asteraceae [30]. Lamiaceae and Apiaceae are frequently used for traditional medicine in other Arab countries, such as Syria, Lebanon and Palestine, as they thrive in the relatively humid coastal zones and dry inland regions [7]. These countries share with Saudi Atabia a history of trade and cultural exchange that has contributed to common plant uses.

Fig. 2

Percent of the MPs families used in the Aseer region

The family Lamiaceae, known as the mint family, was represented in Saudi Arabia by 76 species [58] frequently used in traditional medicine by Saudi people [59]. Apiaceae, one of the common families in the flora of Saudi Arabia [60], was represented by 24 genera and more than 45 species in Saudi Arabia [25]. The Apiaceae family has a distinctive aromatic smell, and its wide distribution was due to its traditional use as culinary herbs and spices in the Aseer province.

The relative importance of the mentioned 80 plant species in folk medicine in the Aseer province was evaluated through the RFC calculation, which verifies the frequency of citation of a MP used to treat numerous ailments. The use of RFC is important for the election of promising MPs for additional pharmacological research and approval in pharmaceutical progress. Table 4 shows that the studied plants’ RFC values ranged from 0.01 to 0.71. The 10 highest values of RFC corresponded to the following taxa: Syzygium aromaticum (L.) Merr. & L.M. Perry and Mentha spicata (RFC = 0.71), Zingiber officinale (RFC = 0.63), Ziziphus spina-christi (RFC = 0.62), Lepidium sativum L. (RFC = 0.56), Hibiscus sabdariffa L. and Pimpinella anisum L. (RFC = 0.49), Matricaria chamomilla L. (RFC = 0.48), Citrus limon (L.) Osbeck (RFC = 0.45) and Lawsonia inermis L. (RFC = 0.44). These MPs were cited by at least 66 informants out of 150, representing the solicited useful plants by the communities in Aseer province. Most of these species were well-known in Saudi Arabia for their therapeutic effects. The interplay of economic importance and cultural heritage has profound implications for the exploitation of these herbs. For instance, S. aromaticum is an important ingredient in the traditional Saudi cuisine, which is widely used in several traditional dishes and preparations. For this reason, Saudi Arabia became the second importer of S. aromaticum from its native area, Indonesia [61]. On the other hand, M. spicata is traditionally used alone or mixed with tea and other herbs as a refreshing drink. It is also used in traditional Saudi dishes to add aroma and flavor. Mentha sp. is widely distributed in Aseer province due to the favorable climatic and edaphic conditions [62].

Z. officinale is native to South Asia and has spread to many parts of the world [63]. Since ancient times, Z. officinale has been one of the most important seasonings traded products imported into the Roman world through the Arabian Peninsula [64]. For this reason, it is used in traditional Saudi medicine as well as in the traditional cuisine [65]. Matricaria is a widespread genus native to Europe, Asia, America, Africa, and Australia [66]. It was mentioned in ancient Arabic medical literature. For example, Avicenna in his famous work “The Canon of Medicine” [67] described the Matricaria antiseptic and diuretic properties. L. inermis is a plant with cosmetic and medicinal uses, native to North Africa and Southwest Asia [68]. The use of L. inermis for medicinal and cosmetic purposes is linked to ancient and modern cultures of North Africa and Asia. Literature indicated that L. inermis played an important holistic role in the daily lives of the Arabian Peninsula people, providing psychological and medicinal benefits, as well as being used for personal adornment [69].

A previous work by Aati et al. [60] showed that a total of 471 species have been used in ethnomedicine in Saudi Arabia, and the three plants Ziziphus spina-christi, Rumex nervosus, and Juniperus procera have been at the core of the Saudis’ practices. In the present study, however, Juniperus procera was not mentioned by the participants, Rumex nervosus had the lowest RFC and was used by a small portion of the Aseer population as antidiabetic or to improve immunity during cold and flu (Table 4). This could be due to a decline in the use of such species in favor of other MPs over the last years. Furthermore, a recent work by Teuscher and Lindequist [70] showed that Rumex nervosus was rich in oxalic acid, whose consumption can lead to hypocalcemia and the formation of calcium oxalate crystals.

A comparison of MPs mentioned in the present study with nearby Western areas of KSA, such as Jazan [27, 71, 72], Al-Baha [3, 30, 73, 74], and Makkah [75, 76] divulgated the documentation of 10 species (Malus domestica, Abelmoschus esculentus, Corchorus olitorius, Vitis vinifera, Schinus molle, Isatis tinctoria, Rosa arabica, Verbena officinalis, Capsicum annuum, and Dolomiaea costus) used only by the Aseer province inhabitants to treat several health issues. This result is of utmost importance since it presents wealth-specific ethnobotanical knowledge which can serve as a basis for additional research.

Preparation and administration methods

People in the Aseer province have been using different techniques for preparing medicinal remedies, which depend on the plant species, the ailments, and the conservation of the active ingredients. These preparation methods included decoction (27.33%), which was the most used method, also, eaten raw (19.33%), infusion (17.33%), maceration (14.00%), powdered (8%), oil (4%), juice and crushing (2.66%), chewed and grinding (2%) and distillation (0.66%) (Fig. 3a). Our results agreed with those of Ullah et al. [77], who showed that decoction was the most used preparation method in Saudi folk medicine. It is worth mentioning that decoction has been one of the most frequent methods to prepare drugs in traditional medicine because it is easy to perform. Also, decoction allows a good extraction of the active ingredients from the MPs and it reduces or completely removes the toxic effect of certain compounds [27]. Several ethnobotanical studies showed that most people in different Arab countries such as Tunisia, Marocco, and Lebanon prepared their remedies by decoction [49, 78, 79].

Fig. 3

Percent of a Preparation methods and b Administration modes used by the inhabitants in the Aseer region, Saudi Arabia

According to the present study, the route of administration of the MPs depended on the type of pathology to be treated and the type of preparation of the used plant. In fact, the plants eaten raw, and the traditional recipes prepared as decoctions and infusions in water were orally administered (58.48%) (Fig. 3b). This agreed with previous ethnobotanical studies, conducted in Saudi Arabia and other Arab countries, showing the predominance of oral administration [3, 27, 49, 80]. The oral administration mode was the most effective and fastest route to treat colds and flu, gastrointestinal tract, as well as stress and insomnia. In case of dermatological problems, insect bites, and toothache, the remedies were locally applied by swabbing (28.40%), rinsing (5.55%), poultice (4.63%), and inspiration (2.78%) (Fig. 3b). Brushing and fumigation were used in less than 1% of cases (0.93%). Some MPs such as C. procera and R. communis are known to be poisonous when orally taken. For this reason, the Aseer communities benefited from their bioactive compounds through external application by swabbing. In fact, the effective bioactive compounds of MPs are considered either toxic or curative depending on how they are prepared and their route of administration [81].

Plant part used

Figure 4 shows the percentage of plant parts used by the local communities in the Aseer province. They mostly used leaves (32.98%) in their traditional curative system followed by seeds (17.02%), fruits (17.02%), flowers (8.51%), beans (4.26%), roots (4.26%), stems (3.19%), cladodes (2.13%), gum-resins (2.13%), rhizomes (2.13%), buds (1.06%), cloves (1.06%), twigs (1.06%) and sticks (1.06%). Our results agreed with previous work by Aati et al. [58], which reported that leaves are the most frequently used parts in conventional medicine systems in Saudi Arabia. Leaves are preferred to the other plant parts because they are the site of photosynthesis and biosynthesis of the secondary metabolites that act as bioactive compounds for the human body [82]. In addition, leaves are a source of photosynthates or exudates [83, 84]. Such phytocomponents are toxins against some environmental hazards; thus, they could provide medicinal value to the human body. Moreover, collecting leaves does not have destructive effects on the MPs, whereas collecting other plant parts, such as roots and rhizomes, could cause severe threats to the local flora.

Fig. 4

Percent of the plant parts used by the inhabitants in Aseer region, Saudi Arabia

Plant-based remedies in the Aseer province

The 80 MPs reported in the present survey and used for various therapeutic purposes were divided into 9 ailment categories associated with different body functional systems (Table 5). We calculated the Informant Consensus Factor (ICF) index to evaluate the homogeneity of the informants’ knowledge. The ICF values ranged from 0.66 to 0.88 (with an average value of 0.77) (Table 5). The highest ICF value (0.88) was depicted for dermatological problems, and 61.3% of the cited MPs were used against them. The second highest ICF value (0.86) was accorded to cold and respiratory tract diseases, stress and insomnia, toothache, and mouth inflammation. The third highest ICF value (0.82) was depicted for skeletomuscular disorders, hypertension, and gastrointestinal disorders. Unlikely, previous studies in other regions of Saudi Arabia, such as Jeddah and Al-Baha [8, 30], indicated that the highest level of agreement was noticed for gastrointestinal disorders. This may be due to the difference in the informants’ knowledge or the existence of specific plant taxa in such areas.

Table 5 Informant consensus factor (ICF) for different use categories

In the present work, diabetes was ranked as the fourth ailment with an ICF value of 0.71, while insect bites received the smallest ICF value (0.66). The latter value could be explained by the fact that insect bites were not considered an important health problem in the studied area or by a divergence among informants regarding the purpose of the plants used.