Features of the targeted localities and respondents

Data were meticulously gathered for the current ethnomedical study from 20 villages dispersed across five distinct valleys in the captivating Kohistan region: Seo, Jalkot, Kandia, Kolai, and Dubair (Table 1). The survey spanned an altitudinal range from 625 m above sea level (m.a.s.l.) in Bateri pine village to 4741 m.a.s.l. in Gotay Baig village. The vegetation cover in the surveyed area exhibited a spectrum from dry temperate to moist temperate, and subalpine to alpine pastures, mirroring the altitudinal variations.

Kohistan’s entire population adheres to Sunni Muslims, with historical records indicating their settlement in the region from the sixteenth to seventeenth century and conversion to Islam occurred during the eighteenth century. According to Fredrik Bart (1956), the Chinese Pilgrims traveled through the Indus Kohistan region. Although the Chinese pilgrim reported about the difficult trains of the routes, it did not mention about the inhabitants of Kohistani [10, 85]. Notably, the Kohistani people differentiate themselves in terms of ethnicity, language, and culture from neighboring populations in the Swat, Dir, Gilgit, and Baltistan regions of Pakistan. Their beliefs underscore distinctions between both Pashtun and other local communities in Gilgit-Baltistan. Most of the local population in Kohistan faces literacy challenges and is engaging in subsistence activities such as pastoralism, animal husbandry, farming, and mining.

In the present study, data were collected from 281 informants of 20–80 years of age. Ethnically, these informants were classified into distinct groups, including Seowos, Gujjars, Shinaki, Jalkoti, Kheloos, Kulooj, Bahtooj, Shongali, Jaagi, and Dubairi. These groups communicate primarily in the Kohistani, Shina, Gujjari, Bateri, and Pushto languages. Each linguistic group exhibits a unique culture and predominantly resides in different valleys, except for the Gujjars, who are dispersed across all valleys. Most of these linguistic or ethnic groups practice endogamy, with rare instances of exogamy, except for the Gujjars and Bateri, who engage in exogamous relationships with other ethnic groups. Unfortunately, the latter two groups often experience marginalization within the Kohistan region. This intricate social fabric reflects the diversity and historical evolution of the Kohistani people.

Diversity of wild medicinal plant species

The wild medicinal plant species (WMPs) have played a significant role in the mountain communities’ healthcare practices for centuries and continue to do so today. The utilization of WMPs has been a longstanding tradition in the healthcare practices of the Kohistan region. This emphasizes the reliance of the mountain communities in this region on various plant species to meet their healthcare needs. Specifically, the WMPs play a crucial role in the local healthcare practices and are considered an integral part of the traditional medicine system of Kohistan.

According to the data presented in Table 2, the inhabitants of Kohistan use 96 WMPs, which belong to 74 distinct genera and 52 botanical families. Among the botanical families, Polygonaceae was the most prevalent, comprising 11 WMPs, followed closely by Asteraceae, Lamiaceae, Solanaceae, and Rosaceae, each contributing 10, 8, 5, and 4 WMPs, respectively. The extensive use of WMPs from the Polygonaceae family can be attributed to their diverse medicinal properties, such as anti-inflammatory, wound-healing, and antibacterial potential that make them effective in treating a wide range of ailments [86]. Interestingly, our findings align with previous studies conducted in the northern parts of Pakistan [22, 87]. These studies have also reported the dominance of Polygonaceae and Lamiaceae families in the Gilgit-Baltistan region, Kohistan, and surrounding areas is due to their widespread ecological distribution [60, 88, 89].

As depicted in Fig. 4A, the reported WMPs consist most of herbs (71.8%), followed by trees (16.6%) and shrubs (10.4%). These findings align with the geographical features of the Kohistan region, which predominantly consists of expansive pasture lands adorned with a variety of lush green herbs. Additionally, the local inhabitants of Kohistan exhibit a preference for collecting and utilizing herbaceous WMPs from their surroundings due to their accessibility and numerous health benefits, as compared to trees and shrubs. This observation corresponds to previous studies conducted in the other areas of Kohistan [79, 89].

Fig. 4

A Different life forms B part(s) used of the reported WMPs

Part(s) used, modes of preparation and application

The inhabitants of Kohistan use different parts of the reported WMPs to treat various ailments (Fig. 4B). Among these, aerial parts of 36 herbaceous plant species are used in traditional therapies, followed by leaves of 28 species, fruits and roots of 18 species each, branches of 8 species, and stem of 5 species, whereas bark, seeds, rind, flowers, and resin of less than 5 WMPs are used in the primary health care system of Kohistan. Among these, leaves are the most utilized plant parts in traditional remedies for treating various diseases.

The use preference of leaves in traditional therapies could be attributed to their ease of collection compared to other parts of WMPs. Moreover, numerous studies have highlighted that leaves contain a rich concentration of secondary metabolites like polyphenolics, alkaloids, carotenoids, and vitamins, which have significant antimicrobial, antioxidant, anti-inflammatory, and other bioactive properties [89, 90]. Furthermore, the use of leaves instead of roots, flowers, seeds, and fruits in traditional medicines represents a more sustainable conservation approach that minimizes the risk of depleting valuable medicinal plant species [35].

The array of methods employed in the preparation of herbal remedies includes everything from sun drying and grinding with mortars and pestles, to fermentation, distillation, and maceration, each having its unique advantages. As illustrated in Fig. 5A, local inhabitants of the study area utilize a total of eight different methods for preparing herbal remedies. Most of the reported WMPs (49 species) are shade dried and grinded using a mortar and pestle to make a fine powder that can be taken orally or applied topically to treat various diseases. According to the local respondents, the powdered crude drugs can be stored for extended periods of time in cotton sacks or pots made from mud or silver. Additionally, fresh plant parts (consisting of 19 species), pastes (13 species), decoctions (12 species), and extracts (10 species) are commonly employed modes of preparation in traditional recipes for the treatment of various ailments. These traditional recipes have their own unique preparations and applications. For instance, fresh leaf decoctions are commonly used as cleansing agents, while pastes made from powdered roots are often applied topically to treat skin infections.

Fig. 5

A Preparation and B administration methods of traditional health care recipes

Among these recipes, approximately 72% (Fig. 5B) are taken orally in the form of decoctions, infusions, or extracts, while 25.8% are applied topically as pastes, powders, or oils, particularly for addressing skin infections. Water, milk, diluted curd (lassi), ghee, and butter are frequently used as mediums for consuming the powdered or fresh parts of wild medicinal plants. It is worth noting that similar methods of preparation and administration have been reported in previous studies conducted in this region, and neighboring areas [31, 32, 34, 57, 60, 67, 77, 91,92,93,94].

In accordance with the guidelines outlined by the international classification of primary care ICPC-2 [95], the recorded ailments among the inhabitants of Kohistan were classified into twelve distinct categories (Table 3). These include general and unspecified diseases (OTHA-A), digestive disorders (GAS-D), cardiovascular problems (CAR-K), conditions related to blood, blood-forming organs, and the immune system (Blood-B), musculoskeletal disorders (SKE-L), neurological disorders (NER-N), respiratory infections (RES-R), skin diseases (DER-S), urological disorders (URO-U), cancer (CAN-C), pregnancies, childbirth, family planning (PRE-W). For diseases that did not neatly fit into any specific category, minor modifications were made. Examples of such cases include fever, allergies, back pain, typhoid, and spiritual uses—these were categorized as general and unspecified.

Table 3 Diseases category, informant consent factor, and fidelity level of the reported WMPsQuantitative analysis of the reported WMPs

In total 281, respondents of five linguistic groups reported medicinal uses of 96 wild plant species, and total use reports were 3298 (Table 2). Among the reported botanical taxa, Myrtus communis had the highest RFC (0.34). This medicinal plant species is evergreen and local inhabitants of Kohistan use its leaves to treat eczema. In addition, M. communis is also used as tea, and flavoring agent in traditional cuisines of Kohistan (Amin et al. [1]) and has been reported as a medicinal plant in the neighboring regions [96, 97]. Beside this, Sambucus wightiana, Punica granatum, Quercus semecarpifolia, Astragalus anisacanthus, Persicaria capitata, Polygonum aviculare, and Polypodium sibiricum had maximum RFC.

The Informant Consent Factor (ICF) specifies consistency of understanding among respondents regarding ethnomedicinal application of specific plant species to cure diseases. The ICF values range from 0 to 1, and a disease category with highest ICF value exhibits maximum consensus of the respondents [98]. The ICF values for various disease categories as mentioned in Table 3 were calculated based on ethnomedicinal information provided by the respondents of different linguistic groups of Kohistan. The ICF values of reported disease categories ranged from 0.65 to 1. The highest number of WMPs were reported against GAS-D disease category, followed by DER-S, OTH, RES-R and OTHA-A (ranged from 13 to 40 botanical species). On the other hand, less than 10 species were documented for the remaining disease categories. Likewise, based on use reports major disease categories were in following order: DER-S ≥ RES-R ≥ OTH ≥ OTHA-A ≥ SKE-L ≥ URO-U ≥ Blood-B ≥ GAS-D ≥ CAR-K ≥ NER-N ≥ CAN-C ≥ PRE-W (Table 3). These findings provide valuable insights into the ethnomedicinal practices within different linguistic groups of Kohistan and highlight which diseases have received more attention in terms of herbal remedies. Overall, findings of this study demonstrate the consistency and agreement among respondents regarding the traditional therapeutic uses of specific plant species for various diseases. The results shed light on potential sources for further exploration and development in ethnobotanical research.

Although the NER-N, CAN-C, and PRE-W disease categories showed the highest ICF values (1 for each category), there was a noticeable lack of WMPs usage (1 species for each disease category) and minimal use reports (26 use reports for each disease category). This could be due to the rarity of neurological disorders (NER-N) and cancer (CAN-C) in the study area or a lack of awareness among the local population about these diseases. In the Kohistan region, neurological disorders such as epilepsy, stroke, and trauma are relatively uncommon. Similarly, cancer is also rare, which could be attributed to under-diagnosis or under-reporting. However, it is important to note that certain regions have a high incidence rate of neurological disorders like epilepsy, while globally there is an increasing trend in cancer cases. Even in developed countries, neurological disorders and cancers contribute significantly to morbidity rates. The difference in reported usage might be attributed to limited accessibility or availability of WMPs, cultural taboos, or a lack of recognition by local healers. Nonetheless, it is worth mentioning that despite being the less common ailments in this region, both CAN-C and PRE-W disease categories still showed high ICF values which indicate the perceived utility of WMPs in this region.

While digestive problems (GAS-D), skin diseases (DER-S), and respiratory system disorders (RES-R) have lower ICF values, they still hold significance in the study area. This is evident from the utilization of a high number of botanical taxa for the treatment of these diseases. For instance, 40 WMPs are used to treat digestive problems, 19 species to cure skin diseases, and 17 species for treating respiratory system disorders (Table 2). The largest number of botanical taxa against the above-mentioned diseases revealed prevalence of such heath disorders in the study area, and acceptability of WMPs among different linguistic groups of Kohistan. Our findings align with previous studies [99,100,101,102], reporting digestive disorders and skin infections as common health issues in high mountain regions. Similarly, the harsh climatic conditions, high altitude, exposure to UV radiation, and unhygienic practices at both individual and community levels may contribute to the prevalence of these diseases in Kohistan.

Female health issues, particularly during pregnancy and childbirth (PRE-W), are most prevalent in Kohistan. However, due to cultural barriers, collecting information on these diseases is challenging. In certain societies like Kohistani communities, there is a cultural taboo associated with discussing women’s health problems, making it even more difficult to gather data. These practices hinder our understanding of the true extent of female health issues in this region. Additionally, family planning issues are not common as having more children is preferred in Kohistan. Therefore, it is essential to address these challenges and find ways to gather accurate information on female health issues in this region. And that can be only possible by the active participation of female researchers from Kohistan and its allied areas. By doing so, we can develop effective interventions and provide appropriate healthcare services to improve the well-being of women in the Kohistan region.

According to Chen et al. [98], the fidelity level (FL) is an important measure for determining the effectiveness of a medicinal plant species in treating specific diseases compared to other plants used for the same purpose. High fidelity levels indicate that a particular plant species is consistently used by many individuals to treat a particular disease [102]. In our study, we found that 12 WMPs had fidelity levels ranging from 41.67% to 94.44%, demonstrating their significant medical applications within different linguistic groups of Kohistan (Table 3). The highest fidelity level of 94.44% was observed for Myrtus communis in treating skin diseases, specifically eczema, followed by Mentha longifolia with a fidelity level of 92.86% (Fig. 6), commonly used for digestive disorders such as diarrhea and indigestion (GAS-D). Interestingly, this finding aligns with Ahmad et al. [103] report on local communities in Madyan valley, Swat Pakistan, where similar species was utilized against gastrointestinal disorders. While it appears that M. communis has not been previously documented for its effectiveness in skin diseases. However, Haq [69] reported that inhabitants of Allai valley in the western Himalayan region of Pakistan use the same species to alleviate bronchial congestion. Likewise, Ajuga integrifolia, Ziziphus jujuba, Clematis grata, Lepidium sativum, Artemisia brevifolia, Verbascum thapsus, and Datisca cannabina have shown fidelity levels of ≥ 60% against various diseases (Table 3). The inhabitants of Kohistan utilize the leaves of A. integrifolia to alleviate fever, skin infections, and purify blood. Conversely, Ozturk et al. [24] stated that the same plant species is used to address hypertension in different regions of Turkey, Pakistan, and Malaysia. Similarly, Muhammad et al. [104] have reported a fidelity level of 100% for Z. jujuba from Malakand division KP, Pakistan in relation to lactation support and the treatment of skin disorders, gastrointestinal issues, urological conditions respiratory ailments diabetes and insomnia.

Fig. 6

Some highly utilized medicinal plant species A Myrtus communis, B Mentha longifolia, C Sambucus wightiana, D Clematis grata, E Ajuga integrifolia F Ziziphus jujuba

Conversely, the local population in Kohistan employ powdered seeds from Z. jujuba to manage blood pressure levels and promote blood purification. Leaf powder from Clematis grata is orally administered for the treatment of urological disorders, but Rehman et al. [32] have highlighted that same species is used among tribal communities in the Buner region of Pakistan for managing skin infections. The efficacy of decoctions made from L. sativum leaves against asthma aligns with reports by Alamgeer et al. [50]. Inhabitants of Kohistan frequently utilize leaf powder derived from A. artemisiifolia as an anti-rodent and mosquito repellent, and its fidelity level is 64.29%. It should be noted that this utilization contradicted to the findings of Zhao et al. [25] who classify A. artemisiifolia as an invasive weed that poses harm to crops in Europe and Asia. Moreover, this species is also known to produce copious amounts of allergenic pollen grains that can adversely affect human health [105]. The fidelity level of V. thapsus in alleviating labor pain and respiratory disorders was found to be 58.33%, while D. cannabina demonstrated has FL 57.14% in reducing joint swelling. It is worth noting that Khan et al. [3] have documented the use of V. thapsus leaves for treating asthma and skin infections among the residents of Kashmir Himalayas, Pakistan. However, the application of this plant species against labor pain remains relatively unexplored in existing local and regional literature. Based on the high FL, we recommend further pharmacological investigations on these WMPs to explore their potential benefits and mechanisms of action.

Cross-culture analysis on the use of the botanical taxa

The cross-cultural analysis conducted among the five linguistic groups in Kohistan has unveiled a notable level of heterogeneity on the medical ethnobotany of the studied groups. Considering the number of plant taxa, the quoted botanical taxa among different linguistic groups are illustrated in Fig. 7. A total of 61 plant taxa (63%) were found to be commonly shared across all groups for the treatment of various health issues. However, a noteworthy exception was found in the Shina community, residing in the Himalayan sites of Kohistan, which reported the highest number of unique medicinal plant taxa. The unique taxa reported by the different groups are as follows: Shina: Aconitum chasmanthum, Juniperus excelsa, Leontopodium himalayanum, Oxyria digyna, Pedicularis oederi, Primula elliptica, P. macrophylla, Pteridium aquilinum, Rheum emodi, Rhodiola integrifolia, Ricinus communis, Rumex nepalensis, and Taraxacum campylodes (refer to Table 2 for detailed information). Bateri: Buxus wallichiana, Daphne mucronate, Dysphania botrys, Hypericum oblongifolium, Silene conoidea, Solanum virginianum, Sonchus arvensis, and Zanthoxylum armatum. Gujars: Caltha palustris and Cirsium arvense. Pushton: Artemisia gmelinii and A. stechmanniana. Kohistani: Clematis grata, Clinopodium vulgare, Persicaria capitata, Polygonatum multiflorum, Polygonum aviculare, Polypodium sibiricum, Rubus fruticosus, Rumex abyssinicus, Solanum miniatum, and Bistorta amplexicaulis.

Fig. 7

Medicinal plant taxa reported by all linguistic groups

The complex web of medicinal uses of the commonly used plants among the various groups is shown in Fig. 8. Venn diagram elucidates the intricate tapestry of medicinal plant utilization within these linguistic communities. Out of the total 109 documented medicinal uses, approximately 1.83% of the quoted uses were found to be shared across all linguistic groups. We have observed that 12.84% of the uses do overlap among the plant uses of Kohistani, Shina, and Gujjari. It is also important that close affinities (36 uses commonly along 33.02%) on the uses lie between Shina and Kohistani and this may be due their cultural and social dominancy and their social interactions might lead them to share and retain knowledge.

Fig. 8

Comparison of medicinal uses mentioned by different linguistic groups

Most of the communal land is owned by these two groups in Kohistan and therefore is evident that these have been the original inhabitants of the study area for generations. The Kohistani and Shinaki people have shared sufficient idiosyncratic uses of plant species, while Bateri also emerged along with them. The Bateri linguistic group who claim to be autochthonous to the study area have some interactions with Kohistani, and we have observed the names of some plants who shared them with Shina although the fact is that their language is branch of Kohistani languages. Despite claiming indigenous roots in Kohistan, the Bateri population has diminish gradually in size over time and now only concentrated in the Bateri village, nestled within the Himalayan expanse of Kohistan-an area. Although Bateri is a linguistic minority in Kohistan, the distinctive wealth of traditional knowledge on idiosyncratic medicinal uses of wild plant species among them can be attributed to their ancestral knowledge, strong association with traditional health care system, historical marginalization, and to some extent due to intermarriage with Kohistani and Shinaki communities.

Within the broader context of Kohistan, Shina speakers (Shinaki) and Kohistani constitute the predominant linguistic groups, collectively spanning almost 80% of the region. The Shinaki groups assert dominance in the Himalayan regions, while the Kohistani communities prevail along the Hindu Kush Mountain range, flanking the right and left banks of the Indus River, respectively. Despite the abundant diversity of medicinal plants in both mountainous terrains, the Kohistani and Shina groups reported relatively fewer medicinal uses, documenting 27 and 26, respectively. As reported earlier [106, 107], discernible impact of modernization, encapsulating factors such as enhanced education, migration, and urbanization, is evident within Kohistan, and Shina linguistic groups is leading to a discernible decline in traditional knowledge. Adding a layer of complexity, the migratory patterns of the Shinaki people of Jalkot and allied areas offer insights into their traditional knowledge. During the summer, these communities typically migrate toward subalpine and alpine pastures where the above-mentioned botanical taxa are commonly found. As a result, the Shinaki people possess an intimate understanding of the medical applications of these unique plant species prevalent in the alpine and subalpine regions. The Pushton and Gujjari communities, often perceived as non-native in Kohistan, are confined to specific geographical areas. The Gujjari people, primarily nomadic, exhibit a preference for alpine and subalpine valleys and pastures. In contrast, a limited population of Pushto speakers resides in the lower regions of Kohistan along the River Indus. This limited dissemination of traditional knowledge is attributed to the tendency of Gujjari community to preserve such knowledge within the confines of their own family circles. The exploration of plant resource utilization among diverse ethnolinguistic groups unveils a fascinating tapestry of both homogeneity and heterogeneity [1, 108,109,110].

Novelty in reported WMPs

Comparative assessment of ethnomedicinal uses reported by different linguistic groups of Kohistan (as shown in Table 2) with previously reported literature revealed that out of ninety-six documented WMPs about 90% have already been reported from different areas of Pakistan and neighboring regions. However, to best of our knowledge, 10 botanical taxa, namely Leontopodium himalayanum, Pedicularis oederi, Plocama brevifolia, Polypodium sibiricum, Pteridium esculentum, Sambucus wightiana, Solanum cinereum, Teucrium royleanum, Rhodiola integrifolia, and Aconitum chasmanthum, have been reported for the first time (Fig. 9). In addition, although Artemisia stechmanniana, Cirsium verutum, Rubus niveus, Rumex abyssinicus, and Silene conoidea, are used in traditional health care systems of China, Nepal, Bangladesh, Ethiopia, and India [27, 36, 66, 68, 71], they never have been reported as medicinal plant species in Pakistan. Likewise, there were significant variations in plant part(s) used, mode of preparation, application, and types of diseases treated of the commonly reported medicinal plant species. For instance, the aerial parts of Primula elliptica and P. macrophylla are used in snuff by the inhabitants of Kohistan, but roots and flowers of the same species are used to heal wounds and against jaundice in Swat, Pakistan [61]. Likewise, inhabitants of Kohistan use seeds of Ziziphus jujuba as blood purifier; however, fruits and roots of same species were reported to treat diabetes and obesity [53, 79].

Fig. 9

Some newly reported medicinal plants of Kohistan. A Rhodiola integrifolia, B Pedicularis oederi, C Leontopodium himalayanum, D Aconitum chasmanthum, E Pteridium esculentum, F Teucrium royleanum

Threats to ethnomedicinal knowledge of Kohistan

Ethnomedicinal knowledge among various linguistic groups reflects their beliefs, cultural practices, and bioresource management experience [111]. This knowledge, especially among minor groups in mountain regions like northern parts of Pakistan, is at risk of erosion due to challenges like globalization and urbanization [