The use of traditional and medicinal plants in developing countries is widely attracting attention as the main basis for maintaining health. Maintaining health through traditional medicine in general and utilization of medicinal plants in particular is almost as old as the history of humankind. According to Huat’s research, when tourists visit a particular place, they stay locally and participate in free time activities at their leisure; therefore, the development of medical tourism could bring considerable benefits to the countries, in addition to their medical services. Iran is a growing one of the developing countries which has growing destination for medical tourism. In 2012, 30,000 people visited Iran to receive medical treatment. Most health tourists were from Azerbaijan, Turkmenistan, Iraq, Turkey, Kuwait, Oman, India and Pakistan. Last year, more than 4.5 million foreign tourists spent $9 billion in Iran and created jobs for 2.5 million people directly or indirectly. Tourism is up by a million people on 2011; people being attracted by diversified climates as well as numerous tourist and historical attractions. The number of Omani nationals visiting Iran for medical tourism is on the rise with around 5,000 Omanis seeking treatment in the country every year, according to the Iranian Embassy. Medical tourists from neighboring states mostly come for transplants, ophthalmology, orthopedics and dentistry.

About 80% of the population of most developing countries still use traditional medicines derived from plants for treating human diseases. There is no specific statistics of Traditional Medicine and different schools of supplementary medicine and Traditional Medicine schools in Iran. However, a study in Esfahan city in 2000 showed that in the last 5 years, 62.5% of individuals had already used one of the substitute medicine methods at least once and using medicinal herbals, prayer therapy, cupping and acupuncture were more often used in 76.6%, 10.1%, 9.5% and 5.5%; respectively [1].

It has been estimated that there are between 35,000 to 70,000 plant species that have been used at one time or the other in one culture or another for medicinal purposes in the world. At least 6,500 species are used in Asia alone as home remedies for various ailments [2]. Iran has 80% of the world medicinal herbs. It has around 8000 species of plant life and researches indicate that more than 2300 species have remedial characteristics or can be used as cosmetic products (mehrnews.com). Today, medicinal plants are still widely used in Iran. Among different ailments, jaundice, aroma and febrifuge are the commonest ailments in Iran and herbal remedies (Kakoti, Zereshk Kuhi, Shir Khesht) are used to heal them [3].

Traditional knowledge transmitted verbally from one generation to another, and valuable information about medicinal plants is easily lost if not maintained in written form. Moreover, and for the first time in any region of Iran, the medicinal plants of the study area (Figure 1) are classified according to biological and chorological characteristics as well as ecological properties. It is necessary to know habitats (Figure 2) ethno-medicinal plants, as such knowledge is a vital to identify medicinal plants in each area. The aim of this article is aware of the importance of medicinal plants in providing primary health care to Iranian people. Also, the current study aimed to identify the medicinal plants used to treat prevalent disease in Darkesh, North khorasan Iran.

Figure 1: Inhibitory effect of the Morinda citrifolia 70% aqueous-ethanolic fruits (Mc.Cr.F) (A) and leaves extract (Mc.Cr.L) (B) on spontaneous and high K+- induced contractions and concentration-response curves of Ca++ in isolated rabbit jejunum. The symbols represent mean ± S.E.M, n= 4-6.

Figure 2: Habitat types of medicinal plants in Darkesh, North east Iran.

Darkesh forest region is placed in the North of Khorasan Province of Iran. Its elevation ranges from 900 m to more than 2030 m a.s.l. and consists of about 22,500 ha (Figure 1). The land-use consists of: forest (45%), rangelands (35%), arable lands (12%), settlement areas (5%) and other (3%). The inhabitants are approximately 1,200 people having a demographic decline in the last decades. The farms in the area are about 0.5 ha and the main crops grown are wheat and barley. The climate of the region is in the range of cold-humid climate according to Amberger coefficient.

Methods

Plant species were collected from field sites that representing major habitats of study area. Surveys were managed during active growth periods (from 21 March to 21 September) in 2013 and 2014. The following plants (Table 1) were collected and identified with the help of standard flora [4-10] and preserved in the form of Herbarium for correct identification of plants.

Table 1: 10 of the most common medicinal plants of the Darkesh area, Iran with their medicinal properties, and biological, ecological and chorological characteristics.

The results of this study demonstrate that Darkesh area as a remarkable tourist site has rich medicinal plants that play a crucial role in human healthcare in Iran.

A total of 10 medicinal plants were found which were used traditionally by local communities to cure human disease are given in Table 1 and Figure 3. The vegetation in this area is very diverse. These 10 medicinal plants belong to 6 Families (4 plant belong to Lamiaceae, 2 plant belong to Asteraceae and 4 plants belongs to Berberidaceae, Rosaceae, Fagaceae, and Apiaceae family) and consist of herbs, grasses, tree, shrub and perennial. Different parts of plants were having different medicinal values and were used to cure different disease. Out of 10 medicinal plants, 1 plant species was having Gum as medicinal part, 5 species containing fruit, flower, shoot and bark as medicinal, leaves of 6 species, and 2 plant species were identified as having medicinal value in whole plant body (Figure 2). The local people of the region usually utilize every part of the plant. The use of a medicinal plant part depends on the plant habit and user’s needs. The most frequently used plant parts in the preparation of herbal remedies were leaves (50%),followed by fruit (33%), seeds, flowers, bark and whole plants (33%) and Gum (17.1%).

Figure 3: Achillea, Cotoneaster, Ferula, Thymus, Berberis, Dracocephalum, Ziziphora, Tanasetum, Teusrium, Quercus in Darkesh North Khorasan, Iran.

Among the 10 indigenous medicinal plants are indigenous to the area, the majority of species is common (50%) or scattered (50%) in the study area. More than 60% of the medicinal plant species encountered in this area occur in natural habitats, 40% occurred in woodland and mountain grasslands (Figure 2).

This study was concerned with the wide variety of diseases treated using the medicinal plant species found in the Darkesh area for the first time in Northeast of Iran. In this study, 10 medicinal plants used for treatment of gout, pain and fever, hysteria and nervous affections, urinary infection, Carminative, asthma, hiccup, rheumatism and hysteria and nervous affections were identified. A number of diseases are treated by many medicinal species, indicating the predominance of those specific conditions in the community. These included diseases related to pain, fever and cold (4 species), worm infestation and urinary infection (3 species) jaundice, febrifuge and aroma (1 species). This study was concerned with the wide variety of diseases treated using the medicinal plant species found in the Darkesh area in Iran (Figures 3 and 4). Medicinal plants and remedies include;

Figure 4: Use of different plant parts in the preparation of remedies.

Achillea biebersteinii, commonly known as “Qaysoum” in Arabic, is one of the predominant Achillea species in the Mediterranean region. It is a medicinal plant has essential oils, polyphenolic compounds, several types of flavonoids, sesquiterpene lactones, betaine, acetylene compounds, resin, tannins, phosphates, nitrates, potassium salts and organic acids. According to Persian traditional literature, Achillea biebersteini have been used in medicine for treatment of hemorrhage, pneumonia, rheumatic pain and in wound healing [11]. Herbal teas prepared from Achillea species are traditionally used for abdominal pain and flatulence.

Berberis integerrima (Berberidaceae) is an important medicinal shrub that grows in most regions of Iran, especially in northern and northeast regions of the country. It has much medicinal properties and is used in the treatment of gastrointestinal disease, bleeding, swollen gums teeth, sore throat, fever, bile, malaria, hepatitis, inflammation and diarrhea. In addition, it has an important role in reducing blood cholesterol.

The genus Cotoneaster (Rosaceae) comprises 85 species, which are predominately distributed around the Asia [12].

Several species of Cotoneaster are used to medicinal purposes such as cardiotonic, diuretic, expectorant and antiviral in different countries [13,14]. Cotoneaster multiflora called Shir Khesht is perennial herbs and grows in Iran. The medicinal uses of the species is advised for Jaundice, Febrifuge.

Dracocephalum kotschyi belongs to Labiatae family and is known as badarnjboye in Persian. The aerial parts of this plant continue to be traditionally used to treat rheumatoid arthritis in Iran [8].

Quercus spp showed wound healing activity in excision, incision, and dead space wound models with improvement of tensile strength, percentage of wound closure, complete epithelization, and size of scar [15]. Furthermore, Q.spp fruits exhibited significant wound healing activity in an excision wound model with enhancement of collagen deposition and antioxidant activity [16]. Q, spp fruits showed antibacterial activity, in addition, Q. ilex leaves demonstrated antioxidant activity in vitro [17].

One of species from the wide range of Asteraceae family, which has been found many applications both in folk and modern medicine, is Tanacetum budjnurdense . Extracts from this species have been used for treating many health problems such as digestive disorders, rheumatism, fever and ulcers [18]. It acts anti-inflammatorily [2,18,19] and also has been reported to have antimicrobial, antitumor and antioxidant properties [19].

The genus Teucrium (Germander) belongs to the family Lamiaceae, within the subfamily Ajugoideae. The Labiatae family (Lamiaceae) is one of the largest and most distinctive families of flowering plants, with about 220 genera and almost 4000 species worldwide. They are mostly perennial herbs, shrubs or subshrubs, while T. chamaedrys is an herbaceous annual herb. The species of this genus are widespread on all continents of the world, and a very large number of species are present in the Mediterranean. The most popular species of this genus are T. chamaedrys, T. montanum and T. polium, used in treatment of digestive and respiratory disorders, abscesses, gout and conjunctivitis, in the stimulation of fat and cellulite decomposition, and possess antiinflammatory, antioxidative, antimicrobial, antidiabetic and antihelmintic effects. However, their most significant therapeutic effect was the elimination of some problems in the digestive tract [20,21].

Thymus genus, which belongs to Lamiaceae family, is among the most popular plants throughout the world, commonly used as herbal teas, flavoring agents (condiment and spice), and aromatic and medicinal plants [22]. Furthermore, the essential oil and extract of different Thymus species are widely used in pharmaceutical, cosmetic, and perfume industry, as well as for flavoring and preservation of several food products [23]. Leaves and aerial part of this genus have also been used as herbal tea, antiseptic, antitussive, carminative, and flavoring agents [24].

Ziziphora persica L. is a common teapot herb. This species is available in local market or in Attaris (traditional medicinal plant stores). Four species of plant called Ziziphora clinopodioides (mountains’ Kakoty) Ziziphora capitata, Ziziphora persica and Ziziphora tenuir have been identified in Iran [11]. Among the healing properties of this plant sputum collection, carminative and stomach reinforcement can be named. In some areas the dust of its grains mixed with honey is used to treat dysentery [11]. In different areas, the plant’s powder is used as a garnish on yogurt and dairy products [25]. Also, it is used for treatment of diseases of the stomach and as an antiseptic to relieve colds [26].

Ferula species mostly distributed in Iran, is used in different countries for various purposes and not only used as a culinary condiment but also traditionally used to treat various diseases, including asthma, gastrointestinal disorders, intestinal parasites, etc. This oleo-gum-resin has been known to posse’s antifungal, anti-diabetic, anti-in ammatory, anti-mutagenic and antiviral activities. A wide range of chemical compounds including sugars, sesquiterpene coumarins and polysulde have been isolated from oleo- gum-resin of the plant [27,28].

This study contributes knowledge about medicinal plant species not only in Darkesh, but also a potential to share this knowledge in Northeast of Iran.

The present study reveal that there are 10 medicinal species for various purpose not only used as trade in North east of Iran but also traditionally used to treat various disease, including cold, kidney disorder, Blood and Liver Cleanser, pain and fever, Febrifuge and etc . Poor health is among the biggest problems in Iran, while medical tourism could be one of the solutions and medical tourism can led to improved public health.

The results of this study showed that the plants are potentially a good source of medical remedies and is a suitable option for medical tourism in this area, as well as keeping natural resources. Unfortunately there is no information available from Iran, about the present status of medical tourism and the action being taken for keeping natural resources. Research on medical tourism in Iran is currently inadequate and this study stimulates further development of medical tourism in Iran. For purpose of forest conservation and to increase the medical tourism we suggest to cultivate 10 medicinal plants with commercial value in Darkesh, North Khorasan Iran.