ETHNOBOTANICAL STUDY OF TRADITIONAL MEDICINAL PLANTS USED IN THE MANAGEMENT OF DIABETES IN THE URBAN AREAS OF KHURDA, ODISHA, INDIA

Objective: The present work deals in collecting information about the medicinal plant species used for the treatment of diabetes by the traditional healers in the urban areas of Khurda districts of Odisha and identification as well as documentation of these species. 
Methods: Extensive field survey was conducted in the study area; information about plants were collected from local herbal practitioners, village elders, patients, and traditional healers through normal conversations, interviews, and discussion. 
Results: During survey, 40 medicinal plant species belonging to 36 genera and 25 families were identified and documented having antidiabetic activity. Most of the species were trees (47.5%) followed by shrubs (32.5%) and herbs (20%). It was observed that among all the parts, generally leaves were mostly used. During this survey work, Gymnema sylvestre paid the attention and found as the most common species used by traditional healers. 
Conclusion: From the current findings, it was concluded that medicinal plants have the potential to replace the synthetic drugs which are restricted by their efficiency and side effects.


INTRODUCTION
Diabetes was first recognized as a disease about 3000 years ago in the ancient Egypt [1]. Diabetes is rapidly emerging as serious and major public health-care problem throughout the world. Diabetes mellitus (DM) is a metabolic disturbance of carbohydrates, proteins, and fat due to relative lack or complete absence of insulin and insulin resistance [2]. Diabetes is a metabolic disorder where human body does not produce or properly use insulin, a hormone that is required to convert sugar, starches, and other food into energy. It is characterized by high levels of blood glucose [3]. In Ayurveda, DM is referred to as Madhumeha or Kshaudrameha, which literally means excessive urine with sweet taste like honey [4]. Globally, an estimated number of about 387 million people are currently diagnosed to have diabetes [5]. In India, there are more than 4 crore diabetic patients and the number is going to be about 9 crore by 2030. The WHO projected that diabetes will be the 7 th leading cause of death in 2030 [6,7]. The essential and effective drugs for diabetes are insulin injection and hypoglycemic agents, but these compounds possess several adverse effects and have no effects on diabetes complications in the long term [8]. The issue of herbal medicine is fast growing around worldwide [9]. There are many plants present in nature which possess marked antidiabetic activity. There has been an increasing demand of herbal antidiabetic medicines due to their low cost, easy availability, effectiveness, and lesser side effects.

Study area
Khurda is a landlocked district of Odisha with a total geographical coverage of 2888 Sq. Km. The geographic location of Khurda district stands at 19˚ 55'-20˚ 25' North Latitude and 84˚ 55' to 86˚-5' East Longitude. It is bounded by Cuttack district in the north, Puri district at south, (Fig 1) Jagatsinghpur at the east, and Ganjam in the west. Its bioclimatology is greatly impacted for the short outspread separation from the Bay of Bengal and existences of an immense water body like the Chilika Lake. The district appreciates typical 1408 mm rainfall with maximum and minimum temperature of 42.2°C and 11.1°C, respectively. Essentially, the mean relative humidity ranges from 46 to 89%. Khurda district situated in the East and Southeastern coastal plain and the agro-climatic zone privileged with sandy topsoil, loam, clay loam, and clayey soil in varied agro-ecosystem.

Field survey
The various urban areas around Khurda district were identified and field trips were carried out at regular intervals. Ethnobotanical uses of plants were studied in situ by establishing close intimacy with the local people. Traditional medicinal knowledge of plants and their therapeutic Mishra et al.

RESULTS AND DISCUSSION
As a result of intensive and extensive ethnomedicinal field explorations and interactions with local people, village medicine -men, patients, and senior knowledgeable persons who practice native phytotherapy in Khurda district, it became possible to generate enormous amounts of data. During the survey, 50 species belonging to 45 genera and 34 families have been identified which are used against the treatment of diabetes. These plants showed antidiabetic activity due to the presence of some secondary metabolites [14]. After checking and rechecking of particular folklore claims by the different dwellers in different areas and with published literature [15][16][17][18][19][20][21], it was found that 40 species belonging to 36 genera and 25 families were widely used by traditional healers of different areas of Khurda district of Odisha for the treatment of diabetes. Most of the species were trees (47.5%) followed by shrubs (32.5%) and herbs (20%) (Fig. 3). It was observed that among all the parts, generally leaves were mostly used, followed by fruits, whole plants, and roots (Fig. 4). The information on the mode of the uses of medicinal plants used against the treatment of diabetes was collected from the traditional healers and was described below: 1. Achyranthes aspera L.      Ethnic uses: A. vera has always remained one of the most important and most used plants in folk medicine. Pulp juice (10-15 ml) is usually taken with some amount of water in empty stomach. The dose is usually once in a day in the morning, but it can be higher according to blood glucose level. Ethnic uses: A. paniculata has been used for centuries in herbal formulations in the Ayurvedic traditional health system. The leaf extract or juice is used as an herbal remedy for the treatment of diabetes. About 10 ml of fresh leaf juice is given once in day for 6 months against diabetes. Ethnic uses: Both leaf and roots are usually used in diabetes treatment. Leaf juice is orally administered twice in a day, which shows lower blood sugar level. Root paste is occasionally used for the treatment of the disease. Ethnic uses: Chewing the nut of A. catechu stimulates the flow of saliva to aid digestion. About 15 g of nut powder mixed with 10 g of old jiggery is orally administered once in a day which shows lower blood glucose level. Ethnic uses: A. indica is a major source of herbal drug for the treatment of diabetes. The young tender leaves are prescribed to patients. The seeds are also very useful in diabetes treatment. The paste of the seeds (10 g) mixed with 50 ml rice wash is given to patients after a meal to cure diabetes. Ethnic uses: B. monnieri is known for regulating the blood sugar levels in diabetic patients and may help improve symptoms of hypoglycemia.

Azadirachta indica
Fresh leaf juice (about 10-15 ml) of the plant is used once in a day as potential antidiabetic herbal drug.  Ethnic uses: The leaf juice (10 ml) mixed with cucumber once in a day in an empty stomach is used as an herbal remedy for the treatment of diabetes. Ethnic uses: The juice of the whole plant is taken with jeera powder and salt as an herbal remedy for treatment of diabetes. This is used 2 times in a day for 1 month.  Ethnic uses: The leaf and bark of C. tamala are used as medicine. It is used to cure diabetes, cough and cold, arthritis, heart, and liver health. About 10-15 g of leaves is boiled in water 100 ml of water and the water is used by patients 2 times in a day after meal.  Ethnic uses: C. dactylon has hypoglycemic effect, thus helpful in controlling of blood sugar levels and reduces fatigue. The juice of the whole plant with rhizome along with A. indica leaf juice is good in normalizing blood sugar level. Drinking juice at empty stomach in the morning is good in normalizing the sugar level. Ethnic uses: The unripe fruits of F. racemosa have antidiabetic properties. A paste (50 mg) made out of boiled unripe fruit and equal quantity of fine rice, given with normal meal once in a day to patients, to lower sugar levels in blood. Ethnic uses: The fruit of the plant is used as a diabetic herbal drug. The paste of the boiled unripe fruit is consumed with salt and cumin powder. The dose used is 10 g paste once in a day in an empty stomach for nearly 15 days. Ethnic uses: Powdered roots (5 g) are given 2-3 times a day with a cup of hot milk to reduce the sugar content in blood as well as urine. Young fruit or leaf juice is also given to patients at least for 6 months as an herbal remedy for the treatment of diabetes. Ethnic uses: Fresh fruit juice or paste is given to patients in the morning in empty stomach at least for 1 month. The patients are also advised to take the fruit as vegetable in daily diet to treat diabetes. Ethnic uses: Unripe fruits and stem bark of M. paradisiaca have antidiabetic effects and show reduced glucose levels in blood. Unripe fruits are boiled and taken with salt and jeera to reduce blood sugar. The stem bark juice is also used once in a day in the morning empty stomach for the treatment of diabetes. Ethnic uses: The leaves and seeds of the plant are medicinally important. The leaf juice is used as an antidiabetic herbal remedy. Seven tender young leaves or leaf juice is given to patients 2 times in a day, which shows a lower glucose level in blood. Ethnic uses: The fruit shows antidiabetic properties, the fruit is made into paste and taken with a glass of water once in a day to cure diabetes.  Ethnic uses: S. cumini is a great source of herbal remedy for diabetes. The ripe fruits and dried seeds usually show antidiabetic effects and reduce the blood glucose level. The ripe fruits are also used to lower the diabetes. Ethnic uses: Dried ripe fruits of T. bellerica showed antidiabetic effects. Dried fruits made into powder are given to patients with hot water twice in a day for nearly 6 months to control diabetes.  Ethnic uses: T. cordifolia is commonly known as Guduchi. About 15-20 ml of stem juice is extracted and mixed with two drops of honey which are given 2 times a day for 15 days to cure diabetes. Dried stem powder (5 g) mixed with 2-3 g of P. longum is also prescribed for 1 week to reduce sugar level in blood.

CONCLUSION
At present, diabetes is a common and chronic metabolic disorder throughout the world. Diabetes is spreading in an alarming way throughout the world and three-fourth of the world populations and considered as a major cause of high economic loss which can, in turn, impede the development of nations. Moreover, uncontrolled diabetes leads to many chronic complications such as blindness, heart disease, and renal failure. For this, therapies developed along the principles of western medicine (allopathic) are often limited in efficacy, carry the risk of adverse effects, and are often too costly, especially for the developing world. The present study has presented comprehensive details of antidiabetic potential of medicinal plants. Some of these plant-derived medicines, however, offer potential for cost-effective management of diabetes through dietary interventions, nutrient supplementation, and combination therapies with synthetic drugs in the short term and as the sole medication from natural sources over the long term. More investigations must be carried out to evaluate the bioactive compounds present and mechanism of action of medicinal plants with antidiabetic effect.

ACKNOWLEDGMENT
The authors are grateful to local people and traditional healers for their valuable knowledge transfer. The authors are also grateful to the Head of Department, Department of Botany and Dean, School of Applied Sciences, Centurion University of Technology and Management, Odisha, India, for their help and suggestions to carry out research work successfully.

AUTHORS' CONTRIBUTIONS
Gyanranjan Mahalik: Conceptualization and designing the research work; Jiban Mishra: Survey, collection, and documentation of field data;