Demography of informants

A total of 200 informants, including 137 males (< 45 years = 60.58%, < 30 years = 27.73%, < 18 years = 11.67%) and 63 females (< 40 years = 61.90%, < 18 years = 38.09%), were interviewed in local languages including Phari, Hindko, Gojri, Kashmiri, and Urdu. The majority of female informants were illiterate (Table 1). Female informants’ percentage is lower due to social setup because local people don’t allow women to talk with strangers. The local people of the Kashmir region have a close interaction with nature and the best experience of resource utilisation [47].

Table 1 Demographic information of the informants from the investigated areaFloral diversity and anthropogenic pressure

The floral diversity of medicinal plants belonging to different families, local names, used parts, voucher numbers, ailments, remedies, and modes of administration are presented in Table 2. An ethnomedical plant survey documented 110 medicinal plants belonging to 90 genera and 49 families. Out of these medicinal taxa, herbs (85.45%) were predominant, followed by shrubs (6.36%), trees (5.45%), ferns (1.81%), and epiphytes (0.90%) (Fig. 3). Among the 49 families, Asteraceae was the dominant family and contributed the most (9.09%) to medicinal plants, followed by Polygonaceae (8.18%), Apiaceae (7.27%), Lamiaceae (5.45%), and Ranunculaceae (5.45%) (Fig. 4). The genera with the highest number of species represented are Angelica (3 species), Geranium (3 species), Aconitum (3 species), Polygonatum (2 species), Taraxacum (2 species), Berberis (2 species), and Rheum (2 species). The study shows that indigenous peoples of the Kashmir region heavily depend on medicinal plants for primary healthcare, especially during the winter when the area is inaccessible for longer due to heavy snowfall. These medicinal plant species were traditionally used to strengthen and energise, thereby improving health. In addition, the use of medicinal plants found at higher elevations is primarily driven by remoteness, poverty, and limited job opportunities. The study region's lack of infrastructure and socio-economic development exacerbates the problems. The survey revealed that high anthropogenic pressure on medicinal plants is likely caused by illegal extraction and environmental stress. Hence, local populations heavily depend on these higher elevation medicinal plants to sustain their primary healthcare and daily requirements. Asteraceae, Polygonaceae, Ranunculaceae, Apiaceae, Lamiaceae, and Ranunculaceae have been reported as dominant families from the Western Himalayas by several other researchers as well [38, 48,49,50]. The Asteraceae, Polygonaceae, and Ranunculaceae plant families are most prevalent in many open-habitat ecosystems [51, 52]. These aforementioned plant families are rich in medicinal chemical compounds such as sterols, alkaloids, glycosidase, and flavonoids, which are used for the treatment of numerous health problems [43]. These families were recorded as dominant families due to their broader ecological amplitudes and adaptations like small dwarf size, stunted growth, and semi-woody and spiny vegetation at higher altitudes with extreme environmental conditions [53]. Several other studies on ethnomedicinal applications in the Himalayan region support the present study results [54,55,56,57].

Table 2 Taxonomic diversity of plants used as ethnomedicines by the local communities of KashmirFig. 3

Classification of floral diversity on the basis of habit

Fig. 4

Proportion of dominated Plant Families and Genera recorded from the study area

Endemic species

Endemic species refers to species found exclusively in a specific geographical area or specific habitat [58]. There were 31 endemic species in the study area, 15 of which were endemic to the Kashmir region and 16 to the Western Himalaya. Arnebia benthamii, Bergenia ciliate, Bergenia stracheyi, Bupleurum longicaule, Caltha palustris, Corydalis govaniana, Dolomiaea macrocephala, Euphorbia wallichii, Gentiana alii, Lagotis cashmeriana, Ligularia jacquemontiana, Meconopsis aculeata, Podophyllum hexandrum, Rheum webbianum, and Taraxacum laevigatum were found to be endemic to the Kashmir region. Aconitum chasmanthum, Aconitum hetrophyllum, Aconitum violaceum, Aucklandia costus, Dactylorhiza hatagirea, Gentiana kurroo, Hymenidium brunonis, Hypericum perfotatum, Inula royleana, Iris hookeriana, Persicaria amplexicaulis, Polygonatum verticillatum, Rosa webbiana, Thymus linearis, Verbascum Thapsus, and Viola biflora were found to be endemic to the Western Himalayan region.

Observations

A total of 166 remedies were used for the treatment of various diseases in humans, and 9 remedies were used for animals. Quercus semecarpifolia was a medicinal plant used only in veterinary medicine. Twelve medicinal plants (i.e. Phytolacca acinose, Hymenidium stellatum, Primula denticulate, Rheum webbianum, Rumex nepalensis, Ligularia jacquemontiana, Verbascum Thapsus, Sambucus wightiana, Iris hookeriana, and Betula utilis) were used for the treatment of both animals and humans. Thirteen medicinal plants (i.e. Geranium wallichianum, Geranium caespitosum, Bergenia ciliate, Aucklandia costus, Rheum webbianum, Rheum austral, Picrorhiza kurrooa, Phytolacca acinose, Geranium nepalense, Bergenia stracheyi, Berberis umbellate, Ajuga integrifolia, and Aconitum hetrophyllum) were observed to have more diversified uses for the treatment of more than 5 ailments. All recorded species are wild and mostly collected from nearby subalpine forests and alpine pastures. Among the medicinal plants, herbs (85.5%) were most frequently used by the local populations of Kashmir (Fig. 3), whereas leaves (20.51%) were used for the treatment of various ailments (Fig. 5). Use category results for documented plants showed that the majority of plants were used for medicinal purposes (63.62%), followed by food (10.34%) and fodder (5.75%) (Fig. 6). Furthermore, females had better knowledge about medicinal plants and remedies for the treatment of different ailments because the majority of male members are out of their homes for jobs due to poverty and limited job opportunities. Similar findings were also reported from the Western Himalaya and Brazil [52, 59].

Fig. 5

Proportion of plant parts used by medicinal plants for remedies

Fig. 6

Percentage distribution of medicinal flora on the basis of use category

Preparation of medicinal plants remedies and usage

All parts of medicinal plants were used to prepare various remedies, such as leaves, rhizomes, roots, tubers, and stems. Herbs were recorded as the dominant life form (94 species) used as a major remedy source in the Kashmir region's local populations. The most frequently used medicinal remedies were tea or decoction (24.1%), paste or crushing (20.6%), raw (14.2%), cooked (12.8%), juice or extract (10.6%), infusion (7.8%), powder (7.1%), and others (2.8%) (Fig. 7). The present study results revealed that leaves (20.51%) were used for the preparation of various remedies, followed by roots (17.95%), whole plant (13.46%), rhizomes (16.03%), aerial parts (7.69%), the flowers (9.62%), bark (3.21%), seeds (3.21%), fruits (3.21%), stem (1.92%), resin (1.28%), tubers (1.28%), and bulbs (0.64%) (Fig. 5). Local communities residing in the mountainous region of Kashmir did not frequently use medicinal plants' bark, seed, stem, and bulbs, rendering these plant parts unsustainable for medicinal use. The aforementioned plant parts are difficult to crush for decoction and hence cannot sustainably be used as remedies in the local communities. The plant's parts, such as the root, entire plant, and rhizome, are extensively employed in native healthcare systems for basic healthcare purposes in Kashmir. So, these plant parts have been considered sustainable for medicinal use in the prevailing area as they contain major constituents of medications. Excessive use of leaves and roots, especially for vulnerable species, could adversely affect their growth, leading to population decreases and even species extinction [56]. Due to the presence of alkaloids, leaves can be used as food as well as a potential source of valuable pharmaceuticals [3]. As a result, they are frequently used as a remedy in the traditional healthcare system because they are so effective. A total of 166 remedies were made, of which 142 employed fresh parts of plants and the rest were made from 24 dried plant parts. Approximately 31.81% of the 110 species enlisted were used for the treatment of a specific type of disease. The most common methods of administration are oral (72.81%), external (24.56%), and eye drops (0.7%). The dosage and duration of medications are based on the severity of the disease, the age of the patient, and the information provided by different informants. Similar findings were also reported, which supports our results [52, 60,61,62,63,64]. The differences in the duration and dosage of medicinal plants are given in Table 2.

Fig. 7

Percentage distribution of methods of remedies preparation

Ailments treated

The most frequently recorded diseases from the Kashmir region are fever, stomach, body pain, coughs, colds, joint problems, constipation, wounds or cuts, and skin problems. Due to heavy snowfall in certain regions, local people have moved from high-altitude areas (i.e. alpine pastures) to lower elevations. In some areas, the availability of modern medications for quick pain relief has caused a decline in the use of medicinal plants. In contrast, the majority of people in remote areas still rely on medicinal plants for their primary healthcare. The documented ailments were classified into 20 general categories: gastro-intestinal/digestive disorders (67 remedies), external and internal injuries (44 remedies), pulmonary disease/respiratory problems (32 remedies), cold and fever (25 remedies), oral, dental, hair, and ENT disorders (21 remedies), dermatological/skin problems (17 remedies), bleeding, cuts, and wounds (17 remedies), liver and hepatic disorders (17 remedies), others (17 remedies), cardiovascular blood system (14 remedies), gynaecological problems (14 remedies), urogenital disorder (12 remedies), diabetes (10 remedies), anthelmintic and anti-lice (8 remedies), condiments (7 remedies), veterinary diseases (4 remedies), cancer (3 remedies), cultural uses (2 remedies), nervous system disorders (2 remedies), and antidote (2 remedies) (Fig. 8). Most studies reported ethnomedicinal applications for the treatment of gastroenterological, respiratory, and wound healing, which were recorded as the most prevalent diseases in the Himalayan region [4, 22, 62, 65, 66].

Fig. 8

Major disease treated through medicinal plants

Informants consensus factor

Different ailments reported from the study area were classified into 20 general categories to develop a consensus among informants (Fig. 8). The informant’s consensus factor was calculated based on disease categories, as single medicinal taxa are used for the treatment of 2–3 or more disease categories. The ICF value ranged from 0.64 to 0.85. The highest value of ICF was recorded for gastro-intestinal/digestive disorders (0.85), whereas the lowest value of ICF was recorded for liver and hepatic disorders (0.64). Among the categories, gastro-intestinal/digestive disorders were the leading disease categories based on ICF values, as strongly supported by various studies [67,68,69,70,71,72,73]. The prevalence of gastro-intestinal/digestive disorders is mainly due to fuel wood smoke inhalation unhygienic conditions, contaminated food, and poor water quality mostly arise in the study area due to animals and humans frequently sharing water sources, such as little springs and wells [67, 74, 75]. Fritillaria cirrhosa, Allium humile, Bergenia stracheyi, Berberis umbellate, Angelica glauca, Ajuga integrifolia, and Achillea milliefolium were the most commonly used medicinal plants for the cure of gastro-intestinal and digestive disorders. These medicinal plants were preferred to cure digestive disorders because they are a rich source of vitamins, essential oils, flavonoids, and other bioactive compounds [76].

The second highest categories of ICF were estimated for dermatological/skin problems (0.84). Skin problems might arise due to UV exposure at higher elevations, unhygienic living conditions, sharing a room with family members or even cattle, and contaminated food [77, 78]. The third highest IFC value (0.83) was recorded for the cold and fever categories. Cold and fever problems arise due to different factors, including harsh winter conditions such as frosting and snowfall, increased moisture at higher elevations, unhygienic conditions, and abrupt changes in weather [79]. The high ICF value (0.82) for gynaecological disorders in the study area may be due to limited access to hospitals and medicines, remoteness, and heavy snowfall causing road blockages. However, over 95% of females give birth naturally, without regular check-ups or operations. This is attributed to their healthy lifestyle, daily walking for daily needs, and reliance on medicinal herbs with no side effects.

Use value

Use value is an essential tool for identifying highly valuable medicinal plants in a region for detailed pharmacological research. The use value ranged from 0.07 to 1.34 (Table 2). The highest use value was reported for Fritillaria cirrhosa (1.34) followed by Allium humile (1.29), Bergenia stracheyi (1.20), Abies pindrow (1.05), Berberis umbellata (1.04), Angelica glauca (0.92), Aconitum hetrophyllum (0.88), Rheum australe (0.85), Taxus wallichiana (0.85), and Geranium nepalense (0.84). The high usage of reported medicinal plants implies a strong association and reliance of local populations on the surrounding flora, particularly for the treatment of various diseases [43]. There is a strong correlation between use value and use reports for a plant. Medicinal plants with a higher number of records have a higher use value [67, 80].

Relative frequency citation

RFC is a tool used for assessing the significance of different species in curing different ailments based on how often they are mentioned by local communities [36]. The RFC value ranged from 0.07 to 0.78 (Table 2). The highest RFC value was reported for Allium humile (0.78), followed by Fritillaria cirrhosa (0.70), Aconitum hetrophyllum (0.68), Geranium nepalense (0.60), Aconitum chasmanthum (0.60), Ajuga integrifolia (0.58), Berberis umbellata (0.56), Rheum australe, Thymus linearis, and Skimmia laureola (0.55), respectively. Locals are familiar with numerous plant species with high RFC values that are prevalent throughout the area due to their traditional use as medicine. These plant species could prove valuable for drug discovery and commercial authentication [70, 81]. High RFC values indicate that a species is commonly used for the treatment of various ailments, leading to overexploitation and a serious threat to conservation. Some plants with high RFC are critically endangered in the study area.

Novelty of study

The findings of this study were compared with the 20 published papers from the Himalayan region represented in Table 3. In the comparison, the JI value ranged from 18.23 to 3.05 (Table 3). The maximum value of the Jaccard index was reported from District Poonch, Jammu & Kashmir (18.23), followed by the northern region of Kashmir, Himalaya (16.45), and District Chamba, Western Himalaya (16.27). High JI values indicate that the vegetation in these areas has similar characteristics due to common traditions, cultures, geography, and environmental conditions. The lowest value of JI was calculated in the Ladakh region of the Himalayas (3.05). The low JI value represents that the geographical features are different. The lower value of JI indicates that the high-elevation areas where the study was conducted do not possess similar topography to the cold desert of Ladakh, which accounts for the lowest value observed. It demonstrates that there are significant variations in the site features between the two regions, which is the reason the current study's JI value is the lowest.

Table 3 Jaccard Index data for medicinal plants

This study reports 22 medicinal plants that are new or rarely documented in ethnomedicinal literature: Aconogonon alpinum, Actaea spicata, Angelica archangelica, Asparagus racemosus, Berberis jaeschkeana, Bupleurum longicaule, Chaerophyllum villosum, Clematis napaulensis, Corylus colurna, Diplazium maximum, Gentiana alii, Herminium edgeworthii, Lindelofia longiflora, Polygonatum multiflorum, Potentilla atrosanguinea, Rhodiola fastigiata, Salvia hians, Selinum vaginatum, Taraxacum tibetanum, Taraxacum laevigatum, Viola biflora, and Valeriana himalayana. This research discovered new ethnomedicinal uses of plants, i.e. the flower and rhizome of Aconitum chasmanthum for treating asthma in humans and mukhar in animals, the aerial part of Aconogonon alpinum for leucorrhoea, Actaea spicata as an anti-lice, roots of Alcea rosea for urination problems (red urine), roots of Angelica archangelica for wound healing, Asparagus racemosus for fever, Berberis jaeschkeana for cancer, bleeding, and vertebral column pain, Bupleurum longicaule for headache, Chaerophyllum villosum for typhoid fever and skin problems, Clematis napaulensis for fever, Corylus colurna for jaundice, Diplazium maximum for body pain, Gentiana alii for Leucorrhoea, Herminium edgeworthii for diabetes, Geranium caespitosum for gynae problems, Gentiana kurroo for blood purification, Lindelofia longiflora for female disorders, Polygonatum multiflorum for cough and headache, Potentilla atrosanguinea for stomach, Rhodiola fastigiate for stomach, Salvia hians for eye diseases, Selinum vaginatum for cold, Taraxacum tibetanum for diabetes, Taraxacum laevigatum for joint pain, Valeriana himalayana for fever and headache, and Viola biflora for malaria.

Threats to medicinal plants

The indigenous communities in the mountainous areas of Kashmir rely on domesticated animals, agriculture, and natural resources for their livelihood. Due to remoteness and limited job opportunities, local communities rely on natural resources to sustain their lives at higher elevations. The majority of the aforementioned communities are involved in numerous activities, including deforestation, illegal wood smuggling, and the extraction of medicinal herbs and fungi (Morchella esculenta) as their main source of income. Unfortunately, over 50% of populations collect medicinal plants to sell to local herb sellers, resulting in the overexploitation of these medicinal plants and subsequently leading to the extinction of endemic medicinal plants. Numerous factors, such as natural disasters like avalanches and soil erosion, as well as anthropogenic activities like deforestation, urbanisation, forest fires, and overgrazing, are significant contributors to the decline of medicinal plants. To prevent these alarming trends, relevant authorities must implement effective conservation measures to ensure sustainable utilisation and protection of these important medicinal plants. Furthermore, the government, academic institutions, and the Forest Department's work to raise awareness about the importance, conservation, and cultivation of medicinal plants among the local community might serve as an important factor in restoring the declining numbers of these invaluable plants. These initiatives are anticipated to enhance the region's sustainability while simultaneously providing the foundation for its socio-economic development.

Ecological transition and sustainability of medicinal plants

Biodiversity in the mountains is ecologically valuable because it regulates the stability of soil and is essential for the functioning of ecosystems, as well as having substantial social, ethical, and aesthetic values. Mountains comprise approximately 25% of the world's terrestrial biodiversity and have a presence in 50% of the world's biodiversity hotspots [97]. However, anthropogenic activities have caused remarkable changes in ecosystems over the last few decades, resulting in an alarming decline in biodiversity. The maintenance of a healthy and sustainable ecosystem is significantly challenged by the alarming rate of change driven by the human race, which is exceptional in human history. The impacts of the global climate change scenario have exerted a profound impact on different countries all over the world, contributing to a variety of ecological transformations such as glacial melting, altered precipitation patterns, droughts, floods, and a significantly increased worldwide temperature. Due to the instability of ecological processes, biodiversity is lost and ecosystems are degraded.

The significant contribution of wild medicinal plants for the treatment of different ailments in indigenous communities is currently under threat. Mountainous ecosystems, where a majority of medicinal plants grow, are particularly vulnerable to the adverse impacts of climate change due to their confined geographical boundaries. However, urbanisation, immense population pressure, expansion of agricultural fields, overgrazing, deforestation, forest fires, and overexploitation pose an additional threat to wild medicinal plants. The aforementioned factors have substantially decreased the diversity of medicinal plants that are readily available in mountainous areas. The extraction of wild medicinal plant rhizomes, roots, and flowers by untrained local collectors has imposed enormous stress on their populations, leading to the extinction of many endangered and endemic taxa. This represents a significant threat to the availability of basic healthcare in remote regions that depend significantly on the healing properties of wild medicinal plants due to a lack of modern healthcare facilities.

In the context of climate change, ecological transition is a serious and debatable issue around the world, and policy makers are tasked with implementing effective strategies to protect against the increasing risk of extinction and ensure the uninterrupted availability of wild medicinal plants for local communities. As a consequence, immediate action is required to ensure the sustainable long-term utilisation and preservation of these valuable natural resources. There are 400 endemic species in Pakistan, and the northern and western higher elevations of Pakistan and Kashmir are home to 80 per cent of the country's endemic flowering plants [98]. Mountainous ecosystems are characterised by their rich biodiversity because they are home to a variety of protected areas and an extensive diversity of medicinal plants as well as animals. Due to the existence of endemic medicinal plants, the conservation of mountainous ecosystems is of utmost significance [99]. Hence, it is critically important that decision-makers give thoughtful consideration and then implement measures that prioritise the conservation and sustainable uses of these valuable resources, ensuring their availability for future generations.

The active participation of doctors in indigenous communities is one way to encourage the use of wild medicinal plants for basic healthcare. This comprises educating and promoting awareness among local communities and patients about the potential healing properties and health advantages of wild medicinal plants. Doctors who are familiar with the traditional usage of wild medicinal plants can be highly valuable in promoting their use in basic healthcare. They may guide their patients on how to properly and successfully include natural remedies in their treatment plans while urging them to consider these practices. However, doctors’ involvement in encouraging the therapeutic potential of medicinal plants incorporates the opportunity to have a significant impact on local populations by improving healthcare access and promoting sustainable utilisation of natural resources.

Importance of revitalising sustainable ethnomedicinal practices

In isolated mountainous areas, indigenous knowledge is disappearing or being replaced by non-native knowledge, which is a serious problem. Youth education is critical for the sustainable utilisation of local natural resources and the preservation of cultural heritage. Traditional knowledge is dwindling due to social changes and reliance on standardised plant elements, threatening the viability of local practises. Due to the availability of modern medication and modern agricultural methods, traditional ecological knowledge in mountainous areas is being lost. Due to the aforementioned problems, some of the medicinal plants are rare, and a few are overexploited. In the future, this could have a severe negative impact on basic healthcare practices. Numerous indigenous communities are losing traditional foraging practices as a result of socio-environmental changes. The majority of wild medicinal plants are commonly available, and LEK needs to be revitalised to foster the ecological transition. Ethnobotanical research documenting the disappearance of wild plant knowledge can be an invaluable tool to prepare for future challenges.

Ethnobiologists have historically emphasised the crucial need to revitalise the valuable traditional ethnomedicinal knowledge. Ethnobiologists demand the development of dynamic frameworks that not only revive these old traditional healthcare practises but also encourage their implementation through holistic educational approaches [100,