UMR 152 Pharmadev, Université de Toulouse, IRD, UPS, France.
Faculty of Medicine, University of Health Sciences, Phnom Penh, Cambodia.
J Ethnopharmacol. 2017 Apr 18;202:38-53. doi: 10.1016/j.jep.2017.03.002. Epub 2017 Mar 9.
Liver disorders are a major health problem in Cambodia, where some patients prefer to seek treatment from traditional healers. The aim of the study was to document the knowledge and practices of these healers in four Southern Cambodian provinces.
An ethnopharmacological survey was carried out from September 2015 to January 2016 in Cambodian urban and rural areas. Thirty-three Khmer traditional healers (KTH) were interviewed using a semi-structured questionnaire including socio-demographic data, healer's formation and their professional practice conditions, perception of liver diseases (types and causes of liver disorders, diagnostic methods and symptoms of liver problems), dietary recommendations given to patients, and herbal remedies used to treat them. For each medicinal plant mentioned in herbal remedies, the local name, part of the plant, mode of preparation and administration, and their properties, according to the healers, were recorded. The plants mentioned by the traditional therapists were collected and later identified by specialists.
Different types of liver disease are identified by the healers, and diagnosis was mostly based on reading medical records, and by observing the yellow discoloration of the skin and eyes. A total of 42 herbal remedies including 83 medicinal plants belonging to 40 families were mentioned for treating liver disorders. The most predominant families were Leguminosae and Poaceae. Among the plants reported, Cananga latifolia, Andrographis paniculata, Smilax aff. glabra, Gomphrena celosioides, Passiflora foetida and Physalis minima were the most cited species. A large part of the herbal remedies used were multi-ingredient recipes, and were prepared mainly by a decoction administered orally. Plants are combined in multi-ingredient recipes, and selected on the basis of their properties (trocheak, psah, somrap mé rok, ktchol) which originate from Khmer medical concepts. Most of the plants used by healers have a wide ethnobotanical use for liver disorders, and have been studied for their hepatoprotective activity and related activities on the liver.
In the diagnosis and treatment of liver diseases, KTH have incorporated biomedical concepts and new practices, which suggest that they could be defined as neotraditional healers. Medicinal plants constitute the core of traditional medicine practice by these healers, and these plants play a very important role in the health care of people with liver problems in Cambodia. Therefore, more attention should be paid to the integration of healers in national health care programs for the development of combined therapies. Furthermore, two plant species (i.e. Cananga latifolia and Willughbeia edulis) were found to be widely used for treating liver disorders in our survey, and should be studied for their pharmacological potential for liver problems.
肝脏疾病是柬埔寨的一个主要健康问题，一些患者更愿意寻求传统治疗师的治疗。本研究的目的是记录柬埔寨南部四个省份这些治疗师的知识和实践。
2015 年 9 月至 2016 年 1 月在柬埔寨城乡地区进行了民族药理学调查。采用半结构化问卷对 33 名高棉传统治疗师（KTH）进行了访谈，问卷包括社会人口统计学数据、治疗师的形成和他们的专业实践条件、对肝脏疾病的认识（肝脏疾病的类型和原因、诊断方法和肝脏问题的症状）、给患者的饮食建议以及用于治疗肝脏疾病的草药。对于草药中提到的每一种药用植物，根据治疗师的说法，记录了当地名称、植物部位、制备和给药方式以及它们的特性。传统治疗师提到的植物被收集起来，然后由专家鉴定。
治疗师确定了不同类型的肝脏疾病，诊断主要基于阅读病历和观察皮肤和眼睛发黄。总共提到了 42 种草药疗法，包括 40 个科的 83 种药用植物，用于治疗肝脏疾病。最主要的科是豆科和禾本科。在所报道的植物中，黄花夹竹桃、穿心莲、土甘草、千日红、百香果和小酸浆被引用最多。使用的大部分草药疗法都是多成分配方，主要通过口服汤剂制备。植物是根据其特性（trocheak、psah、somrapmé rok、ktchol）组合成多成分配方的，这些特性源自高棉医学概念。治疗师使用的大多数植物都广泛用于治疗肝脏疾病，并且已经研究了它们的保肝活性和与肝脏相关的活性。
在肝脏疾病的诊断和治疗中，KTH 已经融入了生物医学概念和新的实践，这表明他们可以被定义为新传统治疗师。药用植物构成了这些治疗师传统医学实践的核心，这些植物在柬埔寨肝脏问题患者的医疗保健中发挥着非常重要的作用。因此，应该更加关注治疗师在国家卫生保健计划中的整合，以开发联合疗法。此外，在我们的调查中发现两种植物（黄花夹竹桃和黄藤）被广泛用于治疗肝脏疾病，应该研究它们对肝脏问题的潜在药理作用。
