Plant Use in Ante- and PostpartumHealth Care in Lao PDR

Degree project in biology, 2007 Examensarbete i biologi 20 p, 2007Biology Education Centre and Department of Systematic Botany Uppsala UniversitySupervisors: Lars Björk and Hugo de Boer

Emma C. S. Lundh

Plant Use in Ante- and Postpartum Health Care in Lao PDR

Master of Science thesis by Emma C.S. Lundh

Under supervision of

Lars Björk & Hugo de Boer

Department of Systematic Botany Uppsala University, Sweden

September, 2007

ABSTRACT

An ethnobotanical study, combining systematic botany, pharmacology and anthropology was carried out December 2005 to Mars 2006 in Central and Northern Lao People’s Democratic Republic (PDR). The study documents the medicinal use of plants in an important and complicated passage of life, childbirth. Semi-structured interviews were conducted in five rural villages among four ethnic groups on the plants employed during the birth process as well as their associated beliefs. Fifty-four different plant species were found to treat 15 conditions occurring during pregnancy, birth and the postpartum stages. The most common uses of plants were to promote maternal health and postpartum recovery of strength, healing and contraction of uterus, and to promote lactation. Other common reports included reduce postpartum haemorrhage, alleviate postpartum abdominal pain and protect or cure the newborn from infections. An ethnobotanical plant collection including 93 genera in 59 families was made from species with medicinal uses in the five villages. In addition 18 species used in traditional steam saunas as a postpartum health procedure for lowland Lao in urban areas are presented and compared to the plants used in the villages.

As a result of the study six species used in postpartum health care, representing four Zingiberaceae genera (Zingiber, Amomum, Alpinia, Elettariopsis) as well as two common steam sauna species (Adenosma bracteosum and Cymbopogon nardus) were selected for Gas Chromatography combined with a Mass Spectrometry (GC-MS) analysis. Identified compounds are presented and their potential effects in comparison to western medicine are discussed.

Few studies have been made on plant use in ante-and postpartum health care. The knowledge of medicinal plants presented in this study may provide an important resource for improving maternal and infant health among upland and highland populations, as well as a rich source of further phytochemical, pharmacological and clinical studies on medicinally applied species in Lao PDR.

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PREFACE

In your hand you have the outcome of an ethnobotanical study performed in Lao People’s Democratic Republic (PDR) and financed as a Minor Field Study (MFS) by the Swedish International Development cooperation Agency (SIDA). For those who are not familiar with the word ethnobotany, it refers to the study of the interaction between people and plants, and covers a broad range of different fields and techniques. This study principally encompasses systematic botany, pharmacology and anthropology.

Performing an MFS in one of the poorest and least developed countries in the world is a great challenge. Except for the daily complications with language barriers, health, transport and equipment issues, it requires you to become acquainted with cultural worldviews that in many aspects collide with your own worldview, and it makes social skills as fundamental as academic skills.

I believe that a combined study of this kind would be favoured if performed in cooperation with specialists from the different fields and on a longer time-span. However, this is rarely the reality, and unfortunately impossible for a Master thesis project/MFS that is greatly restrained concerning the time aspect. Nevertheless, except for educational purposes, an ethnobotanical MFS can be of great value for the local people and for potential future research project.

The original aim for the study was to investigate the use of the plant family Zingiberaceae in local health care in rural villages in the National Biodiversity Conservation Area (NBCA) Nakai Nam-Theun (NNT). Pointed out as a biodiversity hotspot and the largest and most well preserved NBCA in Laos, we saw this as an exceptionally interesting area for the study. We also had the opportunity to cooperate with a Lao Ph.D. student, Mr Vichith Lamxay, who was doing research on Zingiberaceae genera. The villages situated in the NNT Conservation Area are highly dependent on Non Timber Forest Products (NTFPs) for survival. This also applies in health care where plants in the remote villages serve as medicine due to the inaccessibility or high cost of modern pharmaceuticals.

The project was interview based and it was essential to find a good interpreter, yet this was a difficult task. The most important quality of an interpreter is the accuracy of the information he/she relays, and it is difficult to know in beforehand. The project’s tight budget and the fact that we preferred a female interpreter complicated it further. A female interpreter was preferred as women in earlier studies have been noted to give different answers in the presence of men then those they give when they are alone or in presence of other women. It can also happen that a male interpreter relays different information than a female informant expresses and for example neglect, substitute or fill in answers during interviews in the belief that he has a greater knowledge. We also intended to interview men and women separately because knowledge, gathering and the use of the plants can differ greatly between the genders. Other consideration on working with interpreters is the time aspect, because more time-consuming interviews are tiring for the informants.

After two weeks research in the NNT Conservation Area our project took an abrupt turn. Our female interpreter could not longer assist us and we had to return to Vientiane capital in search of a new interpreter. In the mean time regulations concerning the access to the Nakai Nam-Theun NBCA were made more stringent and impeded us to return. We found ourselves forced to change the location of the project. Through contact with the aid organizations ADRA and GTZ we were able to arrange access to some interesting villages in northern Laos. The change of location also required us to change the focus of the study, from Zingiberaceae to a more general view of plants in health care and use during pregnancy, birth and convalescence. My choice of focus on plants connected with childbirth was partly because many of the Zingiberaceae species in Nakai Nam-Theun were used in postpartum health care, and the interesting subject had been given little attention in previous research. Unfortunately the change of focus and study area after our start in Nakai Nam-Theun

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caused some species mentioned from these villages to be classified as having an undefined postpartum use in this report.

Also included in the project were interviews performed with steam sauna owners. The idea of making steam sauna interviews arose after our visit to the villages in Nakai-Nam Theun NBCA. Our Swedish supervisor Lars Björk had in his earlier visit to Laos got in contact with a steam sauna manager in Vientiane interested in steam distillation for the production of oils that could substitute the fresh plant material for species not available all year around. Steam baths were found to be an important and common postpartum procedure in the villages visited in Nakai-Nam Theun NBCA. Due to the resemblance of steam sauna to steam bath I believed it also could play an important role in postpartum health care and be an interesting area of investigation. When the project later needed to change location and widen its focus from Zingiberaceae, including steam sauna interviews gave an interesting insight in the postpartum care for lowland Lao.

During the interviews the plants’ vernacular names were written in Swedish phonetics since it made it possible to re-read the names with greater accuracy. We chose not to further translate the Swedish phonetic to English because accuracy loss would be inevitable. All local plant names in this report are thus expressed in Swedish phonetics. Swedish contains three more vowels, å, ä and ö which are well represented by to the Lao letters Âx, Áx, Àx ó respectively, where x stand for a consonant. In English the Swedish å represent the sound of “a” in call, “o” in “fore” or “ou” in four. The Swedish “ä” is the sound of “a” in back, “ai” in fair or “e“ in best, and the “ö” represent the English “e” in her, the “u” in fur, or short “a” in about. The Swedish pronunciation of “j” resembles the English “y” in many words. However the Lao sound xõ does not exist in Swedish or English and is represented with the symbol ü in this report. It is a nasal sound that lies between the Swedish “u” and “y”. Further guidance in pronunciation of Swedish letters can be found on the web page for Stockholm school of economics (2007).

Finally I would like to comment that this ethnobotanical study followed the rules of the Convention on Biological Diversity (CBD) and aims to share experience and knowledge. Although a short study like this might give only limited possibilities, some basic ethnobotanical methods like making plant collections were introduced to the villagers and our interpreters. Voucher duplicates were deposited at the herbarium of the National University of Laos (NUOL). At NUOL some technical equipment was also introduced and left for educational purpose. The contacts established and the interchange of culture and language were also to be considered of great value.

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CONTENTS

ABSTRACT ...........................................................................................................................................................i

PREFACE.............................................................................................................................................................ii

ACRONYMS AND DEFINITION OF MEDICAL TERMS..................................................................vi

1. INTRODUCTION.........................................................................................................................................1 1.1 Ethnobotany........................................................................................................................... 1 1.2 Background ............................................................................................................................ 1 1.3 Objectives............................................................................................................................... 5 1.4 History and cultural believes of ethnic groups in Lao PDR ..................................................... 5

2. METHODS....................................................................................................................................................19 2.1 Field work ............................................................................................................................ 19 2.2 Steam sauna interviews ......................................................................................................... 22 2.3 Extraction of essential oil and chemical analysis.................................................................... 22

3. RESULTS........................................................................................................................................................23 3.1 Ban Kaoy and Ban Mak Feuang............................................................................................ 23 3.2 Lao Khao village................................................................................................................... 30 3.3 Ban Nam Vang ..................................................................................................................... 30 3.4 Ban Nam Lue ....................................................................................................................... 31 3.5 Steam sauna results ............................................................................................................... 33 3.6 Summary of results ............................................................................................................... 37 3.7 GC-MS results ...................................................................................................................... 38

4. DISCUSSION................................................................................................................................................41 4.1 Reflection upon some genera and species in APP health care................................................ 41 4.2 Steam sauna .......................................................................................................................... 43 4.3 Informants and gender specific knowledge ........................................................................... 44 4.4 Voucher collections .............................................................................................................. 44 4.5 GC-MS analysis .................................................................................................................... 44 4.6 Reflections on future medicinal plant use and research in Laos ............................................. 46

ACKNOWLEDGEMENTS ...........................................................................................................................47

REFERENCES..................................................................................................................................................48

APPENDICES

Appendix A – Translation of local plant words Appendix B – Plant family abbrevations Appendix C – Use and preparation of plant species in health care in Lao PDR Appendix D – List of species used in health care in Lao PDR, sorted by vernacular name Appendix E – Vernacular plant names in Lao PDR written in French phonetics

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ACRONYMS AND DEFINITION OF MEDICAL TERMS

Acronym Definition ADRA Adventist Development and Relief Agency APP Ante- and Postpartum COX Cyclogenase enzyme GC-MS Gas Chromatography combined with Mass Spectrometry GTZ Deutsche Gesellschaft für Technische Zusammenarbeit MFS Minor Field Study NBCA National Biodiversity Conservation Area NNT Nakai Nam-Theun NSAID Non-Steroid Anti-Inflammatory Drug NTFP Non Timber Forest Product NUOL National University of Laos PDR People’s Democratic Republic PPH Primary Postpartum Haemorrhage SIDA Swedish International Development cooperation Agency UPS Herbarium of Uppsala University UXO Unexploded Ordnance WHO World Health Organization Term Definition Primary Postpartum

Heamorrhage (PPH) Excessive vaginal bleeding (>500ml) within the first 24 hours after delivery.

Secondary Postpartum Heamorrhage

Excessive vaginal bleeding after the first 24 hours postpartum.

Uterine atony Uterus fails to contract properly after delivery. Prolapse (uterus) Displacement of the organ or structure from its normal position. The

uterus can drop into the vagina (first-degree prolapse) or be seen outside the vulva (third-degree prolapse).

Antepartum period The period before labour starts in pregnancy. Postpartum period See puerperium. Puerperium The period that elapses after the birth until the mother is again restored

to her ordinary health. It is generally regarded as lasting for 6 weeks. Postpartum abdominal

pains or afterpains Pains similar to but feebler than those of labour, occurring commonly in the two or three days following childbirth.

Lactagoge A substance that promote lactation. Abortifacient A drug or other agent used to cause abortion (terminate pregnancy).

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1. INTRODUCTION

1.1 Ethnobotany

The word ethnobotany refers to the study of the interaction between people and plants (Martin 2004). Interactions can take many forms. Plants can provide food, shelter, cloth, fuel and are for a large percentage of the world’s population the only preventives, cures and relief against disease and health problems. The medical use of plants has won great attention in literature, mainly in the search of new drugs, where ethnobotanical inquiry provides a valuable short-cut for locating biologically active compounds. Some examples of important pharmaceuticals derived from plants are aspirin, quinine, morphine and several HIV-blockers (Balandrin & Klocke 1985, Akerele 1993, Lewis & Elvin-Lewis 2003). Another motivation behind ethnobotanical research is to document knowledge that is threatened to disappear, and that may be of great value for future generations but are lost with the old practitioners/healers. Such study could be made for the purpose and aim of sharing experience and knowledge.

In general ethnoobotanical studies cover a broad range of different fields and techniques. This study principally encompasses systematic botany, pharmacology and anthropology. It examines the use of plants in one of the most important and complicated passage of life, childbirth. Included in this study is also the period of convalescence known as postpartum period or puerperium. The study is interview based and performed among five ethnic groups in the diverse country of Lao People’s Democratic Republic (PDR).

1.2 Background

1.2.1 Laos, geography and climate Lao PDR is a landlocked country in the heart of the Indochinese Peninsula in Southeast Asia (Fig. 1). In the land area of 236,800 km2, about the size of Great Britain, approximately six million people reside that representing a wide range of ethnic diversity (The World Factbook 2007). With a relative high forest cover and low population density compared to neighbouring countries (Wikramanayake et al. 2001), Lao PDR is a unique country and has been pointed out as one of the world’s global biodiversity hotspots (Conservation International 2007).

The climate of Laos is tropical to sub-tropical, with a pronounced wet and dry season. A wide variation in temperature and rainfall due to topography create a great number of forest habitats. The principal categories of forest formations are: Evergreen Mountain forest, Evergreen and Semi-Evergreen Lowland Forests, and Deciduous forests (Rundel 1999).

Human impact and exploitation of forest resources have accelerated dramatically in the past few decades (Rundel 1999). Forest cover was reduced from 70% of the total land area in the 1940s to 41% in 1999 (Southavilay & Castern 1999). Forest degradation is largely attributed to inappropriate forest management, uncontrolled logging, and changes in shifting cultivation methods due to increased population pressure. Other threats include road and dam construction, and also hunting and illegal trade in flora and fauna (Chanthirath 1999). In an effort to protect the dwindling forest resources 12.5 % of land area has been allocated as reserves, known as National Biodiversity Conservation Areas (NBCAs) (Berkmuller 1995). The largest of the NBCAs is Nakai-Nam Theun in the Annamite mountains bordering on Vietnam. For villages in the area Non-Timber Forest Products (NTFP) account for up to 80% of the cash income (Foppes & Ketphanh 1997, 2000; Robichaud et al. 2001).

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1.2.2 Ethnic Diversity The biodiversity of Lao PDR is matched only by its ethnic diversity. Administratively, the Lao people are divided into three major groups. Lao Loum (lowland Lao), account for 68% of the population and are mainly ethnic Lao and Thai groups living on the plains along the Mekong river. Lao Theung (upland Lao) comprises 22% of the population, essentially Mon-Khmer and Austroneisian groups that are living on the plateaus and middle slopes, and Lao Soung (mountain/highland Lao) that reside in the remote mountainous area and comprising 10% of the population. Lao Soung incorporates Tibeto-Burman and Hmong-Yao (Milloy & Payne 1997, Evans 1999, Douangsavanh et al. 2003). Within these three major groups the ethnic make-up is extremely diverse. Around 47 ethnic groups and numerous subgroups are recognized, differing in religious beliefs, custom, and language (Chazée 1999).

The diversity and isolation of the numerous ethnic groups in Laos have made the realization of true cultural and political unity difficult. Today Laos is one of the poorest countries in the world, with an ever-increasing gap between the comparably fast economically growing lowlands and the poorer highlands.

Fig. 1. Map of the Lao People’s Democratic Republic.

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1.2.3 History The territory of modern day Lao PDR has throughout history been the victim of foreign nation’s interest and wars. As a nation it won independence in 1953 after six decades of French rule and Japanese occupation during World War II, and a constitutional monarchy was established. A conflict though persisted in the country between the US-backed Royal Vientiane government and the communist Pathet Lao (Land of Lao). Amid continued internal fighting, Laos was drawn into the Vietnam War 1964 when the United States began bombing North Vietnamese forces operating inside Laos. The Pathet Lao finally seized power in 1975 (Stuart-Fox 1997). Lao PDR emerged from the war as the per capita most heavily bombed country in the world (Rumpf & Chagnon 2006). Still today unexploded ordnances (UXOs) constrain the amount of land available for agriculture and logging and cause affliction to the upland and highland people practising swidden agriculture (Bounthong et al. 2003, Douangsavanh et al. 2003).

After the war the country closed its border to outsiders, and it was almost impossible for Western academics to conduct research inside Laos. In the 1990s however the country came into economic crisis and started to open up to foreign aid and investors (Milloy & Payne 1997).

In Laos today the internal change quickens, pressure on natural resources and the influence of foreign culture and goods increases, along with agricultural regimes and resettlement of highland population (Evans 1999). It now becomes increasingly important to document the dynamics of culture and botanical knowledge before the invasion of exotic plants and western ideas diminish its identity.

1.2.4 Traditional Medicine It has been estimated by World Health Organization (WHO 2002) that 80% of the world’s population relies on traditional medicine (TM) to meet their daily health requirements. In Laos TM is widely used, and perceived as effective by a fairly large proportion of the population (Sydara et al. 2005). The reliance on TM is partly owing to the inaccessibility and high cost of modern pharmaceuticals and to inadequate health care facilities. The Laotian government encourages the use of medicinal plants and traditional medicine, particularly in rural areas where modern treatment is not affordable or regularly accessible (Libman et al. 2006).

Until recently, research on the important resource of medicinal plants has been limited and it appears, based on scrutiny of literature, that no ethnobotaical research has been carried out in Lao PDR focusing on the use of plants in ante- and postpartum (APP) health care. Although some literature comprises childbearing and birth among various ethnic groups these are purely anthropological and lack in-depth knowledge on the plant species connected to this vital process.

1.2.5 Childbirth Birth is a natural process that involves great physical stress and consequently can cause serious health complications. Most cultures of the world consider postpartum a period of transition and vulnerability, and more than one-half of all maternal deaths occur during this period. The definition of postpartum period in medical terms is typically 6 weeks after delivery of the infant. Postpartum haemorrhage is one of the most common causes of maternal mortality and morbidity worldwide and accounts for about 25% of maternal deaths. Nevertheless the rates vary greatly between and within countries and for some developing countries it doubles (Gilbert et al. 1987, Drife 1997, Tsu et al. 2004).

Other health consequences of pregnancy and childbirth are abdominal or perineal pain, infections, prolapse, fatigue, nausea, depression, and lactation complications (Goodburn et al. 1995, Kline et al. 1998, Ransjo-Arvidson et al. 1998, McGovern et al. 2006). Plants serve as preventives, cures or relief for these symptoms in many developing countries where access to modern health care facilities is inadequate and birth commonly takes place at home. In these countries plants are also important in

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family planning and have been shown to serve as fertility enhancers, abortifacient and contraceptives (Bourdy & Walter 1992, Jain et al. 2004, Ticktin & Dalle 2004).

1.2.6 Are plants and plant derivatives compatible to synthetic pharmaceuticals? To find out the most common health issues and their cures in western medicine an interview was conducted with Annicka Stridh, who is employed as a midwife at the Swedish hospital Falu Lasarett. She stated that the most common health issue during puerperium was abdominal pain due to contraction of uterus. Analgesics like paracetamol and NSAIDs (non-steroid anti-inflammatory drugs) were prescribed to alleviate this pain. NSAIDs inhibit cyclogenase enzymes (COXs) leading to a decrease in prostaglandin production, which reduces pain and also inflammation (Fox 1999). A literature search was done on plants and plant compounds used in traditional medicine to see if they may exhibit similar analgesic activity. In a study by McGaw et al. (1997) several plant extracts traditionally used to relieve pain and inflammation exhibited high inhibitory activity on prostaglandin synthesis. Psychotria (Rubiaceae), a common genus in Southeast Asia, has attracted a considerable amount of pharmacological investigation. Both extracts and compounds found in Psychotria species showed analgesic activity (Elisabetsky et al. 1995, Amador 1996, Both et al. 2002). Plants in the family Solanaceae also proved to contain numerous species with analgesic effects, for example Mandragora officinarum and Solanum melongena (Vohora et al. 1984, Markovits & Gilhar 1997, Lewis & Elvin-Lewis 2003). Some plant compounds have gained an important position in western medicine. One well-known analgesic in clinical practice is morphine derived from opium poppy, Papaver somniferum, a species widely used in traditional medicine against pain and stomach problems. Another known compound traditionally found in Salix spp. is salicin, the precursor of acetyl salicylic acid found in Aspirin (Vane & Botting 1992, Calixto et al. 2001, Lewis & Elvin-Lewis 2003).

Primary Postpartum Haemorrhage (PPH), defined as excessive bleeding within the first 24 h. after delivery, can be caused by uterine atony (the uterus fails to contract properly after delivery), retained placenta, inverted or ruptured uterus and genital tract tears. Uterine atony is the most important cause of PPH and in developing countries prolonged labour is one of the main risk factors. Secondary postpartum haemorrhage (haemorrhage after the first 24 h postpartum) is mainly caused by retained portions of placenta and infections (Drife 1997, Pelage et al.1998, 1999, Tsu et al. 2004). The pharmaceutical Syntocinon is given on a routine basis to women in Sweden before delivery. Syntocinon have shown to lower the incidents of postpartum haemorrhage. It contains a synthetic version of the naturally-occurring hormone oxytocin, released by the pituitary gland. Oxytocin causes the muscle of the uterus to contract and by that help start or continue labour and to control bleeding after delivery (A. Stridh, personal communication). A number of articles have been published on plants and plant extracts possessing an oxytocin-like effect. Piyachaturawat et al. (1985) examined the antifertility activity of Citrus hystrix, containing the essential oil menthol, and found that extracts form the species caused abortion and could hasten labour time in pregnant rats. Extracts form Melastoma candidum tested on guinea pigs also gave an increased contraction frequency of uterus (Chou & Liao 1982)

The use of plants as contraceptives and abortifacient may be difficult to investigate as these preparations are sometimes outlawed or cultures taboos, and informants are commonly reluctant to relay their knowledge. In the Hmong culture for example women’s most important task is to give birth and they are promoted to have more children than there mothers (Symonds 2004). Some examples on plants used in family planning are Mimosa pudica (Mimosaceae) and Mussaenda pubescens (Rubiaceae). A decoction of the widespread M. pudica is used traditionally as a contraceptive in Northeastern India and has shown by Valsala & Karpagaganapathy (2002) to alter the oestrous cycle in rats. Extracts of M. pubescens has also been tested on rats and exhibit significant effects on terminating early pregnancy (Qin & Xu 1998).

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Plant use during the childbirth and convalescence is important worldwide and refers to a large number of plants and substances, which further have a wide spectrum of biological properties beneficial in APP health care.

1.3 Objectives

The primary objective of the project was to document the medicinal use of plants during pregnancy, birth and puerperium, as well as some of the associated beliefs in Lao PDR.

The project included interviews and collection of botanical specimens in five rural villages in the Central and Northern Laos. In total fifteen informants from the ethnic groups Akha, Brou, Hmong and Lanten participated. The various groups’ history, cultural belief and language are presented in section 1.4.

Plant use in traditional steam saunas was also included as a postpartum health procedure for lowland Lao in urban areas. The steam sauna procedure, greatly resembling the steam bath practiced in the Brou villages, has been given surprisingly little attention in literature in spite of its’ importance in Lao health care.

Furthermore essential oils from selected species (Adenosma bracteosum, Alpinia cf. oblongifolia, Amomum cf. microcarpum, Cymbopogon nardus, Elettariopsis cf. and Zingiber sp.) were extracted and analyzed through Gas Chromatograph combined with Mass Spectrometer (GC-MS). The analyses were performed in Sweden and aimed to determine bioactive compounds in these species and indicate their potential effect in comparison to western medicine.

Collection of botanical specimens was carried out both with the purpose of identifying useful health care species and contributing to the currently limited knowledge on floral biodiversity in Lao PDR.

1.4 History and cultural believes of ethnic groups in Lao PDR

1.4.1 Hmong In Laos the Hmong can be divided into the Hmong Khao, or White Hmong and Hmong Lay, or Striped/Colored or Green Hmong (also commonly called Blue Hmong). Dialect divergences and minor variations in dress, traditions, handicraft and house arrangements mark the differences between these groups (Chazée 1999). They are further subdivided into clans and lineages, and marriages are arranged between members of different clans, or subclans. Slight variations in healing methods and taboos can exist between the clans. The extended family household constitutes the basic cultural and political unit. The oldest male has virtually unlimited authority over its members and he is responsible for settling disputes between family members and make the final decisions (Symonds 2004).

Hmong belong to the Miao-Yao language group of the Sino-Tibetan family (Ovensen 2004). Of the Lao Soung, the Hmong are clearly the most numerous. In 1995 they amounted to about 315.000 persons, or 6.9 percent of the population, while none of the other groups made up more than 0.8 percent (Lao Census 1995, Lemoine 2005).

History Hmong, means “free people”, and they have been seeking their freedom and independence throughout history. The exact origin of Hmong, or Miao/Yao speaking people, is unclear but they lived in the highlands of south-western China for centuries. The Chinese government attempts to subjugate and settle the Hmong led to periods of protracted conflicts, and in the nineteenth century many Hmong migrated to Laos, into Burma (Myanmar) and Vietnam, and eventually also to Thailand (Anderson 1993, Tapp et al. 2004). In their new homelands Hmong descendants, like their ancestors

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Fig. 2. Nam Vang, a Hmong village in Luang Namtha, Lao PDR. The houses are built directly on the ground and each has two doors, the entrance door and the spirit door.

settled in high altitudes and continued the practice of swidden agriculture and opium (Papaver somniferum) cultivation.

During the Vietnam War many Hmong were recruited and trained by the United States Central Intelligence Agency (CIA) to fight against the North Vietnamese forces and the communist Pathet Lao (Reineke 2001, Moua 2003). In 1975 when United States withdrew and further Lao came under communist regime thousands of Hmong (soldiers with their families) fled to Thailand fearing for their lives. Many of these Hmong were placed in refugee camps, and some were later resettled in Australia, Canada, France, French Guyana and the United States (Tapp 1986, 1988, Anderson 1993, Reineke 2001). The Hmong are still today struggling for their rights in Laos and challenged not only by resettlements and opium eradication but also by poor access to education, unemployment, and lack of land for cultivation.

Village structure Hmong villages can vary greatly in size, partly depending on land available for cultivation. There is no fence around the village and it does not have gates like Akha villages. The construction and the location of the house is important and often village-wide social event. Both the location of the village and houses within it are chosen with great care, as it is important that the site is acceptable to the ancestors. The houses are always built on the ground (Fig. 2), usually on a slope and in no straight line to each other, because the good spirits enter the house in a straight line and nothing must obstruct their path (Lewis & Lewis 1984). Every Hmong Khao house has two doors, one regular door for entering and leaving the house and one spirit door used during rituals like the naming ceremony when a child’s third spirit is called upon. The doors are never opposite to each other, and a spirit altar is on the wall facing the front door (Khao Toh, personal communication).

Gender and division of labour Gender roles are pronounced in the traditional Hmong family. Women are responsible for the domestic work including cleaning, feeding animals, cooking and childcare. Hunting animals is restricted to the men; women are only allowed to kill chickens. Both men and women work with slashing and burning the fields and harvesting of the rice (Moua 2003).

Patrilineality is the framework of Hmong society. Or as a Hmong man expressed in Tapp (1989): “The important part of a Hmong family is the men… Women are important, but women change…

Wives and daughters are like leaves and flowers, but men are the branches and trunk of the tree, always strong and never changing”. This is consistent with the idea that men make up the structure of the society on which all else is built. Hmong women conform to this view and give less prestige to themselves than to men. Symonds (2004) points out that both men and women, stress that “men are more important” and that “Hmong is maleness”. They believe that men have better judgment than women and men are both more intelligent and more capable. For that reason, men have the power to make formal and final decisions in most areas of Hmong society.

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Although women can become shamans, they are not allowed to participate in rituals like calling the souls of newborns or guide the dead back to the otherworld (land of darkness), feed ancestors at New Year or visit gravesites, as this concern the patriline. First in the afterlives the souls of men and women become equal, and in the next life the woman’s returning soul may be reborn in a male form, carry the patriline along and have a public voice (Symonds 2004).

Religious believes: The natural and supernatural world Hmong are animists and believe that the physical and spiritual worlds coexist. Spirits are involved in every aspect of their life. The wild spirits of the outside can cause trouble and sickness. These are the spirits of the forests, fields, rivers, hills, valleys, trees, rocks and even wind currents. The tame and cared for spirits are ancestor and households’ spirits that live inside and in the walls of the house (Livo & Cha 1991). They offer protection from the wild spirits of the outside, but can also cause illness or even death if they are not cared for and treated with honour and respect (Symonds 2004).

The Hmong believe that the body contains various souls, the number of souls can vary between different Hmong groups but the concept of souls and soul loss remains similar across groups. Three different types of souls are generally recognized. The first soul enters the body as soon as the bone structure starts to form and will always reside in the body, even after death it stays with the bones in the grave to guard them. The second soul is brought by the wind at the moment the child takes its first breath. It is unstable and easily frightened or stolen away by wild spirits. At death this soul makes the journey back to the land of darkness to join the ancestors, and is fed and remembered by its descendants. The last soul, the “returning vital soul” enters the body on the third day after birth during the name calling ceremony. It reincarnates or wanders between the land of darkness and light with the shifting stages between life and death in a never-ending cycle (Symonds 2004, Sperstad & Werner 2005).

Illness, Spiritual Healers and Shamans In Hmong culture; society, religion and medicine are connected and cannot be separated easily into categories. Beliefs and practices about childbearing, birth and childcare are closely inter-convened in

the cultural beliefs of the natural and supernatural world. In health care both worlds are important as illnesses are considered to be sent by the spirits, or a result of being out of balance. Both neglecting the good spirits of ancestors or of the household, as well as catching the attention of wild spirits can be reasons for illness. A person can also easily lose a soul if frightened by a loud noise, a fall, or an animal, which can lead to serious illness or death if it is not restored by a shaman (Symonds 2004).

Every village has at least one shaman. A Shaman is a man or a women that been chosen by the spirits, this often reveals in a long illness, which is cured only when the person consents to become a shaman. Each shaman has “teacher spirits”, whom he/she calls upon during trance when making the journey to the spiritual world (Fig. 3). Usually a shaman is consulted when the illness is very serious and cannot be cured by the soul calling rituals made by the family or by the sole use of medicinal plants (Plotnikoff et al. 2002, Sperstad & Werner 2005).

Fig. 3. A Shaman (sitting) making the journey to the spiritual world to negociate about a childs soul. Nam Vang village, Lao PDR.

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If specific restrictions are not respected it can impoverish health. For example if a woman does not follow a special diet and obey the restrictions in behaviour during the postpartum month she may experience physical problems like headaches, joint/back pain, excessive haemorrhage or a prolapsed uterus (Kao Tho, personal communication, Symonds 2004). Due to the vulnerable state after childbirth as well as during pregnancy it is also important to avoid streams and other bodies of water because of the presence of malevolent spirits (Tsia hua moa, personal communication).

Midwives Midwives are respected and known in the village for their knowledge about pregnancy and birth. They can deal with complications during birth like turning a breech baby to the right position and can recommend herbs for fertility and birth. A shaman might also assist if complications arise during birth, he will perform rituals seeking the answers for the complications in the spiritual world (Symonds 2004).

Fertility Fertility is important both to Hmong women and men, as it provides the opportunity of rebirth. Many children are appreciated as the infant-mortality rate is high and children are a good help in the fields. In addition children are needed to care for their parents when they get older and to make the funerary rites and feed their souls when they die and wander to the ancestors’ village. If a couple stays childless, the woman is often seen as the responsible for the couple’s inability to conceive. She can then seek help from an herbalist that possesses knowledge about fertility-enhancing herbs. Nevertheless the first child is believed to seal the marital union and if the wife remains childless the husband may seek divorce (Symonds 2004).

A Hmong woman’s power and value are located in the realm of reproduction and many Hmong women are reluctant to use any form of abortifacient or birth prevention. Preventing conception might deny a soul its opportunity for rebirth. Another reason why contraception is avoided is that a woman who expresses her wish of not having more children might fear that the husband take a junior wife. Women are also enjoined by their families to have as many children as possible. It is believed (but not taken very seriously today) that a women must give birth to more children than did her own mother or mother-in-law if she is to fulfil her destiny (Symonds 2004).

Sons are highly appreciated as they carry the clan name along, but a great value is also placed on having an equal number of sons and daughters because of the bride price a family receives in exchange for its daughters (Moua 2003).

Childbirth Birth consists of two parts, the actual physiological event, and the soul calling ceremony on the third day after birth, when the baby is given a name and its last soul enters the body. However before birth a number of preparations have to be done. A supply of chicken for the new mother has to be arranged, and herbs have to be picked to serve as pain relief and to make decoctions to wash the newborn. In Ban Nam Vang, a Hmong village included in this study the plant “Qaub dej” (Begonia handellii) was picked to relieve pain after delivery. The delivery took place in a sitting position where the husband normally was supporting the woman from behind. Present was also a midwife and one or two more women from the family. Tough this does not seem to be case for all Hmong. Symonds (2004) states in her study of a Hmong Lay village in Northern Thailand, that birth is a women’s issue handled only by the women. She says that most births take place alone and point out the importance of privacy.

On the husband responsibility lays recollecting and burying the infant’s birth shirt, or placenta. It has to be done with great care because the child’s health may suffer if insects or animals eat any of it. As in many South Asian cultures the placenta is believed to be collected when the person’s soul returns

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to the land of darkness. All other blood from the delivery also has to be buried with care as the mother and child risk getting sick if the wild spirits finds it (Symonds 2004).

The first three days after delivery is the most dangerous period for a newborn. During this time it is of highest importance that the mother and child are kept warm and a bed is made up next to the fire (Rice 2000, Symonds 2004). The mother should also shower in warm water and eat warm food and drinks up to 30 days after birth. The concept of hot and cold foods and body temperatures connected with a woman’s postpartum vulnerability has been documented for many Southeast Asian countries (Manderson & Mathews 1981, Steinberg 1996, Symonds 2004). It is believed that the woman is in a cold and weak stage after giving birth. In order to return her body to balance and regain strength and weight she eats a special postpartum diet, usually a combination of herbal teas, boiled chicken with herbs, rice and eggs (Potter & Whiren 1982, Lewis & Lewis 1984, Symonds 2004).

Chicken is believed to be an excellent food in many South Asian countries, and promotes the recovery of heat and strength. According to the informants in both Nam Vang (Hmong) and Nam Lue (Lanten) village, and also mentioned in Hmong folktales (due to a bargain struck between men and women about who would give birth) one chicken should be slaughtered and prepared by the husband every day during one month. However due to food shortage, nowadays one chicken usually has to last for 2-3 days (Laolee and Kao tho, personal communication). In Nam Vang village the shaman Tsia hua moa reported a number of recipes of chicken boiled with curative herbs to recover health and strength postpartum. Symonds (2004) reports that herbs are boiled with the chicken to remove any residues of stale blood from the body and cleanse the uterus. From the third day after delivery and for a month a decoction of Schizomussaenda dehiscens (Rubiaceae) is also drunk by the mother to promote lactation and quick recovery of strength (Kao tho, personal communication). During this resting period the mother is not permitted to visit other households as her state may harm other people. Warning signs made from bamboo are put up outside the house to warn people that are ill, as well as pregnant women not to enter, because they can diminish a new mother’s milk supply (Lewis & Lewis 1984, Symonds 2004). After one month the woman can usually start to do work in the field and resume sleeping together with her husband (Kha tho, personal communication).

1.4.2 Akha

History In Lao PDR the Akha (also named Kho, Ikor and Kha) live along the Chinese border, and are the second largest Lao Soung after the Hmong (Fig. 4). Akha originated from the Yunnan and the Tibetan region. They have migrated through Burma to their current position in Northeast Laos, Northern Thailand and Vietnam. The Akha first entered Laos in the 1850s, but the majority came from Yunnan and Burma in the 1900s (Lewis & Lewis 1984, Chazée 1999). Akha represent with a population of approximately 66,000 about 50% of the Tibeto-Burman family in Laos (Lao Census 1995), the majority is living in Phongsaly and Luang Namtha provinces.

The Akha language falls within the Yi (Lolo) branch of the Tibeto-Burman family, and is only a spoken language, lacking written characters. This makes research on their history and origins difficult. The period of emergence of the Akha as an ethnic group occurred over 55 generations Fig. 4. Akha woman in Lao Khao village, Sing

district, Lao PDR.

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ago according to the elder of Akha villages in Long district, Luang Namtha province (Chazée 1999).

Although no written history exists, a rich heritage of legends, proverbs, and rituals, verbally transmitted through the generations gives the Akha a sense to who they are and what being an Akha means. Their strong concerns about continuity and ancestral beliefs make them able to recite the names of all ancestors in the male line back to the “beginning”, including more than 60 names, and astonishingly the Akha from China, Burma, Thailand and Laos agree in their repetition of genealogy and migration routs (Lewis & Lewis 1984).

The Akha explain the last part of their migration to Laos as a retreat to escape from political rebellions and Chinese bandits who stole their livestock and pillaged the village. Laos also offered abundant natural resources and had favourable land for shifting cultivation (Chazée 1999).

The Akha Way Akha often refers to themselves as those who “carry the Akha Way” (Aka zah taw-eu). The Akha Way includes their beliefs, traditions and ceremonies. It determines how they cultivate their fields and hunt animals, and also how they view and treat illness (Lewis & Lewis 1984). Rice cultivation, preparation and consumption are given special attention in the Akha Way, and a number of ceremonies are connected to it. Akha believe that by diligently following the Akha Way they will maintain good health and have good luck in life as well as behaving in contradiction to the Akha Way will bring sickness and death to the family. Great respect is shown to the ancestors, through offerings at the ancestral altar, this keeps the ancestor happy and in turn they care for the family by providing abundant rice, wealth and good health (Lewis & Lewis 1984).

Spirits and Souls Although formal aspects of the Akha Way are based primarily on the Akha relationship with the ancestors, in everyday life, perhaps more than among any other ethnic groups in Laos, they are constantly concerned about spirits. Spirit affliction can cause serious illness and need a traditional healer or shaman to be summoned and usually a ceremony to be held. The most harmful kind of spirits are those who possess people and can cause epilepsy or death if not driven out by punching the body of the victim with a fang of a wild animal (Lewis & Lewis 1984). Nevertheless not all spirits are harmful, the sun and the moon spirit that according to the Akha legend are husband and wife, are two great powers that can be asked to cure the sick person during healing ceremonies. Other spirits asked for help are the owner spirits, which are in charge of the fields, the livestock, and the people themselves (Anderson 1993).

According to Chazée 1999 each person has three souls. Soul loss as well as spirit affliction can cause illness. Symptoms of soul loss are depression, sense of lassitude, weakness, lack of apatite and all-over aches. Treatments for ordinary ailments such as wounds and cuts, aches or stomach problems are somewhat more common knowledge and a number of herbal cures are passed on from parents to their children.

The village The Akha traditionally prefer to locate their villages over 800 meters altitude and up to 1500 meters. Through the last decade districts authorities have encouraged the Akha to cultivate the lowland and many villages in the province of Luang Namtha are today situated between 400 to 600 meters (Chazeé 1999).

The Akha village is represented by an administrative chief or headmen elected by the family elders and approved by the district. In addition to the village chief/headmen, the community is guided by religious leader and an ethnic representative, whose title is hereditary. Although the headman is generally the political leader, the village religious leader is usually more powerful. He is responsible for the sacred sites in and around the village; he performs the most important ceremonies and makes

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sure that “the Akha way” is well respected. His knowledge will be passed on to his eldest son. An Akha village also has its own traditional healers, which can be both male and female, and whom contact the spirits during healing ceremonies at the family level (Lewis & Lewis 1984).

The village site is chosen at a location on the saddleback of a mountain where there is a good breeze, a dependable source of drinking water, and adequate arable land in the surrounding area. Trials with rice grains and egg drops are further made to see if the ancestor spirits and Apoe Miyeh, the creator of first being, are approving the site for settlement (Lewis & Lewis 1984). The traditional house is built on stilts, and usually a number of small huts or meeting houses are constructed for the young in the village “courting” area. The village is entered and left through the village gates. These gates protect the village from the wild spirits of the jungle, as well as dangerous wild animals, illnesses and plagues (Chazeé 1999).

Family organisation The Akha household is ruled by the eldest male member, and the Akha society consists of patrilineal clans (Jaafar & Walker 1975). Polygamy can occur, but is not common. The elder son, according to the tradition, remains in the parents´ house to help them. The transmission of the Akha history, their origin and customs are particularly transmitted from the father to the elder son (Chazée 1999).

Pre-Natal precautions When an Akha woman becomes pregnant she alters her lifestyle to follow a number of taboos and restrictions. Some of the taboos include her diet, as a pregnant women she should not eat white buffalo, duck or wild pig and certain vegetables (Laser, personal communication). According to Yeha, an informant from Lao Khao village, snake should be avoided during pregnancy or after the woman had her first child, as well as the husband should avoid killing snakes because these actions might cause the child to resemble a snake. Other taboos, common in Southeast Asia, are the cutting and tying of knots as this might magically endanger delivery later on. During the pregnancy period it is also usually forbidden to speak of pregnancy, as the spirits may easily take the child away if something inappropriate is said (Goodman 1996).

During the study and our walks around Lao Khao village we noticed a number of holes dug in the ground (Fig. 5). We asked what animal had made these and got the answer that these were dug by the villagers themselves, as eating clay soil, especially for women is good for health. Laser, one of our informants in the village, said “It is good to eat when you feel weak; it makes you strong and brings

you good health”. Where to dig for the soil has to be asked the spirit/ghosts and a person in contact with the spirits does this. Both during pregnancy and after childbirth eating clay soil promotes health, but the place you dig it from might have to be different depending on the spirits.

In the past pregnant women were encouraged to work right up to the time of delivery, but the baby was often weak and sometimes born in the field. Nowadays the women rest during the last month of pregnancy. Delivery may take place in a hospital but still it is more common to give birth at home. In case women have a difficult or prolonged delivery, magic rites are performed by the village shaman (Yeha, personal communication).

Fig. 5. Clay soil has been dug out and eaten by Akha women who believe that it promotes good health, Lao Khao village, Lao PDR. In picture also Soyae, local interpreter.

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A child is born The newborn must not be picked up until it has cried three times. These cries are to Apoe Miyeh, begging him for a blessing, a soul and a long life (Lewis & Lewis 1984). Then the baby is picked up and given a name usually by the mother-in-law or grandparents. Even if this name only is temporary it protects the child against wild spirits/ghosts that otherwise can assume that the child is unwanted and take its soul away (Laser, personal communication). The formal name, linked to the father’s, is given during the naming ceremony that takes place when it is evident that the baby is healthy and will survive (Lewis & Lewis 1984). The umbilical cord is buried with great care under the house. Other customs and ceremonies are performed to ensure the baby’s link with the parents’ spirits and the house spirit (Chazée 1999).

During the post-natal period certain food are forbidden, like pig, white buffalo, fish and certain vegetables, varying between villages (Lewis & Lewis 1984, Chazeé 1999). In Lao Khao village the post-natal diet is restricted to rice and salt for the first week, except for the ceremonial chicken and egg that are prepared and eaten the day of birth. The second week it is acceptable to eat vegetables and chicken and the third week also pig and fish (Yeha & Soyae, personal communication).

The mother rests indoors for one week after delivery. During this time she shall avoid drinking cold water as it impoverishes her health and can make her sick. A decoction made from the root of “Kö-sö” is drunk instead of water to promote healing of the mother inside after given birth (Laser, personal communication). It also increases appetite, which in turn promotes recovery of strength and health (Yeha, personal communication). A bed made from a carpet and covered with fresh herbs is arranged for the mother close to the fire. The fire ensures that she keeps warm and the herbs promote healing of uterus and prevent postpartum haemorrhage. The woman should rest for 1-2 weeks before she can do easier housework. After approximate 2 month she can start working in the fields, and the childcare is divided between the husband and wife, and older sisters and brothers. It takes 2-5 month before she will regain sleeping with her husband (Laser, Yeha & Soyae, personal communication)

The child is normally breastfed until the next baby comes. In the past the girls married young and had many children. Up to about two generations ago giving birth to 10 or more children was not uncommon, but nowadays only 4-5 children are desirable and marriage take place around the age of 18 (Laser, Yeha & Soyae, personal communication).

Unusual birth Giving birth to twins or a deformed child (harelip, too many fingers or webbed fingers) was considered the worst thing that could happen to the family and a tragedy for the Akha village as a whole. Such children were commonly killed and the parents had to leave the village in absolut poverty, their house and belonings were burned. However due to the government’s effort and outside interference these actions of the Akha Way are uncommon today, and may only exist in isolated villages (Chazeé 1999).

1.4.3 Lanten

History Lanten, like the Hmong belong to the Miao-Yao speaking family. Only two subgroups of the Yao live in Laos, the Mien and Lanten (also called Lao Huay). These groups are closely related in history and seem to have migrated from southern China to Vietnam, where some communities are still settled today. They further entered Laos in the early twentieth century and established themselves in the provinces of Luang Namtha, Phongsali, Udomsai and Bokeo (Chazée 1999, Schliesinger 2003a) (Fig. 1).

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The Chinese origin can be found in their traditions, beliefs and calendar. Before 1975 Mien and Lanten occupied the same regions and though both groups speak their own dialect today, they can understand each other quite easily. Lanten is the smaller subgroup of Yao and make up around 20% of the Yao population in Laos. According to Chazée (1999) around 4500 Lanten resided in Laos 1995.

Society and religion Lanten, like the Hmong society is strongly patriarchal in its organization. The husband is the commander of the family. Membership of the clan is inherited patrilineally for life, and all members

are considered descendants from a common ancestor. The children belong to the father’s lineage and even adopted children from other ethnic groups are integrated into the household head’s linage (Chazée 1999).

The Lanten practice an ancient form of Taoism combined with the beliefs in spirits and ancestor worship. They recognize an array of spirits that can either provide protection or cause illness. Worshipped spirits in the Lanten society are the village-, house-, family- and father spirit; other important spirits are those of the natural surroundings, the sky-, forest-, land-, water- and big fig tree spirit (Chazée 1999, Schliesinger 2003a). Lanten villages can have several shamans. They connect to the ancestral and village spirits during rituals and ceremonies.

Lanten have strong believes and willingness to preserve their ethnic identity. Men and women still wear traditional clothes made of home woven indigo-dyed cotton, from which also their name Lanten, or more correctly Làn Tien comes, meaning people wearing blue (Fig. 7).

Souls and soul loss The Lanten believe that each individual possesses several souls; generally the woman has twenty-four souls, and the man twenty-three. If one of the souls parts from the body the person falls ill and a family healing ceremony should be organized to catch the erring soul. The loss of souls can be caused by a number of reasons and in case of serious illness the intervention of a healer or shaman is needed.

A healer learns healing rituals by inheritance from the elders, whereas a shaman is appointed by calling from the spirits. In the most complicated cases, like those related to the father, mother or ancestral spirits, extensive ceremonies are held. These include animal sacrifices and courier dispatches on bamboo paper to the spirits (Schliesinger 2003a).

Language and Script Lanten have their own spoken language and unlike the Hmong have “preserved” the tradition of writing with Chinese characters. Documents and ancient books written on handmade bamboo paper can be found in Lanten villages (Fig. 8). These books concern ancestors, marriage and healing methods, and are consulted during ceremonies. However, the culture and beliefs preserved in these documents are threatened, both due to village’s fires and the lack of knowledge about Chinese characters in the younger generations (Chazée 1999).

Fig. 7. Lanten woman wearing traditional clothes, Ban Nam Lue, Luang Namtha, Lao PDR.

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Village structure Lanten villages are generally situated in a valley along a river. Villages were traditionally located in mountain valleys between 700-1000 meters altitude. However nowadays many villages settle in the lowland, as the presence of water and availability of land for paddy cultivation are the most important concerns. The river is used for domestic needs, production of bamboo paper, fishing and cultivation of vegetables and corn on the riverbanks. A village ritualist who first ensures that the forest spirit is well disposed to leave the chosen site decides the settlement. Wood and bamboo houses are built on the ground in no defined arrangement (Chazée 1999).

Cultivation The traditional Lanten production system relies on shifting cultivation (of ordinary rice and corn), small livestock husbandry, hunting, gathering, weaving and production of bamboo paper. Lantén as Hmong and Akha are well-known for cultivating opium poppy. Maize and poppies are often grown together in the same field. Rice as their staple crop is grown separately. They also commonly grow vegetables, cotton, and tobacco (Chazée 1999).

Nam Lue, the village visited in this study base their production system mostly on irrigated paddy production and small and big livestock. Weaving and bamboo paper production are other income bringing activities (Fig. 9). Many villages have not had access to lowland and are thus forced to continue the swidden farming system but in a restricted territory as authorized by the district. Depletion of soil due to short fallow cycles cause low productivity and for many families does not allow food self-sufficiency anymore. Hunting and gathering, seasonal agricultural work in lowland villages, woodcutting, sale of fuel wood or employment in Namtha town replaces the loss of land for cultivation. Poverty and increasing insecurity for the future tends to increase the opium addiction, which in turn adds to poverty in a bad circle (Chazée 1999).

Birth Women have no other food restrictions than goat and monkey during pregnancy and normally work up until delivery. When labour pains start the plant ”Gom dam ma” is crushed with water and poored on the woman’s head. As the water goes done the woman’s neck and back it is believed to facilitate birth. Birth often takes place in the house in a squatting position. In complicated cases a midwife is called for, otherwise only the husband is present to help (Laolee, personal communication). After delivery the mother and child rest together for three days. During this time only the husband is allowed to visit them. The husband washes the clothes and helps with the cooking for his wife. Special cooking gear is used for the mother the first 30 days, as she is not

Fig. 8. Three hundred year old “bible” related to ancestors, written in Chinese characters on bamboo paper, Nam Lue village, Lao PDR.

Fig. 9. Bamboo paper is made locally in Lanten villages and used for writing down family records, rituals and treatments of illnesses. The production takes place October to February, and the excess is sold. Bamboo fibres have to be crushed and macerated in the stream in anaerobic conditions up to 30 days before a mass of paper can be obtained and spread out to dry in the sun.

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allowed to eat chili or spicy food (Laolee, personal communication). Ginger (Zingiber officinale) is however recommended as it will promote internal healing and is good for the stomach. Unlike the Brou, Hmong, and Akha, no special bed is made up for the new mother close to the fire.

Three days after delivery the women can leave the bedroom. Ten days after parturition she can do easier work and after 15 days she can start working in the field. Tea is made from the leaves of “Ma tjaj” (Gonocaryum sp.) and drunk from the 3rd day after delivery and for one month. It promotes the internal healing and makes the child healthy and strong. The tea is drunk warm as consumption of cold drinks and foods prevents the healing inside. Chicken are considered to be good postpartum food and eaten during the first month. If chicken is not available one type of river fish named “Plaa khen”, male pigs and male bats can be eaten. Not respecting the food restrictions can have serious consequences. It can cause diarrhea, paralysis, and if the woman is weak it might lead to death (Laolee, personal communication).

Three days after delivery a ceremony is held for the mother and newborn to protect them from bad spirits and to ensure the link between the child and the ancestors. A pig is sacrificed and the ancient scripts are consulted. If a boy was born, as preferred, the ceremony will be bigger than if a girl was born (Laolee, personal communication).

The time of sexual abstinence seems to vary, according to Laolee, Nam Lue village, sexual abstinence is observed 10-15 days after delivery. However Chazée (1999) states that two months of sexual abstinence must be observed after given birth. Contraception is asked for in the hospital today and number of preferred children is much lower than past times, when having more than 10 children was not unusual (Laolee, personal communication).

1.4.4 Brou

History In the Nakai Nam Theun NBCA (Khammoune province) 50% of the inhabitants belong to the ethnic group Brou. Brou is included in the Austroasiatic linguistic family (IUCN 1999). Although Brou are mainly established in Laos and Vietnam representatives from the Austroasiatic family are

settled in the whole Southeast Asia. It is the family with the greatest diversity of the four main linguistic families, and is represented by the Mon-Khmer language group in Laos. About 9 percent of the total Austroasiatic population is Makong, and in Laos, Brou is often included in the Makong group due to the Lao government definition of the Makong in 1995 (Chazée 1999). The validity of this grouping is however disputed and many consider, as the Brou people themselves, that they should be regarded as an independent group (Schliesinger 2003b). There is no actual record of the number of Brou in Laos but the total population of the Makong group (including Bru, Van-Kieu, Leun, Khua, So, and Kaleung) was 92,000 in 1995 (Lao census 1995).

The Brou are believed to originate from Quang Tri province of central Vietnam where they migrated in to the west of Laos, and further settled southward in Savannakhet and Khammoune provinces. The absence of writing traditions makes it difficult to determine their exact origin. Chazée (1999) states that different texts mention that they were victims of the slave market in Vietnam until the 1880s.

Fig.10. Brou women in Ban Mak Feuang, Lao PDR.

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Brou in Laos have generally little sense of ethnic unity and very little ethnic or village socio-political organisation. They are vulnerable to acculturation as they easy assimilate their customs to the lowlanders (Chazée 1999). They have suffered a loss of religious traditions and traditional cloth as well as adapted the language, habitat and system of the neighbouring Lao, Lue, Phouane and Thi Deng (Schliesinger 2003b). Nowadays in Nakai-Nam Theun most people, especially men speak Lao as well as Brou, and wear Lao type of cloths (Fig. 10).

Village life Brou commonly occupy land from 300 to 800 meters altitude. They like to put their village close to streams or rivers in mountainous forest. Their houses are built on strong wooden stilts and often have a small, uncovered porch where housework is done (Fig. 11). Brou are essentially swidden cultivators of glutinous rice (Fig. 12), but use relatively advanced wet rice cultivation in the lowland areas. Brou’s low demographic density is a condition of their survival on shifting cultivation as it requires a fare amount of suitable land. Except for glutinous rice, significant amounts of cassava, maize and a variety of other crops are also cultivated in the swiddens. They raise buffaloes and cattle, and also pigs, chickens, dogs and goats (Schliesinger 2003b). Hunting, fishing and gathering are also essential for the subsistence of many families. In Mak Feuang village (NNT Conservation Area) it was observed that agriculture and livestock production are insufficient to meet dietary needs. In 1996-1998 the village suffered significant food shortage. Further regulations and restrictions of trapping and hunting wild animals in the area have made the villagers lives even more difficult, and many families are dependent on NTFPs (IUCN 1999). NTFPs provide construction materials, food and medicine, and thus play an essential role in supporting households and making up for any shortfalls in production.

Religion Animism mixed sometimes with shamanism characterizes the religion of these minorities, although some communities have been converted to Buddhism or Catholicism. Differing from the animism of Miao-Yao and Tibeto-Burman, the animism of the Austroasiatic living in Laos is not as strongly linked to the cult of the ancestors and the lineage. Therefore there is no longer any strong spiritual link to continuity in the knowledge of the family, ethnic history, and descendants. There is no great ceremonial obligation and conservation of inheritance anymore. There still exist a spirit of ancestors, sometimes the spirits of the father and mother, but their role is much more passive then that of the spirits of Miao-Yao and Tibeto-Burman families (Chazée 1999).

Fig. 11. Brou house, Nakai-Nam Theun NBCA, Lao PDR. Photo taken by Vichith Lamxay.

Fig.12. Upland rice is being threshed by hand by young girls in Ban Kaoy, Khammoune province, Lao PDR.

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Childbirth

Marriage occurs at early age, around 14-15 and many women use contraceptives to limit the number of children. Normally childbirth takes place in the home, with the help of a village midwife. After giving birth it is important to stay warm. A special bamboo bed, called Ka-seung is made for the mother to rest on close to the fire. This bed is elevated from the floor, which allows charcoal to be placed under it, usually on thick banana leaves covered with earth (Yan Pohn, personal communication). Fresh herbs like Bai-Nat (Blumea balsamifera) are commonly placed on the bed for promoting healing of the wound caused by parturition. Otherwise the way of sleeping is on bamboo mats directly on the floor. The resting period lasts for at least 10-15 days. It used to be a month but has reduced the last decades due to elevated work load and shortage of food. Nevertheless a woman who gives birth for the first time might be allowed a longer resting period. It may also depend on the season, as the hot season require less time close to the fire (Chan Hom, Khaet, Long Maet and Peo, personal communication).

The woman does not follow any special diet during pregnancy but alcohol and some medication are avoided. After parturition cold drinks are avoided as they can cause excess of bleeding. Instead a tea made form Gok van tjoth (Psychotria asiatica) is drunk. It helps the contraction of uterus. A diet of rice, salt, and a special type of fish called “Plaa chat” or “Plaa khan” (recognized by its green tail fin), black chicken and vegetable is followed in Ban Mak Feunag (Chan Hom, Khaet and Yan Pohn, personal communication). However in the village Kaoy (NNT Conservation Area) only rice, salt and some vegetables were allowed the first 15 days, during the resting period, and first after that black chicken and wild pigs could be consumed. The diet after the first born child rules the diet during following childbirths. Some do avoid chicken because they fear it will cause excessive haemorrhage, if they do so after the first born then chicken can not be eaten after the following deliveries either (Yan Pohn, personal communication). Eating pig make the uterus stretch and become longer and eating other unsuitable food may cause dizziness, blindness or lack of milk for the baby (Chan Hom, Khaet, Maet and Peo, personal communication).

1.4.5 Challenges and changes for the ethnic groups The ethnic groups presented in this study are greatly affected by the fast internal changes in Laos. Due to population growth the pressure on natural resources has increased and brought along changes affecting the customs and lives of the highland and upland populations. Maybe the main challenges are the new forestry and agricultural policies together with governmental resettlement regimes, causing for many families an abrupt change from extensive slash and burn practise, and opium cultivation to a life oriented to the plain and the road.

Opium cultivation Hmong and Akha, as well as Lanten are well known for cultivating opium poppy (Papaver somniferum). Opium cultivation was first integrated to their culture by the Chinese in the 18th century. Traditionally opium was used for its medical properties, and although it still today is used to relive pain and cramps, and for stomach problems like diarrhoea, the high rate of addiction in many Hmong and Akha villages is of great concern. Addicted people often become a burden to the family both economically and in terms of labour due to addicts reduced time and energy to perform the daily work (Tapp 1986, Cohen 2000, Cohen & Lyttleton 2002).

Opium has been an important life-sustaining crop for many mountain populations in Laos. It grows well in the highland soils of low fertility, and the gathered sap can easily be stored for a long time and sold for a higher price per weight unit than anything else (Tapp 1986). Laos was the world’s third largest producer of opium and in the past officials in Laos collected taxes in form of opium. Nevertheless today a number of opium eradication programs have managed to drastically decrease the cultivation of opium (UNODC 2004).

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Swidden agriculture Shifting cultivation is the traditional means of production, but is possible only when sizeable forestland, suitable for cultivation is available (Fig. 13). Annually each family uses about 1.2 hectare of land. Each cleared area of land can be cultivated 1-3 years and will be left as bush or secondary forest fallow for about 7-10 years (Chazée 1999, IUCN 1999). Although not very productive this

system was well adapted to the upland life as long as the natural resources were sufficient and the demographic density remained low. However demographic growth and policy of forest protection has greatly restricted the access to swidden territories.

The main staple crops of the highland system are glutinous rice, poppy, cotton and corn. Besides from the staple crops additional foods are drawn from the forest through gathering and hunting activities. The village site was traditionally selected for the availability and quality of the surrounding territories suitable to sustain this farming pattern as well as validity according to the cultural and religious concerns. Today when communities are moving, at the request of the local authorities, near to a road or into lowland areas the traditional and religious conditions of settlement are rarely considered. As more villages settle in the lowland the production systems evolve in the direction of settled agriculture, and rural activities are more and more directed towards the demands of the market (Chazeé 1999).

Resettlements More recently many Hmong communities, as well as other highland people, have been forced to settle in lowland areas. This is because the Lao government, pressured by the United States, aims to settle and stabilize their agricultural practices, and to accelerate their social and cultural integration. The resettlements also enable national authorities to exercise better control over the population and reduce the opium cultivation (Evrard & Goudineau 2004). Resettlement does not only mean entering a new territory but also parting from a traditional lifestyle and a dominant means of livelihood. Consequences of resettlements are often poverty and disease, and in many cases a return to the original upland site occurs. An example is the Hmong village Ban Nam Vang that was forced to resettle in 1976 from an altitude of 1800 m, to a site near the road thousand meters lower in altitude. There, fifty-two people died in three months and the villagers lost most of their buffaloes and cattle (Evard & Goudineau 2004). After several months, the villagers moved back to their original village location.

Although the crop yield may be lower and lives in many aspects harder in the mountains the population’s long history and accustomed highland lifestyles make them often fear the lowland as expressed by a Hmong man in Chazée (1999): “If you are not afraid of hunger, stay in the mountain – if you are not afraid of the death, go to the plain”. One of the main problems with the resettlement policy is the lack of assistance needed for the people to start a new life downhill.

Fig. 13. Land is cleared for swidden cultivation.

19

2. METHODS

The work can be divided into three groups of data: the interviews with villagers (2.1); the interviews with owners of steam saunas (2.2); and the chemical analysis of essential oils (2.3). The interviews with villagers and steam sauna owners were performed in Lao PDR together with my co-student Lina Ahnby. During the interviews both general questions about common plants used in health care and more specific questions about plants used during the birthing process were asked. Conducting the interviews together reduced the chance of misinterpretation and consumed less of the informants’ time. The chemical analyses of essential oils distilled from selected plant species were performed at the Department of Organic Chemistry, Lund University, Sweden.

2.1 Field work

The field work was conducted in two periods, during December 2005 and at the end of February- beginning of Mars 2006. It includes interviews in 5 selected villages and collection of botanical specimens applied in local health care. During the first field period two Lao PhD students Mr. Chanda Vongsombath, and Mr. Vichith Lamxay who was doing research on the Zingiberaceae family, assisted with the collection of botanical specimens and the village meeting upon arrival.

2.1.1 Study site The villages selected for this study are situated in two provinces, Khammoune -and Luang Namtha, in Lao PDR (Fig. 1).

In Khammoune province we visited two Brou villages, Kaoy and Mak Feuang. Their locations are above the Nakai plateau in the Nakai-Nam Theun (NNT) National Biodiversity Conservation Area (NBCA), the largest NBCA in Laos embracing the Annamite mountains bordering on Vietnam. The dominant vegetation in the NNT NBCA is evergreen forest, but variations in topography and climate create a complex mosaic of habitats (IUCN 1998). The area was chosen for its rich but poorly investigated flora in addition to its rather isolated location, making the traditional knowledge and use of herbal medicine essential and perpetual in the villages. Kaoy village could be reached by a two hours boat trip from NNT NBCA headquarters, approximately 70 km east of Thakek. Kaoy is now relocated due to a hydroelectric power project that will inundate the Nakai plateau within one year. From Kaoy village, Mak Feuang was reached through a 6 hours walk combined with boat transportation. The villages’ positions make it likely for interchange of botanical knowledge to take place.

The three remaining villages, Lao Khao, Nam Lue and Nam Vang, are all situated in the northern province Luang Namtha, but separated in the Namtha, Sing and Vieng Poukha districts. The villages were selected for their ethnic groups, Hmong, Akha and Lanten and were accessible through contacts with aid-organisations. The villages were reachable by smaller vehicles, which also made them more exposed to exploitation. Surrounding terrain was secondary forest and fields.

The size of the villages together with position, altitude, ethnic groups, number of key informants and our duration of stay are presented in table 1.

20

Table 1. Villages visited in Lao PDR. Their positions, altitudes, number of households, ethnic groups, number of key informants and the duration of stay in each village. 

Village Province Position Altitude (m)

Ethnic groups

# of households

Duration of stay

# of key-informants1

Kaoy Khammoune 17º43.70’N 105º20.12’E

529 Brou3 and Lao

32 13/12 - 17/12 2005

4

Mak Feuang

Khammoune 17º50.45’N 105º21.52’E

555 Brou3 62 17/12 - 23/12 2005

5

Lao Khao

Luang Namtha

21º07.34’N 101º08.66’E

854 Akha4 54 17/2 - 22/2 2006

3

Nam Vang

Luang Namtha

20º43.06’N 101º12.65’E

1170 Hmong/ Mousseur

86/43 2/3 - 6/3 2006

3

Nam Lue

Luang Namtha

20º54.50’N2 101º24.00’E2

5502 Lanten5 75 28/2, 7/3 2006

1

1 The informants that participated in an entire interview and mentioned more than 5 medicinal plants. 2 Estimated from nearby location. 3 Autonym, officially called Makong

4 Autonym; ethnonyms are Iko(r), Kho, Kha and Ekow. 5 Also called Lao Huay

2.1.2 Interview methods Upon arrival at the villages we presented our selves and the project, informing the headmen and villagers about the intention of making interviews in order to record the use of plants in health care. The interviews were conducted with individuals that had a position in the villages associated with the use of medicinal plants (such as shamans, healers and midwifes) as well as knowledgeable members of the general community interested to participate (table 2). Interviews were semi-structured and took place in the informants’ homes and/or during forest walks around the village. In a semi-structured interview the informant answers open-ended questions and has the opportunity to add information he/she consider important. During the interviews ethno-botanical information was gathered about the plants’ local names, uses, preparations, properties, dosages and availability (wild harvested/cultivated and ease/difficulty to find). The informants were also asked to explain common words in the local plant names (Appendix A).

In general the interviews varied between 2-5 hours, depending on the informant knowledge as well as the number of assisting interpreters. If an interview took longer time it was ended and continued the following day. The informants were between 40-65 years old, although no demands on age were placed on the participators.

We opted to interview men and women separately, individually or in groups of two, as knowledge, gathering, and use of plants may differ between genders (Howard-Borjas, 1999). Men can also have a tendency to dominate discussions and overrule women making their knowledge overlooked or neglected in mixed interviews (Fortmann & Rocheleau 1985, Pfeiffer & Butz 2005). Furthermore we intended to use a female interpreter when interviewing women because the gender of the interpreter can affect the quality and content of the interview.

In the Brou villages the informants knew Lao in addition to their local language and a female interpreter, Amsy Ounmany (22 years old), translating Lao to English, assisted during the interviews. Amsy was an international student in Cambodia, studying as orthopaedist technician and spoke English fluently. For the Akha, Lanten and Hmong villages two interpreters were needed as the informants were not Lao speaking. Due to the unavailability of female interpreters, male interpreters had to be used for these interviews. Fongsamude Sivilay (27 years old) assisted translating Lao to English. He was daily using English in his employment at a Steam sauna in Vientiane and

21

communicated easily. Khay (Hmong) and Soyae (Akha) were the additional local interpreters, both under the age of 30.

During the interviews the plants’ vernacular names were written in Swedish phonetics as it made it possible to re-read the names with greater accuracy. We chose not to further translate the Swedish phonetic to English since accuracy loss would be inevitable. All local plant names in this report, as well as Appendix A, are thus expressed in Swedish phonetics (for pronunciation see Stockholm school of econmics 2007). Species known by our Lao supervisor, Vichith Lamxay, were in addition written in French phonetics and are presented in Appendix E. Appendix E will facilitate the recognition of the species for Lao biologist as French phonetics are well understood in Laos and previously used in Lao checklists of plants. Table 2. Information about persons participating in interviewees performed in selected villages in  Khammoune‐ and Luang Namtha province, Lao PDR. 

Informant Village of residence

Ethnicity Gender Age Position in the village

Khamphon Kaoy Brou1 m 65 Niam Kaoy Brou1 f 40 Nang mee Kaoy Brou1 f 55 Youm Kaoy Brou1 f 65 Midwife Chan Hom Mak Feuang Brou1 f 544 Khaet Mak Feuang Brou1 f 604 Long Maet Mak Feuang Brou1 m 61 Peo Mak Feuang Brou1 m 61 Yan Pohn Mak Feuang Brou1 m 46 Midwife Yeha Lao Khao Akha2 m 65 Soyae Lao Khao Akha2 m 52 Laser Lao Khao Akha2 f 53 Midwife Kao tho Nam Vang Hmong khao m 43 Tsia hua moa Nam Vang Hmong khao m 65 Shaman Nyea Toh Nam Vang Hmong khao f 60 Midwife Laolee Nam Lue Lanten3 m 63 Ritualist /Healer 1 Officially named Makong 2 Autonym; ethnonyms are Iko(r), Kho, Kha and Ekow

3 Also called Lao Huay 4 Aged estimated as the informant did not know her own age.

2.1.3 Collection of botanical specimens During the forest walks voucher specimens were collected of plants recognized by the informants for a medicinal application. On the collection occasion each plant was tagged with a voucher number, vernacular name and specific plant characteristics were noted. In addition the majority of the plants were recorded with digital camera. Nearly all plants were collected in secondary forest close to the villages. One collection was however made further away from the village, entering primary forest, and without our presence on the informant’s own request. Duplicates were collected when possible. The plants were pressed in a field press, or when drying might be difficult due to weather conditions or transportation, spirit collections were made and later dried in a plant drier at the National University of Laos (NUOL). The plants were further identified at the National Herbarium Nederland -Leiden branch (NHN-L), the Herbarium of Uppsala University (UPS) and the the Royal Botanic Garden in Edinburgh (E), complete voucher collection is deposited at the Herbarium of Uppsala University and duplicates were left at the NUOL herbarium. Zingiberaceae species are at the writing moment with a specialist in the the Royal Botanic Garden for further identification.

22

Steam sauna: fresh and dry plant material is added to a barrel containing water kept at boiling temperature by a heat source placed underneath. The steam is led by a tube to the steam sauna floor and consequently the sauna fills up with hot steam containing essential oils.

2.2 Steam sauna interviews

Semi-structured interviews were carried out between January and Mars 2006 with five individuals each responsible for the management of a steam sauna. Questions concerning the general health aspects of visiting steam saunas, plants used and their medicinal properties as well as frequency of visits recommended for special ailments were inquired. Two of the interviews were conducted in Luang Namtha, two in Vientiane (prefecture) and one in Muang Sing. Each interview took place in the respective sauna. The age span of the informants was 23-70 and the time the informants’ have been engaged in steam sauna management varied greatly. Due to practical difficulties and the informants and our own limited time we were not able to make a voucher collection. The majority of the plants were however common and identification was done together with Lao biologists and a Lao research list of documented steam saunas species, where the species was listed in both Latin and Lao name. Further facilitating the recognition of plant species used in the steam saunas was our interpreter’s earlier employment at a Steam sauna in Vientiane.

2.3 Extraction of essential oil and chemical analysis

Seven species used for postpartum health care were selected for extraction of essential oil followed by chemical analyses. Two of the species were reported from steam saunas (Adenosma bracteosum and Cymbopogon nardus), one was commonly used both in the steam sauna and in the villages (Blumea balsamifera), and the remaining 4 (Alpinia cf. oblongifolia, Amomum cf. microcarpum, cf. Elettariopsis and Zingiber sp.) were Zingiberaceae species used in the NNT villages.

Extraction of essential oils was done through distillation with a steam distillation column. In the field, coal fires were used to create a stable heat source and cold water were led from a high stationed container through the column and gathered in a low stationed container for recycling (Fig. 2). Distillations of the steam sauna species were carried out at the National University of Laos (NUOL) with the same distillation equipment that was brought to the villages.

The weight of fresh or dried plant material were recorded as well as gained millilitres of extracted oil. The oils were preserved in small glass containers and brought to Sweden for further GC-MS analyses in collaboration with prof. Olov Sterner and Einar Nilsson at the department of Organic Chemistry, Lund University.

The GC-MS analyses were performed using an Agilent 6890N, equipped with HP-5 capillary column (30m, 0.32mm i.d., 0.25μm film thickness) and a Micromass GCT as detector. The carrier gas was helium, at a flow rate of 1 ml/min. Injector temperature was set to 250°C. Column temperature was initially 70 °C for 2 min, and then gradually increased to 250 °C at 2 °C/min. For GC-MS detection an electron ionization system was used with ionization energy of 70 eV. The extracts were diluted 1:10 with dichloromethane (CH2Cl2) and 1.0 μl of the diluted samples was injected automatically in split mode 1/100.

23

3. RESULTS

3.1 Ban Kaoy and Ban Mak Feuang

Ban Kaoy and Ban Mak Feuang were both situated east of the Nakai plateau in the Nakai-Nam Theun National Biodiversity Conservation Area (NBCA), Khammoune Province. They were located at an altitude between 500-600 meters. Kaoy village was reached by a two hours boat trip from Nakai-Nam Theun NBCA headquarter, approximately 70 km east of Thakek. Kaoy is now relocated due to a hydroelectric power project that will inundate the plateau within one year. From Kaoy village, Mak Feuang was reached through a 6 hours walk combined with boat transportation. The villages’ positions make it likely for interchange of botanical knowledge to occur.

Brou is the dominating ethnic group in both villages and all interviews were conducted with Brou villagers. The informants knew Lao in addition to their local language and only a female interpreter, interpreting Lao to English, assisted during the interviews.

In total 24 species were reported from the Brou villages for a use connected to ante- or postpartum health care. Eighteen of these were decided to species or genera and are presented together with use and mode of application in table 3. Six of these species were reported both from Mak Feuang and Kaoy village.

A common procedure in both villages was steam bath. In steam bath the person exposed to the treatment sits under a thick blanket together with a sealed pot of water-boiled plant material. The steam from the pot is let out little by little until the water gets cold. This exposes the person, through inhaling and skin contact, to the steam containing essential oils and other volatile substances from the plants. Species belonging to the ginger family (Zingiberaceae) were commonly used in steam bath to improve postpartum strength/health. As many as 3 different Amomum species, 2 Alpinia and a Zingiber species were used in steam baths. Mak neng kam (Zingiber sp.), Ka (Alpinia sp.) and Ka dong (Amomum cf. microcarpum) were steam bath species used after given birth in both villages.

Nat (Blumea balsamifera) and Gok Van Tjot (Psychotria asiatica) are two other species commonly used in both villages. Blumea balsamifera is used for sitting or lying on after given birth to promote recovery of strength/health. The plant material is usually put on the woman’s bed in combination with a heat source under it. A decoction of Psychotria asiatica is believed to encourage lactation in Kaoy and promote postpartum healing and contraction of uterus in Mak Feuang village.

Almost all plants used in postpartum health care were wild harvested from secondary forest around Mak Feuang and Kaoy village; only Sä:n mü:ang (Gonocaryum sp.) was found further away from the village along a footpath leading to Nam noi river. Ka, (Alpinia sp.) was cultivated.

24

Table 3. Plants used in ante‐ or postpartum health care in Ban Kaoy and Ban Mak Feuang, Khammoune province, Lao PDR. 

Scie

ntifi

c na

me

Fam

1 V

erna

cular

2 V

ouch

er3

Plan

t so

urce

4V

illag

e In

form

ant

Use

Pl

ant p

art

Mod

e of

pre

para

tion5

Alpi

nia c

f. ob

longif

olia

ZIN

K

a ko

:(k)

5

Kao

y N

iam a

nd

Nan

g m

ee

Prom

ote

post

partu

m

reco

very

of h

ealth

a:

Stem

and

le

af

b: Y

oung

sh

oots

a: St

eam

bat

h b:

Pee

led a

nd e

aten

Alpi

nia

oblon

gifoli

a Z

IN

Ka

ko:(k

) /K

a th

ong

10

w

Kao

y Y

oum

Pr

omot

e po

stpa

rtum

re

cove

ry o

f he

alth/

stre

ngth

Who

le p

lant

Stea

m b

ath

Alpi

nia

sp.

ZIN

K

a 2

w

Kao

y Ba

si Pr

omot

e po

stpa

rtum

re

cove

ry

Stem

and

leaf

St

eam

bat

h. U

sed

in

com

bina

tion

with

Gok

paiv

en,

Püak

mai

püay

and

Püa

k m

ai ka

don

Alpi

nia

sp.

ZIN

K

a (T

ham

pr

üng)

c M

ak

Feua

ngCh

an H

om

and

Kha

et

Post

partu

m

Shoo

ts (

Stem

an

d lea

f) St

eam

bat

h. In

com

bina

tion

with

Mak

nen

g ka

m

Alpi

nia

sp.

ZIN

K

a

M

ak

Feua

ngY

an P

ohn

Post

partu

m, S

team

bat

h he

als th

e w

ound

s afte

r de

liver

y an

d m

akes

the

body

bec

ome

one

unit

again

, stro

ng a

nd h

ealth

y

Stem

and

leaf

St

eam

bat

h. P

ossib

le to

co

mbi

ne w

ith M

ak n

eng

kam

, G

ok p

idin

and

Gok

paiv

en

Alpi

nia

sp.

ZIN

K

a

w/c

K

aoy

You

m a

nd

Kha

mph

onPr

omot

e po

stpa

rtum

re

cove

ry o

f he

alth/

stre

ngth

You

ng st

em

and

leaf

Stea

m b

ath.

Can

be

used

to

geth

er w

ith G

ok p

aiven

Amo

mum

sp.

ZIN

M

ak n

eng

kam

po

13

w

Mak

Fe

uang

Chan

Hom

an

d K

haet

Po

stpa

rtum

St

em a

nd le

af

Stea

m b

ath

Amo

mum

cf.

micro

carp

um

ZIN

K

a /K

a do

ng

28

w

Mak

Fe

uang

Long

Mae

t an

d Pe

o Pr

omot

e po

stpa

rtum

re

cove

ry

Stem

and

leaf

St

eam

bat

h

Amo

mum

cf.

micro

carp

um

ZIN

K

a do

ng

w

K

aoy

You

m

Prom

ote

post

partu

m

reco

very

of

healt

h/st

reng

th

Who

le p

lant

Stea

m b

ath

Amo

mum

sp.

ZIN

M

ak n

eng

kam

po

16, 1

7 w

M

ak

Feua

ngLo

ng M

aet

and

Peo

Post

partu

m

Upp

er p

art o

f pl

ant

Stea

m b

ath

25

Amo

mum

sp.

ZIN

M

ak n

eng

/Mak

kon

g (P

rai n

eng)

19

w

Mak

Fe

uang

Chan

Hom

an

d K

haet

Po

stpa

rtum

St

em a

nd le

af

Stea

m b

ath

Amo

mum

sp.

ZIN

M

ak n

eng

nyai

19

w

Mak

Fe

uang

Yan

Poh

n Po

stpa

rtum

, Ste

am b

ath

heals

the

wou

nd a

fter

deliv

ery

and

mak

es th

e bo

dy b

ecom

e on

e un

it ag

ain, s

trong

and

hea

lthy

Stem

and

leaf

St

eam

bat

h

Amo

mum

sp.

ZIN

M

ak n

eng

nyai

19

w

Mak

Fe

uang

Long

Mae

t an

d Pe

o Po

stpa

rtum

St

em a

nd le

af

Stea

m b

ath

Amo

mum

sp.

ZIN

M

ak n

eng

1 w

K

aoy

Niam

and

N

ang

mee

Po

stpa

rtum

Stea

m b

ath

Aren

ga ca

udata

A

RE

Gok

tao

noj

w

M

ak

Feua

ngY

an P

ohn

Reco

ver a

fter m

iscar

riage

Ro

ot

Dec

octio

n dr

unk.

Use

d in

co

mbi

natio

n w

ith G

ok sa

n A

renga

caud

ata

ARE

G

ok ta

o no

j (K

a ye

:n)

25

w

Mak

Fe

uang

Chan

Hom

an

d K

haet

Re

cove

r afte

r misc

arria

ge

Root

D

ecoc

tion

drun

k. U

sed

in

com

bina

tion

with

Gok

san

Aren

ga ca

udata

A

RE

Gok

tao

noj

25

w

Mak

Fe

uang

Long

Mae

t an

d Pe

o A

fter m

iscar

riage

to st

op

haem

orrh

age

and

reco

ver

stre

ngth

Root

U

sed

in c

ombi

natio

n w

ith G

ok

tao

noj g

ives

twic

e th

e ef

fect

Beils

chmi

edia

cf. w

allich

iana

LAU

G

ok m

ai hå

:m

w

M

ak

Feua

ngY

an P

ohn

Clog

ged

milk

duc

ts

Bran

ch a

nd

leaf

St

eam

bat

h co

mbi

ned

with

m

assa

ge o

f the

bre

asts

with

he

ated

leav

es.

Beils

chmi

edia

cf. w

allich

iana

LAU

G

ok m

ai hå

:m

21

w

Mak

Fe

uang

Long

Mae

t an

d Pe

o Cl

ogge

d m

ilk d

ucts

a:

Stem

b:

You

ng le

af

a: St

eam

bat

h b:

Mas

sage

the

brea

sts i

n co

mbi

natio

n w

ith st

eam

bat

h Be

ilsch

mied

ia cf

. wall

ichian

a LA

U

Gok

mai

hå:m

21

w

M

ak

Feua

ngCh

an H

om

and

Kha

et

Clog

ged

milk

duc

ts

Leaf

St

eam

bat

h co

mbi

ned

with

m

assa

ge o

f the

bre

asts

. Bl

umea

ba

lsami

fera

AST

N

a:t

/Nja-

qu

Kao

y Y

oum

and

K

ham

phon

Post

partu

m u

se

Leaf

Pl

aced

on

chair

and

/or b

ed to

sit

and

lie

done

on

Bl

umea

ba

lsami

fera

AST

N

a:t

w

M

ak

Feua

ngY

an P

ohn

Feel

light

er p

ostp

artu

m

Stem

and

leaf

Pl

aced

on

chair

and

/or b

ed to

sit

and

lie

done

on

Bl

umea

ba

lsami

fera

AST

N

a:t

(A:p

hoak

)

w

Mak

Fe

uang

Long

Mae

t an

d Pe

o Pr

omot

e he

aling

of

the

post

partu

m w

ound

St

em a

nd le

af

Plac

ed o

n ch

air to

sit o

n 10

-15

days

afte

r del

iver

y

26

Blum

ea

balsa

mifer

a A

ST

N:at

(A

:pho

ak)

w

M

ak

Feua

ngCh

an H

om

and

Kha

et

For h

ealin

g of

the

wou

nd

caus

ed b

y pa

rtum

St

em a

nd le

af

Sit o

r lie

done

on

in

com

bina

tion

with

hea

t Ch

romola

ena

odor

ata

AST

Y

elam

an

w

K

aoy

You

m a

nd

Bang

Pr

omot

e qu

ick

post

partu

m h

ealin

g of

the

body

and

mak

es it

hea

lthy

and

stro

ng

Bran

ch, l

eaf

and

flow

er

Plac

ed o

n ch

air a

nd/o

r bed

sit

or li

e do

ne o

n

Chrom

olaen

a od

orat

a A

ST

Yela

man

w

Kao

y K

ham

phon

Post

partu

m

Bran

ch, l

eaf

and

flow

er

Plac

ed o

n ch

air o

r bed

to si

t or

lie d

one

on

Elet

tario

psis

cf.

ZIN

G

ok k

å: pa

ka

ng (T

a ko

ng k

alua)

w

M

ak

Feua

ngLo

ng M

aet

and

Peo

Stop

seco

ndar

y po

stpa

rtum

hae

mor

rhag

e Ro

ot

Dec

octio

n dr

unk

Elet

tario

psis

cf.

ZIN

G

ok k

å: pa

ka

ng (T

a ko

ng k

alua)

18

M

ak

Feua

ngCh

an H

om

and

Kha

et

Stop

seco

ndar

y po

stpa

rtum

hae

mor

rhag

e Ro

ot

Dec

octio

n dr

unk

Gon

ocaryu

m sp

. IC

A

Sä:n

m

ü:an

g

w

Kao

y K

ham

phon

Post

partu

m

Bran

ch a

nd

leaf

St

eam

bat

h

Lygo

dium

cf.

LYG

N

i ray

koj

/ Ph

a(k)

ko:

t kh

eo

26

w

Mak

Fe

uang

Yan

Poh

n Pr

even

t diz

zine

ss a

nd

mak

e yo

u fe

el li

ght t

he

day

you

leave

the

fire6

po

stpa

rtum

.

Who

le p

lant

Stea

m b

ath

Lygo

dium

cf.

LYG

N

i ray

koj

26

w

M

ak

Feua

ngLo

ng M

aet

and

Peo

Prom

ote

post

partu

m

healt

h af

ter l

eavi

ng fi

re6

Who

le p

lant

Stea

m b

ath

Lygo

dium

cf.

LYG

N

i ray

koj

26

w

M

ak

Feua

ngCh

an H

om

and

Kha

et

Prev

ent d

izzi

ness

and

fe

eling

sick

whe

n lea

ving

fir

e6

Who

le p

lant

Stea

m b

ath

Psych

otria

asiat

ica

RUB

Gok

van

tjo

th

3 w

K

aoy

You

m

Post

partu

m

Stem

D

ecoc

tion

drun

k

Psych

otria

asiat

ica

RUB

Gok

van

tjo

th

3 w

K

aoy

You

m a

nd

Kha

mph

onLa

ctag

oge

Stem

D

ecoc

tion

drun

k

Psych

otria

asiat

ica

RUB

Gok

van

tjo

th

22

w

Mak

Fe

uang

Yan

Poh

n Pr

omot

e po

stpa

rtum

he

aling

insid

e W

ood

Dec

octio

n dr

unk

hot

Psych

otria

asiat

ica

RUB

Gok

van

tjo

th

22

w

Mak

Fe

uang

Long

Mae

t Pr

omot

e he

aling

of t

he

post

partu

m w

ound

St

em

Dec

octio

n dr

unk

27

Psych

otria

asiat

ica

RUB

Gok

van

tjo

th

22

w

Mak

Fe

uang

Chan

Hom

Pr

omot

e po

stpa

rtum

he

aling

and

con

tract

ion

of

uter

us (A

strin

gent

)

Woo

d D

ecoc

tion

drun

k in

stea

d of

w

ater

Zing

iber c

f. Z

IN

Mak

nen

g ka

m /

Mak

ne

ng n

oi

w

K

aoy

You

m

Post

partu

m

St

eam

bat

h

Zing

iber c

f. Z

IN

Mak

nen

g ka

m /

Mak

ne

ng n

oi

w

K

aoy

Kha

mph

onPo

stpa

rtum

St

em a

nd le

af

Stea

m b

ath

Zing

iber s

p.

ZIN

M

ak n

eng

kam

15

w

M

ak

Feua

ngCh

an H

om

and

Kha

et

Post

partu

m

Stem

and

leaf

St

eam

bat

h. C

an b

e us

ed

toge

ther

with

Ka

and

Gok

pa

iven

Zi

ngibe

r sp.

Z

IN

Mak

nen

g ka

m /

Mak

ne

ng n

oi

15

w

Mak

Fe

uang

Yan

Poh

n Pr

omot

e po

stpa

rtum

he

aling

, mak

es th

e bo

dy

stro

ng a

nd h

ealth

y

Stem

and

leaf

St

eam

bat

h. C

an b

e us

ed

toge

ther

with

Ka,

Gok

pid

in

and

Gok

paiv

en

Zing

iber s

p.

ZIN

M

ak n

eng

kam

(mä:)

15

w

M

ak

Feua

ngLo

ng M

aet

and

Peo

Post

partu

m

Stem

and

leaf

St

eam

bat

h

Zing

iber s

p.

ZIN

G

ok p

idin

4

w

Mak

Fe

uang

Yan

Poh

n La

ctag

oge

Stem

and

leaf

St

eam

bat

h. P

ossib

le to

co

mbi

ne w

ith M

ak N

eng,

Mak

ne

ng k

am, K

a an

d G

ok p

aiven

Zizip

hus

oenop

lia

RHA

G

ok lä

p m

eo

w

M

ak

Feua

ngY

an P

ohn

Alle

viat

e po

stp.

ab.

pain

an

d he

al ut

erus

St

em, o

uter

ba

rk re

mov

ed

Dec

octio

n dr

unk

Zizip

hus

oenop

lia

RHA

G

ok lä

p m

eo (s

i mu

tjong

)

w

M

ak

Feua

ngCh

an H

om

and

Kha

et

Exp

el re

tain

ed p

lacen

ta

Stem

, out

er

bark

rem

oved

D

ecoc

tion

drun

k

1 Pl

ant F

amily

are

abb

revi

ated

to th

e fir

st th

ree

lette

rs in

the

fam

ily n

ame,

for c

ompl

ete

fam

ily n

ame

see

App

endi

x B.

2 La

ngua

ge o

f ver

nacu

lars,

refe

rred

spec

ies a

nd c

ollec

tion

num

ber a

re fo

und

in a

ppen

dix

D

3 Pr

efix

for v

ouch

er c

ollec

tion

num

ber i

s ELL

A

4 Sy

mbo

ls fo

r sou

rce

are

c, cu

ltiva

ted

and

w, c

ollec

ted

from

the

wild

5 Fo

r mor

e th

orou

gh d

escr

iptio

n of

pre

para

tion

and

dosa

ge se

e ap

pend

ix C

6 W

hen

the

wom

an st

arts

wor

king

, nor

mall

y 15

-30

days

afte

r deli

very

, and

not

has

to b

e co

ncer

ned

abou

t sta

ying

war

m/c

lose

to th

e fir

e

28

3.1.1 Ban Kaoy Kaoy was visited during four days in the middle of December 2006. It contained 32 households and even if it had a favourable location close to the river little cultivation of vegetables took place and a shortage of food seemed to exist in the village. However cultivation of some vegetables, cassava, papaya, jackfruit and green tea was observed. Some food like bamboo shoots and plants used for medicine were mainly collected from the forest.

Interviews were conducted with four Brou villagers. Mr Khamphon, 65 years old, born and raised in Kaoy was the only male informant. He like the other informants had gained his knowledge from parents and grandparents. His wife Mrs Youm was also interviewed. She was approximately of the same age as her husband and the village midwife. The other two informants were Mrs Nang mee, 55, and Mrs Niam, 40. Niam was born in Ban Theung, another village in the NNT conservation area, and had only lived in Kaoy for 5 years.

During the forest walks and interviews eleven plants were mentioned for a use related to childbearing and postpartum health care. Eight of the eleven plants were used in steam bath for healing of the postpartum wound or recover strength and health (table 3).

3.1.2 Ban Mak Feuang Ban Mak Feuang was established in 1974 and is almost twice as big as Kaoy with its 62 housholds and 70 families. During our six days stay in Ban Mak Feuang interviews were carried out with two women and three men. One of the female informants, Mrs Khaet (60 years old, born in Mak Feuang) was the leader of the woman association in the village. The aim of the organisation was to increase the knowledge and development among women. The organisation distributed information about problems and diseases and collected money for those in need. The work also concerned equality and a lot have been done to improve the women’s situation in the village. Mrs Khaet says that in the past women did the majority of work; garden work, field work, threshed rice and took care of the children. While the men did wood cutting, burned the fields and drunk in the evenings. Now, since the training from the government the workload is more equal.

Our other female informant, Mrs Chan Hom, was approximately 55 years old and had been living 25 years in the village. She was originally from Ban Soklek, a day walk from Ban Mak Feuang. In her case, like in Mrs Khaets, the knowledge about curative plants has been passed on from older generations.

The three male informants Mr Peo (61 years old), Mr Long Maet (61) and Mr Yan Pohn (46), were all born in Ban Mak Feuang. Mr Long Maet learned about medicinal plants mostly from his grandfather who was a healer in the village. Yan Pohn started working as a nurse 1998, for which he took a course during 18 days. 2002 he made a midwife-course and has been working in this occupation ever since. Nevertheless most of his knowledge regarding medicinal plants he learned from his parents and grandparents. Yan Pohn has so far helped during 14 deliveries.

In Mak Feuang village a total of 19 plants were pointed out by the informants to be used postpartum. Fourteen were identified to genera or species, of which half belonged to the Zingiberaceae family and were commonly used in steam bath (table 3).

29

Table 4. Species used in postpartum maternal and newborn care in Lao Khao village, Luang Namtha, Lao PDR. 

Scien

tific

nam

e Fa

m1

Ver

nacu

lar

Vou

cher

2Pl

ant

sour

ce3

Info

r-m

ant

Use

Pa

rt us

ed

Mod

e of

pre

para

tion4

Arch

idend

ron

clype

aria

FAB

Jam

alaga

47

w

Y

eha

and

Soya

e Pr

even

t inf

ectio

n an

d dr

ies t

he

nave

l afte

r cut

ting

the

umbi

lical

cord

Leaf

Cr

ushe

d lea

ves a

re a

pplie

d ex

tern

ally

on th

e um

bilic

al

Arto

carp

us

heter

ophy

lla

MO

R M

a:mi

50

c Y

eha

and

Soya

e Pr

omot

e lac

tatio

n Le

af a

nd b

ud

Cons

umpt

ion

Arto

carp

us

heter

ophy

lla

MO

R M

a: m

i

c La

ser

Prom

ote

lacta

tion

Leaf

and

frui

t D

ecoc

tion

drun

k in

stea

d of

wat

er

Blum

ea

balsa

mifer

a A

ST

Asa

ma

49

w

Yeh

a an

d So

yae

Stop

pos

tp. h

aem

orrh

age

and

prom

ote

inte

rnal

heali

ng

Leaf

Pl

aced

on

chair

or b

ed to

sit o

r lie

on

Blum

ea

balsa

mifer

a A

ST

Asa

ma

w

La

ser

Prom

ote

post

p. h

ealin

g in

side

(of u

teru

s)

Leaf

Pl

aced

on

chair

or b

ed to

sit o

r lie

on

Clero

dend

rum

fragra

ns

VE

R H

ahon

-de

tze

86

w

Yeh

a St

op p

ostp

. hae

mor

rhag

e an

d pr

omot

e he

aling

(of u

teru

s)

Leaf

Si

t or l

ie do

ne o

n. U

sed

in c

omb-

inat

ion

with

Ab

Sutz

i and

Osa

ma

Dicr

anop

teris

sp.

GLE

A

shu

42

w

Lase

r G

ood

for t

he n

ewbo

rns h

ealth

St

em a

nd le

af

New

born

bat

hed

in d

ecoc

tion

D

icran

opter

is sp

. G

LE

Ash

u 92

w

Y

eha

Aga

inst

chi

cken

pox

and

good

fo

r the

new

born

s hea

lth

Stem

and

leaf

N

ewbo

rn b

athe

d in

dec

octio

n U

sed

in c

ombi

natio

n w

ith S

ima

Phlog

acan

thus

cf.

anna

mens

is A

CA

Lå h

ama

53

w

Yeh

a an

d So

yae

Stop

pos

tp. h

aem

orrh

age

and

prom

ote

inte

rnal

heali

ng

Leaf

Pl

aced

on

chair

or b

ed to

sit o

r lie

on

Phlog

acan

thus

cf.

anna

mens

is A

CA

Lå h

ama

w

La

ser

Prom

ote

post

p. h

ealin

g in

side

(of u

teru

s)

Leaf

Pl

aced

on

chair

or b

ed to

sit o

r lie

on

Pogo

stemo

n gla

ber

LAM

Su

tzi

85

w

Yeh

a St

op p

ostp

. hae

mor

rhag

e an

d pr

omot

e he

aling

(of u

teru

s)

Leaf

Si

t or l

ie on

. Use

d in

com

bina

tion

with

Hah

onde

tze

and

Osa

ma

Pogo

stemo

n gla

ber

LAM

A

b Su

tzi

w

La

ser

Prom

ote

post

p. h

ealin

g in

side

(of u

teru

s)

leaf

Plac

ed o

n ch

air o

r bed

to si

t or l

ie on

Rh

us ch

inen

sis

AN

A

Sim

a 91

w

Y

eha

Aga

inst

chi

cken

pox

and

good

fo

r the

new

born

s hea

lth

You

ng

bran

ch, l

eaf

New

born

bat

hed

in d

ecoc

tion.

Use

d in

com

bina

tion

with

Ash

u 1 Pl

ant F

amily

are

abb

revi

ated

to th

e fir

st th

ree

lette

rs in

the

fam

ily n

ame,

for c

ompl

ete

fam

ily n

ame

see

App

endi

x B.

2 Pr

efix

for v

ouch

er c

ollec

tion

num

ber i

s ELL

A

3 Sy

mbo

ls fo

r sou

rce

are

c, cu

ltiva

ted

and

w, c

ollec

ted

from

the

wild

. 4 F

or d

osag

e se

e ap

pend

ix C

30

3.2 Lao Khao village

Lao Khao is an Akha village situated in Muang Sing district, Luang Namtha province in the northwest of Laos. This village was settled around 1990 at its present altitude of 850 meters when Akha moved downhill to improve their livelihood, facilitate rice production and get closer to the market. This transfer was strongly encouraged by the district and sub-district authorities (Chazée 1999). Today Lao Khao contains 54 households and more than 200 residents. They cultivate sticky rice, steam rice and corn. Corn is commonly cultivated on the rice fields in a shifting manner. Other crops are sweet potato, cucumber, melon, banana, tamarind and jackfruit.

Three Akha informants were interviewed, one woman and two men. The woman, named Laser, was the midwife in the village and 52 years old. She moved to Lao Khao from the uphill village Hoa Nam Keo 5 years ago. The two men interviewed, Yeha and Soyae, were 65 and 50 years old respectively. Yeha, was also born in Hoa Nam Keo and moved to Lao Khao 15 years ago. Today he is considered to be the person that possesses the greatest knowledge of medicinal plants in the village. He will also, together with the midwife, attend when birth takes place and is present during the name giving ceremony. Soyae, the younger of the two male informants, moved to Lao Khao from Ho La village 9 years ago. Soyae and the other informants stated that their knowledge about medicinal plants was gained from parents and grandparents. Interesting is that Akha have no written language and story telling forms a central role in the community for continuation of plant knowledge and Akha culture.

The interviews took place in the informants’ homes and during forest walks together with two assisting interpreters, one interpreting from Akha to Lao and the other from Lao to English. Virtually all plants collections were done within a radius of 2 km around the village in secondary forest and abandoned fields. One collection was however done further away from the village, entering primary forest, and without our presence on the informants’ own request.

During the interviews and forest walks 10 plants were mentioned to be used in postpartum maternal and newborn care. Eight of these were identified to genera or species and are presented in table 4 together with use and mode of application. Three species were used for the newborn, to promote health, cure chickenpox and dry the navel after cutting of the umbilical cord. Four species were used externally to stop postpartum haemorrhage and promote healing of the postpartum wound and one, jackfruit (Artocarpus heterophylla) was used to promote lactation. Jackfruit was the only cultivated species reported.

3.3 Ban Nam Vang

Nam Vang village is situated in the Luang Namtha province in Northern Laos. The village is characterized by its altitude of 1,170 meter and its relatively isolated location. Two different ethnic groups reside in the village, Hmong and Mousseur. Hmong make up for the majority of the population with 86 of the total 129 households (864 inhabitants). During the 4 days visit two Hmong men and a Hmong woman were interviewed. The interviews had to be done with two interpreters, one interpreting from Hmong to Lao and a second interpreting Lao to English. All informants mentioned plants connected with the birth process, although one informant, an elderly man named Tsia hua moa, was unable to walk and had poor vision. The plant he mentioned we were not able to collect or identify by cross-referencing. He had earlier been the shaman of the village and it is a belief in the village that if one possess great knowledge about curative plants and frequently performs magic spelling it will cause immobility in the legs when getting old. The other male informant was Kao tho, a 43 years old married man with 5 children. He was born and raised in Ban Nam Vang and he worked with construction in the village and helped during the village meetings. He had gained his knowledge about medicinal plants from training in Luang Prabang (Lao PDR), China and Thailand. The last informant was a 60 years old woman named Nyea Toh. She had been the midwife in the village for 6 years, after one week of training in Luang Namtha.

31

During the interviews and forest walks a total of 14 plants were mentioned for a use related to pregnancy, birth and convalescence. The majority of species were used for maternal health and quick postpartum recovery. Other applications were to relieve pain, encourage lactation, promote postpartum healing of uterus, and prevent conception. Six plants were identified to genera or species and their scientific and vernacular names together with uses and mode of preparations are presented in table 5.

All plants, except Radermachera ignea (Bignoniaceae) were collected along footpaths close to the village. R. ignea was locally reported as a rare species and the collected specimen was located approximately 100m from the nearest footpath. Table 5. Plants used in ante‐or postpartum health care in Nam Vang village, Luang Namtha, Lao PDR. 

Scientific name

Fam.1 Verna-cular

Vou-cher2

Plant source3

Infor-mant

Use Plant part

Mode of preparation4

Melastoma sp. MEL Jaj to 135 w Kao tho

Contraceptive Root Decoction drunk

Kalanchoe sp. CRA Kai-yang 148 c Kao tho

Analgesic during pregnancy

Leaf Infusion drunk

Radermachera ignea

BIG Pa i:a 134 w Kao tho

Postpartum protection against genital infections

Inner bark

Decoction for vaginal douche, combination of plants

Aristolochia cf. pierrei

ARI Ma koa mi

157 w Nyea Toh

Lactagoge Stem and leaf

Cooked and consumed with chicken

Schizomussaenda dehiscens

RUB Not known

130 w Kao tho

Promote lactation and postpartum recovery of strength

Root Decoction drunk warm

Begonia handelii BEG Kao de 129 w Kao tho

Alliviate postp. ab. pain

Whole plant

External use, cover lower part abdomen

1 Plant Family is abbreviated to the first three letters in the family name, for complete family name see Appendix B. 2 Prefix for voucher collection number is ELLA 3 Symbols for source are c, cultivated and w, collected from the wild. 4 For dosage see appendix C

3.4 Ban Nam Lue

Ban Nam Lue is an old village situated in the lowland, in Luang Namtha province, northern Laos. The village is located at approximately 500 meters altitude, 8 km from Namtha town and accessible by vehicle. Seventy-five households reside in the village, whereof 60 are Lanten (also named Lao Huay) and 15 are Lao Theung, this total up to 370 villagers. Unfortunately we were not able to stay over night in the village and because of the high travel cost back and forth, and the limited time possible for interviews; our visits were restricted to two days (28/2 and 7/3 2006) and one informant. The informant was Laolee, 63 years old and the village headmen. He was born and raised in Nam Lue and had an important role as the village healer and ritualist. The knowledge about curative plants Laolee had gained from both his parents and grandparents, and now villagers came to him with candles and money to receive consultation and herbal medicine for their ailments. Before medicinal plants could be collected from the surrounding forest the forest spirit had to be asked for permission.

32

The interviews were done during walks close to the village, both in secondary forest, old fields, plantations, and along roads. All the species were wild harvested but not uncommon. In total 11 spp were mentioned for a use related to pregnancy, birth and postpartum care. Numerous plants were mentioned as fertility enhancers, lactagoges or health tonics. Other uses, for which only one species was mentioned, were to facilitate delivery, alleviate pain, healing of the womb and cervix after parturition and for prolapsed uterus. Eight species were identified to genera or species and are presented in table 6 together with uses and mode of preparation. Table 6. Plants used in ante‐ and postpartum health care in Nam Lue village, Luang Namtha, Lao PDR. 

Scientific name

Fam.1 Verna-cular2

Vou-cher3

Plant source4

Infor-mant

Use Plant part

Mode of preparation5

Gonocaryum sp.

ICA Ma tjaj (Ja-ket)

108 w Laolee Healing inside and promote postp. recovery of strength for mother and newborn

Leaf Decoction drunk

Urena lobata MAL Krai-tzing (Nja kat moan)

114 w Laolee Increase fertility Root Decoction drunk. Used in combination with other species6

Phyllanthus cf. reticulatus

EUP Naj sej ma

116 w Laolee Increase fertility Root Decoction drunk. Used in combination with other species6

Clerodendrum fragrans

VER Njong-me 118 w Laolee Lactagoge and promote re-covery of postp. strength/health

Root Decoction drunk. Used in combination with other species7

Mimosa pudica

MIM Nam jay (Nja Njok)

121 w Laolee Alleviate pain in vagina and menstrual pain.

Root Decoction drunk

Micromelum falcatum

RUT Tjotjoma 162 w Laolee Recover strength/health postpartum

Root and wood

Decoction drunk

Scleria sp. CYP Lo-gaj /Khom pao

170 w Laolee Lactagoge and promote re-covery of postp. strength/health

Whole plant

Decoction drunk. Used in combination with other species7

Stixis suaveolens

CAP Mai njeng dong

174 w Laolee Lactagoge and promote re-covery of postp. strength/health

Root Decoction drunk. Used in combination with other species7

1 Plant Family is abbreviated to the first three letters in the family name, for complete family name see Appendix B. 2 When both local and lao name is stated for a plant, lao name given in parenthesis. 2 Prefix for voucher collection number is ELLA. 4 Symbols for source are c, cultivated and w, collected from the wild. 5 For dosage see appendix C 6 Krai-tzing, Naj sej ma, Krai-kok ma and Jam-lao are used together. Scientific names and/or voucher numbers can be found in Appendix D. 7 Njong-me, Lo-gaj and Mai njeng dong are used together.

33

3.5 Steam sauna results

3.5.1 Information on the informants Five informants, Seng, Noy, Pohn, Say, and Nil were interviewed during visits to their respective steam saunas in Vientiane, Naxaythong, Luang Namtha and Muang Sing. The number of years the informants’ have been engaged in steam sauna management, as well as the knowledge of curative plants, varied greatly between the five informants. Nevertheless regarding the informants’ knowledge there was an indirect connection. The knowledge leading to the construction of the three saunas visited in Luang Namtha province originate from saunas in Vientiane.

Informants in Vientiane prefecture • Seng (Ismae Kaokeo Maungsan, 70 years old; 20 spp mentioned1) nun from the age of 30,

got taught about medicinal plants by the monks Bori, Pengma and Pan. She was responsible for the sauna at Vat soop pa luang in Vientiane since it opened in 1979 until she moved to Vatnakhounnoy monastery outside the capital (Naxaythong district) and her niece Noy took over the sauna.

• Noy (Paphavadee Keomaungsan, 26 years old; 8 spp mentioned1) learned about steam sauna and the plants used there by helping her aunt. She is now managing the sauna at Vat sop pa luang in Vientiane.

Informants in Luang Namtha • Pohn (approx 40 years; 5 spp mentioned1) has been running a sauna in his hometown Luang

Namtha for 5 years, although only one year in the currant place. He learned from his brother in law that had worked at the sauna in Vat soop pa luang in Vientiane and helped him build the sauna in Luang Namtha. His brother in law also built the sauna in Muang Sing three and a half years ago.

• Say (23 years, 1 sp mentioned1) took over the sauna in Muang Sing two years ago and got his knowledge from the previous owner as well as the customer visiting the sauna.

• Nil (approx. 35 years; 1 sp mentioned1) opened a second steam sauna in Luang Namtha town three years ago. She had earlier been working with sauna and massage in Vat Nat in Vientiane and has been studying in a hospital for handicapped people.

3.5.2 Plant use in steam saunas All informants stated that steam sauna was important in postpartum health care. Plants used in steam saunas were mentioned to alleviate abdominal pain, cleanse and heal the uterus, encourage lactation, increase the appetite and promote postpartum recovery of strength. The advice on the time and frequency the sauna should be visited during puerperium varied between the informants. However all informants except Say stated that steam sauna should not be used directly after parturition, or during pregnancy as doing so could cause miscarriage. Pohn stated that sauna can start 10 days after birth and should be carried out daily during 1 week, while Seng recommended starting sauna on the 7th day postpartum and performing it twice a day during the following 15 days. She also recommended using private sauna not public, due to the risk of infection. Other informants did not have clear recommendation, but said it was good to perform sauna during the first month when the mother needs to stay warm and rest. Some sauna plants was also recommended for sitting and lying on (sometimes in combination with heat), or for herbal showers as these procedures could be started directly after given birth.

A total of 22 species were mentioned during the interviews to have a postpartum beneficial effect. Eighteen of these were decided to species or genera and are presented in table 7. The species mentioned by at least two informants where: Nat (Blumea balsamifera), Pao (Croton roxburghii), (Hoa)

1 Only species mentioned in postpartum healthcare

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Sikay kheuang (Cymbopogon nardus), Wick (Eucalyptus globules), Chi nai khome (Adenosma bracteosum), Khimin (khun) (Curcuma longa), Som sün (Glycosmis pentaphylla). The former four are used on daily basis in all saunas visited, and are easy to find, or cultivated by the owners themselves. The only species mentioned for postpartum health care by all informants was Nat (Blumea balsamifera). Its’ claimed effects was healing of the uterus/postpartum wound and alleviate postpartum abdominal pain. All informants also mentioned it was used for alleviate pain in the body caused by accident (e.g. pain in muscle and nerves or bruises and swellings). Table 7. Species used in Lao steam saunas, their properties and utilizations. 

Scientific name

Family1 Vernacular Infor-mant

Health care indication

Plant part

Use

Adenosma bracteosum

SCR Chi nai khome

Noy Good to use postp., good for the mind, relaxing.

Whole plant

Steam sauna

Adenosma bracteosum

SCR Chi nai khome

Seng Alleviate postp. ab. pain and promote healing.

Whole plant

Steam sauna. Used in combination with other species2

Areca catechu ARE Hak mak Seng Alleviate postp. ab. pain and promote healing.

Root Steam sauna. Used in combination with other species2

Artocarpus heterophylla

MOR Khuam mak mii

Seng Increase lactation and make the womb and female parts that are wet and loose after childbirth dry.

Fruit pedicel

Decoction drunk. Used in combination with other species3

Averrhoea carambola

OXA Mak feuang

Seng Alleviate postp. ab. pain and promote healing.

Leaf Steam sauna. Used in combination with other species2

Blumea balsamifera

AST Nat Nil Promote postp. healing and health/strength.

Leaf a: Decoction to wash b: Sit or lie on c: Steam sauna

Blumea balsamifera

AST Nat Pohn Relieve postp. ab. pain

Leaf a: Steam sauna b: Decoction to wash c: Lie or sit directly on the leaves b & c: used together with Pao leaves.

Blumea balsamifera

AST Nat Say Alleviate post. ab. pain and promote healing.

Leaf a: Steam sauna b: Decoction to wash oneself

Blumea balsamifera

AST Nat Seng 1: Increase lactation and make the womb and female parts that are wet and loose after childbirth dry. 2: Alleviate postp. ab. pain and promote healing of the postp. wound.

1: Root2: Leaf

1: Decoction drunk 2a: Steam sauna. Used in combination with other species2 2b: Decoction to wash. Used in combination with other species4 2c: Lie on5. Used together with Pao

Blumea balsamifera

AST Nat Noy Postp. healing and recovery of health

Leaf Sit or lie done on

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Ochna cf. integerrima

OCH Sang nao Seng Increase milk for the child and make the womb and female parts that are wet and loose after childbirth dry.

Root Decoction drunk. Used in combination with other species3

Citrus aurantifolia

RUT Mak nao Seng Alleviate postp. ab. pain and promote healing.

Leaf Steam sauna. Used in combination with other species2

Citrus hystrix RUT Ki:-ho:t Seng Alleviate postp. ab. pain and promote healing.

Leaf Steam sauna. Used in combination with other species2

Croton roxburghii

EUP Thon Pao Noy Good to use postp. Leaf Steam sauna

Croton cf. roxburghii

EUP Pao Pohn Makes bad blood come out postp.

Leaf a: Decoction to wash b: Lie or sit directly on a & b: Can be used together with Bai Nat. c: Steam sauna. Can be used in combination with other species6.

Croton roxburghii

EUP Pao Seng 1: Increase milk for the child and make the womb and female parts that are wet and loose after childbirth dry. 2: Alleviate postp. ab. pain, and promote healing.

1: Root2: Leaf

1: Decoction drunk. Used in combination with other species3

2a: Steam sauna. Used in combination with other species2 2b: Decoction to wash. Used in combination with other species4 2c: Lie on5. Used together with Nat

Curcuma longa ZIN Khimin khun

Noy Good for skin postp., and helps against stretch marks.

1: Leaf2: Root

1: Steam sauna. 2: Apply on skin

Curcuma cf. longa

ZIN Khimin Pohn Good for skin postpartum, make it smooth and soft.

Root Mix with honey, fresh milk and tamarind, smear on skin.

Curcuma cf. longa

ZIN Khimin (khun)

Seng Prevent postp. infections and is good for the skin, makes it return to the state it was before pregnancy

Root Mix with honey and apply on skin before sauna visit

Cymbopogon nardus

POA Sikhay kheuang

Noy Good to use postp. Leaf Steam sauna

Cymbopogon nardus

POA Hoa sikay kheuang

Seng Alleviate postp. ab. pain and promote healing.

Leaf Steam sauna. Used together with other species2

Eucalyptus globulus

MYRT Wick Noy Good to use postpartum

Leaf Steam sauna

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Eucalyptus globulus

MYRT Wick Seng Alleviate postp. ab. pain

Leaf 1: Steam sauna. Use together with other species2

Glycosmis pentaphylla

RUT Som sün Noy To cleanse the womb after parturition

Leaf Steam sauna

Glycosmis pentaphylla

RUT Som sün Pohn Promote postp. recovery of strength/health

Leaf Steam sauna. Used together with other species6

Glycosmis pentaphylla

RUT Som sün Seng Alleviate postp. ab. pain and promote healing.

Leaf a: Steam sauna. Used together with other species2

b: Decoction to wash oneself. Used together with other species4

Imperata cylindrica

POA Nja kha Seng Alleviate postp. ab. pain and promote healing.

Whole plant

Steam sauna. Used together with other species2

Limnophila spp.

PLA Pak khat njeng

Seng Alleviate postp. ab. pain and promote healing.

Whole plant

Steam sauna. Used together with other species2

Sida sp. MAL Nja khat Seng Alleviate postp. ab. pain and promote healing.

Whole plant

Steam sauna: Used together with other species2

Tamarindus indica

FAB Mak kham Seng Alleviate postp. ab. pain and promote healing.

Leaf a: Steam sauna. Used together with other species2 b: Decoction to wash

Zingiber purureum

ZIN Van Phay Noy 1: Against gases in the baby’s stomach 2: Good to use postp.

1: Root2: Leaf

1: Apply chewed material on baby's stomach 2: Steam sauna

1 Plant Family are abbreviated to the first 3 or 4 letters in the family name, for complete family name see Appendix B. 2 Use Pao, Nat Song sün, Mak khian, Ki:ho:t, Mak nao, Chi nai khome, Pak khat njeng, Wick , Hoa sikai, Mak feuang, Mak kham, Hak mak, Pao, Nja khat and Nja kha together. 3 Use Pao*, Ian Ah, Sang nao*, Nat*, Nom sao* and Khuam mak mii together. * = essential 4 Use Nat, Pao, Som sün and Mak kham together. 5 Used in combination with heat. 6 Gom lä, Bai pao, Bai Som sün and Bai Nat are good to use together. Steam sauna was sometimes combined with other procedures. Seng, Noy and Pohn reported the beneficial effect of using a cream made from Curcuma longa before the sauna visit. The root of C. longa was mixed with honey, and Pohn also recommend tamarind and fresh milk. The cream was applied postpartum for contraction of lose skin, stretch marks and to prevent bacterial infections. Sauna could also preferably be combined with herbal shower afterwards.

Except for the use during puerperium steam sauna can help a person suffering from muscle pain, pain in neck or back, bruises and swelling after an accident, cold and cough, skin problems or muscle and nerve problems. Nevertheless health problems exist when steam sauna should be avoided. These are: high fever, breathing problems/lung problems, high or low blood pressure, heart attacks, and vomiting or diarrhoea.

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Fresh plant material was preferred to dried, although for some species, like Adenosma bracteosum, fresh material was only available during the rainy season, and had to be collected and dried for use during the remaining part of the year.

3.6 Summary of results

During the field study approximately 160 plant species were reported to be used in health care from five rural villages of four ethnic groups in Lao PDR. Ninety-three genera have been identified in 59 families. A complete list of the medicinal plants reported, their local names, uses, preparations, doses, and herbarium voucher number can be found in Appendix C.

Approximtely a third (54) of all species mentioned had a use associated with the birthing process, including postpartum maternal and newborn care. The applications of these species can be divided into 15 categories (table 8). The most common uses were to promote maternal health and postpartum recovery of strength, (20 species), healing and contraction of uterus (16 species), and for promote lactation (8 species). Species for these purposes were mentioned in all five villages. Other reports included stopping postpartum haemorrhage, alleviate postpartum abdominal pain, protect or cure the newborn from infections, expel retained placenta, increase fertility, prevent postpartum infection, recover after miscarriage, clogged milk ducts, vaginal or uterine prolapse, prevent conception, provoke miscarriage and facilitate delivery. Sixteen of the species were used for various health problems and 4 species mentioned were not defined to a specific health problem and are excluded from table 8.

The three main modes of utilize the APP medicinal plants were: decoction, external application (mainly sit or lie on the herb), and steam bath2. The application method varied between the villages. In Nam Lue and Nam Van village decoction (for drinking or bathing), was the most common preparation, although it was found as an ordinary application in all villages. External use, generally to sit or lie on plants placed on a chair or bed was a usual procedure both in the Akha and the Brou villages, whereas steam bath was exclusively applied by the Brou. Table 8. Applications of medicinal plants in Lao PDR divided into categories, number of plant species and reports for each category, and number of villages in which the application was mentioned. 

Use Species Informants Villages Postpartum recovery of strength/health 20 15 5 Healing and contraction of uterus 16 13 5 Lactagoge 8 9 5 Stop postpartum haemorrhage 6 6 2 Alleviate abdominal pain 4 3 3 Promote newborn health and cure infections 4 4 2 Increase fertility 4 1 1 Prevent postpartum infection 3 1 1 Recover after miscarriage 2 5 1 Clogged milk ducts 1 5 1 Expel retained placenta 1 2 1 Uterine or vaginal prolapse 1 1 1 Contraceptive 1 1 1 Facilitate delivery 1 1 1 Provoke abortion 1 1 1

2 In steam bath the person exposed to the treatment sits under a thick blanket together with a sealed pot of water-boiled plant material. The steam from the pot is let out little by little until the water gets cold. This exposes the person to the volatile substances in the steam through inhaling and skin contact.

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Number of plants mentioned in APP health care from the different villages varied considerable, (Lao Khao 10 spp, Nam Vang 14 spp; Nam Lue, 12 spp; Kaoy, 11 spp; Ban Mak Fueang, 19 spp) depending mainly on the informants’ knowledge about plants and their curing properties and not on the number of informants per village. In total 12 species were used in more than one village, however 7 of these were only reported from the relatively closely situated Brou villages, and only five species by more than one ethnic group (Archidendron clypearia, Blumea balsamifera, Clerodendrum fragrans, Phlogacanthus cf. annamensis, and Psychotria asiatica). In addition, mentioned by various groups, were three collections identified to generic level (Gonocarym, Kalanchoe, and Melastoma).

Blumea balsamifera was reported for a postpartum use in all villages except Nam Lue. It was also used on a daily basis in all 5 steam saunas included in the study. Artocarpus heterophylla and Curcuma longa were other species mentioned both during the village interviews and by the steam sauna informants. A. heterophylla was claimed to promote lactation and C. longa mainly used for different skin problems. They are both cultivated commercial species. This applies to many of the species used in steam saunas unlike the species reported from the villages which were almost exclusively picked from the wild.

3.7 GC-MS results

Six of seven distillates yielded results in the Gas Chromatograph combined with a Mass Spectrometer (GC-MS) analyze. The identified compounds for each species are presented in tables 9-14. Table 9. List of compounds detected by GC‐MS in Ka kok, Alpinia cf. oblongifolia, ELLA 51. Pseudostem and leves used in steam bath and young shoots are consumed for quick postpartum recovery of strengh/health. Informants: Mrs Youm, Mrs Niam and Mrs Nang mee (Ban Kaoy). RTT (min)2

Compounds CAS number Abundance (%)

Concistency3

5.97 α-phellandrene/δ-terpinene 586-62-9 /99-83-2

5.99 2

7.35 β-ocimene 13877-91-3 5.60 2 9.46 1,8-cineol (Eucalyptol) 470-82-6 62.10 1 27.02 trans-p-mentha-2,8-dienol 1000139-65-3 15.96 2 1 Fresh weight of extracted material approx. 200gr. Destillation was made with 0.5L of water. Essential oil yield missing

due to leakage. 2 Retention time in minutes 3 Consistency of compound spectra to yielded spectra and earlier documented compounds in the species. 1 equals high

consistency and 3 indicate low (needs to be confirmed by further analysis).

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Table 10. Compounds in Mak neng kam (mae), Zingiber sp., ELLA 151. Stem and leaves used for steam bath postpartum. Informants: Mrs Chan Hom, Mrs Khaet, Mr Long Maet and Mr Peo (Ban Mak Feuang). RTT2 (min)

Compounds CAS number Abundance (%)

Concistency3

5.83 α-phellandrene 99-83-2 6.384 3 5.83 β-terpinene 99-84-3 6.384 3 6.27 Camphene 79-92-5 1.62 1 7.22 β-ocimene 13877-91-3 25.74 2 7.73 β-phellandrene 555-10-2 2.16 1 21.44 p-anisaldehyde 123-11-5 6.82 2 47.90 4-(4-methoxyphenyl)-2-butanone 104-20-1 9.30 2 1 Fresh weight of extracted material 250gr. Distillation was made with 0.5L water. Essential oil yield 0.2ml. 2 Retention time in minutes. 3 Consistency of compound spectra to yielded spectra and earlier documented compounds in the species. 1 equals high

consistency and 3 indicate low (needs to be confirmed by further analysis). 4 Compounds merged in detection peak. Table 11. Compounds in Gok ko pa kang, cf. Elettariopsis, ELLA 181. Decoction of root used to stop secondary postpartum haemorrhage. Informants: Mrs Chan Hå:m and Mrs Khaet, Mr  Maet, Mr Peo and Mr Yan Pohn (Ban Mak Feuang). RTT2 (min)

Compounds CAS number

Abundance (%)

Concistency3

5.97 α-phellandrene/β-Terpinene 99-83-2 /99-84-3

8.80 2

6.42 2,5,6-trimethyl-1,3,6-heptatriene 42123-66-0 38.95 2 7.35 β-ocimene 13877-91-3 19.48 2 9.51 1,8-cineole (eucalyptol) 470-82-6 15.354 1 9.51 1-methyl-4-(1-methylethyl)-2-cyclohexen-1-ol, cis 17699-16-0 15.354 3 19.54 α-terpinene 99-86-5 8.81 2 1 Fresh weight of extracted material 268 gr. Distillation was made with 0.5L water. Essential oil yield 0.08ml. Material was collected 4 days before distillation was made.

2 Retention time in minutes. 3 Consistency of compound spectra to yielded spectra and earlier documented compounds in the species. 1 equals high consistency and 3 indicate low (needs to be confirmed by further analysis).

4 Compounds merged in detection peak. Table 12. Compounds in Ka/ Ka dong, Amomum cf. microcarpum, ELLA 281. Whole plant used in steam bath for quick postpartum recovery of strength/health. Informants Mrs Youm (Ban Kaoy) Mr Long Maet and Mr Peo (Ban Mak Fueang). RTT2 (min)

Compounds CAS number

Abundance (%)

Concistency3

5.97 α-phellandrene/β-Terpinene 99-83-2 /99-84-3

5.85 2

7.35 β-ocimene 13877-91-3 11.56 2 9.49 1.8-cineole (eucalyptol) 470-82-6 75.89 1 1 Fresh weight of extracted material approx. 200 gr. Distillation was made with 0.5L water. Essential oil yield 0.2 ml. 2 Retention time in minutes. 3 Consistency of compound spectra to yielded spectra and earlier documented compounds in the species. 1 equals high consistency and 3 indicate low (needs to be confirmed by further analysis).

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Table 13. Compounds in Chi nai khome, Adenosma bracteosum1.  Whole plant used in steam sauna to relax the mind, for people that are to serious and think too much, and to alliviate postpartum abdominal pain and promote healing. Informants: Ms Seng and  Ms Noy (Steam sauna, Vientiane). RTT2 (min)

Found compounds CAS number

Abundance (%)

Concistency3

9.23 p-cymene 99-87-6 46.23 1 10.77 1,3,8-p-menthatriene 21195-59-5 28.744 3 21.06 1-methoxy-4-methyl-2-(1-methylethyl)-benzene 31574-44-4 22.98 3 1 Dried material destillated with 0.5 L of water. Essential oil yield 0.3ml. 2 Retention time in minutes. 3 Consistency of compound spectra to yielded spectra and earlier documented compounds in the species. 1 equals high

consistency and 3 indicate low (needs to be confirmed by further analysis). 4 Compounds merged in detection peak. Table 14. Compounds in Hoa sikai, Cymbopogon nardus1. Leaves used in steam sauna to promote healing postpartum. Informants: Ms Noy (Steam sauna, Vientiane). RTT2 (min)

Found compounds CAS number

Abundance (%)

Concistency3

20.61 cis-carveol 1197-06-4 12.93 221.53 α-terpinene 99-86-5 59.79 31 Fresh weight of extracted material 120gr. Distillation was made with 0.5L water. Essential oil yield 0.25 ml. 2 Retention time in minutes. 3 Consistency of compound spectra to yielded spectra and earlier documented compounds in the species. 1 equals high

consistency and 3 indicate low (needs to be confirmed by further analysis).

The distillate from Blumeea balsamifera was discarded due to indication of suspected contamination and no results are presented for this species.

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4. DISCUSSION

The great number of plant species reported in this paper demonstrates the importance of traditional medicine (TM) in ante- and postpartum (APP) health care in Lao PDR. Women in rural villages often relied directly on plants during pregnancy, birth and convalescence. The majority of births in the villages appeared to take place at home; alone or with the attendance of family members or/and a local midwife. Visiting hospitals did not seem like a preferred alternative but a last way out. This, in addition to unavailability of pharmaceuticals, made the reliance of plants well defined in postpartum situations of haemorrhage, abdominal pain and lactations complications. Plants were also used to increase fertility, facilitate birth, prevent or cure infections in the newborn, and promote postpartum recovery of strength/health.

Many of the species presented in this study were only reported by one informant or in one village. This could be a reflection of a large number of species used in APP health care in combination with a relative low number of informants. It could also be a difference in species use between the ethnic groups, however to make such a conclusion a more comprehensive investigation including more villages and informants/village are needed. Some differences in modes of preparation between the villages could nevertheless be observed. Steam bath was a common postpartum health procedure reported by all informants in the Brou villages in Nakai-Nam Theun NBCA. In the Northern villages, Akha, Hmong and Lanten, no informant mentioned steam bath in postpartum health care. If the lack of this health care procedure only is due to the villages northern location or to ethnic groups there residing is left to future research.

Most species used in APP health care were wild harvested and this could also be a reason to the low consensus of species and use between the villages. The villages’ locations could cause variations in species composition and diversity due to distinction in topography and climate. In a study of APP medicinal plant use by Tickin and Dalle (2005) it was clearly the commonly cultivated plants that made up the greatest consensus of use.

4.1 Reflection upon some genera and species in APP health care

4.1.1 Postpartum abdominal pain Postpartum abdominal pain is the most common problem after delivery (A. Stridh, personal communication). One of the species reported from Mak Feuang to alleviate postpartum pain was Ziziphus oenoplia. Species within the genus Ziziphus are used in South Asian as well as African countries in TM to treat pain and inflammatory related ailments. Z. oxyphylla and Z. spina-christi have demonstrated potent antinociceptive and anti-inflammatory activities when tested on mice and rats (Adzu et al. 2001, Adzu & Haruna 2007, Nisar et al. 2007). Another species with analgesic properties through inhibition of COX-2 is Ziziphus jujuba (Shah 1989, Su et al. 2002). Further investigations of Z. oenoplia and on components responsible for the observed effects would be of importance.

Only three species used in APP health care were found to be cultivated. One of these is Kalanchoe sp. reported from Nam Vang village to alleviate pain during pregnancy. In Lao Khao it served as an application on broken bones. In previous studies the genus Kalanchoe is mentioned for its use in TM against convulsions, headaches and inflammations. Ibrahim et al. (2002) have shown anti-inflammatory effects of K. brasiliensis, and K. crenata shows efficacy as a central and peripheral analgesic by Nguelefack et al. (2004, 2005).

4.1.2 Lactation Mussaenda (including Schizomussaenda) is an important genus in local Lao health care. It was reported form all northern villages in use for various health problems. Kha tho form the Hmong village

42

claimed the use of Schizomussaenda dehiscens as a lactagoge and usefulness for the mother to regain strength/health after delivery. Li et al. (2006) reported its use in medicinal baths among Yao communities in southern China. For Mussaenda species anti-bacterial and immuno-stimulating effects as well as significant effects on terminating early pregnancy in rats have been demonstrated (Zhao et al. 1997; Kim et al. 1999; Li et al. 2004; Qin & Xu 1998).

The use of Artocarpus heterophylla, commonly known as Jackfruit, was reported from two interviews in Lao Khao village as well as from one steam sauna interview. In both, a decoction was drunk to promote lactation. Little effort has been made in investigation of Jackfruit’s medicinal qualities despite a history of widespread use in Southeast Asia. It usefulness as a lactagoge is worth further investigation and Jackfruits chemical constituents and their effect would be of greatest interest.

4.1.3 Contraception Only one species was mentioned to be used as a contraceptive and one to provoke abortion. The low number of plants reported for these purposes could due to various reasons. One informant claimed that use of plants as abortifacients was outlawed. The use of contraceptives does not seem to be encouraged in some ethnic groups due to cultural believes, and women are promoted to have many children. Other precautions of using plants as contraception could be unwanted side effects on health. Khao Tho stated that a decoction of “Jaj to”, Melastoma sp, was only to be drunk by elderly women who did not want any more children as it could cause permanent infertility. Scrutiny of literature does not reveal any reported effects on Melastoma spp. to prevent conception, although Melastoma candidum has showed to give an increased contraction frequency of uterus when tested on guinea pigs (Chou & Liao 1982) which might provoke abortion in early state of pregnancy.

4.1.4 Postpartum haemorrhage Five identified species were reported by more than one ethnic group. Four of these (Blumea balsamifera, Clerodendrum fragrans, Phlogacanthus cf. annamensis, Psychotria asiatica) were used to promote healing and contraction of uterus, one of the most common treatments mentioned in all villages. Postpartum haemorrhage caused by reduced uterus contraction after delivery is one of the most common causes of maternal mortality and morbidity in developing countries (Gilbert et al. 1987; WHO 2000). Species effective against this postpartum complication can thus be considered of highest importance and an interesting research field in need of more attention.

Clerodendrum species have shown to contain interesting and rare compounds. Although Clerodendrum spp. are most known for their pesticidal properties they are used in traditional medicine to arrest bleeding from cuts and other wounds as well as stopping postpartum haemorrhage (Devi et al. 1997, Madhu & Madhu 1997, Bandaranayake 2002). These uses agree with the applications reported for Clerodendrum fragrans in Lao Khao village. However literature search does not reveal any biological testing of these alleged effects.

Psychotria asiatica was claimed by the informants in Mak Feuang village to heal the wound inside the mother after delivery and cause contraction of uterus. All informants also mentioned its use for healing wounds and cuts and stating its astringent effect. Analgesic properties have been reported (Elisabetsky et al.1995, Amador 1996, Both et al. 2002), but it is still unclear whether it has wound healing and contractive qualities.

Phlogacanthus cf. annamensis, commonly used in the northern villages Lao Khao and Nam Vang against postpartum haemorrhage and to alleviate pain, does not seem to appear in previous ethnobotanical reports nor been given attention regarding chemical composition. However from some species in the genus diterpene lactones, steroids and triterpenes have been isolated (Barua et al. 1985, Yadav et al. 1998, 1999, Yuan et al. 2005). Further investigation of Phlogacanthus annamensis and bioactivity of compounds within the genus would be of great interest.

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Blumea balsamifera is by far the most important postpartum species in Laos. It was mentioned to have a beneficial postpartum effect in three villages and in four steam saunas. Its use in steam saunas included: healing of the postpartum wound and to alleviate postpartum abdominal pain, as well as relief of other bodily pains (e.g. pain in muscle and nerves or bruises and swellings caused by accident). While the use applied in the villages was to sit or lie on to promote healing of the uterus after childbirth and to stop postpartum haemorrhage. Non-postpartum applications were for pain in bones, rheumatism and arthritis, dengue fever, skin diseases, headache and dizziness, sore throat, breathing problems through the nose and weakness and tiredness. Blumea balsamifera has a widespread traditional use in Asia. It has been reported from Thailand, Malaysia and the Philippines to be applied in herbal baths by women after given birth (Quisumbing 1978, Ruangrungsi et al. 1985, Fasihuddin & Holdsworth 2007). In China it is used in traditional medicine for menstrual pain and to provoke abortion (Kong et al. 1976, Hai et al. 1999). B. balsamifera is also an important herb of Ayurvedic medicine and externally applied for injuries, rheumatic pains and skin diseases.

Previous investigations of the chemical constituents of B. balsamifera specify numerous bioactive flavonoids, sesquiterpene lactones, blumealactones A, B, and C, and cryptomeridiol. The major essential oil components are borneol, camphor and β-caryophyllene (Zhou et al. 2001 cited in Ragasa et al. 2005, Nguyen et al. 2004). Borneol is produced by reduction of camphor. Camphor is readily absorbed through the skin and acts as analgesic/local anaesthetic, antipruritic and antimicrobial substance. Fazilatun et al. (2005) provides results that extracts of B. balsamifera have interesting antioxidant properties.

4.2 Steam sauna

The high number of species (22) mentioned in steam saunas for treating postpartum complications demonstrates its importance in Lao health care. The species used in the town saunas greatly differed from the species used in the villages. Only three species reported from the villages were also found to be used in the steam saunas. Of these, two were the cultivated commercial species, Artocarpus heterophylla and Curcuma longa, and one was the widely used Blumea balsamifera. The steam sauna procedure greatly resembles the steam bath performed as a postpartum procedure in the Brou villages. However none of these three species were reported both for steam bath and steam sauna use. The lack of coherence is probably due to the frequent use of cultivated or commercially available plants in the town saunas.

Curcuma longa (Zingiberaceae) was used in steam saunas both for general skin problems and after childbirth for tensing of lose skin, treatment of stretch marks and to prevent bacterial infection. The species was also used for skin problems in the villages although not specifically postpartum. C. longa is cultivated in tropical regions and used in textile, food and pharmaceutical industries (Srimal & Dhawan 1973). It is also known as tumeric and it is commonly used in Indian folk medicine. Curcumin is a polyphenolic compound present in the extracts of the plant. Numerous studies have indicated that curcumin has high antioxidant and anti-inflammatory properties (Aggarwal et al. 2005). A Medline search revealed over 1000 publications describing various activities of this polyphenol. Sidhu et al. (1998) examined wound healing capacity of curcumin in rats and showed that wounds in curcumin-treated animals healed faster than in untreated animals. Biopsis of wounds showed reepithelialisation of epidermis and increased migration of various cells in the wound bed. Mani et al. (2002) also showed that topical application of curcumin significantly accelerated healing of wounds. Curcumin also protects from scarring. Phan et al. (2003) show that it has potent effects in inhibiting proliferation and contraction of excessive scar-derived fibroblasts. Other effects of C. longa extracts on skin are anti-psoriatic and anti-fungal (Bosman 1994, Bernd et al. 1997, 2000; Heng et al. 2000; Wuthi-Udomlert et al. 2000). Moreover curcumin has not demonstrated any toxicity in human trials (Chainani-Wu 2003, Aggarwal et al. 2005). Based on the documented effects of compounds and extracts form both Curcuma longa and Blumea balsamifera, as well as the long traditional use of the species, they can most likely be regarded as safe and useful plants in traditional health care.

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Interestingly steam sauna was not recommended during pregnancy or directly after childbirth. Reasons for this could be that some plants may have a hypotensive effect on the uterus, or could be slightly toxic which could put the baby, and mother, at risk.

4.3 Informants and gender specific knowledge

The key informants in this study were 8 men and 7 women. We opted to have equal numbers of male and female informants in each village to be able to evaluate if there existed a difference in knowledge about ante- and postpartum plants between men and women. Due to the type of study and the difficulty of finding informants interested to participate, especially in the northern villages, we cannot draw any final conclusions about this interesting subject. However in Mak Fueang the great overlap of plant species reported by the three men and the two women interviewed, and the nearly equal number of species reported, 13 and 11 plants respectively, suggests that there is no significant difference in knowledge between the genders.

In the northern villages it was more difficult to find informants as knowledge on medicinal plants was more heterogenically spread, being mainly a knowledge realm of healers and shamans, and not as general as in the Nakai-Nam Theun area. Several Brou people without a special village position had a broad knowledge about medicinal plants, especially in the older generation. This difference could due to the northern villages more exposed location. In the Akha village, Lao khao, informants mentioned the use of pharmaceuticals, especially against pain, bought in Muang Sing approximately 5 km from the village. Differences in culture and the pronounced role of the shamans’ (usually men) can also be reasons to a more restricted knowledge in the northern villages.

During the interviews it was noticed that some shamans and healers were reluctant to give information on their knowledge as a whole. And questions had to be restricted to a single symptom or a set of symptoms. This not only led to a better understanding of what was expected of them, but made them more willing to reveal what amounted to restricted areas of their expertise. Nevertheless one village shaman was not interested in participation because he suspected us, rich white people, of coming to steal his knowledge to make expensive medicine to sell back to them.

In addition plant use in the northern villages was more connected to magic and spells. Some plant remedies needed magic spelling to function and some health complications were due to spiritual issues and a shaman’s performance was required.

4.4 Voucher collections

The aim of collecting voucher specimens for all plants used in health care was unfortunately not achievable as some informants were not able to do forest walks or the plants mentioned during the interviews were not found during the walks. This caused a minor uncertainty in the number of species reported as species lacking vouchers could have been mentioned under different names, especially in different villages.

The plant identification, that mainly took place in Sweden, was difficult and time consuming mainly due to incomplete or lacking floras, but also because the collection took place during the dry season, November to April, and a large percentage of the species was not bearing flowers or fruits. Nevertheless the collections are of great value as earlier collected material from Laos is very limited.

4.5 GC-MS analysis

4.5.1 Compounds within the species Four of the six species distilled and analyzed for possible bioactive compounds belonged to the Zingiberaceae family, placed in the genera Alpinia, Amomum, Elettariopsis and Zingiber. Although the compound composition varied between the species, Alpinia cf. oblongifolia (ELLA 5), Amomum cf.

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microcarpum (ELLA 28) and cf. Elettariopsis (ELLA 18) all contained 1,8-cineol. In the former two it was the main compound, constituting 60-80% of the oil. 1,8-cineol has also shown to be the dominant constituents of large cardamom (A. subulatum) (Gurudutt et al. 1996, Adegoke et al. 1998, Naik et al. 2004), while other species in the genus like A. villosum seem to lack or contain low percentages of the compound.

1,8-Cineol is a terpene oxide found in many plant essential oils. It is the dominating terpene in Eucalyptus species and is therefore also called eucalyptol. In a study by Umezu et al. (2001) intraperitoneal administration of 1,8-Cineol significantly increased ambulatory activity in mice, indicating its act as psychostimulant upon the central nervous system. Other properties of 1,8-cineole are antimicrobial, anti-inflammatory and analgesic (Pattnaik 1997, Jurgens et al. 1998, Santos & Rao 2000, 2001, Jurgens et al. 2003, Santos et al. 2004). It relaxes bronchial, vascular and cardiac muscle (Lahlou et al. 2002, Soares et al. 2005). It has also been shown that prolonged exposure to eucalyptol inhalation increases cerebral blood flow correlated with eucalyptol concentration in blood (Stimpf et al. 1995). The administration in steam bath/saunas is mainly through inhalation, which has been proved to give more effective diffusion to blood than by oral intake (Kovar et al. 1987). It has also shown to be non-toxic and non-irritant (Opdyke 1975). Based on above investigations it is likely that species with a high content of 1,8-cineol have a beneficial effect on health after childbirth. Eucalyptus (E. globulus) was commonly used in steam saunas and mentioned to alleviate postpartum pain, which is coherent with the reported analgesic effects of eucalyptol.

Amomum microcarpum is a sparsely investigated species and no documentation of its chemical composition could be found in literature. In this study except for 1,8-cineol, β-Ocimene was found as a main compound. β-Ocimene is one of the most commonly found monoterpenes of the volatile blends that are emitted from leaves in response to damage (Fäldt et al. 2003). The substance allo-ocimene, closely related to β-ocimene, has showed to increase the intensity of healing of skin and skin-muscle wounds (Pravdich-Neminskaya & Kachkov 1978).

Analysis of the ELLA 15 (Zingiber sp., Mak neng kam) essential oil indicated a high number of compounds, some of which were not identified in this study. Zingiber species have been given plenty of research attention. The widely cultivated and commercially sold Z. officinale (Ginger) is the best known species but also Z. zerumbet and Z. cassumunar have gained attention for their use in Chinese, Thai and Malaysian traditional medicine (Vimala et al. 1999, Somchit et al. 2005). Z. cassumunar is used for reliving muscle pain and inflammation and possess analgestic, anti-spasmodic, and anti-inflammtory effects (Ketusinh et al. 1984, Kanjanapothi et al. 1987, Ozaki et al. 1991, Masuda et al. 1995). In Laos, the fruits of ELLA 15 are also picked and sold to Vietnamese and Chinese buyers. Some interesting compounds detected were camphene, 4-(4-methoxyphenyl)-2-butanone, and p-anisaldehyde. Phenylbutanonids, alough rare in nature are characteristic for the genus. P-anisaldehyde is common in anis oil and has anti-fungal activity (Ozcan & Chalchat 2006). P-anisaldehyde has not been previously detected in this genus.

ELLA 18 (Gok ko pa kang, probably Elettariopsis sp.) was claimed to be useful against postpartum haemorrhage. However non of the detected compounds (β-Ocimene, α-phellandrene/ β-Terpinene, cis-1-methyl-4-(1-methylethyl)-2-cyclohexen-1-ol, 2,5,6-trimethyl-1,3,6-heptatriene, 1,8-cineole or α-terpinene) have been showed to have contractive or anti-haemorrhaging effects.

The main constituent of the steam sauna plant Adenosma bracteosum was p-cymene (46% of the oil content). P-cymene is harmful with inhalation and irritates the eyes, respiratory system and skin (Cometto-Muniz 1998), and it is questionable if A. bracteosum is a suitable plant to use in steam saunas.

4.5.2 General considerations of steam distillation and GC-MS analysis Some Zingiberaceae species analyzed in GC-MS were distilled in the villages, others at a laboratory at NUOL. Distillation in the villages increased the possibility of contamination due to impure water and

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difficulties of cleaning the material. Further in the field the process needed to be surveyed at all time, to maintain a stable heat source and recycling of water for cooling, making it quite time consuming. However we noted that performing the steam distillation on the same day as the material was collected provided a greater oil yield. If the plant material needed to be stored for later distillation there was also an increased risk for fungal growth. The low yield of ELLA 15 (cf. Elettariopsis) is most likely a reflection of storage loss. Storage might also change the composition of the oil due to oxidation processes.

It should be pointed out GC-MS analysis is not a full-proof method and the results should be confirmed with references or another reliable technique. In GC-MS computers, programs and databases can suggest likely compounds by comparing unknown (yielded) mass spectra against a file of reference spectra. However the result is only an indication of what may be in the oil. It should be noted that most likely some compounds in the species will not be known. For qualitative identification the compound one considers most apt for the given spectra should be verified by running it against a reference under identical conditions. In this study references were not run due to the project’s restricted time, and the compounds presented are only based on interpretation of mass spectra and personal judgment. The results from GC-MS can also be confirmed by NMR spectroscopy, which can provide more detailed information on the topology and dynamics of the molecules. However the results presented in this study indicate some interesting species for further investigation.

4.6 Reflections on future medicinal plant use and research in Laos

It is important to note that what makes plants essential during childbirth and puerperium in Laos is the fact that the majority of the women in rural villages give birth at home, and the access to pharmaceuticals and health care facilities are still poor. Due to the fast internal changes in the country: road constructions, habitat degradation and the relocation of highland populations, the human interaction with plants is likely to change, the access to modern medical centres increase and the role of plants during birth and convalescence are likely to diminish. However contradicting this is the great poverty of many upland and highland populations and their deeply rooted cultural believes making traditional medicine often deemed a more appropriate method of treatment. TM is readily available, affordable and functional in many aspects, and should not be underestimated. Projects can be started together with local villagers to make essential species more available through small-scale cultivation which also lessen the risk for species extinction. Small scale commercial production should also be investigated, and this production should follow Good Agricultural Practice (GAP). Such production could lead to the development of local or regional commercialization, especially if Good Manufacturing Practice (GMP) is observed. In the end the value of traditional plant knowledge, generally acquired over hundreds of years, and the value of plant species themselves cannot be over emphasized (Farnsworth & Soejarto 1985).

Laos with its rich flora and high ethnic diversity create unique possibilities for further ethnobotanical research. Much remains to be learned about the essential use of traditional medicine during pregnancy, birth and convalescence as well as the similarities and differences regarding plant use between the ethnic groups. Further phytochemical, pharmacological and clinical studies could improve the knowledge about beneficial and potentially harmful plant remedies and allow for incorporation of some of these remedies in an organized system of health care. Furthermore knowledge of the active substances would facilitate standardization and defined dosages.

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ACKNOWLEDGEMENTS

First I would like to thank my supervisors Dr. Lars Björk and Hugo de Boer MSc, Dept. of Systematic Botany, Uppsala University, Sweden for their time and support from the first application, through the fieldwork to getting it all together in the end. I appreciate all inventive ideas, feedback on previous versions of the report and help with the onerous identification of specimens.

My Lao supervisors Dr. Bouakhaykhone Svengsuksa, Vichith Lamxay MSc, and Chanda Vongsombath MSc, at Faculty of Science, National University of Laos were invaluable during the field study, both in regard to their botanical expertise and assistance in the field as well as their valuable help with many practical problems in Laos, thank you.

I wish to thank my co-student Lina Ahnby for all her work put into the study, her positive attitude and talent for making things possible, Amsy Ounmany and Fongsamude Sivilay who interpreted and helped with the plant collections during the fieldwork, Paphavadee Keomaungsan who kindly provided plant material for distillation and shared her expertise about steam saunas, Say Phonekeo and Chantala Saphakdy for their hospitality and friendly support throughout the study. I express my gratitude to Meike Mumm at GTZ, Muang Sing, Laos, to Yangyia Senyakoun and Marcel Frederik at ADRA, Luang Namtha, Laos, and all other people who helped making our study in Luang Namtha possible. I am also deeply grateful to the local interpreters Soyae and Khay, and to the people participating in interviews: Bang, Basi, Khamphon, Niam, Nang mee and Youm (Ban Kaoy), Boa see, Chan Hom, Khaet, Long Maet, Peo and Yan Pohn (Ban Mak Feuang), Yeha, Soyae, and Laser (Ban Lao Khao), Kao tho, Tsia hua moa and Nyea Toh (Ban Nam Vang), Laolee (Ban Nam Lue), Ismae Kaokeo Maungsan (Vatnakhounnoy, Naxaythong), Pohn, Say and Nil (Luang Namtha), Lao PDR, and Annicka Stridh at Falu Lasarett, Sweden. Thank you for sharing time and knowledge regarding births, plants and plant remedies.

A special thanks to Dr. Paul Kessler and other researchers at the National Herbarium Nederland Leiden branch (NHN-L), Leiden, the Netherlands for all the help with transportation and identification of collected specimens, to Dr. Mark Newman at the Royal Botanic Garden Edinburgh, Scotland, U.K. for his help with identification of Zingiberaceae species, and to Jens Klackenberg and the people at the herbarium at the Swedish Museum of Natural History for their cooperation. At the Dept. of Organic Chemistry at Lund University, Sweden, Einar Nilsson and Prof. Olov Sterner deserves warm thanks for the assistance in GC-MS analysis.

I thank also the Swedish International Development Cooperation Agency (Sida) for financial support.

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Appendix A. Translation of common words in local plant names in Lao PDR Vernacular word Language Translation in English

Phi Akha Ghost Jaga Akha Medicine Jo-ho-tje Akha Big Jo-ja-tje Akha Small Gok Brou Tree, tree trunk Neng Brou Food Bao bai Hmong Butterfly Chao Hmong Vegetable De(j) Hmong Water Djii (zib) Hmong Sweet Do Hmong Black Dong Hmong Tree I:a Hmong Bitter Kao (Quab) Hmong Sour Kü Hmong Wrap Lia Hmong Red Mi Hmong Nipple Njo Hmong Cow Pa Hmong Flower Shi Hmong Dog Tsi Hmong Fruit Yeng Hmong Opium Joa Hmong Green Zoa Hmong Wash Me jay Lanten Eyes On Lanten Red Ab Lao Wash/for bathing Bai Lao Leaf Ban ton ban tå: Lao Light (about the feeling of the body) Sa:ng Lao Elephant Deng Lao Red Dok Lao Flower Dong Lao Evergreen forest Håm Lao Good smelling Hoa Lao Head Kao Deng Lao Red glue Läp meo Lao Cat claw Mä Lao Mother Mai Lao Tree, wood Mai håm Lao Tree with good smell Meo Lao Cat Ngä:n Lao Lift up one’s head Nja Lao Weed Noi Lao Small, little Nyai Lao Large, big Phak / pak Lao Green vegetable Püak Lao Bark Thon Lao Tree Thong Lao Open forest

Appendix B. Plant family abbreviations Abbrevation Family Abbrevation Family

ACA Acanthaceae POLYG Polygonaceae ANA Anacardiaceae POLYP Polypodiaceae ANN Annonaceae RAN Ranunculaceae APO Apocynaceae RHA Rhamnaceae ARA Araceae ROS Rosaceae ARE Arecaceae RUB Rubiaceae ARI Aristolochiaceae RUT Rutaceae ASPA Asparagaceae SAU Saururaceae ASPL Aspleniaceae SCR Scrophulariaceae AST Asteraceae SEL Selaginellaceae BEG Begoniaceae SMI Smilacaceae BIG Bignoniaceae SOL Solanaceae CAP Capparaceae TIL Tiliaceae CAR Caryophyllaceae VER Verbenaceae COM Combretaceae VIT Vitaceae COS Costaceae ZIN Zingiberaceae CRA Crassulaceae CUR Curcubitaceae CYP Cyperaceae ELA Elaeagnaceae EUP Euphorbiaceae FAB Fabaceae GEN Gentianaceae GLE Gleicheniaceae HEM Hemerocallidaceae HYP Hypoxidaceae ICA Icacinaceae JUG Juglandaceae LAM Lamiaceae LAU Lauraceae LEG Leguminosae LIL Liliaceae LYG Lygodiaceae (incl. Schizaeaceae) LYT Lythraceae MAL Malvaceae MAR Marantaceae MEL Melastomataceae MEN Menispermaceae MIM Mimosaceae MOR Moraceae MYRS Myrsinaceae MYRT Myrtaceae OCH Ochnaceae OLE Oleaceae ORC Orchidaceae OXA Oxalidaceae PAP Papaveraceae PIP Piperaceae PLA Plantaginaceae POA Poaceae

Appendix C. Plants used in health care in Lao PDR Scientific name Family1 Vernacular Voucher

ELLA #Plant source2

Informant Village Use Plant part

Mode of preparation and dosage

Ageratum conyzoides AST Må po 60 w Laser Lao Khao

Wounds and cuts, stop bleeding

Leaf Chewed and applied on the wound

Aglaonema sp. ARA Blong kü yeng 139 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits

Stem and leaf

Boiled in combination with Bai nat, Jang k(g)o, Lao shja, Ma kia thå, ELLA 138, ELLA 141, ELLA 144, and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available

Aglaonema sp. ARA Yo meo 169 w Laolee Nam Lue

Goitre (probably caused by deficiency of iodine)

Stem Cleaned and chopped stem are put fresh or dried in lao-lao for one day. Little is drunk from a piece of folded banana leaf that is later ripped apart. The extract is drunk every morning before breakfast until feeling better

Ajuga macrosperma var. macrosperma

LAM Sohö: ma: jaga 58 w Laser Lao Khao

Toothache, relieves pain Leaf Crushed and put on the tooth

Alocasia cucullata ARA Neja 104 c Yeha and Soyae

Lao Khao

Cuts Leaf Crushed leaves applied on wound

Alocasia macrorrhizos ARA Yå: 159 c Laolee Nam Lue

Big wounds and cuts under the foot

Leaf petiole

Heated in fire and stepped on. Repeat 3 times a day during 2 days

Alpinia /Hedychium ZIN A-tjö 89 w Yeha Lao Khao

Promote health after hard work and tiredness, or if to skinny

Root Used together with Metumeloma and Pa-tji Pa-tja. Decoction from chopped root is drunk hot

Alpinia cf. oblongifolia ZIN Ka ko:(k) 5 w Niam and Nang mee

Kaoy 1: Promote postpartum recovery of health 2: Food

1: Whole plant 2: Root

1: Decoction from stem and leaves are preferred for steam bath. Young shoots are peeled and eaten postpartum 2: Cooked with e.g. chicken la:p and eaten

Alpinia oblongifolia ZIN Ka ko:(k) (Ka thong)

10 w Youm Kaoy 1: Promote postpartum recovery of health/strength 2: Food

1: Whole plant 2: Shoot and root

1: 40-60min decoction used for steam bath during 5-15 days postpartum 2: Young shoots are cooked and eaten under rainy season and roots are used in chillimix, soup, la:p

Alpinia sp. ZIN Ka w Basi Kaoy Promote postpartum recovery. (Also used in food, taking away bad smell on fish and meat)

Stem and leaves

Decoction for steam bath 3 times per day during 10 days postpartum. Used in combination with: Gok paiven, Püak mai püay, and Püak mai kadån

Alpinia sp. ZIN Ka w/c Youm and Khamphon

Kaoy Promote postpartum recovery of health/strength

Stem and leaf

Decoction for steam bath. 10-20 young pseudostems used for one pot. Can be used in combination with Gok paiven

Alpinia sp. ZIN Ka 2 w/c Niam and Nang mee

Kaoy Stomach ache Root Decoction drunk warm or cold

Alpinia sp. ZIN Metumeloma 88 w Yeha Lao Khao

Promote health after hard work and tiredness, or if to skinny

Root Used together with A-tjö and Pa-tji Pa-tja. Decoction from chopped root is drunk hot

Alpinia sp. ZIN Ka c Chan Hom Mak Feuang

Food

Alpinia sp. ZIN Ka Yan Pohn Mak Feuang

Promote healing of the postpartum wound and recovery of strength/health

Stem and leaf

Decoction used for steam bath, at least during 10 days (the time spent close to the fire). Can be used in combination with (Gok) Mak neng kam, Gok pidin and Gok pai-ven

Alpinia sp. ZIN Ka (Tham prüng, Brou name)

Chan Hom and Khaet

Mak Feuang

Postpartum Shoots (Stem and leaf)

Mixed with Mak neng and decoction used for steam bath. Shoots best to use, available June-July

Alpinia/ Amomum ZIN Ka dong w Youm Kaoy 1: Promote postpartum recovery of health/strength 2: Food

1: Whole plant 2: Shoot and root

1: 40-60min decoction used for steam bath during 5-15 days postpartum. Can be used in combination with Mak neng noi and Gok pai-ven 2: Young shoots are cooked and eaten under rainy season and roots are used in chillimix, soup, la:p

Amomum cf. ZIN Mä 80 w Yeha Lao Khao

Pain in bones and back, caused by hard work

Stem and leaf

Used together with Va, Va so, Di soma and Pate. Crushed leaves are applied on the place of pain during 2-3 days, changed 3 times a day

Amomum cf. ZIN Mak neng w Kao tho Nam Vang

Sold Fruit Fruit are sold to upland farmer and further to a company in Luang Nam Tha

Amomum cf. ZIN Mak neng njaj 168 w Laolee Nam Lue

Cough Root Cleaned and chopped root is boiled, and decoction drunk instead of water until feeling better

Amomum cf. ZIN Mejene 75 w Yeha Lao Khao

Stomach ache, diarrhoea Shoots, leaf or root

Used together with Ajene. Fresh or dried shoots, leaves or root are boiled together with Ajene and drunk as tea

Amomum cf. ZIN Mä 97 w Yeha Lao Khao

Strong pain that can affect elderly or adults. Not caused by work, accident or rheumatism

Use together with Whoa, Alatja:ma, Sogapa and Sogapatja. Crushed plant material is applied on the place of pain and changed two times per day until the pain disappear

Amomum cf. microcarpum ZIN Ka dong 28 Long Maet and Peo

Mak Feuang

1: Promote postpartum recovery 2: Food

1: Stem and leaf 2: Root

1: Decoction used for steam bath 2: Cooking la:p or soup

Amomum cf. villosum ZIN Mak neng sa: (Mak neng nyai)

w Khamphon Kaoy Sold Fruit Fruits are sold

Amomum cf. villosum ZIN Mak neng sa: (Mak sa nyai or Mak sa deng)

w Youm Kaoy Food and Sold

Fruit Fruits are eaten or sold

Amomum cf. villosum ZIN Mak thö: 12 w Chan Hom and Khaet

Mak Feuang

Sold and food Fruits Fruits are picked in September for eating and selling

Amomum repoeense ZIN Mak sa: 14 w Chan Hom and Khaet

Mak Feuang

Sold Fruits Fruits are picked in September- October and mixed with mak neng fruits for selling to people in Nakai

Amomum sp. ZIN Mak neng kam po

13 w Chan Hom and Khaet

Mak Feuang

Postpartum Stem and leaf

Decoction used for steam bath

Amomum sp. ZIN Mak neng 1 w Niam and Nang mee

Kaoy Postpartum Decoction used for steam bath

Amomum sp. ZIN Mak neng kam po

16/17 w Chan Hom and Khaet

Mak Feuang

Postpartum Stem and leaf

Decoction used for steam bath

Amomum sp. ZIN Mak neng kam po

16/17 w Long Maet and Peo

Mak Feuang

Postpartum Upper stem and leaf

Decoction used for steam bath

Amomum sp. ZIN Mak neng nyai 19 Long Maet and Peo

Mak Feuang

1: Postpartum 2: Sold

Stem and leaf

1: Decoction used for steam bath. Can be used together with Ka 2: Fruits are sold to Lao and Vietnamese

Amomum sp. ZIN Mak neng nyai 19 w Yan Pohn Mak Feuang

Postpartum, Steam bath heals the wounds after delivery and makes the body become one unit again, strong and healthy

Stem and leaf

Decoction used for steam bath during the postpartum resting period close to the fire

Amomum sp. ZIN Mak neng, Mak kong (Prai neng Brou name)

19 Chan Hom and Khaet

Mak Feuang

1: Postpartum 2: Sold

Aerial parts

1: Decoction used for steam bath 2: Fruits are picked in September-October for selling

Archidendron clypearia FAB Jamalaga 47 w Yeha and Soyae

Lao Khao

1: Prevent infection and dries the navel after cutting the umbilical cord 2: Pain outside the ear

1: Leaf 2: Leaf

1: Crushed leaves are applied on the umbilical and changed 3 times per day 2: Crushed leaves are put behind the ear

Archidendron clypearia LEG Goa di 149 w Nyea Toh Nam Vang

Dust in eyes Stem and leaf

Decoction (5 min.) is used to wash the eyes

Arenga caudata ARE Gok tao noj 25 w Long Maet and Peo

Mak Feuang

For stopping heamorrhage and recover after miscarriage

Root Used together with Gok san gives twice the effect.

Arenga caudata ARE Gok tao noj 25 w Yan Pohn Mak Feuang

Promote recovery after miscarriage

Root Roots from Gok tao noj and Gok san are singed, cleaned and boiled. 1 pot of decoction drunk per day during 3-7 days (depending on state)

Arenga caudata ARE Gok tao noj (Ka ye:n, Brou name)

25 w Chan Hom and Khaet

Mak Feuang

Promote recovery after miscarriage

Root Roots from Gok tao noj and Gok san is singed, cleaned and boiled. Amount of decoction drunk depends on when miscarriage occurred, e.g. misscarrige after 1 month - 1 pot +refill drunk, after 2 month - 2 pots +refills drunk etc.

Aristolochia cf. pierrei ARI Ma koa mi 157 w Nyea Toh Nam Vang

Lactagoge Steam and leaf

Chicken filled with cleaned plant material is cooked and eaten. Use one handful of the plant for a little chicken. Eaten every day until the milk is coming and for another two days

Artemisia sp. AST Sampü 69 c Yeha and Soyae

Lao Khao

Cuts and wounds. Stops haemorrhage

Leaf Applied on the wound

Artocarpus heterophylla MOR Ma: mi w Laser Lao Khao

Lactagoge Leaf and fruit

Decoction drunk instead of water until milk is coming

Artocarpus heterophylla MOR Ma:mi (Jakfruit) 50 c Yeha and Soyae

Lao Khao

Promote lactation Young leaf and bud

Eaten at least 3 times/day until enough milk is produced

Asparagus sp. ASPA La pu jaga (Pinnju, Lao name)

74 w Yeha Lao Khao

Pain when urinating Root 2-3 L. of decoction drunk

Asplenium nidus ASPL Name not known

141 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits

Leaf Boiled in combination with Bai nat, Blong kü yeng, Jang k(g)o, Lao shja, Ma kia thå, ELLA 138, ELLA 144, and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available.

Begonia handellii BEG Kao de (Qaub dej, hmong writing)

129 w Kao tho Nam Vang

Directly after parturition, to alleviate pain

Whole plant

Lower part of abdomen is covered by cleaned, crushed, and salted plant for 10 min. (bandage used to keep in place). Repeat if pain persist

Beilschmiedia cf. wallichiana

LAU Gok mai hå:m 21 w Long Maet and Peo

Mak Feuang

Clogged milk ducts Leaf and stem

Decoction from singed stem (outer bark removed) and leaf used for steam bath. Breast massaged with singed young leaves (massage can be performed on its own as well)

Beilschmiedia cf. wallichiana

LAU Gok mai hå:m 21 w Chan Hom and Khaet

Mak Feuang

Clogged milk ducts Leaf Decoction of leaf used for steam bath, in combination with massage of the breast

Beilschmiedia cf. wallichiana

LAU Gok mai hå:m 21 w Yan Pohn Mak Feuang

1: Clogged milk ducts 2: Construction material

1: Branch and leaf 2: Stem

1: Decoction used for steam bath. Breast massaged with singed leaves 2: For building houses and mangers (“hang mo:”)

Blumea balsamifera AST Asama w Laser Lao Khao

Postpartum healing of uterus Leaf Placed on the bed or chair for lying or sitting on. Used for 5-7days and changed 2-3 times a day

Blumea balsamifera AST Asama(Bai nat, Lao name)

49 w Yeha and Soyae

Lao Khao

Stop postpartum haemorrhage and promote healing inside

Leaf Placed on chair or bed for sit or lie on. Leaves changed when dry

Blumea balsamifera AST Bai nat 140 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits.

Leaf Boiled in combination with Blong kü yeng, Jang k(g)o, Lao shja, Ma kia thå, ELLA 138, ELLA 141, ELLA 144 and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available.

Blumea balsamifera AST Bai nat (Nja-qu)

w Youm and Khamphon

Kaoy Postpartum use Leaf Placed on the bed (covered with a blanket) or special chair, to sit or lie on

Blumea balsamifera AST Chai-yeng w Kao tho Nam Vang

Tired or weak, breathing problems

Leaf Boiled in pot for steam bath

Blumea balsamifera AST Ha tje küta 78 w Yeha Lao Khao

Sore throat Leaf Decoction made together with Kobja najaga, 2L of water to 1 hand of cut plant material. Drunk until feeling better

Blumea balsamifera AST Ha-tje-küta 57 w Laser Lao Khao

Pain in bones, rheumatism or arthritis

Root Cut, boiled and drunk instead of water until feeling better

Blumea balsamifera AST Yang ko (Bai-nat, Lao name)

w Nyea Toh Nam Vang

Headache and dizziness Leaf Forehead is covered with warmed and crushed leaves. Hold in place by bandage for 2 hours. Repeat if not better.

Blumea balsamifera AST Gok na:t (A:phoak, Brou name)

w Chan Hom and Khaet

Mak Feuang

For healing of the wound caused by parturition

Stem and leaf

Placed on the chair or bed (covered by blanket) for sitting or lying on during 10-15 days postpartum. Combined with heated coal under the bed

Blumea balsamifera AST Gok na:t (Bai na:t)

w Yan Pohn Mak Feuang

Feel lighter postpartum Stem and leaf

Placed on the woman’s chair or/and bed (cover with blanket) to sit or lie on. Plant material changed every day

Blumea balsamifera AST Gok nat (A: phoak, Brou name)

Long Maet and Peo

Mak Feuang

Promote healing of the wound caused by delivery

Leaf Placed on chair to sit on, use during 10-15 days after delivery

Caesalpinia cf. major FAB Me jay ti 117 w Laolee Nam Lue

Red and painful eyes, from e.g. dust.

Leaf Eyes washed in lukewarm decoction. Leaves boiled 10 min

Canscora andrographoides GEN Sü fa 151 w Nyea Toh Nam Vang

Pain when urinating Root, stem and leaf

Boiled for a few min., and drunk one time a day until improvement

Caryota mitis ARE Va 82 w Yeha Lao Khao

Pain in bones and back, caused by hard work

Leaf Used together with Mä, Va so, Di soma and Pate. Crushed leaves are applied on the place of pain during 2-3 days, changed 3 times a day

Caryota mitis ARE Whoa 95 w Yeha Lao Khao

Strong pain that can affect elderly or adults. Not caused by work, accident or rheumatism

Leaf Used together with Sogapa, Alatja:ma, Mä and Sogapatja. Crushed plants are applied on the place of pain and changed two times per day until the pain disappear

Chromolaena odorata AST Yelaman w Khamphon Kaoy 1: Postpartum 2: Wounds

1: Aerial parts 2: Leaf

1: Plant material is picked for the mother to sit on 2: Chewed and applied on wound

Chromolaena odorata AST Yelaman w Youm and Bang

Kaoy 1: Promote postpartum healing and recovery of health and strength 2: Wounds

1: Aerial parts 2: Leaf

1: Sit or lie on postpartum, placed on the chair or bed (cover with blanket) 2: Chewed and applied on wound

Chromolaena odorata AST Yelaman w Chan Hom and Khaet

Mak Feuang

Wounds Flower Chewed and applied on the wound, keep in place during 1 day

Chromolaena odorata AST Yelaman Long Maet and Peo

Mak Feuang

Cuts Leaf Chewed and applied on the wound

Chromolaena odorata AST Yelaman w Yan Pohn Mak Feuang

Prevent infection and helps healing of wounds.

Leaf Crushed leaves mixed with salt and applied on the wound for 5 min. Repeat every day during one week, or until healed. Keep clean and out of water

Clausena sp. RUT Dong dej shi 131 w Kao tho Nam Vang

Antipyretic Leaf Wrists and ankles are covered with crushed leaves

Clausena/Micromelum RUT Lo:tajaga 77 w Yeha Lao Khao

Wounds, prevent infection and fly larvae in wounds on buffalos

Leaf Crushed leaves are applied on the wound

Cleghornia malaccensis APO Küa en on 33 w Long Maet and Peo

Mak Feuang

For increased movement if shortened tendon or muscle

Stem and leaf

Decoction used for steaming the area of stiffness (covered with blanket). In combination with massage with the leaves and stretching

Clematis sp. RAN Tja bon tja ka (Ja ke poa, lao name)

43 w Laser Lao Khao

Suffering from pain and not able to eat food

Whole plant

Chopped and boiled for 5-10 min. Drunk instead of water until feeling better

Clerodendrum fragrans VER Hahondetze 86 w Yeha Lao Khao

Stop postpartum haemorrhage and promote healing (of uterus)

Leaf Placed on the chair or bed to sit or lie on postpartum. Preferably used in combination with Sutzi and Osama

Clerodendrum fragrans VER Njong-me 118 w Laolee Nam Lue

Lactagoge and promote postpartum recovery of strength

Root Decoction is made in combination with Lo-gaj and Mai njeng dong. One hand of cleaned and chopped plant material is boiled for 10-20 min and drunk instead of water during one week or until enough milk are produced for the baby

Coscinium fenestratum MEN Küa hä:m 9 w Khamphon Kaoy Sold Stem, bark

Pick and sold at the market

Coscinium fenestratum MEN Küa hä:m 9 w Long Maet and Peo

Mak Feuang

Malaria, preventive or cure Stem Singed, cleaned and used for decoction. Plenty drunk during numerous days

Costus sp. COS Massüjaga (Japi, Lao name)

73 w Yeha Lao Khao

Feeling weak and skinny Root and lower part of stem

Used together with Kö-sö and Håtjalage. Decoction from chopped plant material is drunk instead of water until you feel better

Crotalaria assamica var. assamica

FAB Gom om ma 161 w Laolee Nam Lue

Swollen or aching muscle, not caused by work.

Aerial parts

An armful of is boiled for 10 min in 3 L of water. Decoction used as bath water, 2 times a day for 2 weeks

Croton kongensis EUP Tjimepapü 65 w Yeha and Soyae

Lao Khao

Antipyretic Young stem and leaf

Used together with "Mi tja lå jaga" and Spo. Decoction mixed with cold water for bathing.

Curculigo cf. capitulata HYP Alatja:ma 96 w Yeha Lao Khao

Strong pain that can affect elderly or adults. Not caused by work, accident or rheumatism

Leaf Use together with Whoa, Sogapa, Mä and Sogapatja. Crushed plants are applied on the place of pain and changed two times per day until the pain disappear

Curcuma sp. ZIN Dok katio w Khamphon Kaoy Food Flower Flowers are eaten Curcuma sp. ZIN Dok katio 20 w Chan Hom

and Khaet Mak Feuang

Food Flower Inflorescence are picked in August for eating

Curcuma sp. ZIN Dok katio 20 Boa see Mak Feuang

Scorpion bite Root Crushed and put on the bite (The whole plant can be used, but preferably root)

Curcuma sp. ZIN Dok katio 20 w Long Maet and Peo

Mak Feuang

Stinging bites, like bee and scorpion

Root Crushed and applied on the bite

Curcuma sp. ZIN Kimin c/w Youm and Khamphon

Kaoy Itching, skin rash, insects bite, and acne.

Root Cut and applied directly

Dicranopteris sp. GLE Ashu 42 w Laser Lao Khao

Promote health of newborn. Aerial parts

Cut and boiled for 5-10 min. Decoction mixed with cold water and used for bathing the baby one time/day during one week. Used by most mothers.

Dicranopteris sp. GLE Ashu 92 w Yeha Lao Khao

Promote health in newborn and used against chickenpox

Stem and leaves

Cut plant material is boiled for 5-10 min and mixed with cold water for bathing. 3 times/day during the first week (newborn health) or until symptoms disappear (chixenpox). Used in combination with Sima

Dicranopteris sp. GLE Shåa dong, (A:shu)

w Kao tho Nam Vang

After accident, to reduce pain, swellings, and bruises

Root Pluck a fowl and put a handful of roots inside. Boil in water and eat.

Drymaria cordata CAR Ma thin 165 w Laolee Nam Lue

White spots occurring on gums in mouth.

Whole plant

A bun is made and hanged around the neck. Used until spots go away

Drynaria quercifolia

POLYP Gok hang hok w Long Maet and Peo

Mak Feuang

Accumulation of body fluids, causing swelling

Base of stem

1: Chop the base of the fern in a pot and boil in water for steam bath 2: Signed leaves are put on the bed (give good smell), cover with blanket to sleep on

Drynaria quercifolia POLYP Gok hang hok w Khamphon Kaoy Sobering when drunk. Stem Take of the bark and chew the stem

Elaeagnus sp. ELA Tsi njo(n) mi 133 w Kao tho Nam Vang

Diarrhoea Root Decoction drunk hot 3 times a day, very bitter. Root is cleaned, chopped and boiled together with “Ma kaow”. Used until feeling better

Elettariopsis cf. ZIN Gok kå: pa kang

18 w Yan Pohn Mak Feuang

Pain in joints, e.g. after hard working or long walk

Root Decoction drunk until pain disappears (usually after one pot)

Elettariopsis cf. ZIN Gok kå: pa kang (Ta kong kalua)

18 w Chan Hom and Khaet

Mak Feuang

Stop secondary postpartum haemorrhage

Root Singed and cleaned root is boiled. Decoction drunk as tea until the bleeding stops. About 20 roots for 2 pots

Elettariopsis cf. ZIN Gok kå: pa kang (Ta kong kalua)

18 w Long Maet and Peo

Mak Feuang

Stop secondary postpartum haemorrhage

Root Decoction drunk from singed and cleaned root. 3 pots can be made from the same material.

Embelia sp. MYRS Ma kaow 132 w Kao tho Nam Vang

Diarrhoea Stem or root

Decoction drunk hot 3 times a day, very bitter taste. Stem/root cleaned, chopped and boiled together with Tsi njo(n) mi. Used until feeling better

Engelhardtia spicata JUG Gok pao (Pa tja(k), Brou name)

27 w Chan Hom and Khaet

Mak Feuang

Against leaches Inner bark Inside of the bark smeared on the leach, makes it drop or die

Engelhardtia spicata JUG Gok pao (Pa tja(k), Brou name)

27 w Long Maet and Peo

Mak Feuang

Against leaches Inner bark Inside of the bark smeared on the leach, makes it drop or die

Evodia simplicifolia RUT Nepaha 103 w Yeha Lao Khao

After funeral, for protection against spirits that can follow you home

Leaf Leaves are placed behind the ear

Fibraurea cf. MEN Vom khat ma 177 w Laolee Nam Lue

Heartburn Leaf Leaves cleaned and crushed with water turns into a jelly that are eaten with added spring onion, salt and seasoning powder. One big hand of leaves are used for ½ L. of water

Ficus hispida MOR Si ko ma thö 38 w Laser Lao Khao

Disease causing weakness, tiredness, yellow eyes and skin, and weight loss

Root Decoction from cleaned and cut rot is drunk instead of water. Drink as much as possible until feeling stronger, same plant material can be used for 3 pots

Ficus sp. MOR Spo 64 w Yeha and Soyae

Lao Khao

Antipyretic Young stem and leaf

Used together with "Mi tja lå jaga" and Tjimepapü. Decoction mixed with cold water to wash yourself

Fissistigma sp. ANN Klå-pjet-na 115 w Laolee Nam Lue

Strained a muscle Bark (dried)

The place of the strained muscle (e.g. arm, leg) is put over a boiling decoction and steamed, 2 times per day (morning and evening)

Glochidion cf. EUP Ka tap dom 167 w Laolee Nam Lue

Stomach ache, diarrhoea Root or young leaf

Young leaves eaten or root boiled for 10 min and the decoction drunk instead of water until feeling better

Gonocaryum sp. ICA Ma tjaj, (Ja-ke(t), Lao name)

108 w Laolee Nam Lue

Promote postpartum healing inside, and recovery of strength for mother and newborn

Leaf Decoction made from 7-8 leaves boiled for 10 min, drunk warm from the second day of delivery and during one month instead of water. Can also be used last month of pregnancy

Gonocaryum sp. ICA Sä:n mü:ang w Khamphon Kaoy 1: Postpartum 2: Food

1: Branch and leaf 2: Young leaf

1: Decoction for steam bath 2: Young leaves are eaten with la:p

Gonocaryum sp. ICA Sä:n mü:ang w Long Maet and Peo

Mak Feuang

Pain in joint, rheumatism or arthritis, makes swelling go done

Leaf and stem

Decoction of leaves is used for steam bath, and decoction of chopped stem is drunk instead of water

Gonocaryum sp. ICA Sä:n mü:ang w Yan Pohn Mak Feuang

Food Leaf Young leaves are boiled and eaten with chilli

Grewia sp. TIL Kamai ken 112 w Laolee Nam Lue

Stomach ache, diarrhoea and gases

Young leaf or bark

Fresh young leaves (bitter) or bark are chewed. Over consumption will cause constipation

Hedyotis sp. RUB Do jha 152 w Nyea Toh Nam Vang

1: Fever 2: Luxation of joint

1: Root 2: Stem and leaf

1: Cleaned and cut roots are boiled for 1-2 min, 3 glasses of decoction is drunk for maximum 2 days 2: Crushed stem and leaves are applied on the place of luxation and covered with bandage to keep in place 2-3 h.

Hedyotis sp. RUB Name not known

145 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits

Whole plant

Boiled in combination with Bai nat, Blong kü yeng, Jang k(g)o, Lao shja, Ma kia thå, ELLA 138, ELLA 141, and ELLA 144 for steam bath. Perform once a day during 5-6 days if plant material is available.

Hedyotis sp. RUB Ü:tü ja 40 w Laser Lao Khao

Pain in bones Whole plant

Rub the plant externally on the place of pain. Use until feeling better

Hibiscus sp. MAL Ajene 76 w Yeha Lao Khao

Stomach ache, diarrhoea Leaf Used together with Mejene. Decoction drunk

Houttuynia cordata SAU Då ka tå (Pak a thång, Lao name)

154 w Nyea Toh Nam Vang

Stomach ache, diarrhoea Stem and leaf

Cleaned and crushed herb is mixed with egg and wrapped in banana leaf, cooked in fire for a few minuets. Eaten 3 times a day

Imperata cylindrica POA Nja Ka w Long Maet and Peo

Mak Feuang

Antipyretic Root Root soaked in water together with Mai Kang pa, Gok Düa pong, and Nja Kha(t) for 5-6 min, then drunk Fresh material is preferred but dried can be used

Jasminum sp. OLE Nja moi ma 110 w Laolee Nam Lue

Toothache Leaf Crushed leaves are put on the tooth

Kalanchoe sp. CRA Patö 68 c Yeha and Soyae

Lao Khao

Broken bones Leaf Crushed leaves are applied on the place of injury

Kalanchoe sp. CRA Kai-yang 148 c Kao tho Nam Vang

1: Pain during pregnancy due to incident that made the infant move quickly 2: Cuts

Leaf 1: Infusion, let 2-3 chopped leaves draw for 5 min two-three glasses drunk during 1 day. 2: Crushed leaves and applied on the cut.

Ligustrum sinense OLE Pa hå pö 125 w Kao tho Nam Vang

Heartburn, White spots in mouth

Leaf Twenty young leaves are chewed one time a day. Bitter taste

Lycianthes sp. SOL A tje bå ha 67 c Yeha and Soyae

Lao Khao

Stomach ache, constipation Root Decoction drunk

Lygodium cf. LYG Ni ray koj 26 w Long Maet and Peo

Mak Feuang

Promote postpartum health when starts working

Whole plant

One pot of decoction used for steam bath when the postpartum resting periods ends. Plant can be dried

Lygodium cf. LYG Ni ray koj 26 w Chan Hom and Khaet

Mak Feuang

Prevent dizziness and feeling sick when postpartum resting period ends

Whole plant

Decoction used for steam bath on the day the woman starts working postpartum. The steam has hot smell like chilli. Same material can be used twice

Lygodium cf. LYG Ni ray koj, Brou name (Pha(k) ko:t kheo, lao name)

26 w Yan Pohn Mak Feuang

1: Prevent dizziness and cause a feeling of lightness the day you start working postpartum2: Food

Whole plant

1: Decoction used for steam bath the day the woman starts working (leaves the fire) postpartum. 2: Young leaves are eaten with la:p (traditional food)

Maesa sp. MYRS Di soma 83 w Yeha Lao Khao

Pain in bones and back, caused by hard work

Leaf Used together with Mä, Va, Va so, and Pate. Crushed leaves are applied on the place of pain during 2-3 days, changed 3 times a day

Mallotus barbatus EUP Krat nom, (Koh Tao hoang, Bai hoa sang Lao name)

111 w Laolee Nam Lue

Prevent fly larvae infection of animal wounds and cuts

Leaf Crushed leaves and put on the wound

Mallotus barbatus EUP Mai hoa sa:ng 23 w Long Maet and Peo

Mak Feuang

Diarrhoea Root/ Stem

3 pots of decoction drunk. Stem/root singed and bark removed before use

Mallotus barbatus EUP Mai hoa sa:ng (Ka torr a:tjian)

23 w Chan Hom and Khaet

Mak Feuang

Diarrhoea Root Decoction drunk, made of signed root

Melastoma cf. saigonense MEL Gok kan tuaj 32 w Long Maet Mak Feuang

Stomach ache and bloody diarrhoea

Root Decoction drunk from singed and cleaned root

Melastoma sp. MEL Jaj tå 135 w Kao tho Nam Vang

Contraceptive, mainly for older women that do not wish to have more children

Root 1L. of decoction made from cleaned and chopped root is drunk every day during 2-3 days. Over dosage can damage health and cause permanent infertility

Melastoma sp. MEL Tam chan (Gok ki kan, Lao name)

119 w Laolee Nam Lue

Diarrhoea Root Decoction drunk instead of water three times a day. One hand of cleaned and chopped roots are boiled for 20 min. Decoction can be made two times of the same roots

Micromelum falcatum RUT Tjotjoma 162 w Laolee Nam Lue

Used after childbirth, if the mother is weak and thin. Promote health and strength, makes the face blossom

Root or wood

One hand of cleaned and chopped root/wood is boiled in a pot of water. Decoction drunk warm instead of water until feeling better. Can be used directly after delivery

Mimosa pudica MIM Nam jay (Nja Njok, Lao)

121 w Laolee Nam Lue

Alleviate pain in vagina and menstrual pain

Root Decoction drunk

Mussaenda sp. RUB Ha pa 44 w Laser Lao Khao

Pain when urinating, blood can occur in urine

Root (branch and leaf)

Root decoction (10-15 min) preferred, drunk instead of water until feeling better

Mussaenda sp. RUB Halababa 105 w Laser Lao Khao

Burns Leaf Crushed and put on the wound, covered with bandage. Use until the pain disappear

Mussaenda sp. RUB Halababa w Yeha and Soyae

Lao Khao

Burns Leaf Crushed leaves are applied on the wound and covered with bandage. Used until the pain disappear

Mussaenda sp. RUB Pa bao bai 126 w Kao tho Nam Vang

Headache or dizziness Leaf orRoot

Cleaned, crushed leaves are put on forehead for 2-3h. When suffering from strong headache cleaned and chopped root are boiled for 10 min and drunk 3 times a day. Half a hand to ½ L. of water

Mussaenda sp. RUB Täng mäng dom

166 w Laolee Nam Lue

Sore throat Root Cleaned root are chewed on and swallowed. Used until feeling better

Papaver somniferum PAP Opium c Kao tho Nam Vang

Diarrhoea Fruit The fruit is singed over fire and cuts are made with a knife before the sap are collected with a spoon. The sap are further heated on a needle in the fire and consumed

Papaver somniferum PAP Opium w Yeha Lao Khao

Stomach ache and bloody diarrhoea. Sore throat. Pain

Fruit, or fruit sap

Eat a tiny bit of grilled fruit or boil a little piece of the fruit in half a litre of water and drink as tea. Against pain the dried sap from the fruit are smoked and sometimes mixed with crushed paracetamol

Peliosanthes sp. LIL Son ga ama 93 w Yeha Lao Khao

Constipation Root Have to be used in combination with Tapiatalå. Decoction from cleaned roots can be drunk warm or cold

Phlogacanthus cf. annamensis

ACA Lå hama w Laser Lao Khao

Postpartum healing of uterus Leaf Placed on the bed or chair for lying or sitting on. Used for 5-7days and changed 2-3 times a day

Phlogacanthus cf. annamensis

ACA Lå hama 53 w Yeha and Soyae

Lao Khao

Stop postpartum haemorrhage and promote healing inside

Leaf Placed on chair or bed for sit or lie on. Leaves changed when dry

Phlogacanthus cf. annamensis

ACA Pa dgii (Paj zib, hmong writing)

153 w Nyea Toh Nam Vang

Pain in body, not from work Leaf Picked and put on the bed, covered with blanket, and slept on during night. Leaves should be changed every day, use until feeling better. Best results given when the leaves are heated over fire and then lie down on directly, without clothes

Phlogacanthus cf. annamensis

ACA w Kao tho Nam Vang

Headache Leaf Crushed leaves are put on forehead and covered with bandage

Phrynium sp. MAR Pa-tji Pa-tja 90 w Yeha Lao Khao

Promot health after hard work and tierdness, or if to skinny

Root Used together with A-tjö and Pa-tji Pa-tja. Decoction from chopped root is drunk hot

Phyllanthus cf. reticulatum EUP Naj sej-ma 116 w Laolee Nam Lue

Increase fertility Root Two glasses of decoction drunk by the woman before going to bed. Used in combination with Krai-kok ma, Jam-lao and Krai-tzing

Piper sp. PIP Lao shja 142 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits

Leaf, stem and flower

Boiled in combination with Bai nat, Blong kü yeng, Jang k(g)o, Ma kia thå, ELLA 138, ELLA 141, ELLA 144 and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available

Pluchea indica AST Me jay ma 113 w Laolee Nam Lue

Red and painful eyes, from e.g. dust

Leaf Eyes washed in lukewarm decoction made from one hand of leaves boiled for 10 min

Pogostemon glaber LAM Ab Sutzi w Laser Lao Khao

Postpartum healing of uterus Leaf Placed on the bed or chair for lying or sitting on. Used for 5-7days and changed 2-3 times a day

Pogostemon glaber LAM Ab Sutzi w Yeha and Soyae

Lao Khao

Stop postpartum haemorrhage and promote healing inside

Leaf Placed on chair or bed for sit or lie on. Leaves changed when dry

Pogostemon glaber LAM Sutzi 85 w Yeha Lao Khao

Stop postpartum haemorrhage and promote healing (of uterus)

Leaf Placed on the chair or bed to sit or lie on postpartum. Preferably used in combination with Hahondetze and Osama

Polygonum sp. POLYG A kü melane 45 w Laser Lao Khao

Sickness and vomiting, from eating meet

Stem and root

Root and lower part of stem are boiled 5-10 min. Decoction drunk for 2-3 days. New decoction is made every day

Polygonum sp. POLYG Ga mi ma: 54 w Yeha and Soyae

Lao Khao

Pain in joints, (rheumatism, arthritis)

Leaf Chopped leaves are applied on the place of pain

Psidium guajava MYRT Ba oj (Mak si da, Lao name)

120 w Laolee Nam Lue

Stomach ache, diarrhoea Young leaves and root

Young leaves are eaten and root decoction is drunk. Has astringent taste

Psychotria asiatica RUB Gok van tjoth 3 w Youm Kaoy Postpartum Stem Decoction drunk instead of water. Made from singed stem cleaned from bark

Psychotria asiatica RUB Gok van tjoth 3 w Youm and Khamphon

Kaoy Lactagoge Stem Singed, cleaned and chopped for decoction. Drunk warm instead of water during 5 days. Astringent taste

Psychotria asiatica RUB Gok van tjoth 22 w Long Maet Mak Feuang

1: Promote healing of the postpartum wound 2: Wounds and cuts

1: Stem 2: Bark

1: Chopped stem used for decoction. Drunk instead of water. Commonly used. 2: Decoction from chopped bark is used for cleaning the wound

Psychotria asiatica RUB Gok van tjoth 22 w Chan Hom Mak Feuang

1:Promote postpartum contraction of uterus (Astringent) 2: Wounds

1: Wood 2: Leaf

1: Stem singed, bark removed and chopped in 10-15 cm pieces for decoction. 4-5 pots drunk per day instead of water during 10-15 days (or during the time close to the fire) 2: leaves are chewed and put on the wound

Psychotria asiatica RUB Gok van tjoth 22 w Yan Pohn Mak Feuang

1: Postpartum 2: Healing of bad wounds and cuts, antibiotic effect

1: Wood 2: Inner bark

1: Stem singed, bark removed and chopped for decoction. Drunk warm instead of water during 10 days. Same material can be used for maximum 2 pots. 2: Chopped and applied on wound

Psychotria sp. RUB Jan quan tham 163 w Laolee Nam Lue

Relieves itching from skin rash, eczema and insects bites

Leaf Cleaned and crushed leaves are put on rash or bite 3 times a day

Punica granatum LYT A kha kao 48 c Yeha and Soyae

Lao Khao

Stomach ache Leaf and fruit

Fruit eaten, or decoction made of leaves, drunk instead of water

Radermachera ignea BIG Pa i:a 134 w Kao tho Nam Vang

Postpartum protection against infections

Inner bark Decoction used for bathing water/vaginal douche one time a day on the third day after delivery and up to 3 weeks. 1Kg of chopped plant material to 5 L of water. Used together with “Phå ja” and “Joan thjå” if encountered

Rauvolfia cf. serpentina APO Xai thao (Txhais Taum, hmong writing)

128 w Kao tho Nam Vang

Stomach gases Root 3 glasses of decoction drunk per day, made from approx. 10 cm. of cleaned and cut root in 1 L. of water. Used until feeling better. Extremely bitter

Rhaphidophora ARA Sogapatja 98 w Yeha Lao Khao

Strong pain that can affect elderly or adults. Not caused by work, accident or rheumatism

Leaf Use together with Whoa, Alatja:ma, Mä and Sogapa. Crushed leaves are applied on the place of pain and changed two times per day until the pain disappear

Rhaphidophora cf. peepla ARA Så ka jojatje 55 w Yeha and Soyae

Lao Khao

Infected wounds or pain caused by work

Leaf Crushed leaves and put on the wound/place of pain

Rhaphidophora cf. pertusa ARA Sogapa 99 w Yeha Lao Khao

Strong pain that can affect elderly or adults. Not caused by work, accident or rheumatism

Leaf Use together with Whoa, Alatja:ma, Mä and Sogapatja. Crushed plants are applied on the place of pain and changed two times per day until the pain disappear

Rhuacophila cf. javanica HEM Ma djeo 172 w Laolee Nam Lue

For children suffering from big stomachs and pale faces

Leaf The soft lower part of the leaf is fried together with egg and eaten in the morning during 2-3 days. 10 leaves are used for 1 egg

Rhus chinensis sp. ANA Sima 91 w Yeha Lao Khao

Promote health in newborn and used against chickenpox

Young branch and leaf

Cut plant material is boiled for 5-10 min and mixed with cold water for bathing newborn. 3 times/day during the first week (newborn health) or until symptoms disappear (chickenpox). Used in combination with Sima

Rostellularia procumbens ACA Nga so o ha 56 w Laser Lao Khao

Cuts Leaf and flower

Crushed and applied on cut, covered with Heliconia leaf

Rubus sp. ROS Lä:o sü 51 Yeha and Soyae

Lao Khao

Constipation Root Decoction drunk, made from chopped root

Schizomussaenda dehiscens RUB Name not known

130 w Kao tho Nam Vang

Lactagoge and promote recovery of strength postpartum

Root Decoction drunk warm 3 times per day during one month. One hand of cleaned and chopped root for 1 L of water. Minimum use one week.

Schizomussaenda dehiscens RUB Pa deu 155 w Nyea Toh Nam Vang

Sore throat Root Decoction drunk 3 times a day for two days, or until feeling better. Cleaned and chopped root is boiled for 5 min.

Scleria sp. CYP Lo-gaj 170 w Laolee Nam Lue

Promote lactation and postpartum recovery of strength

Whole plant

Decoction is made in combination with Njong-me and Mai njeng dong. One hand of cleaned and chopped plant material is boiled for 10-20 min and drunk instead of water during one week or until enough milk are produced for the baby

Selaginella sp. SEL Kiao tham 164 w Laolee Nam Lue

Burns Stem and leaf

Stem and leaves are heated over fire for 2 min, cut and crushed to small pieces and applied on the burn. It is also possible to apply pig oil on the burn before the chopped plant material. Plant material changed when dry

Sida retusa MAL Nja Kha(t) w Long Maet and Peo

Mak Feuang

Antipyretic Root Root soaked in water together with Mai Kang pa, Gok Düa pong, and Nja Ka for 5-6 min, then drunk. Fresh material is preferred but dried can be used

Smilax glabra SMI Jahoa w Long Maet and Peo

Mak Feuang

Promote health Root Chopped and boiled 2-3 times. Decoction drunk and root eaten

Smilax glabra SMI Jahoa w Chan Hom Mak Feuang

Promote health Root Signed, cleaned, and cut in small pieces for direct use in decoction or drying. Good to drink after given birth.

Smilax glabra SMI Jahoa (Hoa loang)

6 w Niam and Nang mee

Kaoy Promote health Root Decoction drunk from chopped fresh (singed) or dried root. Same root can be used for three pots of decoction

Smilax sp. SMI Ma thao chia 124 w Kao tho Nam Vang

Pain in bones Whole plant

Decoction

Smilax sp. SMI Va en ma 171 w Laolee Nam Lue

Kidney stones Whole plant

Cleaned and chopped plant is boiled for 10 min. One pot of decoction is drunk per day until feeling better.

Solanum violaceum SOL Sihaja 52 c Yeha and Soyae

Lao Khao

Stomach ache Fruit Fruit eaten

Solanum violaceum SOL Täi fai pjeo 158 c Laolee Nam Lue

Stomach ache, vomiting Fruit 10 fruits (yellow or red in colour) are crushed and urinated on by another person (preferably the opposite sex), then drunk

Spilanthes paniculata AST Pat menn ma 160 Laolee Nam Lue

Tooth pain Flower Flower chewed and put on the aching tooth

Stephania sp. MEN Thong pan 109 w Laolee Nam Lue

Prevent infections of wounds and cuts

Leaf 4-5 crushed leaves are put on the wound and covered with bandage, changed in the morning and evening

Steudnera colocasiaefolia ARA Name not known

138 w Kao tho Nam Vang

Weakness and tiredness Breathing problems through the nose Skin disease, normally occurring between fingers, in groins and armpits

Root, stem leaf

Boiled in combination with Bai nat, Blong kü yeng, Jang k(g)o, Lao shja, Ma kia thå, ELLA 141, ELLA 144, and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available

Stixis suaveolens CAP Mai njeng dong 174 w Laolee Nam Lue

Promote lactation and postpartum recovery of strength

Root Decoction is made in combination with Njong-me and Lo-gaj. One hand of cleaned and chopped plant material is boiled for 10-20 min and drunk instead of water during one week or until enough milk are produced for the baby

Syzygium gratum MYRT Pa:(g)hå 63 w Yeha and Soyae

Lao Khao

Cuts, stop the bleeding and prevent infections

Leaf Chopped leaves are applied on the cut

Terminalia sp. COM Gok mak ngen 24 w Chan Hom and Khaet

Mak Feuang

Disease causing tiredness, yellowing of skin and weakness. “Lack of blood”

Stem (bark removed)

Decoction drunk from singed wood

Terminalia sp. COM Gok mak ngen 24 w Long Maet and Peo

Mak Feuang

Disease causing tiredness, yellowing of skin and eyes, and weakness (no fever)

Stem (bark removed)

Decoction drunk from singed wood. As much as possible until feeling better

Tetrastigma sp. VIT Håtjalage 72 w Yeha Lao Khao

Feeling weak and skinny Root Used together with Kö-sö and Massüjaga . Decoction from chopped plant material is drunk instead of water until you feel better

Urena lobata MAL Krai-tzing (Nja kat moan, Lao name)

114 w Laolee Nam Lue

Increase fertility Root Two glasses of decoction drunk by the woman before going to bed. Used in combination with Krai-kok ma, Jam-lao and Naj sej-ma

Wallichia siamensis ARE Va so 81 w Yeha Lao Khao

Pain in bones and back, caused by hard work

Leaf Used together with Mä, Va, Di soma and Pate. Crushed leaves are applied on the place of pain during 2-3 days, changed 3 times a day

Wallichia siamensis ARE Whå so 102 w Yeha Lao Khao

Mute child, under the age of 15

Leaf Use together with Mä tho mä lo and Mäbo. A bunch of plants is placed on the child and a magic spelling is performed.

Zingiber cf. ZIN Mäbo 100 w Yeha Lao Khao

Mute child, under the age of 15

Stem and leaf

Use together with Mä tho mä lo and Whå so. A bunch of plants is placed on the child and a magic spelling is performed

Zingiber cf. ZIN Wan-fai c Chan Hom Mak Feuang

Stomach ache, gases Chop and mix with Ka-khom. Boil in water and drink as tea.

Zingiber cf. ZIN Mak neng kam (Mak neng noi)

w Khamphon Kaoy 1: Postpartum 2: Sold

1: Stem and leaf 2: Fruits

1: Decoction for steam bath 2: Sold to Vietnamese and Chinese people

Zingiber cf. ZIN Mak neng kam (Mak neng noi)

w Youm Kaoy 1: Postpartum 2: Sold

1: Stem and leaf 2: Fruits

1: Decoction for steam bath 2: Fruits are picked and sold

Zingiber sp. ZIN Gok pidin 4 w Niam and Nang mee

Kaoy Hard stomach. Stem Consumed

Zingiber sp. ZIN Gok pidin 4 w Khamphon Kaoy Hard stomach Stem Chewed on Zingiber sp. ZIN Gok pidin 4 w Yan Pohn Mak

Feuang Lactagoge Stem and

leaf Decoction used for steam bath. Possible to combine with, Mak neng kam, Ka and Gok paiven. Ought to be used at least during 10 days postpartum.

Zingiber sp. ZIN Mak neng kam 15 w Yan Pohn Mak Feuang

Promote postpartum healing, makes the body strong and healthy

Stem and leaf

Decoction used for steam bath during at least 10 days. Can be used in combination with Ka, Gok pidin and Gok pai-ven.

Zingiber sp. ZIN Mak neng kam 15 w Chan Hom and Khaet

Mak Feuang

1: Postpartum 2: Sold

1: Stem and leaf 2: Fruit

1: Decoction used for steam bath. Can be used together with Ka and Gok paiven 2: Fruits are sold

Zingiber sp. ZIN Mak neng kam 15 Long Maet and Peo

Mak Feuang

1: Postpartum 2: Sold

1: Stem and leaf (root) 2: Fruit

1: Decoction used for steam bath 2: Fruits are picked and dried for selling to the Vietnamese. 1kg cost around 14 000-25 000 Kip.

Zingiber sp. ZIN Mak neng kam (Mak neng noi)

15 w Yan Pohn Mak Feuang

1: Promote postpartum healing, makes the body strong and healthy 2: Stiffness and muscle pain

1 & 2: Stem and leaf

1: Decoction used for steam bath during the resting period close to the fire 2: Decoction made together with Gok mak to:m sang for steam bath

Zingiber sp. ZIN Mak neng kam mä:

15 w Long Maet and Peo

Mak Feuang

1: Postpartum 2: Sold

1: Stem and leaf 2: Fruit

1: Decoction used for steam bath 2: Fruits picked and sold

Zingiber sp. ZIN Gok pidin 4 w Youm Kaoy Stomach ace, diarrhoea (Also used as food)

Stem Chewed on after outer layer removed

Ziziphus oenoplia RHA Gok lä:p meo w Yan Pohn Mak Feuang

Alleviate postp. ab. pain and heal uterus

Stem Stem singed and cleaned from bark. One pot of decoction drunk the day of delivery.

Ziziphus oenoplia RHA Gok läp meo (Si mu tjong, Brou name)

w Chan Hom and Khaet

Mak Feuang

Expel retained placenta Stem Two-three 30 cm long pieces of trunk are singed and cleaned from bark, split in middle and boiled. Decoction drunk by most mothers. Used before Gok van tjoth. Same material can be used for 2 pots

Indet. AST cf. Kobja najaga 79 w Yeha Lao Khao

Sore throat Whole plant

Decoction made together with Ha tje küta, 2L of water to 1 hand of cut plant material. Drunk until feeling better

Indet. CUR cf. Ma kia thå 146 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits

Stem and leaf

Boiled in combination with Bai nat, Blong kü yeng, Jang k(g)o, Lao shja, ELLA 138, ELLA 141, ELLA 144 and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available

Indet. LAU Gok paiven w Youm and Khamphon

Kaoy Postpartum healing and recovery of health

Branch and leaf

Decoction for steam bath 3 times per day

Indet. LAU Gok paiven w Niam and Nang mee

Kaoy Postpartum Branch and leaf

Decoction for steam bath

Indet. LAU Gok pai-ven w Chan Hom and Khaet

Mak Feuang

Postpartum Stem and leaf

Decoction used for steam bath. Used in combination with Ka and Mak neng kam

Indet. LAU Gok pai-ven w Long Maet and Peo

Mak Feuang

Postpartum Stem and leaf

Decoction used for steam bath, during 10-15 days (during the resting period close to the fire) Can be used together with Mak neng kam, Mak neng nyai and Ka. Fresh plant material can also be put under the pillow

Indet. LAU Gok pai-ven w Yan Pohn Mak Feuang

Postpartum Stem and leaf

1: Decoction used for steam bath, in combination with Gok mak neng kam, Gok pidin and Ka. 2: Placed on the chair or/and bed (cover with blanket) for sitting or lying on. 1 & 2: Used during the resting period close to the fire (at least 10 days)

Indet. ORC Name not known

144 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits

Leaf Boiled in combination with Bai nat, Blong kü yeng, Jang k(g)o, Lao shja, Ma kia thå, ELLA 138, ELLA 141, and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available

Indet. POA Jam-lao 175 w Laolee Nam Lue

Increase fertility Whole plant

Two glasses of decoction drunk by the woman before going to bed. Used in combination with Krai-kok ma, Krai-tzing and Naj sej-ma

Indet. RUB Ako: 46 w Laser Lao Khao

Stomach ache Stem Chew the stem

Indet. ZIN Mä tho mä lo 101 w Yeha Lao Khao

Mute child, under 15 years old. Stem and leaf

Use together with Mäbo and Whå so. A bunch of plants is placed on the child and a magic spelling is performed

Indet. Ja samagü 62 w Laser Lao Khao

Coughing blood Root Decoction made from cut root drunk 3 times a day until better. 1 hand of roots to 1 L of water.

Indet. Ja tji tha 41 w Laser Lao Khao

After accident, swelling and bruises, inner bleedings and problem with circulation.

Bark Infusion made from cut bark. Drunk until feeling better

Indet. Jang k(g)o 137 w Kao tho Nam Vang

Weakness and tiredness. Breathing problems through the nose. Skin disease, normally occurring between fingers, in groins and armpits

Stem and leaf

Boiled in combination with Bai nat, Blong kü yeng, Lao shja, Ma kia thå, ELLA 138, ELLA 141, ELLA 144 and ELLA 145 for steam bath. Used once a day during 5-6 days if plant material is available

Indet. Joan thjå 147 w Kao tho Nam Vang

Postpartum protection against infections

Wood Decoction used for bathing water/vaginal douche one time a day on the third day after delivery and up to 3 weeks. 1Kg of chopped plant material to 5 L of water. Used together with “Pa i:a” and “Phå ja” if encountered

Indet. Krai-kok ma 173 w Laolee Nam Lue

Increase fertility Root Two glasses of decoction drunk by the woman before going to bed. Used in combination with Krai-tzing, Jam-lao and Naj sej-ma

Indet. Küa kao moak 29 w Yan Pohn Mak Feuang

1: Food 2: Washing detergent

1: Leaf 2: Bark

1: Young leaves eaten with chilli 2: Not used nowadays due to the access to soap

Indet. Küa kao moak 29 w Long Maet and Peo

Mak Feuang

Provoke abortion in the 2 first month of pregnancy

Stem, bark removed

Decoction drunk made from signed stem. 1-2 pots, or until you feel change in stomach

Indet. Kö sö 71 w Laser Lao Khao

Promote health, and healing internally and externally. Use when feeling ill or to alleviate pain Promote healing of the postpartum wound

Root Decoction from cleaned and chopped root is drunk. Use until feeling better

Indet. Kö-sö 71 w Yeha Lao Khao

1: Increase appetite postpartum and promote quick recovery 2: Feeling weak and skinny

1: Root 2: Root

1: One litre of decoction (10 min boiling) of chopped root is drunk warm instead of water during 1 week. Same material can be used 3 times 2: Used together with Massüjaga and Håtjalage. Decoction from chopped plant material is drunk instead of water until you feel better

Indet. Mi tja lå jaga 66 w Yeha and Soyae

Lao Khao

Antipyretic Young stem and leaf

Used together with Tjimepapü and Spo. Decoction mixed with cold water for bathing.

Indet. Name not known

123 w Kao tho Nam Vang

Stomach ache, constipation Whole plant

Decoction, made from one handful cleaned and chopped plant material are boiled in 2L of water together with chilli root. Drink every day during one week instead of water. Avoid spicy food, vinagre, salt and alcohol.

Indet. Name not known

127 w Kao tho Nam Vang

High blood pressure Stem Decoction from cleaned and chopped stem are drunk

Indet. Osama 87 w Yeha Lao Khao

Stop postpartum haemorrhage and promote healing (of uterus)

Leaf Placed on the chair or bed to sit or lie on postpartum. Preferably used in combination with Sutzi and Hahondetze

Indet. Pate 84 w Yeha Lao Khao

Pain in bones and back, caused by hard work

Leaf Used together with Mä, Va, Va so, and Di soma. Crushed leaves are applied on the place of pain during 2-3 days, changed 3 times a day.

Indet. Phå ja” 136 w Kao tho Nam Vang

Postpartum protection against infections

Bark Decoction used for bathing water/vaginal douche one time a day on the third day after delivery and up to 3 weeks. 1Kg of chopped plant material to 5 L of water. Used together with “Pa i:a” and “Joan thjå” if encountered.

Indet. Sa ku jaga 59 w Laser Lao Khao

Stop the bleeding and prevent infection of cuts and wounds

Aerial parts

Crushed and applied on the wound

Indet. Sondjilå 122 Kao tho Nam Vang

Strong pain in the area of the diaphragm

Leaf Crushed leaves are wrapped in banana leaves and heated over fire, then applied on the area of pain and kept in place with a bandage for 2h. Procedure repeated if not better

Indet. Tapiatalå 94 w Yeha Lao Khao

Constipation Root Used in combination with Son ga ama. Decoction from cleaned roots can be drunk warm or cold.

1 Plant Family is abbreviated to the first three-five letters in the family name, for complete family name see Appendix B 2 Symbols for source are c, cultivated and w, collected from the wild

Appendix D. Species used in health care in Lao PDR, sorted by vernacular name Vernacular name Language Species Voucher

ELLA #

A kha kao Akha Punica granatum 48A kü melane Akha Polygonum sp. 45A tje bå ha Akha Lycianthes sp. 67A:phoak, Brou Blumea balsamifera Ab Sutzi Akha Pogostemon glaber 85Ajene Akha Hibiscus sp. 76Ako: Akha Indet. 46Alatja:ma Akha Curculigo cf. capitulata 96Asama Akha Blumea balsamifera 49Ashu Akha Dicranopteris sp. 92Ashu Akha Dicranopteris sp. 42A-tjö Akha Alpinia /Hedychium 89Ba oj Lanten Psidium guajava 120Bai hoa sang Lao (southern) Mallotus barbatus 111Bai nat Lao Blumea balsamifera 49Bai nat Lao Blumea balsamifera 140Blong kü yeng Hmong Aglaonema sp. 139Chai-yeng Hmong Blumea balsamifera Cham ting mai Lanten Indet. 176Di soma Akha Maesa sp. 83Do jha Hmong Hedyotis sp. 152Dok katio Brou Curcuma sp. 20Dong dej shi Hmong Clausena sp. 131Då ka tå Hmong Houttuynia cordata 154Ga mi ma: Akha Polygonum sp. 54Goa di Hmong Archidendron clypearia 149Gok hang hok Lao Drynaria quercifolia Gok kan tuaj Lao Melastoma cf. saigonense 32Gok ki kan Lao Melastoma sp. 119Gok kå: pa kang Lao Amomum/ Elettariopsis 18Gok lä:p meo Lao Ziziphus oenoplia Gok mai hå:m Lao Beilschmiedia cf. wallichiana 21Gok mak ngen Lao Terminalia sp. 24Gok nat Lao Blumea balsamifera Gok pao Lao Engelhardtia spicata 27Gok pidin Lao Zingiber sp. 4Gok tao noj Lao Arenga caudata 25Gok van tjoth Lao Psychotria asiatica 3Gok van tjoth Lao Psychotria asiatica 22Gom om ma Lanten Crotalaria assamica var. assamica 161Ha pa Akha Mussaenda sp. 44Ha tje küta Akha Blumea balsamifera 78Hahondetze Akha Clerodendrum fragrans 86Halababa Akha Mussaenda sp. 105Ha-tje-küta Akha Blumea balsamifera 57Håtjalage Akha Tetrastigma sp. 72Ja ke poa Lao Clematissp. 43Ja samagü Akha Indet. 62Ja tji tha Akha Indet. 41Jackfruit Lao Artocarpus heterophylla 50Jahoa Lao Smilax glabra

Jahoa (Hoa loang) Lao Smilax glabra 6Jaj tå Hmong Melastoma sp. 135Ja-ke(t) Lao Gonocaryum sp. 108Jamalaga Akha Archidendron clypearia 47Jam-lao Lanten Indet. 175Jan quan tham Lanten Psychotria sp. 163Jang k(g)o Hmong Indet. 137Japi Lao Costus sp. 73Joan thjå Hmong Indet. 147Ka Lao Alpinia sp. 2Ka dong Lao Amomum cf. microcarpum 28Ka ko:(k) Lao Alpinia cf. oblongifolia 5Ka ko:(k) (Ka thong) Lao Alpinia oblongifolia 10Ka tap dom Lanten Glochidion cf. 167Ka torr a:tjian Brou Mallotus barbatus 23Kai-yang Hmong Kalanchoe sp. 148Kamai ken Lanten Grewia sp. 112Kao de (Qaub dej, hmong phonetics)

Hmong Begonia handellii 129

Kiao tham Lanten Selaginella sp. 164Kimin Lao Curcuma sp. Klå-pjet-na Lanten Fissistigma sp. 115Kobja najaga Akha Indet. 79Koh Tao hoang Lao (northern) Mallotus barbatus 111Krai-kok ma Lanten Indet. 173Krai-tzing Lanten Urena lobata 114Krat nom Lanten Mallotus barbatus 111Küa en on Lao Cleghornia malaccensis 33Küa hä:m Lao Coscinium fenestratum 9Küa kao moak Lao Indet. 29Kö-sö Akha Indet. 71La pu jaga Akha Asparagus sp. 74Lao shja Hmong Piper sp. 142Lo:tajaga Akha Clausena/Micromelum 77Lo-gaj Lanten Scleria sp. 170Lå hama Akha Phlogacanthus cf. annamensis 53Lä:o sü Akha Rubus sp. 51Ma djeo Lanten Rhuacophila cf. javanica 172Ma kaow Hmong Embelia sp. 132Ma kia thå Hmong Indet. 146Ma koa mi Hmong Aristolochia cf. pierrei 157Ma thao chia Hmong Smilax sp. 124Ma thin Lanten Drymaria cordata 165Ma tjaj Lanten Gonocaryum sp. 108Ma: mi Akha Artocarpus heterophylla 50Mai hoa sa:ng Lao Mallotus barbatus 23Mai njeng dong Lao Stixis suaveolens 174Mak (neng) sa: Lao Amomum cf. villosum Mak sa deng Lao Amomum cf. villosum Mak sa nyai Lao Amomum cf. villosum Mak neng Lao Amomum sp. 1Mak neng kam (mä:) Lao Zingiber sp. 15Mak neng kam po Lao Amomum sp. 13Mak neng kam po Lao Amomum sp. 16,17

Mak neng njaj Lao Amomum cf. 168Mak neng noi Lao Zingiber sp. 15Mak neng nyai Lao Amomum sp. 19Mak neng, Mak kong Lao Amomum sp. 19Mak sa: Lao Amomum repoeense 14Mak si da Lao Psidium guajava 120Mak thö: Lao Amomum cf. villosum 12Massüjaga Akha Costus sp. 73Me jay ma Lanten Pluchea indica 113Me jay ti Lanten Caesalpinia cf. major 117Mejene Akha Amomum cf. 75Metumeloma Akha Alpinia sp. 88Mi tja lå jaga Akha Indet. 66Må po Akha Ageratum conyzoides 60Mä Akha Amomum cf. 80Mä Akha Amomum cf. 97Mä tho mä lo Akha Indet. 101Mäbo Akha Zingiber cf. 100Naj sej ma Lanten Phyllanthus cf. reticulatum 116Nam jay Lanten Mimosa pudica 121Neja Akha Alocasia cucullata 104Nepaha Akha Evodia simplicifolia 103Nga so o ha Akha Rostellularia procumbens 56Ni ray koj Brou Lygodium cf. 26Nja Ka Lao Imperata cylindrica Nja kat moan Lao Urena lobata 114Nja Kha(t) Lao Sida retusa Nja moi ma Lanten Jasminum sp. 110Nja Njok Lao Mimosa pudica 121Njong-me Lanten Clerodendrum fragrans 118Osama Akha Indet. 87Pa bao bai Hmong Mussaenda sp. 126Pa deu Hmong Schizomussaenda dehiscens 155Pa dgii (Paj zib, hmong phonetics)

Hmong Phlogacanthus cf. annamensis 153

Pa hå pö Hmong Ligustrum sinense 125Pa i:a Hmong Radermachera ignea 134Pa tja(k) Brou Engelhardtia spicata 27Pa:(g)hå Akha Syzygium gratum 63Pak a thång Lao Houttuynia cordata 154Pat menn ma Lanten Spilanthes paniculata 160Pate Akha Indet. 84Pa-tji Pa-tja Akha Phrynium sp. 90Patö Akha Kalanchoe sp. 68Pha(k) ko:t kheo Lao Lygodium cf. 26Phå ja Hmong Indet. 136Pinnju Lao Asparagus sp. 74Prai neng Brou Amomum sp. Sa ku jaga Akha Indet. 59Sampü Akha Artemisia sp. 69Shåa dong Hmong Dicranopteris sp. Si ko ma thö Akha Ficus hispida 38Si mu tjong Brou Ziziphus oenoplia Sihaja Akha Solanum violaceum 52

Sima Akha Rhus chinensis 91Sogapa Akha Rhaphidophora cf. pertusa 99Sogapatja Akha Rhaphidophora sp. 98Sohö: ma: jaga Akha Ajuga macrosperma var.

macrosperma 58

Son ga ama Akha Peliosanthes sp. 93Sondjilå Hmong Indet. 122Spo Akha Ficus sp. 64Sutzi Akha Pogostemon glaber 85Sü fa Hmong Canscora andrographoides 151Så ka jojatje Akha Rhaphidophora cf. peepla 55Sä:n mü:ang Lao Gonocaryum sp. Ta kong kalua Brou Amomum/ Elettariopsis 18Tam chan Lanten Melastoma sp. 119Tapiatalå Akha Indet. 94Tham prüng Brou Alpinia sp. Thong pan Lanten Stephania sp. 109Tja bon tja ka Akha Clematissp. 43Tjimepapü Akha Croton kongensis 65Tjotjoma Lanten Micromelum falcatum 162Tsi njo(n) mi Hmong Elaeagnus sp. 133Täi fai pjeo Lanten Solanum violaceum 158Täng mäng dom Lanten Mussaenda sp. 166Va Akha Caryota mitis 82Va en ma Lanten Smilax sp. 171Va so Akha Wallichia siamensis 81Wan-fai Brou Zingiber cf. Whoa Akha Caryota mitis 95Whå so Akha Wallichia siamensis 102Vom khat ma Lanten Fibraurea cf. 177Xai thao (Txhais Taum, hmong phonetics)

Hmong Rauvolfia sp. 128

Ü:tü ja Akha Hedyotis sp. 40Yang ko Hmong Blumea balsamifera Yelaman Lao Chromolaena odorata Yo meo Lanten Aglaonema sp. 169Yå: Lanten Alocasia macrorrhizos 159

Appendix E. Vernacular plant names in Lao PDR written in French phonetics Vernacular name in French phonetics

Scientific name Voucher ELLA #

Dok Ka Chioù Curcuma sp. 20Hing Crotalaria assamica var. assamica 161Kao Deng Rauvolfia cf. serpentina 128Kha Alpinia /Hedychium 89Kha Alpinia sp. 2/88Kha Dong Amomum cf. microcarpum 28Kha Kok Alpinia cf. oblongifolia 5Kha Kok, Kha Thong Alpinia oblongifolia 10Khad Houa Vene Spilanthes paniculata 160Kheua En On Cleghornia malaccensis 33Kheua Hèm Coscinium fenestratum 9Kheua Khao mouak Indet. 29Kheua Kheuang Smilax sp. 124Khi min Curcuma sp. Khom pao Scleria sp. 170Khon Khen Indet. 84Khouang Smilax sp. 171Kok En A Melastoma sp. 39/119/135Kok Hang Hok Drynaria quercifolia Kok Kan Thouay Melastoma cf. saigonense 32Kok Kha Pa Kang Amomum/ Elettariopsis 18Kok Mai Hom Beilschmiedia cf. wallichiana 21Kok Mak Ngièng Terminalia sp. 24Kok Nam Lep Meo Ziziphus oenoplia Kok Phao Engelhardtia spicata 27Kok Pi Din Zingiber sp. 4Kok Tao Noi Arenga caudata 25Kok Vane Chod Psychotria asiatica 3/22Koud Kheua Indet. 94Ma li Pa Jasminum sp. 110Mai Houa Chang Mallotus barbatus 23Mai So Clerodendrum fragrans 86Mak Deua Khon Ficus hispida 38Mak Kheng khom Solanum violaceum 52Mak Mi Artocarpus heterophylla 50Mak Neng Amomum sp. 1Mak Neng Kham (Mè) Zingiber sp. 15Mak Nèng Kham noi Zingiber sp. 15Mak Neng Kham Phou Amomum sp. 13/16/17Mak neng nhai Amomum cf. 168Mak Sa Amomum repoeense 14Mak Si Da Psidium guajava 120Mak Teua Amomum cf. villosum 12Mak Toum Rubus sp. 51Meng Ka Beua, Khèm Khao Mussaenda sp. 126Mong Ka tai Hedyotis sp. 40/145/152Nad Louang Blumea balsamifera 49/57/140Nha Kha Imperata cylindrica Nha khat Sida retusa Nha Khat Mone Urena lobata 114

Nha Kiou, Nha Eua La Mane, Nha Fa Lang

Chromolaena odorata

Nha Ngoua Lia Indet. 146Nha Ngoub Mimosa pudica 121Nha Sè Ma Phyllanthus cf. reticulatum 116Nha Sou Si Pogostemon glaber 85Pak Khao Thong Houttuynia cordata 154Pak Phiou Indet. 106Pao Croton kongensis 65Phak Kad Khèo Lygodium cf. 26Phak phièo Polygonum sp. 45Pi din Zingiber sp. Pib Radermachera ignea 134Seng Mouang Gonocaryum sp. Som phot Rhus chinensis 91Tang Caryota mitis 95Thoun Alocasia macrorrhizos 159Ya houa Smilax glabra 6