Ethnobotanical survey of the medicinal flora of Harighal, Azad Jammu & Kashmir, Pakistan
Ethnobotanical surveys focus on the complex connection between local inhabitants and local plants, including practices and cultural beliefs associated with different forms of uses . These studies are important in highlighting the value of native plant species, e.g., for discovering novel drugs . Medicinal plants are imperative for the livelihoods of underprivileged communities across the world . Globally, 35,000–70,000 plant species are used in folk medicine . In developing countries, 60–80% of the population is still relying on plant-based medicines because they are economical and safe alternative to often inaccessible allopathic medicine . Even in the developed world, herbal remedies are extensively used, e.g., 30–50% of the population in China, 40–50% in Germany, 48% in Australia, 42% in the USA, and 49% in France reported using herbal medicine as supplementary health care . About 25% of modern allopathic drugs are derived directly from plants or synthetic analogues of different compounds isolated from medicinal plants . Plant-based drugs are effective and often have less side effects. This can be best explained by comparison between the extract bark of important medicinal plant Salix alba (white willow) with the synthetic drug aspirin which has more reported side effects. Different studies confirmed that extract of Salix alba bark can avoid the side effects caused by aspirin . The traditional knowledge of medicinal plants is held by many rural communities even in our times . Such knowledge is transmitted from generation to generation . Differences and similarities in traditional knowledge and practice among two different cultural groups living within the same ecological region are fascinating, as they can provide understanding of how cultural reflection can change individual viewpoints about the environment and also guide interactions between human beings and resources in the ecosystem . However, traditional knowledge on plant species is decreasing gradually across the globe . This knowledge is usually held by hakims (traditional healers) and elderly people and be passed to the next generation via verbal communication only ; thus, there is a serious danger of knowledge loss due to the progression in the modern health care system, rapid urbanization, and poor relations between younger and old generation . The documentation of traditional ethnomedicinal knowledge is of high importance and may contribute to the development of new drugs. Furthermore, this may also contribute to the maintenance of indigenous culture and natural resource management. Pakistan has a large wealth of medicinal and aromatic plants due to its diverse habitat, climate, and soil types and harbors about 6000 wild plant species . Among them, 400–600 species are used for therapeutic purposes. Eighty percent of this medicinal flora is restricted in Northwestern areas of Pakistan and Azad Kashmir . In the early 1950s, 84% of population of Pakistan depended upon plants for treating various ailments; but nowadays, this practice is restricted to remote areas due to modernization and rapid change in lifestyle . Previously, different ethnobotanical studies were conducted to document the traditional knowledge about medicinal plants and herbal recipes in remote areas of Pakistan and Azad Jammu & Kashmir . However, Tehsil Harighal of District Bagh is still unexplored ethnobotanically, especially due to topographical challenges like hilly terrain and steep slopes, and cultural and religious restrictions that limits researcher access to document ethnobotanical knowledge. We hypothesized that due to the remoteness of the area, the ethnobotanical knowledge of Harighal would considerably differ from other areas of Pakistan. This study was planned with the objective to document the indigenous knowledge about medicinal plants used for primary health care particularly focusing on methods of preparation and administration of herbal recipes. The data was further analyzed by using various numerical indices and compared with previous studies to determine the novelty of work. 

Study area Harighal (33° 54′ 34° 08′ N to 73° 01′ 73° 38′ E), a Tehsil of District Bagh, is located in western Himalayan foothills of Pirpanjal, with altitude ranges between 900 and 2300 m (Fig. ) . It is 155 km away from Islamabad, the capital of Pakistan and 98 km away from the Muzaffarazad, the capital of Azad Jammu & Kashmir. The total area of Harighal is 712 km 2 and its population is about 120,000 according to the 2017census. The climate is subtropical-temperate with about 1500 mm average annual precipitation. The summers are hot with temperature ranges between 21 and 40 °C while winters is cold with temperatures around 2 °C during January (Fig. ) . The vegetation is mainly dominated by Olea ferruginea at lower altitudes, Pinus roxbughaii and Quercus incana at mid altitudes, and Pinus wallichiana at higher altitude of the forest belt. Most of the area is occupied by open grassland. The region has a diverse and complex ethnic composition with Rajputs, Maldial, Sudhan, Khawaja, Gujar, and Jat. Rajput tribes spread across the region and the Maldial tribe is regarded as the most influential ethnic group in Harighal, Azad Kashmir. Almost all of the inhabitants are Muslims. Popular languages are Pahari, Hindko, Gojri, and Kashmiri, but most inhabitants are also familiar with Urdu. The area is remote, with difficult mountainous terrain and quite far from urban centers. Local inhabitants have poor socioeconomic conditions, lacking government services, and modern healthcare facilities. The roads and other infrastructure are poorly developed, and many inhabitants are dedicated to agriculture, livestock, and their own small-scale business. Some are educated and are government servants, while very few are serving abroad. Agriculture is mainly dependent upon rain-fed cropping system and maize is the main crop of the region. Basic health facilities are mainly provided by few public health dispensaries in the region, but locals residing at higher altitudes have very limited access to them and are mainly dependent upon herbal preparations for curing most ailments. Indigenous ethnomedicinal knowledge is mostly in the hand of elder people and health practitioners. Data collection Ethnomedicinal data was collected from 79 informants including 45 men and 34 women during April 2017 to March 2018, using semistructured interviews and group discussions, after obtaining prior informed consent from the participants. Informants were selected randomly by convenience sampling (i.e., a sampling method in which units are selected based on easy access or availability)  and sometimes by using a snowball method . Questionnaires were prepared according to Edward et al. . The ethical guidelines provided by International Society of Ethnobiology ( http://www.ethnobiology.net/ ) were strictly followed. The ethical approval to conduct the study was given before initiating surveys from the Ethics Committee of the Women University of Azad Jammu & Kashmir, Bagh. In addition to this, legal permission to conduct interviews was given by members of municipality committee. A prior informed consent form (PIC) was signed by all the informants after explaining the objective and consequence of study. The PIC was translated into local Pahari language. Sample size was determined by following Kadam and Bhalerao . Plant collection and identification The medicinal plants were collected dried, pressed, and mounted on standard herbarium sheets following standard taxonomic methods . The specimens were identified with the help of plant taxonomist and confirmed using flora of Pakistan (https:// http://www.efloras.org ) . Further verification of identified specimens was done at the Herbarium of Medicinal and Aromatic Plants in AJ&K established by the Pakistan Agriculture and Research Council (PARC). APG IV (2016)  was used for family taxonomy while The Plant List (2013)  was used to verify scientific names. The final voucher specimens were deposited in herbarium of the Women University of AJ&K, Bagh. Ethnobotanical indices The homogeneity and validation of collected ethnomedicinal data was checked by applying following quantitative indices. Informant consensus factor Emic use types were grouped in to 16 etic use categories following International Classification of Primary Care (ICPC) with some modification . The agreement between the respondents about usage of plants for curing various groups of ailments was checked by informant consent factor. It was calculated by following Heinrich et al.  using given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ Fic=-1)} $$ Fic = Nur − Nt Nur − 1 Where; Nur = use-reports in selected group of diseases, Nt = species used for treating various diseases of that group. Informant consensus factor (ICF) values varied from 0 to 1, where value (close to 1) indicates that plant species are selected by using well-defined criteria or information and its uses are extremely exchanged among the informants and low values (close to 0) are obtained when plant species are chosen randomly or information about their use are not exchange among informants . Relative frequency of citation The harmony between respondents on medicinal uses of plants in the study area was determined by relative frequency of citation (RFC). It was calculated by following Vijayakumar et al.  using the given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RFC= FC/N $$ RFC = FC / N Where; FC = informants reporting use of a given species, N = total number of informants. This index is used to identify the most utilized/preferred plants in the area. FC value varies from 0 (when a plant species is not under any use in that area) to 1 (if all the informants refer plant species as useful). FC exhibits the local importance of each species without considering the use categories . Use value index The use value of plant species was determined by following Vijayakumar et al.  using the given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ =}{\ } $$ UV = ΣUi N Where; Ui = use reports cited by each respondent for given species, N = total number of respondents. Use value reflects the relative importance of reported plant species in area. High use value shows that plant species have many use reports and is important in the region, whereas low use value (approach to 0) shows that species have few use reports related to its use. However, use report is not meaningful to differentiate whether a plant species is used for single or manifold purposes . Relative importance It was calculated following Khan et al.  by using the given formula. [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RI=( RelPH+ RelBS) 100/2 $$ RI = RelPH + RelBS × 100 / 2 PH = pharmacological attribute of the selected plant, Rel PH = relative pharmacological attributes of a given plant. [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RelPH=\ \ \ \ \ }{\ \ \ 0.5em \ \ } $$ RelPH = PH of a selected plant maximum PH of all plant species BS = body systems treated by selected plant species, Rel BS = relative body systems treated by selected species. [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RelBS=\ \ \ \ }{\ \ \ \ \ \ } $$ RelBS = BS of a given plant maximum BS of all reported plant species Fidelity level Fidelity level indicates the preference of particular plant species by informants to treat specific disease. It was calculated following Alexiades and Sheldon,  by using the given formula [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ FL\%= Np/N 100 $$ FL % = Np / N × 100 Where; Np = informants reporting use of particular plant species for a specific disease category, N = total number of informants who mentioned uses for a specific plant species for all disease category. High fidelity level (FL) value shows maximum frequency of use by the informants to treat a particular disease . Jaccard index The similarity of knowledge between different communities was determined by comparing the findings of the current study with 22 published peer reviewed papers at regional, national, and global level by applying Jaccard index. These includes 9 studies from Azad Jammu & Kashmir, 7 form Khyber Paktunkhawa, and 3 from other areas of Pakistan. The studies conducted on the areas with similar, vegetation, climatic condition, and culture were consider for comparison. Further, the findings were also compared with 3 studies conducted in other developing counties including Nepal, India, and Ethopia. Jaccard index (JI) was calculated following Gonza et al.  by using the given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ = 100}{(+)-} $$ JI = c × 100 a + b − c Where; a = species of the study area, b = species of the neighboring area, and c = number of species common to both area. 

Harighal (33° 54′ 34° 08′ N to 73° 01′ 73° 38′ E), a Tehsil of District Bagh, is located in western Himalayan foothills of Pirpanjal, with altitude ranges between 900 and 2300 m (Fig. ) . It is 155 km away from Islamabad, the capital of Pakistan and 98 km away from the Muzaffarazad, the capital of Azad Jammu & Kashmir. The total area of Harighal is 712 km 2 and its population is about 120,000 according to the 2017census. The climate is subtropical-temperate with about 1500 mm average annual precipitation. The summers are hot with temperature ranges between 21 and 40 °C while winters is cold with temperatures around 2 °C during January (Fig. ) . The vegetation is mainly dominated by Olea ferruginea at lower altitudes, Pinus roxbughaii and Quercus incana at mid altitudes, and Pinus wallichiana at higher altitude of the forest belt. Most of the area is occupied by open grassland. The region has a diverse and complex ethnic composition with Rajputs, Maldial, Sudhan, Khawaja, Gujar, and Jat. Rajput tribes spread across the region and the Maldial tribe is regarded as the most influential ethnic group in Harighal, Azad Kashmir. Almost all of the inhabitants are Muslims. Popular languages are Pahari, Hindko, Gojri, and Kashmiri, but most inhabitants are also familiar with Urdu. The area is remote, with difficult mountainous terrain and quite far from urban centers. Local inhabitants have poor socioeconomic conditions, lacking government services, and modern healthcare facilities. The roads and other infrastructure are poorly developed, and many inhabitants are dedicated to agriculture, livestock, and their own small-scale business. Some are educated and are government servants, while very few are serving abroad. Agriculture is mainly dependent upon rain-fed cropping system and maize is the main crop of the region. Basic health facilities are mainly provided by few public health dispensaries in the region, but locals residing at higher altitudes have very limited access to them and are mainly dependent upon herbal preparations for curing most ailments. Indigenous ethnomedicinal knowledge is mostly in the hand of elder people and health practitioners. 

Ethnomedicinal data was collected from 79 informants including 45 men and 34 women during April 2017 to March 2018, using semistructured interviews and group discussions, after obtaining prior informed consent from the participants. Informants were selected randomly by convenience sampling (i.e., a sampling method in which units are selected based on easy access or availability)  and sometimes by using a snowball method . Questionnaires were prepared according to Edward et al. . The ethical guidelines provided by International Society of Ethnobiology ( http://www.ethnobiology.net/ ) were strictly followed. The ethical approval to conduct the study was given before initiating surveys from the Ethics Committee of the Women University of Azad Jammu & Kashmir, Bagh. In addition to this, legal permission to conduct interviews was given by members of municipality committee. A prior informed consent form (PIC) was signed by all the informants after explaining the objective and consequence of study. The PIC was translated into local Pahari language. Sample size was determined by following Kadam and Bhalerao . 

The medicinal plants were collected dried, pressed, and mounted on standard herbarium sheets following standard taxonomic methods . The specimens were identified with the help of plant taxonomist and confirmed using flora of Pakistan (https:// http://www.efloras.org ) . Further verification of identified specimens was done at the Herbarium of Medicinal and Aromatic Plants in AJ&K established by the Pakistan Agriculture and Research Council (PARC). APG IV (2016)  was used for family taxonomy while The Plant List (2013)  was used to verify scientific names. The final voucher specimens were deposited in herbarium of the Women University of AJ&K, Bagh. 

The homogeneity and validation of collected ethnomedicinal data was checked by applying following quantitative indices. 

Emic use types were grouped in to 16 etic use categories following International Classification of Primary Care (ICPC) with some modification . The agreement between the respondents about usage of plants for curing various groups of ailments was checked by informant consent factor. It was calculated by following Heinrich et al.  using given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ Fic=-1)} $$ Fic = Nur − Nt Nur − 1 Where; Nur = use-reports in selected group of diseases, Nt = species used for treating various diseases of that group. Informant consensus factor (ICF) values varied from 0 to 1, where value (close to 1) indicates that plant species are selected by using well-defined criteria or information and its uses are extremely exchanged among the informants and low values (close to 0) are obtained when plant species are chosen randomly or information about their use are not exchange among informants . 

The harmony between respondents on medicinal uses of plants in the study area was determined by relative frequency of citation (RFC). It was calculated by following Vijayakumar et al.  using the given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RFC= FC/N $$ RFC = FC / N Where; FC = informants reporting use of a given species, N = total number of informants. This index is used to identify the most utilized/preferred plants in the area. FC value varies from 0 (when a plant species is not under any use in that area) to 1 (if all the informants refer plant species as useful). FC exhibits the local importance of each species without considering the use categories . 

The use value of plant species was determined by following Vijayakumar et al.  using the given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ =}{\ } $$ UV = ΣUi N Where; Ui = use reports cited by each respondent for given species, N = total number of respondents. Use value reflects the relative importance of reported plant species in area. High use value shows that plant species have many use reports and is important in the region, whereas low use value (approach to 0) shows that species have few use reports related to its use. However, use report is not meaningful to differentiate whether a plant species is used for single or manifold purposes . 

It was calculated following Khan et al.  by using the given formula. [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RI=( RelPH+ RelBS) 100/2 $$ RI = RelPH + RelBS × 100 / 2 PH = pharmacological attribute of the selected plant, Rel PH = relative pharmacological attributes of a given plant. [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RelPH=\ \ \ \ \ }{\ \ \ 0.5em \ \ } $$ RelPH = PH of a selected plant maximum PH of all plant species BS = body systems treated by selected plant species, Rel BS = relative body systems treated by selected species. [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ RelBS=\ \ \ \ }{\ \ \ \ \ \ } $$ RelBS = BS of a given plant maximum BS of all reported plant species 

Fidelity level indicates the preference of particular plant species by informants to treat specific disease. It was calculated following Alexiades and Sheldon,  by using the given formula [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ FL\%= Np/N 100 $$ FL % = Np / N × 100 Where; Np = informants reporting use of particular plant species for a specific disease category, N = total number of informants who mentioned uses for a specific plant species for all disease category. High fidelity level (FL) value shows maximum frequency of use by the informants to treat a particular disease . 

The similarity of knowledge between different communities was determined by comparing the findings of the current study with 22 published peer reviewed papers at regional, national, and global level by applying Jaccard index. These includes 9 studies from Azad Jammu & Kashmir, 7 form Khyber Paktunkhawa, and 3 from other areas of Pakistan. The studies conducted on the areas with similar, vegetation, climatic condition, and culture were consider for comparison. Further, the findings were also compared with 3 studies conducted in other developing counties including Nepal, India, and Ethopia. Jaccard index (JI) was calculated following Gonza et al.  by using the given formula: [12pt]{minimal}
				
				 
				 
				 
				
				
				
				
				$$ = 100}{(+)-} $$ JI = c × 100 a + b − c Where; a = species of the study area, b = species of the neighboring area, and c = number of species common to both area. 

Demography and knowledge variation A total of 79 informants were interviewed to collect medicinal plant knowledge based on their gender, age, and education (Table ). The first category used for classification of informants was gender and 45 men and 34 women were interviewed. The easier availability and approachability to male informants and the prohibition of interaction of women with strangers, as well as and veiling ( parda ) forced us to interview more men than women. Demographic data demonstrates that women (average known species = 5.72; average cited uses = 9.38) had more knowledge about plants than men (average known species = 4.98; average cited uses = 8.05). Division of labor between genders in the area may be one reason for this difference, as men generally manage the fieldwork and earning, while women manage the indoor activities and domestic life, which are highly associated with herbal preparations to keep the family healthy. Similar findings were reported by other studies including Qaseem et al.  from Kotli, Ahmad et al.  from Neelum valley, and Kyani et al.  from Abbottabad. Age was used as second classification criterion and informants were classified into three major categories, i.e., above 60, between 40 and 60 and less than 40. Elders (age above 60) had more knowledge about plants than young people (age less than 40). Another reason for lower knowledge of young informants was their limited interest in herbal preparations due to changes in lifestyle with advent of industrialization and modernization. These findings were supported by other reports including Qaseem et al.  from Kotli and Umair et al.  from Hafizabad. Education was a third influential factor. Uneducated informants had a vast ethnobotanical knowledge, while tan educated informants had a more limited knowledge of plants. Likewise, traditional health practitioners had a broad traditional knowledge about medicinal uses of plants compared to other professions. Highly educated informants usually relied on allopathic medicines for their immediate healthcare, and had least knowledge about herbal medicines and their preparation methods. These finding are supported nationally by Kayani et al. , Yaseen et al. , and internationally by Giday et al.  and Tugume et al. . Diversity of ethnomedicinal flora A total of 150 medicinal plants belonging to 60 families and 98 genera were reported from study area (Table ). Out of total 150 species, 76 were endemic or native and 74 exotic and among them, 136 plant species were wild, 10 were cultivated, and 4 were both wild-collected and cultivated (Table ). The herbaceous life form was dominantly (78 sp.; 52%) used in herbal preparation followed by shrubs (27 sp.; 18%), trees (25 sp.; 16.6 %), grasses (12 sp.; 8%), ferns (5 sp.; 3.3%), and epiphytes or climbers (Fig. ). These findings are in accordance with previous reports . The predominance of the herbaceous habit in mountainous areas is a common ecological phenomena throughout the world . The reason might be the high rainfall and moisture content at higher altitudinal areas . Asteraceae, Fabaceae, and Rosaceae were the dominant families having 15 species each, followed by Lamiaceae and Poaceae having 12 species each (Fig. ). Our results are in accordance with Amjad et al. , Kayani et al. , and Tariq et al. . The prevalence of these families might be due to their abundance and easy accessibility in the study area. Moreover, majority of the reported species of these families possess significant pharmaceutical, pharmacological and organoleptic properties . Plant part(s) used Herbal recipes were prepared using different plant parts in investigated area. As shown in Table , leaves, whole plant, and roots were the most preferred plant parts used in herbal preparations (30.2, 16.6, and 14.4%, respectively). These findings were similar as reported earlier from Pakistan and other countries . Local preference of leaves in herbal recipes is because of their collection and availability. Leaves, whole plant, and roots are rich in health beneficial secondary metabolites that contribute significantly in the prevention and treatment of various health disorders . Though, local inhabitants prefer to use whole plant and roots but their use is not recommended, as exploitation of whole plant species or their uprooting could cause harmful effect on regeneration and may cause species extension . Method of preparation and administration Different recipes were prepared from medicinal plants by using different methods based on the actual site and type of disease treated. Decoction was the most common method (41 sp.; 17%) for preparation of herbal recipes, followed by paste (36 sp.; 15%), powder (30 sp.; 13%), extract (28 sp.; 12%), and juice (30 pp.; 13%) (Fig. ). Our findings are supported by previous documentation . Ease of preparation might be a reason for the extensive use of decoctions to treat aliments, as it can be prepared by mixing specific part of plants with soup, tea, water, honey, milk, and butter . The availability of active metabolic compounds might increase due to the fact of heating which speed up the biological reactions . Sometimes, whole plants were used in herbal preparations. Most of the herbal recipes were prepared using single plant species assuming non-toxicity, palatability, and high efficacy. Some recipes were based on application of two or more plants to attain maximum therapeutic effects. The amount of medicinal plants and frequency of dose are based on patient condition, health, age, and disease severity. In the study area, constipation was commonly treated using the fruits of Ficus carica , and for adults 4–5 fruits were used, while 2–3 were regarded as effective for children. The frequent mode of application was internal (76.2%) and only few preparations were applied topically (Table ), as paste, body wash, or rubbed on the affected body parts. These findings were comparable to previous reports . Informant consensus factor A total 127 emic use reports were categorized in to 16 etic use categories (Table ). The informant consensus factor was analyzed based on disease categories, as a single plant might be used to treat 3–4 or more disease categories. A high informant consensus factor (ICF) value reflects high dependence of local inhabitants on medicinal plants  and low ICF values indicate less consistency of informant’s knowledge. Ailments were classified in to 18 categories to develop informant consensus. The ICF value ranged from 0.23 to 0.95. The maximum value of ICF was estimated for digestive disease category (0.95) followed by skin problems and respiratory disorders (Fig. ). This was strongly supported by Qaseem et al. , Umari et al. , Ullah et al. , Amjad et al. , Ahmad et al. , and Bib et al.  who also reported the maximum ICF for digestive diseases in their investigated area. ICF values are generally influenced by the number of informants and are more significant when calculated for uses cited by many informants. In general, ICF values were high in our study, revealing that the informants tend to agree on which plants used in the treatment of common illnesses. According to Heinrich , high ICF can help in identifying potentially effective medicinal plants. It was observed that in our study, the highest agreement level was recorded for diseases reported as the most widespread in rural communities of the Bagh district and other areas of Pakistan. The digestive disorder was also reported as first use class by other ethnic communities across world . The prevalence of digestive disorders among the local inhabitant might be due to inadequate availability of hygienic food and drinking water and also the common inhalation of fuel wood’s smoke . Moreover, the devastating earthquake of 2005 caused extensive damage to water resources (freshwater springs) and water supply schemes, causing the drinking water quality to be very poor, with local communities usually using contaminated water. The second highest ICF was recorded for respiratory disorders which may be due to prevalence of cold and moist conditions at high altitude Kayani et al. . Besides, study area is a rich source of flowering plants and mushrooms and the prevalence of pollen and spore present in air also cause respiratory problem. Skin disorders also have high ICF value, and UV radiations, unhygienic conditions, and combine family systems (where many members live together in one room or home even some time with domesticated animals) could be the possible reasons of the prevalence of skin infections in the study area. Relative frequency of citation and use value Relative frequency of citation (RFC) is used to identify the highly important species in various ailments as cited by local people . The value of RFC ranged between 0.93 and 0.04. Berberis lycium had highest RFC value (0.81). Other plant species with significant RFC value were Ajuga bracteosa , Prunella vulgaris , Adiantum capillus-veneris , Desmodium polycarpum , Pinus roxburgii , Rosa brunonii , Punica granatum , Zanthoxylum armatum , and Jasminum mesnyi (Table ). The plants species with high RFC value were abundant in the area therefore the local people were much familiar with them particularly with reference to ethnomedicinal perspective over a long time period. Likewise, the plants with special properties to cure particular disease were well known among the local culture; therefore, their precise properties to treat particular disease have got famous and deep rooted. The plant species with high RFC values would be interesting for phytochemical and pharmacological profiling and possible future drug discovery, as well as authentication at a commercial level . Use value reflects the relative importance of every species with reference to more use reports cited by local informants. The use value ranged between 1.05 and 0.08. Mentha longifolia (1.05), Olea ferouginea (1.02), and Zanthoxylum armatum (1.01) had high use value while other species with significantly high use value were Solanum villosum (0.93), Cynoglossom lanceolatum (0.94), Rosa indica (0.95), and Punica granatum (0.97) (Table ) . UV value is directly related with use reports. Plant species with more use reports have high use value and vice versa . These plant species are used in repetitive manner and are biologically more active . It is not necessary that the plant which has low UV value become unimportant or not biologically active as the RFC and UV are constant in particular area but they may be change according to the variation in the knowledge of indigenous people from area to area or within area. Species with high RFC and UV show high healing potential for particular disease. Species with high RFC and UV were often overharvested by inhabitants, so they are prioritized for conservation and sustainable use; otherwise, they will be extinct from the area in near future . The ethnomedicinal knowledge is at risk because there might be no resource left for younger generations. The main reason for this is that the local inhabitants of the area, especially young generations, have little interest and understanding or knowledge about ethnomedicinal plants, and are already dependent upon allopathic medicine for their healthcare . Relative importance Relative importance value is used to determine the diversity of a species for treating various ailments. Galium aparine (96) and Mimosa pudica (91) had highest RI values while Verbena officinalis (81.5), Fragaria nubicola (81), Verbascum thapsus (79), and Melia azadirachta (73) had high RI values (Table ). It was observed that species with high RI value was used frequently for treating several ailments. The natives have too much ethnomedicinal knowledge regarding these plants. Therefore, importance of these species increase as the number of treated systems increases . Fidelity level The fidelity value reflects the preference of particular plant species as reported by local people for curing particular ailment in the area. The FL value of reported species ranged from 18.2 to 100%. Fidelity values of four plant species viz Mentha longifolia , Punica granatum , Zanthoxylum armatum , and Olea ferruginea were found 100%, and these species were used to cure stomachache, dysentery, rheumatism, and other digestive disorders. Other medicinal plants having high FL value were Solanum villosum (93.8), Cynoglossum lanceolatum (91.8), Dalbergia sissoo (83.8), Bidens biternata (85.7%), Rubus ellipticus (86.5%), and Melia azadirachta (84.6%) (Fig. ). These species were mostly used to cure the digestive problems like diarrhea, dysentery, indigestion, stomach-ache and gastrointestinal pain, etc. High FL of a species reflects extensive use of a specific plant species to treat a specific disease dominant in area . Species with high FL value are important model plants which can be subjected to further pharmacological studies . Some other studies in literature also recoded high fidelity level for species used to cure digestive problems . The species with low FL values were not well known by the natives in term of ethnomedicinal knowledge. This forecast that may be in upcoming generation the ethnobotanical knowledge about these plant species may be completely depleted  (Table ). Novel uses In this study, we compared our results with 22 published papers from adjoining and areas with similar vegetation across Pakistan and world. The highest values for the Jaccard Index (JI) were result of the studies published by Amjad et al.  and Shaheen et al.  on Toil peer (AJK) and Perl valley respectively. The least value for JI was found in the studies of Jadhava et al.  on Sangli, Maharashtra, India, and Gidey et al.  on the Kunama ethnic group in Northern Ethiopia. High similarity reflects similar culture, traditions vegetation, and geography among the areas along with high level of cross-cultural exchange of traditional knowledge among the community while high differences or least value of JI reflects that areas do not share common cultural values. Further, the ethno-ecological knowledge is often specifically influenced by origin and culture of indigenous communities. The comparative study of current findings with reported research revealed some novel uses which were not reported earlier from this region. These included the use of the extract of the whole plant of Crepis multicaulis and Maytenus nemorosa to treat eye infections. An extract of the aerial parts of Swertia cordata was used to treat hepatic disorders. Leaves of Cotoneaster racemiflora were used to stop bleeding and pus. The root extract of Spiraea canescens is was to as enema to treat venereal conditions. A bark infusion of Dichanthium annulatum was used to cure cough. A pasted based on the whole plant of Polygonum ramosissimum was used to treat urinary tract infections. The seeds of Persicaria maculosa were used in powdered form to treat cholera. Threats to medicinal plants and indigenous knowledge The majority of the local inhabitant in the rural areas of Harighal are illiterate and their main source of income are agriculture and livestock. Some of them collect medicinal plants and sell them at very low prices to local herb sellers. The herbal sellers export herbs to pharmaceutical companies. Over-exploitation of medicinal plant species by untrained collectors, e.g., uprooting of medicinal plants, forest fires, deforestation, over-grazing, and urbanization, are contributing significantly toward the decline of medicinal plant species of the study area, and may finally lead to their extinction. Therefore, authorities should take strict control over protection, conservation, and sustainable utilization of economic plants of the study area. Furthermore, universities, agriculture extension department, and local management may contribute significantly to promote the cultivation of medicinal plants in the area; this will definitely improve the socioeconomic condition of local people of the area. The traditional practices are highly affected by exposure to modern pharmaceuticals and changing lifestyles. The traditional knowledge about medicinal plants in the study area is gradually declining because this knowledge is now mainly restricted to the older members of the community members which are passing away. The younger generation is not interested in learning about traditional plant use, and makes more use of allopathic medicine. The traditional health practitioners ( Hakeems ) have profound traditional knowledge, but many are not willing to share it with other people. These factors may lead to the erosion of traditional medicinal knowledge among the rural communities of area. 

A total of 79 informants were interviewed to collect medicinal plant knowledge based on their gender, age, and education (Table ). The first category used for classification of informants was gender and 45 men and 34 women were interviewed. The easier availability and approachability to male informants and the prohibition of interaction of women with strangers, as well as and veiling ( parda ) forced us to interview more men than women. Demographic data demonstrates that women (average known species = 5.72; average cited uses = 9.38) had more knowledge about plants than men (average known species = 4.98; average cited uses = 8.05). Division of labor between genders in the area may be one reason for this difference, as men generally manage the fieldwork and earning, while women manage the indoor activities and domestic life, which are highly associated with herbal preparations to keep the family healthy. Similar findings were reported by other studies including Qaseem et al.  from Kotli, Ahmad et al.  from Neelum valley, and Kyani et al.  from Abbottabad. Age was used as second classification criterion and informants were classified into three major categories, i.e., above 60, between 40 and 60 and less than 40. Elders (age above 60) had more knowledge about plants than young people (age less than 40). Another reason for lower knowledge of young informants was their limited interest in herbal preparations due to changes in lifestyle with advent of industrialization and modernization. These findings were supported by other reports including Qaseem et al.  from Kotli and Umair et al.  from Hafizabad. Education was a third influential factor. Uneducated informants had a vast ethnobotanical knowledge, while tan educated informants had a more limited knowledge of plants. Likewise, traditional health practitioners had a broad traditional knowledge about medicinal uses of plants compared to other professions. Highly educated informants usually relied on allopathic medicines for their immediate healthcare, and had least knowledge about herbal medicines and their preparation methods. These finding are supported nationally by Kayani et al. , Yaseen et al. , and internationally by Giday et al.  and Tugume et al. . 

A total of 150 medicinal plants belonging to 60 families and 98 genera were reported from study area (Table ). Out of total 150 species, 76 were endemic or native and 74 exotic and among them, 136 plant species were wild, 10 were cultivated, and 4 were both wild-collected and cultivated (Table ). The herbaceous life form was dominantly (78 sp.; 52%) used in herbal preparation followed by shrubs (27 sp.; 18%), trees (25 sp.; 16.6 %), grasses (12 sp.; 8%), ferns (5 sp.; 3.3%), and epiphytes or climbers (Fig. ). These findings are in accordance with previous reports . The predominance of the herbaceous habit in mountainous areas is a common ecological phenomena throughout the world . The reason might be the high rainfall and moisture content at higher altitudinal areas . Asteraceae, Fabaceae, and Rosaceae were the dominant families having 15 species each, followed by Lamiaceae and Poaceae having 12 species each (Fig. ). Our results are in accordance with Amjad et al. , Kayani et al. , and Tariq et al. . The prevalence of these families might be due to their abundance and easy accessibility in the study area. Moreover, majority of the reported species of these families possess significant pharmaceutical, pharmacological and organoleptic properties . 

Herbal recipes were prepared using different plant parts in investigated area. As shown in Table , leaves, whole plant, and roots were the most preferred plant parts used in herbal preparations (30.2, 16.6, and 14.4%, respectively). These findings were similar as reported earlier from Pakistan and other countries . Local preference of leaves in herbal recipes is because of their collection and availability. Leaves, whole plant, and roots are rich in health beneficial secondary metabolites that contribute significantly in the prevention and treatment of various health disorders . Though, local inhabitants prefer to use whole plant and roots but their use is not recommended, as exploitation of whole plant species or their uprooting could cause harmful effect on regeneration and may cause species extension . 

Different recipes were prepared from medicinal plants by using different methods based on the actual site and type of disease treated. Decoction was the most common method (41 sp.; 17%) for preparation of herbal recipes, followed by paste (36 sp.; 15%), powder (30 sp.; 13%), extract (28 sp.; 12%), and juice (30 pp.; 13%) (Fig. ). Our findings are supported by previous documentation . Ease of preparation might be a reason for the extensive use of decoctions to treat aliments, as it can be prepared by mixing specific part of plants with soup, tea, water, honey, milk, and butter . The availability of active metabolic compounds might increase due to the fact of heating which speed up the biological reactions . Sometimes, whole plants were used in herbal preparations. Most of the herbal recipes were prepared using single plant species assuming non-toxicity, palatability, and high efficacy. Some recipes were based on application of two or more plants to attain maximum therapeutic effects. The amount of medicinal plants and frequency of dose are based on patient condition, health, age, and disease severity. In the study area, constipation was commonly treated using the fruits of Ficus carica , and for adults 4–5 fruits were used, while 2–3 were regarded as effective for children. The frequent mode of application was internal (76.2%) and only few preparations were applied topically (Table ), as paste, body wash, or rubbed on the affected body parts. These findings were comparable to previous reports . 

A total 127 emic use reports were categorized in to 16 etic use categories (Table ). The informant consensus factor was analyzed based on disease categories, as a single plant might be used to treat 3–4 or more disease categories. A high informant consensus factor (ICF) value reflects high dependence of local inhabitants on medicinal plants  and low ICF values indicate less consistency of informant’s knowledge. Ailments were classified in to 18 categories to develop informant consensus. The ICF value ranged from 0.23 to 0.95. The maximum value of ICF was estimated for digestive disease category (0.95) followed by skin problems and respiratory disorders (Fig. ). This was strongly supported by Qaseem et al. , Umari et al. , Ullah et al. , Amjad et al. , Ahmad et al. , and Bib et al.  who also reported the maximum ICF for digestive diseases in their investigated area. ICF values are generally influenced by the number of informants and are more significant when calculated for uses cited by many informants. In general, ICF values were high in our study, revealing that the informants tend to agree on which plants used in the treatment of common illnesses. According to Heinrich , high ICF can help in identifying potentially effective medicinal plants. It was observed that in our study, the highest agreement level was recorded for diseases reported as the most widespread in rural communities of the Bagh district and other areas of Pakistan. The digestive disorder was also reported as first use class by other ethnic communities across world . The prevalence of digestive disorders among the local inhabitant might be due to inadequate availability of hygienic food and drinking water and also the common inhalation of fuel wood’s smoke . Moreover, the devastating earthquake of 2005 caused extensive damage to water resources (freshwater springs) and water supply schemes, causing the drinking water quality to be very poor, with local communities usually using contaminated water. The second highest ICF was recorded for respiratory disorders which may be due to prevalence of cold and moist conditions at high altitude Kayani et al. . Besides, study area is a rich source of flowering plants and mushrooms and the prevalence of pollen and spore present in air also cause respiratory problem. Skin disorders also have high ICF value, and UV radiations, unhygienic conditions, and combine family systems (where many members live together in one room or home even some time with domesticated animals) could be the possible reasons of the prevalence of skin infections in the study area. 

Relative frequency of citation (RFC) is used to identify the highly important species in various ailments as cited by local people . The value of RFC ranged between 0.93 and 0.04. Berberis lycium had highest RFC value (0.81). Other plant species with significant RFC value were Ajuga bracteosa , Prunella vulgaris , Adiantum capillus-veneris , Desmodium polycarpum , Pinus roxburgii , Rosa brunonii , Punica granatum , Zanthoxylum armatum , and Jasminum mesnyi (Table ). The plants species with high RFC value were abundant in the area therefore the local people were much familiar with them particularly with reference to ethnomedicinal perspective over a long time period. Likewise, the plants with special properties to cure particular disease were well known among the local culture; therefore, their precise properties to treat particular disease have got famous and deep rooted. The plant species with high RFC values would be interesting for phytochemical and pharmacological profiling and possible future drug discovery, as well as authentication at a commercial level . Use value reflects the relative importance of every species with reference to more use reports cited by local informants. The use value ranged between 1.05 and 0.08. Mentha longifolia (1.05), Olea ferouginea (1.02), and Zanthoxylum armatum (1.01) had high use value while other species with significantly high use value were Solanum villosum (0.93), Cynoglossom lanceolatum (0.94), Rosa indica (0.95), and Punica granatum (0.97) (Table ) . UV value is directly related with use reports. Plant species with more use reports have high use value and vice versa . These plant species are used in repetitive manner and are biologically more active . It is not necessary that the plant which has low UV value become unimportant or not biologically active as the RFC and UV are constant in particular area but they may be change according to the variation in the knowledge of indigenous people from area to area or within area. Species with high RFC and UV show high healing potential for particular disease. Species with high RFC and UV were often overharvested by inhabitants, so they are prioritized for conservation and sustainable use; otherwise, they will be extinct from the area in near future . The ethnomedicinal knowledge is at risk because there might be no resource left for younger generations. The main reason for this is that the local inhabitants of the area, especially young generations, have little interest and understanding or knowledge about ethnomedicinal plants, and are already dependent upon allopathic medicine for their healthcare . 

Relative importance value is used to determine the diversity of a species for treating various ailments. Galium aparine (96) and Mimosa pudica (91) had highest RI values while Verbena officinalis (81.5), Fragaria nubicola (81), Verbascum thapsus (79), and Melia azadirachta (73) had high RI values (Table ). It was observed that species with high RI value was used frequently for treating several ailments. The natives have too much ethnomedicinal knowledge regarding these plants. Therefore, importance of these species increase as the number of treated systems increases . 

The fidelity value reflects the preference of particular plant species as reported by local people for curing particular ailment in the area. The FL value of reported species ranged from 18.2 to 100%. Fidelity values of four plant species viz Mentha longifolia , Punica granatum , Zanthoxylum armatum , and Olea ferruginea were found 100%, and these species were used to cure stomachache, dysentery, rheumatism, and other digestive disorders. Other medicinal plants having high FL value were Solanum villosum (93.8), Cynoglossum lanceolatum (91.8), Dalbergia sissoo (83.8), Bidens biternata (85.7%), Rubus ellipticus (86.5%), and Melia azadirachta (84.6%) (Fig. ). These species were mostly used to cure the digestive problems like diarrhea, dysentery, indigestion, stomach-ache and gastrointestinal pain, etc. High FL of a species reflects extensive use of a specific plant species to treat a specific disease dominant in area . Species with high FL value are important model plants which can be subjected to further pharmacological studies . Some other studies in literature also recoded high fidelity level for species used to cure digestive problems . The species with low FL values were not well known by the natives in term of ethnomedicinal knowledge. This forecast that may be in upcoming generation the ethnobotanical knowledge about these plant species may be completely depleted  (Table ). 

In this study, we compared our results with 22 published papers from adjoining and areas with similar vegetation across Pakistan and world. The highest values for the Jaccard Index (JI) were result of the studies published by Amjad et al.  and Shaheen et al.  on Toil peer (AJK) and Perl valley respectively. The least value for JI was found in the studies of Jadhava et al.  on Sangli, Maharashtra, India, and Gidey et al.  on the Kunama ethnic group in Northern Ethiopia. High similarity reflects similar culture, traditions vegetation, and geography among the areas along with high level of cross-cultural exchange of traditional knowledge among the community while high differences or least value of JI reflects that areas do not share common cultural values. Further, the ethno-ecological knowledge is often specifically influenced by origin and culture of indigenous communities. The comparative study of current findings with reported research revealed some novel uses which were not reported earlier from this region. These included the use of the extract of the whole plant of Crepis multicaulis and Maytenus nemorosa to treat eye infections. An extract of the aerial parts of Swertia cordata was used to treat hepatic disorders. Leaves of Cotoneaster racemiflora were used to stop bleeding and pus. The root extract of Spiraea canescens is was to as enema to treat venereal conditions. A bark infusion of Dichanthium annulatum was used to cure cough. A pasted based on the whole plant of Polygonum ramosissimum was used to treat urinary tract infections. The seeds of Persicaria maculosa were used in powdered form to treat cholera. 

The majority of the local inhabitant in the rural areas of Harighal are illiterate and their main source of income are agriculture and livestock. Some of them collect medicinal plants and sell them at very low prices to local herb sellers. The herbal sellers export herbs to pharmaceutical companies. Over-exploitation of medicinal plant species by untrained collectors, e.g., uprooting of medicinal plants, forest fires, deforestation, over-grazing, and urbanization, are contributing significantly toward the decline of medicinal plant species of the study area, and may finally lead to their extinction. Therefore, authorities should take strict control over protection, conservation, and sustainable utilization of economic plants of the study area. Furthermore, universities, agriculture extension department, and local management may contribute significantly to promote the cultivation of medicinal plants in the area; this will definitely improve the socioeconomic condition of local people of the area. The traditional practices are highly affected by exposure to modern pharmaceuticals and changing lifestyles. The traditional knowledge about medicinal plants in the study area is gradually declining because this knowledge is now mainly restricted to the older members of the community members which are passing away. The younger generation is not interested in learning about traditional plant use, and makes more use of allopathic medicine. The traditional health practitioners ( Hakeems ) have profound traditional knowledge, but many are not willing to share it with other people. These factors may lead to the erosion of traditional medicinal knowledge among the rural communities of area. 

This study is the first to report the traditional uses of indigenous medicinal plants from the remote areas of tehsil Harighal, Bagh. The documented data reflect that local people are still highly dependent on medicinal plants for treating various diseases, as public health facilities are hard to reach, and still have a large knowledge of medicinal plants. The traditional knowledge is mainly in the hand of elder people and health practitioners (hakims), but the young generation is not much interested in herbal recipes. This lack of interest, as well as impacts like overgrazing, deforestation, and soil erosion, are reducing the medicinal flora in the area, and strategies related to resource conservation and further ethnobotanical and pharmacological research are highly recommended for the conservation of this precious treasure. 

Additional file 1:. Appendix I: Cultivation status and endemism of medicinal flora of Tehsil Harighal. Additional file 2:. Appendix II: Emic and etic use reports of medicinal flora of Harighal. 

