title: Treatment and management of liver diseases by Khmer traditional healers practicing in Phnom Penh area, Cambodia.
abstract: BACKGROUND
  Liver disorders are a major health problem in Cambodia, where some patients prefer to seek treatment from traditional healers. The aim of the study was to document the knowledge and practices of these healers in four Southern Cambodian provinces.
  
  
  METHODS
  An ethnopharmacological survey was carried out from September 2015 to January 2016 in Cambodian urban and rural areas. Thirty-three Khmer traditional healers (KTH) were interviewed using a semi-structured questionnaire including socio-demographic data, healer's formation and their professional practice conditions, perception of liver diseases (types and causes of liver disorders, diagnostic methods and symptoms of liver problems), dietary recommendations given to patients, and herbal remedies used to treat them. For each medicinal plant mentioned in herbal remedies, the local name, part of the plant, mode of preparation and administration, and their properties, according to the healers, were recorded. The plants mentioned by the traditional therapists were collected and later identified by specialists.
  
  
  RESULTS
  Different types of liver disease are identified by the healers, and diagnosis was mostly based on reading medical records, and by observing the yellow discoloration of the skin and eyes. A total of 42 herbal remedies including 83 medicinal plants belonging to 40 families were mentioned for treating liver disorders. The most predominant families were Leguminosae and Poaceae. Among the plants reported, Cananga latifolia, Andrographis paniculata, Smilax aff. glabra, Gomphrena celosioides, Passiflora foetida and Physalis minima were the most cited species. A large part of the herbal remedies used were multi-ingredient recipes, and were prepared mainly by a decoction administered orally. Plants are combined in multi-ingredient recipes, and selected on the basis of their properties (trocheak, psah, somrap mé rok, ktchol) which originate from Khmer medical concepts. Most of the plants used by healers have a wide ethnobotanical use for liver disorders, and have been studied for their hepatoprotective activity and related activities on the liver.
  
  
  CONCLUSIONS
  In the diagnosis and treatment of liver diseases, KTH have incorporated biomedical concepts and new practices, which suggest that they could be defined as neotraditional healers. Medicinal plants constitute the core of traditional medicine practice by these healers, and these plants play a very important role in the health care of people with liver problems in Cambodia. Therefore, more attention should be paid to the integration of healers in national health care programs for the development of combined therapies. Furthermore, two plant species (i.e. Cananga latifolia and Willughbeia edulis) were found to be widely used for treating liver disorders in our survey, and should be studied for their pharmacological potential for liver problems.
authors.affiliation: UMR 152 Pharmadev, Université de Toulouse, IRD, UPS, France. Electronic address: francois.chassagne@ird.fr.
authors.forename: François
authors.initials: F
authors.lastname: Chassagne
authors.affiliation: UMR 152 Pharmadev, Université de Toulouse, IRD, UPS, France. Electronic address: eric.deharo@ird.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Deharo
authors.affiliation: Faculty of Medicine, University of Health Sciences, Phnom Penh, Cambodia. Electronic address: hieng_punley@yahoo.com.
authors.forename: Hieng
authors.initials: H
authors.lastname: Punley
authors.affiliation: UMR 152 Pharmadev, Université de Toulouse, IRD, UPS, France. Electronic address: genevieve.bourdy@ird.fr.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bourdy
mesh_terms: D002160:Cambodia; D004032:Diet; D019468:Disease Management; D020834:Ethnopharmacology; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000628:therapy*; D008518:Medicine, East Asian Traditional; D008517:Phytotherapy; D028321:Plant Preparations / Q000627:therapeutic use; D010946:Plants, Medicinal / Q000145:classification; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D028321:Plant Preparations