Ethnomedicinal Uses of Plant Resources in the Machhapuchchhre Rural Municipality of Kaski District, Nepal

Background: Medicinal plants are being used by the majority of the population throughout the world for their primary health care needs. The reliance is also prevalent in Nepal, aided by its ethnic and biological diversity. This study aimed to catalogue the ethnomedicinal knowledge of plants used by local people of Machhapuchchhre Rural Municipality of Kaski district. Methods: Data were collected between February 2017 and April 2018 from eight different villages of the Kaski district by using semi-structured interviews, guided field works, focus group discussions, and in-depth interviews. The reported traditional uses were supported by local assistants, cataloguing vernacular names and crosschecking with the earlier published and gray literature. Results: A total of 105 medicinal plants, belonging to 58 families and 99 genera were documented to treat 70 different diseases and ailments. The highest numbers of plants (37) were used for gastrointestinal disorders and the lowest (4) were used for female genital disorders. Commonly used parts were underground portions (28 species) followed by fruits and seeds (25 species each). The most preferred dosage form was juice, used for 50 ailments, and the oral route was the most favored route of administration (77 species). The medicinal properties of 22 plant species were found hitherto unreported in the district. Conclusions: The study area was found to be rich in plant resources and the people have ample knowledge on the use of medicinal plants. Due to a lack of proper documentation, conservation, and cultivation practices, valuable plant species are at risk of extinction. Thus, appropriate conservation measures and scientific assessment of plant-lore in the district is immediately required.


Introduction
Traditional medicine has played a crucial role in healthcare system for a long time [1]. The World Health Organization (WHO) defines traditional medicine as the "Sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment or physical and mental illness" [2]. Thus, traditional medicine is strongly bonded to nature and dependent on natural resources and culture [3,4]. Historically, plant and animal derived products were the only source of nearly all medicinal preparations [5]. Among them, medicinal plants

Data Collection and Analysis
The year-long fieldwork was carried between February 2017 and April 2018. A total of 6 field visits were made in each study site. The four main data collection strategies such as Semi-structured interviews, guided field surveys, focus group discussions, and in-depth interviews were used following Martin, 1995 [35]. Ethical approval and prior oral consent was obtained from the Institutional Review Committee (IRC), Pokhara University, Nepal, ACA office and the study participants. During the study, a total of 49 traditional healers including Dhami and Jhankri (11), Pujari (4), Vaidhya (3), and a local herbalist (27) were reached out for study and only 45 allowed us to interview further. Four traditional healers refused to respond to our work because they lamented that

Data Collection and Analysis
The year-long fieldwork was carried between February 2017 and April 2018. A total of 6 field visits were made in each study site. The four main data collection strategies such as Semi-structured interviews, guided field surveys, focus group discussions, and in-depth interviews were used following Martin, 1995 [35]. Ethical approval and prior oral consent was obtained from the Institutional Review Committee (IRC), Pokhara University, Nepal, ACA office and the study participants. During the study, a total of 49 traditional healers including Dhami and Jhankri (11), Pujari (4), Vaidhya (3), and a local herbalist (27) were reached out for study and only 45 allowed us to interview further. Four traditional healers refused to respond to our work because they lamented that the methods of treatment shared among others is disgraceful. A semi-structured questionnaire was designed for the interviews. Among the respondents, 85% were male and 89% were above 50 years of age and 72% were literate. Concerning the ethnicity of participants, Brahmins were found to be dominant (53 %), followed by Gurung (16%), Lama and Tamang (18%), and Dalit (13%).
In situ interviews were taken at the homes of the participants. Questionnaires were explained in Nepali and local dialects. Questions used during the interview sought information including the socio-demographic description of the participants, the local names of plants, plant habitats, parts used, dosage forms, the route of crude drug administration, and disease and ailments treated by the plants. Before conducting extensive interviews, questionnaires were pre-tested with five informants and modified as required. Similarity, dissimilarity, and new indication of plants were confirmed by comparing with previous relevant data [6,7,[11][12][13]22,27,28,30,31,.
The ethnomedicinal uses of plants for various diseases and ailments were analyzed following the International Classification of Primary Care (ICPC) and compared with the literature. The comparison analysis helped to sort out the novelty of the findings. The data were entered in Microsoft Office Excel 2010 to analyze the information regarding plant families, habits, parts used, dosage forms, routes of administration, and the number of ailments treated. Data were expressed in terms of number and percentage. Voucher specimens collected during forest walks were identified using the literature, local vernacular names, and experts' knowledge. Herbarium voucher specimens were cross-identified at the National Herbarium and Plant Laboratories (KATH), Godawari, Lalitpur, Nepal and housed in Novel Academy Herbarium, Novel Academy, Pokhara, Nepal.

Medicinal Plant Diversity and Uses
Altogether, 105 medicinal plants belonging to 56 families and 99 genera were recorded. Out of 56 families, Asteraceae and Poaceae were the most dominant families, each with 9 species, followed by Fabaceae and Solanaceae (7 species each), Lamiaceae (5 species), Rutaceae (4 species), Amaranthaceae, Apiaceae, and Rosaceae (each with 3 species). The remaining 47 families possessed less than 3 plant species each. The scientific name, family name, local name, and folk uses of the plants are summarized in Table 1.

Use of Plants for Primary Health Care
It was found that local people used 105 medicinal plants to treat 70 different types of diseases and ailments (Table 1). These diseases and ailments were grouped into 13 different categories (Table 2) based on the International Classification of Primary Care (ICPC) i.e., digestive (37 species), skin (27 species), respiratory (19 species), musculoskeletal (12 species), circulatory (11 species), endocrine, metabolic, and nutritional (10 species), pregnancy, childbearing, family planning (5 species), eye (4 species), urinary (4 species), neurological (3 species), ear (2 species), female genital system (1 species), and general and unspecified (35 species). The information regarding the use of plant species for specific categories of diseases and ailments is listed in Table 2. Similarly, the biomedical and emic use reports are presented in Table 3.

Dosage Forms and Routes of Administration
The study revealed that medicinal plants were mostly used in the decoction, juice, powder, paste, gel, latex, and pickled forms. Less frequently used formulations were roasted, vapor, boiled, and in traditional dishes like Puwa (plant powder cooked with rice flour in butter). Few plant species were also taken in chewable form. It was found that the most frequently used dosage form was juice (50 ailments), followed by paste (33 ailments), decoction (31 ailments), chewable (11 ailments), pickled (8 ailments), latex (7 ailments), gel (2 ailments), and other (17 ailments). Similarly, the oral route was found to be the most preferable route (77 plants) followed by the topical route (37 plants), the inhalation route (2 plants), and the aural route (2 plants). None of the plant preparations were taken through the parenteral route. The diagrammatic representation of the dosage form and their routes of administration are displayed in Figures 3 and 4, respectively.

Dosage Forms and Routes of Administration
The study revealed that medicinal plants were mostly used in the decoction, juice, powder, paste, gel, latex, and pickled forms. Less frequently used formulations were roasted, vapor, boiled, and in traditional dishes like Puwa (plant powder cooked with rice flour in butter). Few plant species were also taken in chewable form. It was found that the most frequently used dosage form was juice (50 ailments), followed by paste (33 ailments), decoction (31 ailments), chewable (11 ailments), pickled (8 ailments), latex (7 ailments), gel (2 ailments), and other (17 ailments). Similarly, the oral route was found to be the most preferable route (77 plants) followed by the topical route (37 plants

Plants and Usefulness
Records of higher numbers of useful plant species from the plant families Poaceae, Asteraceae, and Fabaceae were already manifested in Nepal [82]. Poaceae, Asteraceae, and Fabaceae are the families with a large number of genera and species. It is often hypothesized that there exists a positive correlation between plant use/knowledge and plant density, diversity, and the habitat diversity [54,55]. If the area is biodiverse, the use of plants is heterogeneous and if the area is less diverse (abundant), the use of plants is homogenous [83]. The higher number of ethnomedicinal plants was found to be associated with the area rich in biodiversity.
It was found that the people of the Kaski district are rich in ethnomedicinal knowledge and mostly rely on plant-based remedies for common health problems like gastrointestinal disorders, respiratory disorders, musculoskeletal disorders, cardiovascular disorders, etc. The number of plants used to treat gastrointestinal disorders was found to be the highest ( Figure 5), which is convergent to other studies considered when reviewing this study [22,37,39,41,48,53]. Most of the gastrointestinal problems were due to irregular dietary habit, poor hygiene, and contaminated food. Respiratory, diarrheal, and infectious diseases are also prevalent in Nepal and the country's sociological and topographical complexities burden health and sanitation [84]. Life in rural areas is further complicated [56] because of the effacement of traditional knowledge. Due to a lack of health education, people live with poor hygiene are vulnerable to many diseases. Benign health issues were frequently undermined because of a lack of health education. Some of the skin diseases like photo dermatitis [85], were caused due to prolonged exposure to sunlight during working hours. People suffered from fungal infections in the hands and feet, due to exposure to soil. Many people had musculoskeletal disorders due to greater physical stress, sprains, and fractures.

Plants and Usefulness
Records of higher numbers of useful plant species from the plant families Poaceae, Asteraceae, and Fabaceae were already manifested in Nepal [82]. Poaceae, Asteraceae, and Fabaceae are the families with a large number of genera and species. It is often hypothesized that there exists a positive correlation between plant use/knowledge and plant density, diversity, and the habitat diversity [54,55]. If the area is biodiverse, the use of plants is heterogeneous and if the area is less diverse (abundant), the use of plants is homogenous [83]. The higher number of ethnomedicinal plants was found to be associated with the area rich in biodiversity.
It was found that the people of the Kaski district are rich in ethnomedicinal knowledge and mostly rely on plant-based remedies for common health problems like gastrointestinal disorders, respiratory disorders, musculoskeletal disorders, cardiovascular disorders, etc. The number of plants used to treat gastrointestinal disorders was found to be the highest (Figure 5), which is convergent to other studies considered when reviewing this study [22,37,39,41,48,53]. Most of the gastrointestinal problems were due to irregular dietary habit, poor hygiene, and contaminated food. Respiratory, diarrheal, and infectious diseases are also prevalent in Nepal and the country's sociological and topographical complexities burden health and sanitation [84]. Life in rural areas is further complicated [56] because of the effacement of traditional knowledge. Due to a lack of health education, people live with poor hygiene are vulnerable to many diseases. Benign health issues were frequently undermined because of a lack of health education. Some of the skin diseases like photo dermatitis [85], were caused due to prolonged exposure to sunlight during working hours. People suffered from fungal infections in the hands and feet, due to exposure to soil. Many people had musculoskeletal disorders due to greater physical stress, sprains, and fractures.

Perspective of People Towards Ethnomedicine
We found that the elderly people and traditional healers were rich in ethnomedicinal knowledge and were more interested to conserve plants than younger people. Villagers believed in traditional

Perspective of People Towards Ethnomedicine
We found that the elderly people and traditional healers were rich in ethnomedicinal knowledge and were more interested to conserve plants than younger people. Villagers believed in traditional healers, such as Dhami, Jhankri, and Pujari, as God's messengers and with super healing powers. They believe that plants become more medicinal when processed spiritually and materially. The traditional healers primarily used local medicinal plants to treat diseases. Besides local plants, they also used other important natural products available in other parts of the country. They generally exchanged their grains (such as rice, maize, etc.) with herbal ingredients brought by the transhumants from the Himalayan region.
Some of the elderly people claimed that they have not taken any allopathic medicine in their lifetime. However, they were less conscious of documentation and were unwilling to share their knowledge with others. They believed that if such secrets and their inherent knowledge is shared, the method does not work. They did not have any formal written documents about the use of medicinal plants. Most of the people in this area were not alarmed by the possible extinction of their indigenous knowledge. Few participants even told that traditional healers were remembered in their needs but not rewarded in return. Studies showed that younger people have little knowledge about plants and were inclined to allopathic medicines. However, they were interested in the documentation of their forefather's knowledge. Existing ethnomedicinal knowledge of these indigenous inhabitants has only been transmitted through the verbal prescription. This inherent and practical based knowledge is going to collapse soon, due to the declining interest of youngsters towards the value of traditional medicine and lack of specific plans and policies from the local government.

Plant Parts Used and Their Growth Form
Among the choice of plant parts, underground portions were found to be frequently used. Our finding bears a resemblance with much previous literature on the use of plant parts [22,40,43,45,46,48,50,51,[57][58][59]. Regarding the preference of underground parts, the root was used in most of the cases, as it generally contains a greater amount of active principles, in comparison with other parts [60]. Like roots, leaves are also vulnerable parts of the plant and have a greater role in the plant defense system and possess higher concentrations of bioactive secondary metabolites [49,61,86]. This finding may be beneficial for choosing these parts for bioprospecting and bioactivity determination. However, improper and massive collections of roots may lead to complete destruction and decline of the plant from nature [62]. Herbs were found to be dominant growth form over others, being frequently used in Himalayan folk medicine and other countries [7,13,22,30,39,40,43,48,[50][51][52][53]56,58,59,[63][64][65][66]86]. The reason may be that our study site is located at a higher altitude, where trees are less abundant and other forms of plants are common [22]. It also may be due to the greater ease of collection, storage, transportation, and extraction of active compounds from herbs than other forms [51]. Herbs also contain higher amounts of secondary metabolites for their life strategies [67]. Herbs are relatively easy to cultivate, so they can easily fulfill the demand if needed in higher amounts [68]. Hence, our finding highlighted that the selection and use of herbs depend on factors like their phytochemical profile, their natural habitat, and their accessibility, partially supporting ecological apparency hypothesis.

Dosage Forms and Route of Administration
In this area, the juice was used most frequently, followed by paste, decoction, chewable, pickled, latex, and gel. This information resembles the data published by other studies carried out in Nepal and other countries [7,51,53,59]. The preference of juice may be due to the ease of preparation and its effectiveness [58]. It may also be due to the presence of a greater amount of active principles extracted in juice than other dosage forms [66]. It was also found that most of the herbal plants were used with hot water. Some plants were used along with milk, ghee, and honey. For example, flour of O. sativa and powder of B. ciliata were prepared in a ghee base, both for oral and local application, for backache and inflammation.
Most of the dosage forms were freshly prepared when needed. For example, a fresh paste of G. hirta leaves and latex of M. pustulata was applied around boils for faster healing purposes. A single plant can be used to treat many disorders. Examples of such plants included A. bidentata, A. sativum, A. sessilis, B. ciliata, C. verutum, C. esculenta, D. diandra, J. curcas, L. cubeba, M. arboreus, M. jalapa, O. tenuiflorum, O. sativa, R. arboreum, R. ellipticus, R. nepalensis, S. melongena, T. latifolia, Z. armatum, and Z. officinale. Plants were also used in combined forms. People said that paste and juice of C. asiatica and C. dactylon are used together for typhoid. Similarly, people confirmed that the paste of three plants, A. sativum, Z. armatum, and Z. officinale, is useful for treating snakebites by the expulsion of venom from the snakebite. The increased effect of the plants used together may be due to their synergistic effect. This increased bioactivity of the combined plants opens the door for the identification of compounds with similar mechanism of action. While comparing the choice of routes of drug administration, the oral route was found to be the most preferable route in this study area. The data from other studies also showed that people favor the oral route for medications [22,41,48,51,56,59,61,64].

Comparison of the Reported Uses
We found that there are 47 plant species that have similar uses to treat 42 different ailments. A. bidentata was used in typhoid, tonsillitis, and toothache in this area. However, the same plant was found to be useful in the treatment of urinary disorder and indigestion in the Kavrepalanchok district [7] and asthma in Macchegaun, Kathmandu [36]. Another plant, A. calva, was used for dermatological disorders in the Rupandehi district of western Nepal [69]. However, this plant is used for gastrointestinal disorders like an intestinal worm, gastritis, and flatulence in the Kaski district. The rhizome of A. calamus was used in respiratory disorders like cough, chest pain, and asthma in our study area, which was also practiced in different regions of Nepal, like Rasuwa [13], Rupandehi [44,53], Humla [22], Macchegaun [36], Makawanpur [40], Gulmi [63], Dolpa [46], Nawalparasi [49], and Ghandruk [31]. The bulb of A. sativum fried in mustard oil was applied to treat earaches in Pakistan [70]. Similarly, its oil and fresh bulbs are used to cure skin rashes and blood pressure in the Kavrepalanchok district [7]. The decoction of this plant is taken for gastritis, flatulence, diarrhea, and dysentery in our study area and the paste of bulb is applied topically for snake bites. We found that people used the juice of A. vera for burns and boils. However, the same plant is used for diabetes in the Panchase village of the Kaski district [28], fever and cough in the Makawanpur district of Nepal [40], menstruation cramps, intestinal worms, and constipation in the Badgaun village of the Gulmi district [63], and rheumatism, constipation, and backache in Pakistan [56]. The importance of this plant for burns and boils in our area coincides with the accounts reported in Panchase, Kaski [28], Machhegaun, Kathmandu [36], and the Rudraprayag district of neighboring country India [66].
The inhabitants of Dekhatbuli of Kanchanpur districts used a paste of A. sessilis to treat wounds, venereal diseases, menstrual disorder, fever, and bloody dysentery [11]. The same plant has been reported for scabies in Rupandehi, Nepal [69] and bleeding, cuts, and wounds in Machhapuchchhre, Kaski, and Gulmi, Nepal [63]. Few previous studies showed leaves of B. pinnatum are beneficial for wounds, boils, skin burn, and are also applied to remove pus from the ear and vagina in Rupandehi, Nepal [69] and the plant is used to relieve ear pain in the Kaski district. Local people have been using the apical bud of C. verutum to treat sore throat and epistaxis like in Jajarkot district of Nepal [42,71]. Also this plant is used to treat urinary troubles in our study area which has same application in Karnali and Badagaun of the Gulmi district [63,71]. The practice of using the juice of the root of this plant for typhoid fever and diabetes is unique in our study. In the Mankawanpur district, the whole plant of D. bipinnata was used to correct thirst, fever, libido, asthma, and jaundice [40]. However, the paste of this plant is useful for tooth aches in our study area, which is justified by one study performed in Badagaun of the Gulmi district [63].
The root of A. bidentata contains phytosterols like sitosterol and sigma sterol, which have antibacterial activity, useful for toothaches [87]. The usefulness of this plant for typhoid and tonsillitis is also supported by the antibacterial activity of its ethanolic extract [88]. The plant A. calva is used for anthelmintic activity. This activity is justified by the lethality property of this extract against malarial and filarial vector [89]. A study showed that A. calamus possesses compounds like papaverine, with a dual inhibitor of the calcium channel and phosphodiesterase in the hexane fraction, and the anticholinergic compound rolipram, which has a phosphodiesterase-4 inhibitor in the ethyl acetate fraction [90]. In addition, one study showed that the anti-asthmatic activity of this plant is devoid of side effects [91]. A decoction of A. sativum is indigenously taken for gastrointestinal disorders like flatulence, diarrhea, dysentery, and gastritis in our study area. This medicinal property is justified by its reported anti H. pylori activity [92][93][94]. During the survey, we encountered the plant A. sessilis, which is beneficial for bleeding, cuts, and wounds. These properties can be verified by one study, where a chloroform extract of the leaves showed significant wound healing activity [95]. Though the antipyretic activity of this plant is not yet reported, our research findings will open a door for screening for its antipyretic property. The leaves extract of B. purpurea contain flavonoids and tannins, which exhibit antiulcer activity in rats. This result provides the effectiveness of this plant for the prevention and treatments of gastric ulcers [96]. Additionally, the antimicrobial protein isolated from the seeds of this plant justifies its beneficial effects in gastritis [97]. Folk use of stem and root juice of B. aristata for typhoid fever, jaundice, and diarrhea is supported by its reported antibacterial activity against Salmonella typhi and its hepatoprotective and anti-diarrheal activity, respectively [98][99][100][101][102][103]. One in vivo experiment showed that the same plant contains an excess amount of berberine, an alkaloid responsible for hepatoprotective effects by lowering hepatotoxicity, oxidative and nitrosamine stress, TNF-α, and iNOS levels. The inflammatory modulatory effect of this plant in the liver favors its effectiveness in the treatment of jaundice [104]. Experiments performed by Somania et al. [105] showed that an ethanolic extract of A. racemosus reduced blood glucose level in streptozotocin-induced diabetic rats. Hence, the reported use of this plant in the treatment of diabetes is justified.
C. asiatica is indigenously used to cure typhoid fever, cough, tonsillitis, and gastritis in this study area. The purport of indigenous uses of this plant was substantiated by its pharmacological activities (antibacterial, antiulcer, anti-allergic, anti-spasmodic, antitussive, antiviral, and anti-inflammatory activity) shown by compounds like apigenin, luteolin, α-pinene, and β-pinene [106]. Furthermore, the beneficial effect of C. asiatica is justified by its anti-ulcer activity shown in animal models [107]. The reported osteoporotic activity of the ethanolic extract and isolated compound coelogin from C. cristata justify its traditional use for backache, fractures, and sprains [108]. Its traditional dish, called Puwa, is made from the powder of its pseudobulb and is found to be very popular among the villagers for these musculoskeletal disorders. D. carota is indigenously used to treat jaundice and blindness in this study area. This indigenous use is proved by its antioxidant, hepatoprotective, and intraocular pressure reducing effect [109][110][111][112]. Similarly, F. vulgare has greater uses for musculoskeletal problems, like fractures and bone weakness. This medicinal potency is also validated by its osteogenesis inducing effect in human mesenchymal cells and its inhibitory effect on osteoclast differentiation and ovariectomy induced bone loss [113,114]. Traditional use of J. curcas in gingivitis, tonsillitis, and sore throat is proved by its positive in vitro antibacterial property against various susceptible bacteria [115,116]. The usefulness of J. regia for fungal infection is scientifically confirmed by its fungistatic effect in previous studies [117]. Trigonelline, a potent alkaloid found in M. jalapa, has a β cell protective effect with a good antioxidative potential [118]. This finding supports the clinical use of this plant for diabetes. Additionally, the effectiveness of this plant in the prevention and treatment of diabetes is supported by another hypoglycemic study performed by Zhou et al. [119] in streptozotocin-induced diabetic rats. Experiments performed by Sasa et al. [120] showed that the hypotensive effect of M. charantia is due to momordin, a saponin present in this plant. This compound has the potential to activate the peroxisome-proliferator activated-receptor (PPAR) delta gene in humans. The activation of this gene is responsible for the formation of high-density lipoproteins (HDL), which leads to a decrease in cardiovascular disorders like atherosclerosis and associated hypertension.
In our study area, M. alba is extensively used to reduce toothache. This anti-caries activity is proved by two experiments performed by Lokegaonkar et al. [121] and Islam et al. [122], wherein they found that both the plant extract and the isolated compound 1-deoxynojirimycin worked against Streptococcus mutans, a bacterium responsible for causing dental plaque and tooth decay. Similarly, the antibacterial property of this plant against oral pathogens is supported by the isolation of potent antibacterial flavonoids like cyclocommunol (Cy, 1), morusin (Mi, 3), kuwanon G, and kuwanon E (Ku, 4) [123,124]. Hence, the ethnomedicinal use of this plant for toothaches is also pharmacologically validated.
In the Kaski district, O. corniculata is used to correct gastritis. This beneficial effect is scientifically proved by its gastroprotective effect on experimentally induced gastric ulceration in Wistar rats [125]. P. guajava has been used to reduce blood pressure in our study area, which is justified by its bioactive compounds like guiajaverin and quercetin having anti-hypertensive property [126]. The ethnomedicinal value of R. ellipticus juice for cuts and wounds in many parts of our study area is favored by its wound healing effect in animal experiments [127]. We found that a decoction and cooked leaves of R. nepalensis is used for constipation and its paste is utilized for fungal infections. Literature also showed that the methanolic root extract of this plant has a purgative action in rats and also possesses antifungal activities [125,128]. S. officinarum juice contains polyphenolic flavonoids and possesses good antioxidant activity [129]. In addition, this plant is reported to have a hepatoprotective effect, which justifies its ethnomedicinal values for jaundice [130]. Similarly, the ethnomedicinal use of U. parviflora for jaundice is proved by its hepatoprotective potential in carbon tetrachloride challenged experimental rats [131]. W. fruticosa contains some antimicrobial terpenes like 2-methoxy-4-(2-propenyl) phenol, 2,6-octadien-1-ol,3,7-dimethyl-(E)-2,6-octadienal, 5-methyl-2-(1-methylethyl) phenol, 3,7 dimethylcyclohexanol, cyclohexanol, and 2-methylene-5-(1-methylethenyl), which may be responsible for the local remedies of this plant for diarrhea and dysentery [132]. An aqueous extract of the Z. armatum seed was reported to be active against worm infestation caused by Haemonchus contortus, which validates its application for intestinal worm in our study area [133]. Locally, flour of Z. mays is used to reduce blood glucose level. Previous studies proved that phenolic compounds isolated from Z. mays are effective in reducing complications associated with diabetes mellitus. Hence, the antidiabetic property of this plant in our study area is validated [134]. Z. officinale contains gingerol as an active ingredient, which possesses cholinergic M 3 and 5-HT 3 receptor blocking effects, thereby decreasing gastric emptying time and leading to the prevention of nausea and vomiting [135]. The presence of gingerol, an antiemetic compound, justifies the traditional use of this plant to for the relief of nausea and vomiting.
From the above comparisons of ethnomedicinal uses of medicinal plants with their previous reported uses, it is found that there is a strong variation in their uses within Nepal and other parts of the world. Additionally, the medicinal uses of some plants were newly discovered in our study area and were not encountered in other studies. Such heterogeneity of ethnomedicinal uses of these plants may be due to the predominance in the geographical location and the difference in vegetation. In addition, we found that some of the plants included in our study were already reported for their biological activities and phytochemical constituents. These reported activities and phytochemical constituents are similar to the claimed medicinal uses in this region, which reliability justifies the reported uses. Thus, the ethnomedicinal plant species, which are scientifically validated, are recommended for further studies for advanced pharmacological screening and drug development.

The Novelty of the Work and Future Prospects
Acharya and Acharya [27] recorded 18 medicinal plants, belonging to 17 families, for treating livestock diseases in Machhapuchchhre (formerly Sardikhola village), in the Kaski district. Similarly, another study, conducted by Bhattarai et al. [28] in Panchase, Kaski, reported 45 plant species belonging to 32 families that treat 34 different ailments. Ethnobotanical study conducted by Adhikari and Fisher [31] reported 54 local plant species from the Ghandruk village located inside ACA. Kunwar [30] also reported 66 plant species from Bhadaure Tamagi of the Kaski district. Among all these reported medicinal plants in this study area, 81 of them were reported in the book "Plants and People of Nepal" [136]. Surprisingly, from this survey we were able to document 83 plant species being used to treat 53 different diseases and ailments for the first time. Among them, 22 medicinal plants appeared to have new ethnomedicinal values. These plants include A. adenophora, A. bicolor, B. malabarica, C. cristata, D. macrocapnos, D. racemosus, D. belophylla, E. acuminata, G. hirta, H. lanceolata, M. pustulata, M. chisia, M. arboreus, N. cataria, P. calophylla, P. peruviana, S. fasciculata, S. annuum, S. pseudocapsicum, S. torvum, T. latifolia, and U. parviflora. Thus, we can claim that Machhapuchchhre Rural Municipality of the Kaski district is highly rich in medicinal plant resources. This unexplored ethnomedicinal knowledge pool of this area should be well documented, validated, and promoted for the socioeconomic and health benefits of the local people. Phytochemial profile and biological activities of newly encountered plants are yet unknown. This opens the door for researchers to perform phytochemical and pharmacological studies for the discovery of novel bioactive constituents.

Conclusions
The present study revealed that the Machhapuchchhre Rural Municipality of the Kaski district in Nepal is rich in plant resources that are traditionally used as medicines. The people of this area have been using a variety of plants for treating different diseases and ailments. To recapitulate, this study provides authentic data regarding the ethnomedicinal uses of the local flora of this rural region and will draw the attention of pharmacognosists, pharmacologists, phytochemists, and traditional healers for conducting further research to find therapeutically active natural products. We recommend that the claimed medicinal plants of this area should be protected using appropriate conservation measures and that a scientific assessment of the plant-lore in the district is urgently needed.
Author Contributions: M.A. carried out field survey, collected ethnomedicinal data, processed voucher specimen, and wrote first draft of manuscript. R.T. carried out field survey, analyzed data, and contributed in manuscript writing. H.P.D. and R.M.K. provided the technical support during the manuscript writing and guided the ethnobotanical and ethnomedicinal prospects of the research findings. P.P. designed whole study, supervised the project work, and finalized the manuscript and write up processes. All authors read and agreed for submission of this manuscript.
Funding: This research received no external funding.