Medicinal plants traditionally used in the health care practices by the indigenous communities of the Trans-Himalayan region of Ladakh, India

Ladakh, “the land of high-rising passes,” is a cold arid desert located in the India's northernmost part of the Trans-Himalayan region. Traditional knowledge of medicinal plants in this fragile ecosystem is an important part of the primary healthcare system, particularly in remote areas where modern medical facilities are not fully operational. There is a need to update the traditional information on medicinal plants from time to time to understand any addition of plants or uses to assist in developing new drugs through pharmacological and phytochemical studies. The study was conducted to document the traditional knowledge and current therapeutic practices of the indigenous communities of Ladakh. Besides, the study strives to evaluate previous studies from Ladakh to identify plants that have not been previously reported for medicinal use. Ethnomedicinal information was collected from 350 local informants through open and semi-structured questionnaires and field surveys in 35 villages of 8 regions of Ladakh. The primary data were analyzed for use reports (UR) and the informant consensus factor (ICF). The reported diseases were classified according to the International Classification of Primary Care-2 (ICPC-2). New reported medicinal plants and unreported medicinal uses in this study were identified and compared to 36 prior studies conducted in Ladakh. In the study, 176 medicinal plants belonging to 45 families and 131 genera were reported to treat 116 diseases of 16 (ICPC-2) groups with a total of 4841 use reports. Based on the highest use reports (UR), the most utilized species were Thymus linearis Benth. (134), followed by Aconitum heterophyllum Wall. (127) The highest informant consensus factor (ICF) was reported for Pregnancy, Childbearing, and Family Planning (ICF = 1) followed by respiratory (ICF = 0.91), and digestive (ICF = 0.90) disorders. Based on the comparative literature review, a total of 518 plant species (502 previously reported plus 16 newly cited) are being used in the Ladakh region. A total of 133 use reports for 16 newly cited plants using 30 diseases were recorded. The highest degree of overlapping of medicinal plants and uses for medicines was recorded in regions with comparable ethnicity, and shorter geographical distances. Based on the IUCN Red List, recorded medicinal plants include 7 critically endangered, 9 endangered, and 13 vulnerable species. Ladakh's indigenous populations use a diverse range of medicinal plants to treat a var