*3.3.4* C. spinarum *in human ethnomedicine: route of administration*

The most commonly used route of administration globally for *C. spinarum* is the oral route as seen in **Figure 12** with external application, fumigation and inhalation being the most commonly used routes otherwise. However, the route is not specified at all in 40% of URs. In **Table 2**, the primary methods of preparation and route of administration for each plant part are listed. The table illustrates that the root and rootbark are most commonly prepared by decoction and administered orally. The fruit usually undergoes no preparation and is administered orally. The stem is burned and used as a fumigant or inhalant. The leaf is most commonly burned as an inhalant and boiled as a decoction.

It can be seen from **Figure 13** that the predominance of the oral route is common to all geographical zones apart from Australia where it is more common to apply externally and to fumigate. The oral route of administration is common in EM as it is in BM [110, 111]. This may be explained by factors such as safety, convenience, cost and

#### **Figure 12.** *Top 5 routes of administration of* C. spinarum *globally.*


#### Carissa spinarum *L.: A Case Study in Ethnobotany and Bioprospecting Research DOI: http://dx.doi.org/10.5772/intechopen.104665*

#### **Table 2.**

*Most common route x preparation x plant part in* C. spinarum *used in EM.*

#### **Figure 13.**

*Key routes of administration of* C. spinarum *in different geographical regions (URs > 9).*

acceptability [111, 112]. Route of administration may also be related to the ailments treated. *C. spinarum* is commonly used to treat gastrointestinal ailments and oral administration would thus be logical. In addition, some theories of health and illness in the study areas necessitate the oral route of administration where emesis or purgation is required. In some cases, a mixture of routes is used for one treatment. In the following example oral and topical routes are combined for the treatment of syphilis:

*Infusion (of root) drunk in malwa, sitz bath ([113] Uganda; malwa is local beer made from Eleusine coracana).*

In Tanzania, oral and topical use are combined for the treatment of unspecified chest conditions:

*Root crushed and scraped and pulp is applied as a poultice for chest complaints. Root extract drunk at same time. Tanzania [114].*

In Uganda for the treatment of epilepsy, the root is used internally and externally as follows:

*Powder drunk, bathed, smeared to body. Uganda [113].*

In a study in Uganda, where eight different species used to treat epilepsy, most are applied in some manner rather than taken orally [113]. This includes smearing, bathing, instilling into eye or nostril, fumigating, inhaling or licking. Use of non-oral routes could be a reflection of the practical difficulty of administering orally if a person is having a seizure, or may be a reflection of a ritual component of treatment of a complex illness, or both [79]. The choice of route could be related to the bioactive metabolites present. It is asserted by Le [111] that some phytochemicals such as alkaloids may be more active orally whereas terpenoids may be well absorbed through external or nasal administration.
