From Healing to Harm: Exploring Moroccan Herbalists' Insight Into the Nephrotoxicity and Cancer Threats of Aristolochiaceae

The Aristolochiaceae family consists of hundreds of species. In Morocco, four species have been identified and sold under the vernacular name «Berreztem» in unregulated markets. The aim of this study is to evaluate herbalists’ knowledge, particularly regarding the identification, toxicity, and side effects of Aristolochiaceae plants in eastern Morocco. An ethnobotanical survey was conducted among herbalists and plant sellers including those with fixed premises and street vendors, in the cities of Oujda and Guercif, Morocco. All herbalists were interviewed by the same person using a 30-item questionnaire. Ninety herbalists were included in the study. Men comprised nearly nine out of ten herbalists. Most of them believed that there is only one species of Aristolochia in Morocco. Only 15.6% of the herbalists mentioned that the plant can cause chronic kidney disease. Additionally, 33.3% of the interviewees prescribed Aristolochia when needed, and 77.8% continued selling it. According to the interviewed herbalists, Aristolochia is predominantly used in the treatment of cancerous diseases, followed by skin diseases and wounds, digestive disorders, and able bowel syndrome. The majority (97.8%) believes that Aristolochia can not cause cancer. Despite the documented dangers of Aristolochia, including kidney damage (nephrotoxicity) and increased cancer risk (carcinogenicity), the plant remains readily available for purchase in Moroccan herbal shops. This suggests a lack of awareness among some herbalists and/or a disregard for the severity of these health risks.