The pattern of use of herbal plants by the community to increase body immunity

The immune system functions to protect the body from infectious agents. Modulation of the immune system is needed to ensure that it is able to fight various attacks by microorganisms that cause infection. One simple way to increase the body’s immunity is to consume herbal plants. Several studies have proven the activity of several herbal plants as immunostimulant agents. This research was conducted using qualitative methods. The aim of this research was to identify herbal plants for body immunity, and describe patterns of use of herbal plants to increase body immunity. The research finding revealed that herbal plants that can increase the body’s immunity are ginger, turmeric, lemongrass, cinnamon, sungkai leaves, black cumin and various other plants, most of which are still consumed in traditional ways. The largest number of respondents who used herbal concoctions to improve health was 225 respondents. There was a pattern of using herbal plants in the people of North Sumatra to increase the body’s immunity by consuming them in the form of direct decoction, herbal drink products, capsules and powder form, and syrup form.


Introduction
The use of herbs as therapy for health restoration has been known for a long time by almost all cultures in the world and has been the subject of scientific research to investigate the possibility of being used as a therapeutic measure so that the immunostimulatory properties of herbal plants can be known.[1][2] [3].Immunostimulants are compounds that can increase the body's defenses specifically and non-specifically through cellular or humoral responses.Gotu kola dew plant extract (Hydrocotyle sibthorpioides L.) have an immunomodulatory effect and show immunostimulant activity at doses of 10, 50, and 200 mg/kgbb [4].When the Covid-19 pandemic attacked the entire world, supplements and medicines derived from plants were increasingly in demand because they were considered effective and safe as antivirals, although claims regarding their efficacy were still controversial.Plants that have immunomodulatory, immunostimulatory, and anti-inflammatory effects such as Boswellia spp., Curcuma longa, Echinacea spp., Glycyrrhiza spp., medicinal fungi, Pelargonium sidoides, salicylate-yielding herbs, and Sambucus spp have been shown to improve immune response parameters and may have the potential to reduce risk of cytokine storm [5] The Guduchi plant (Tinospora cordifolia) is one of the plants that is widely used in traditional medicine because of its immunomodulatory activity.The proteins found in the stems of the Guduchi plant show immunomodulatory properties for the treatment and prevention of diseases caused by immune dysfunction.Another plant commonly used traditionally as a remedy for dysentery, leprosy, and leucorrhoea is Woodfordia fruticosa Kurz.(Lythraceae).Ethanol extract of Woodfordia fruticosa Kurz flowers has immunostimulatory properties by stimulating non-specific immune responses, macrophages and bone marrow cells [6].
IOP Publishing doi:10.1088/1755-1315/1297/1/012033 Various herbal plants which have the function of increasing the body's immunity have been studied, such as Morus Alba L. fruit extract, which is a type of mulberry tree belonging to the Morus genus (Moraceae family), which is effective in resisting pathogens and suppressing tumor growth by increasing macrophage activity.[7].Pasak bumi plant (Eurycoma longifolia Jack) is a popular plant originating from the rainforests of Southeast Asia, this plant is used as an aphrodisiac, antimicrobial, antimalarial, antidiabetic and anticancer [8].Indonesian people are familiar with various types of plants which are considered to have health benefits.North Sumatra Province is ranked third as a province that uses traditional medicines derived from plants.Types of plants that are commonly used as part of the treatment are Zingiber officinale, Kaempferia galangal, Ammomum cardamomum, and Morinda citrifolia.Derived products from these medicinal plants have the potential to be developed and have economic value [9].The people of the Lintang Tribe in Talang Baru Village, South Sumatra Province use medicinal plants in a simple way, namely by chopping them, grating them, boiling them, or consuming them directly.Types of plants used as medicines includes: aromatic ginger (Kaempferia galanga L.), mengelai (Zingiber cassumunar Roxb.), jerngau (Acorus calamus), cock's comb (Celosia cristata L.), red henna (Impatiens balsamina L.), curcuma (Curcuma zanthorrhiza Roxb.), ginger (Zingiber officinale Roscoe.),moringa (Moringa oleifera Lam.), betel nut (Piper betle L.), and bay leaf (Eugenia polyantha).The parts of plants used for medicinal purposes are roots, stems, fruit, flowers, leaves, shoots, rhizomes, bark and fruit skin [10].The sources of medicinal plants are very diverse, the Gayo ethnic community in Aceh Province has long been accustomed to using medicinal plants originating from forest areas, namely in the Kedah protected forest area.Types of plants that people usually use for medicinal purposes include: begonia (Begonia pseudoscottii), gotu kola (Centella asiatica), konyel (Ficus punctata Thunb), rereges koro (Teucrium canadense L), and styrax (Styrax benzoin Dryand) [11].The Karo tribe in North Sumatra Province has used the plant to treat diabetes.There are 15 (types) of plants used to treat diabetes, includes: Blumea balsamifera, Nypa fruticans, Bischofia javanica, Eleutherine americana, Allium cepa, A. sativum, Eugenia polyantha, Piper betle, Citrus aurantiifolia, Boesenbergia pandurata, Curcuma longa, Kaempferia galanga, Zingiber montanum, and Z. officinale [12].Based on the diversity of types of medicinal plants available in North Sumatra, it is important to conduct research on the use of herbal medicines among people in North Sumatra.This research aim to to identify herbal.

Methode 2.1. Population and sample
The population is all communities in six districts or cities in North Sumatra Province which are the research locations.Researchers used the Lemeshow formula [13] (n as an unknown population) to determine the samplesize.Samples are selected randomly from the population.

Data collection and analysis
Researchers created a set of instruments regarding respondents' choices regarding: The researchers used frequency/proportion analysis and mode analysis.Frequency analysis was used to calculate the number of respondents who answered each question, then the results were converted into percentages (%), and analyzed descriptively.Mode analysis is used to describe the largest number of respondents who answered each question, and is analyzed descriptively.

Identify Herbal Plants for Body Immunity
Based on the results of the questionnaire, there were 10 herbal plants used to increase the body's immunity and prevent disease.Ginger (Zingiber officinale) contains essential oils, oleoresins, and other compounds.The contains of essential oil produced a fragrant aroma in ginger."The main components of ginger essential oil that caused the fragrant smell were zingiberene and zingiberol."It has been used as a stomach lozenge, cough medicine, rheumatism medicine, antidote, antitussive, laxative, and antacid, as well as an antioxidant, and red ginger powder acts as an anti-inflammatory [14].
Celery 12% Cinnamon (Cinnamomum burmanni) was a type of long-lived plant that produces bark. it contains chemical compounds in the form of phenols, terpenoids and saponins which were sources of antioxidants .The chemicals contained in cinnamon include cinnaldehide, eugenol, trans-cinnamic acid, a group of phenol compounds, tannins, catecchnis, oligomeric proanthocyanidisn, limonene and alpha-terpineol, in small amounts you can also finded minerals and vitamins A, riboflavin (B2), niacin (B3), and vitamin K.
Cinnamomum burmanii was a plant that was to have potential as an antibacterial, antioxidant, antitumor, antidiabetic and as an immunostimulant.In several studies, the main component of C. burmanii extract, cinnamaldehyde, showed contradictory results [16].
Lemons and their processed products were a source of phenolic compounds (especially flavonoids) as well as nutritional and non-nutritional compounds (vitamins, minerals, dietary fiber, essential oils, organic acids and carotenoids).Butterfly pea flower (Clitoria ternatea) increases the production of acetylcholine, a chemical in the brain that plays a role in the process of remembering, learning information, and maintaining concentration.Butterfly pea flowers also contained bioflavonoids and anthocyanins, compounds known to increase blood circulation in the head and can maintain a healthy scalp and can overcome hair loss and reduce the appearance of gray hair [17].Curcuma (Curcuma xanthorrhiza) contains protein, fat, fiber, curcumin, carbohydrates, sodium, potassium, calcium, iron, magnesium, cadmium and manganese.Well, among all these ingredients, carbohydrates were the highest content, followed by calcium and curcumin.Celery contains many vitamins and minerals, was good for digestion and is anti-inflammatory.Sungkai ornamental plant (Peronema canescens Jack) Crushing sunkai leaves and bruising was a common seraii remedy, treatment for smallpox involves drinking warm water from Sunkai.The roots and young leaves of the sungkai plant were used as a diuretic and analgesic.Boiled sungkai leaves were useful as a malariatreatment because they contain peronemine, which functions as an antimalarial drug [18].Black cumin (Nigella sativa) contains quite a lot of minerals and vitamins so it has quite a high antioxidant content.Black cumin oil can facilitate the respiratory tract, reduce inflammation in the lungs and the feeling of tightness when breathing, and relax the muscles in the respiratory tract.Giving black cumin oil to asthma patients or suffererslung disease can reduced difficulty breathing and improve lung function.Black cumin extract can significantly reduce blood pressure and cholesterol levels in hypertension sufferers [19].

Patterns of selection and use of medicinal plants by the community
Figure 1 showed that the level of public preference for the used of herbal medicinal plants to improve health was higher compared to the used of synthetic drugs, namely 225 respondents or 56.25%.This was in line with several previous studies.Sulviyana et al. stated that 65.2% of respondents had knowledge about herbal medicines, this number was higher than the public's knowledge about synthetic medicines which was only 62.1% [20].Rahayu (2012) used the cross section method showed that as many as 63.54% of respondents at the Muara Siberut Community Health Center chosed traditional herbal medicine [21].Theresults of this study also showed a relationship between knowledge and attitudes and treatment selection.Meanwhile Panyod & Sheen also explained that there were several literatures that proved of herbalmedicine had the potential to be effective as an antiviral against SARS-CoV-2 and as a preventive agent against Covid-19 [22].Increasing public awareness of health, as well as public perception of the impact of chemical drugs and their expensive prices, had encouraged the use of various types of plants that grow in Indonesia's natural environment.Sastrapradja (2012) explained that many types of native plants that grow in Indonesia had been used by the community for various purposes [23].One of the uses of this native plant was as a herbal drink which was used to improve health or increase endurance.
Herbal medicine was the nation's cultural heritage so it was known to almost all Indonesian people.Herbal medicine was chosen because of the 'back to nature' lifestyle change [24].Herbal medicine was not only used by people with mild illnesses, this medicine was also used by people with chronic diseases whose treatment period was quite long [25].Najmawati's (2018) was stated that respondents had good knowledge about traditional medicine [26].Patient knowledge and perception also influenced treatment choices.Knowledge was very important to shape a person's actions so that with knowledge the community could increased independence in making decisions regarding personal health problems [27].There were several factors that cause people to choose to use herbal medicine.The factors that led to the choice of traditional medicine in Nagari Talaok as a means of treatment were (1) more effective, natural and cheap, (2) did not cause side effects, (3) because of trust, and (4) traditions passed down from generation to generation [28].This was a valid preference in this research where more than 50% of people used herbal concoctions to maintain body health.Furthermore, for questions related to patterns of use of medicinal plants in improving public health, the results of filling out the questionnaire in Figure 2   Based on Figure 2, it could be illustrated that the pattern of use of medicinal plants in the people of North Sumatra could be divided into 4 groups, namely (1) single use of medicinal plants (ginger, turmeric, lemongrass, cinnamon, black cumin, lemon, sungkal leaves, chrysanthemum flowers, honey, and celery), (2) using 2 combinations of medicinal plants (turmeric & lemongrass, and ginger & lemongrass), (3) using 4 combinations of medicinal plants (combination of ginger, turmeric, lemongrass and cinnamon), and (4) using 5 combinations of medicinal plants (combination of ginger, turmeric, lemongrass, ginger and cinnamon).According to respondents, a mixture or combination of several types of medicinal plants could produced drinks that were more nutritious because the ingredients were richer.In line with Ziraluo research, that described the way of Bawodobara village community in concocting family medicinal plants was by mixing them with other plants or ingredients such as free-range chicken egg yolks toget better benefits [30].Community patterns in using herbal medicinal plants to improve health had different methods according to knowledge, culture/local wisdom and habits in their respective families or regions.In general, the pattern of use of herbal medicinal plants by the community was still conventional.Namely by brewing or drinking water from boiled plants, either in single form or in a combination of several plants which varied from one community group to another.In line with the research results of Bahalwan, et al, they founded that the method of processing and utilizing medicinal plants by the people in Luhutuban Country was relatively simple, namely by boiling, mashing, kneading, smearing, heating and sticking or eating directly (31].Also Yasir and Asnah described the use of 46 species of traditional medicinal plants for the treatment of various types of diseases [32].Another pattern used by the community to use medicinal plants was to process them into powder form.Managing medicinal plants in powder form maked it easier for people to mix them into health drinks.People's knowledge of managing medicinal plants into powder form comes from their families for generations, but there were also those who have received training.This was in line with the research results of Lolok et al (2021) who provided training to the community and produced herbal products in the form of ginger powder (33).

Conclusion
Ginger, turmeric, lemongrass, cinnamon, sungkai leaves, black cumin, and various other plants were herbal plants that could increase immunity, most of which are still consumed in traditional ways.56,25% of respondents used herbal concoctions to improve their health by consuming them in the form of direct decoctions, herbal drink products, capsule and powder form, and syrup form.

46 Figure 1 .
Figure 1.Patterns of drug usage selection among the community in North Sumatra stated that ginger was the plant most widely used by respondents, namely 210 respondents.This was in line with research results which show that ginger had an active ingredient in the form of gingerol.The gingerol compound contained in ginger had immunomodulatory activity which could increase the body's immunity and improve health[29].

Figure 2 .
Figure 2. Patterns of medicinal plant usage among the North Sumatra Community Information : 4 Combinations : Ginger, Turmeric, Lemongrass & Cinnamon Combination 2A : Turmeric & Lemongrass Combination 2B : Ginger & Lemongrass 5 Combinations : Ginger, Turmeric, Lemongrass, Curcuma & Cinnamon 1) which herbal plants are or are often used to increase the body's immunity in preventing disease.Answer choices (ginger, turmeric, cinnamon, black cumin, lemon, sungkai leaves, butterfly flower, lemongrass, curcuma and celery) and blank spaces for other choices were provided in the instrument; and 2) patterns of use of herbal medicinal plants, for example: no combination (only 1 herbal medicinal plant is used), combination of 2 herbal medicinal plants, combination of 3 herbal medicinal plants, combination of 4 herbal medicinal plants,and combination of 5 herbal medicinal plants.Validation and reliability tests were also carried out on the questionnaire.Pearson Product-Moment Correlation with α = 5% and N = 400 was used for validation.Reliability test using Cronbach's Alpha with N = 400 (number of respondents) and n1 = 11 and n2 = 5 (n1 & n2 = number of questions).Validation test results are valid for each r-xy > r-table (0.098).The reliability test results for the two variables were 0.805 and 0.874 which were very high and each r-xy was greater than the r-table (0.098) so the results were reliable.

Table 1 .
Percentage of respondents the types of herbal plants that people often use for body immunity No.Types of Herbal Plants that People Often Use for Body Immunity Percentage of Respondents 1.