Since time immemorial, humans have used plants:, first to feed themselves, then to heal themselves. Medication by plants is currently experiencing a veritable revival, particularly in countries like Morocco, which is known for its great wealth of plants (nearly 42 000 species, including   nearly   600   used   in    traditional    medicine) (Hmamouchi, 1995). The World Health Organization estimates that 80% of the world’s population uses herbal medicines for some aspect of primary healthcare. Although modern medicine is well developed almost everywhere in the world, a significant proportion of the population still relies on herbalists and traditional healers, generally poorly or not at all trained about the diagnosis of diseases and handling of herbal medicine (Bousliman et al., 2012; Bouayyadi et al., 2015).

Consequently, the proportion of intoxications  linked to the use of plants is not negligible; ,they still constitute today a frequent cause of hospitalization in Morocco (Hamia et al., 2009). According to the latest general report of the Anti-poison and Pharmacovigilance Center of Morocco (CAPM), 197 cases of intoxication by plants and products of the traditional pharmacopoeia (PPPT) were identified in 2017, making it the ninth most common (1.17%) cause of intoxication in Morocco.  Moreover, the incriminating PPPT were unknown in 27.04% of cases  (Chebat, 2017). Thus, there is a need to evaluate the clinical efficacy of plants, ensure their safety, strengthen the knowledge and performance of herbalists and, phytotherapists, and ensure adequate follow-up of patients. For this reason a field study was conducted with   herbalists to evaluate their  toxicological and   therapeutic knowledge of the   principal plants cited in cases of vegetal intoxication  collected by the CAPM,  and to determine the availability and conditions of sale of these plants.

It is aA transverse descriptive study was conducted by direct interview with 20 herbalists of the region of Rabat-Témara. This study took place from 01 June to 30 Aaugust 2016.  A field survey by means of a questionnaire (Annex 1) was carried out. The pPlants objects of study weare the 10first ten plants the most reportednotified to the department of pPhytovigilance Unit of the CAPM. The list of these plants wais retrieved during a meeting with Unit the officials of this department. The plants are reportdeclared to the CAPM by their French, Arabic, or Amazigh common names, and the center systematically specifiesd the scientific name of the plant according to the international binomial nomenclature binomial. These declarations are registered in a Herbal medecines adverse events database. The herbalist sparticipants in our study weare randomly selected without distinction as toof sex, age, or professional experience.

The established questionnaire establishedcontained 17 questions (9 multiple-choice questions and 8 open questions)  and  covered four main topichrusts:

(i) Information concerning the herbalist;

(ii) Information on the plant, its use, and its mode of preparation;

(iii) Information about its availability at to the herbalists and the about a conditions of its sale;

(iv) Information about the toxicity of the plant in question.

The results obtained from this study were exploited analyzed through the software SPSS.10.

After having consulted the head of the Phytovigilance Ddepartment of thein CAPM, the 10 plants most reported to the  Department  (Table 1)  are  as  follows:  Atractylis gummifera; Papaver somniferum; Datura stramonium; Nerium oleander; Mandragora autumnalis; Rubia peregrina; Hyoscyamus falezlez; Citrullus colocynthis; Aristolochia longa; Indigo sp.  During the period of study, 30 herbalists were consulted (12 in Temara and 18 in Rabat), but only 20 agreed to participate to in the study. The average age of the participants, all male, was  39 years (range: 22--60). OfAmong the 10 plants studiedobjects of study, 9 weare deemed poisonous plants: (A. gummifera; P. somniferum; D. stramonium; N. oleander; M. autumnalis; C. colocynthis; A. longa, H. falezlez, Indigo sp)   and onlythe one plant is not deemed poisonous, but it (R. peregrina) can become toxic under certain conditions of use. s: it is about the Rubiaperegrina. None of the participants wais a holder of herbalist’'s certificate. The rest of the results willare going to be be presented according to other major axes addressed.

Information on the plant, its uses, and its mode of preparation

The average number of Aarabic vernacular names reported varies between one and four appellations for D. stramonium (Chdaq jemal; Alhayare; Habate semkala; Alghita). Apart from their therapeutic uses, 20 % of the plants were used as an abortifacient, 20% for a criminal intent, 15% in witchcraft, and 10 % are used as psychoactive plants. A. gummifera; N. oleander; R. peregrina and C. colocynthis were known by all the herbalists surveyed (100 %), while H. falezlez wais known only by two2 (10%) herbalists. The pPlants the most recommended to the public were: A. gummifera; R. peregrina; Indigo sp and C. colocynthis. The Table 1 summarizes the principal therapeutic uses of the plants objects of studieds as expressed by the herbalists consulted.

IInformation about its availability to the herbalists and the conditions of its salenformation about its availability at the herbalists and about a condition of its sale

A. gummifera; C. colocynthis; R. peregrina were The following plants are foundavailable toat all the herbalists (100%) interviewed, while H. falezlez wais not available toat any herbalist. The average number in grams sold for each plant is reported in the Table 1.

Information about the toxicity of the plant in question.

No herbalist reportedhas never receivinged notifications about cases of intoxication. The declared symptoms of toxicity declared weare generespecially digestive and neuropsychologic. OfAs regards the toxic plants, only A. gummifera was recognized as toxic by all100 % (100%) of the interviewed herbalists, while none of the surveyed herbalists (0%) knewfor H. falezlez to be no herbalist (0%) knows that it is a toxic plant. THowever the toxic risks the most announced to the buyers weare  those of following plants: A. gummifera, C. colocynthis and M. autumnalis.

Men have always tried to use the properties of certain plants for therapeutic purposes. Evidence of the use of plants for medicinal purposes dates as far back as 60 000 years ago (Solecki and Shanidar, 1975).

In Morocco the use of plants is far from negligible and it is practiced in a completely anarchic way. The Moroccan population often uses them for therapeutic purposes without taking any precautions.

Unfortunately, this enthusiasm, which is not without some hurdles and overruns imply a significant impact on plant-related poisoning (Pentel et al., 2005).

Several factors explain this often irrational and uncontrolled use for this medicine called natural medicine, firstly its reputation for safety and efficacy, its affordability compared to modern medicine, sometimes unable to treat a disease (Lehmann, 2015; Die-Kacou et al., 2009; El Hassani et al., 2013). Besides the lack of an official and codified traditional pharmacopoeia, and the lack of legislation and control determining a viable distribution system to ensure the quality of these products. In the same way, the real ignorance of the properties, the modes of use and the potential risks of the plants, by the people who sell these plants ('' achaba '' and “ aatara”). Which failures open the way to all kinds of skidding in the collection, sale and use of plants, and also hinder the development, optimization and development of our natural resources (Soulaymani, 2010). The '' Achaba '' are the actual herbalists or merchant   who sell the products   of plant origin mainly (medicinal plants, condiments and toxic plants), but also minerals and animals or parts of animals. They play an important role at the medical level through the availability of their products and the propagation of their advice (Bellakhdar, 1997 ; Meziane, 2003). Unfortunately the level of knowledge and skill of some “achaba" is not all satisfactory.

Rarely prescribed by doctors, most of these products, which moreover have a very variable quality in the absence of standards of quality and control, are on free sale and in retail among herbalists.

From a legislative point of view, the profession of herbalist in Morocco is regulated by three separate laws dating all before 1960 (Soulaymani, 2010). The Dahir of February 27, 1923 relating the practice of the profession of herbalist to the provisions of the Dahir of April 12, 1916 whose second article is: “it is especially forbidden for herbalists to sell any poisonous or toxic plant”.

Indeed, at many "achaba" plants and animal and mineral toxic products continue to be sold (Soulaymani, 2010), as for example in our case: A. gummifera which is sold by all the herbalists interviewed; P. somniferum; D. stramonium; N. oleander; M. autumnalis;  C. colocynthis;  A.longa; H. falezlez and Indigo sp.

In Morocco, the job-training of herbalists is usually done, oral transmission of knowledge from  father  to  son or from teacher to boyboy (Bellakhdar, 1997), therefore, knowledge in botany and herbal medicine may be lost. None of the herbalists participating in our survey has a certificate or diploma in herbalism, while the Dahir of February 19, 1960 with Article 17 stipulates that to hold and sell the plants or parts of medicinal plants, fresh or dry, the exception of plants classified in the various tables of poisonous substances, the person concerned must be provided with the herbalist's certificate and authorized under the conditions provided in Article 2 of the same Dahir.

If the legal vacuum is patent regarding the function of herbalist and the herbalism in Morocco, it is as much of the specialized and academic training in the field, evidenced by an herbalist diploma, and which allows these herbalists to have the necessary skills (knowledge of the properties, the indications and toxicities, supply, preparation of mixtures, etc.) (Soulaymani, 2010). Each plant may have more than one vernacular name, the herbalist may not know them all, and so errors in plant determination are possible. Behind the therapeutic use, it has been found in this study that other etiology can lead to intoxication by plants, such their use: as abortive; for criminal purposes; in witchcraft or as psychoactive substance.

The evolution and increasing enthusiasm of phytotherapy, during last year’s, have deepened the analysis of its therapeutic efficacy and specially its toxicological aspect. This last aspect remains behind the progress of herbal medicine. Indeed, the use of traditional herbal treatments can cause therapeutic failures or accidents. On the other hand, the toxic hypotheses of plants are little known, mainly because of their natural complexity [11]. This  observation has been confirmed by our results, since most of the therapeutic uses reported by herbalists are described in the literature (Table 2), except in two cases. The first, H. falezlez, which was known only from two herbalists, one of whom reported that it is used to fatten, indication not reposted in the literature. The second case concerned A. longa, for which three herbalists declare that it is used against hair loss. Certainly, our herbalists have not cited all traditional uses, since a single plant may have several uses, but at least those mentioned are the main traditional uses, which have a close relationship with the mechanism of action of chemical components of the plant. Unlike the well advanced therapeutic knowledge of herbalists, toxicological knowledge remains behind the first. This is how we found that the majority of herbalists don’t know exactly the manifestations of toxicity, nor the potential side effects, nor how they can be safely used, especially since the majority of the events cited are not mentioned in the literature. Table 2 summarizes the main traditional use and main symptoms of intoxication described in the literature of the top ten most notified plants in the phytovigilance department of CAPM. Moreover, these events cited by our herbalists have no scientific arguments that can be explained by the mechanisms of action of the toxic components of the plant in question.

The problem of the toxicity arises for products which get through the evaluation and scientific control, although the market of these products is expanding rapidly. Many people and sometimes the medical corps consider that plants are safe and harmless because they are natural. At present, the warnings are more and more frequent and the awareness by the healthcare professionals is increasing. We hope that a  sufficient attention should be given to  the exercise of the profession of herbalists, because they are considered as an important link in the chain of securitization of phytotherapy. This calls for regulating a profession of herbalists in our country.

The authors have not declared any conflict of interests.

The authors would like to thank all those who contributed to the preparation of this study.