The betel leaf is cultivated in most of South and Southeast Asia. Since it is a creeper, it needs a compatible tree or a long pole for support. Betel requires high land and especially fertile soil. Waterlogged, saline and alkali soils are unsuitable for its cultivation.

In Bangladesh, farmers called barui prepare a garden called a barouj in which to grow betel. The barouj is fenced with bamboo sticks and coconut leaves. The soil is plowed into furrows of 10 to 15 meters’ length, 75 centimeters in width and 75 centimeters’ depth. Oil cakes, manure, and leaves are thoroughly incorporated with the tops oil of the furrows and wood ash. The creeper cuttings are planted at the beginning of the monsoon season.

Proper shade and irrigation are essential for the successful cultivation of this crop. Betel needs constantly moist soil, but there should not be excessive moisture. Irrigation is frequent and light and standing water should not remain for more than half an hour.

Dried leaves and wood ash are applied to the furrows at fortnightly intervals and cow dung slurry is sprinkled. Application of different kinds of leaves at monthly intervals is believed advantageous for the growth of the betel. In 3 to 6 months the vines reach 150 to 180 centimeters in height and they will branch. Harvest begins, with the farmer plucking the leaf and its petiole with his right thumb. The harvest lasts 15 days to one month. The harvested leaves are consumed locally or exported to other parts of Asia, the Middle East, Europe, and the United States. Betel is an important part of the economy in rural Bangladesh.

Varieties include 'magadhi' from Bihar, Gundy, Rasi & Bade varieties from hinjilicut, Orissa which is more popular in Banaras, Mirzapur, Tunda, Agra & southern districts of Orissa, in India, and 'Venmony Vettila' from Kerala. A phoenix wing shaped- betel leaf plate in Vietnam.

An extensive ca. 2004 research monograph by the World Health Organization, reports that betel leaf is consumed,in southeast Asian community worldwide, predominantly as a betel quid (synonymous with pan or paan). The betel quid contains betel leaf, areca nut and slaked lime, and may contain tobacco.

Arecoline is the primary active ingredient responsible for the central nervous system effects of the areca nut. Arecoline has been compared to nicotine; however, nicotine acts primarily on the nicotinic acetylcholine receptor. such as cardamom, saffron, cloves, aniseed, turmeric, mustard or sweeteners according to local preferences. Numerous commercially produced mixtures containing some or all of these ingredients are also available in various parts of the world. The betel quid is thus a mixture of substances, placed in the mouth; and betel leaf is not consumed alone. For a predominant majority, the paan usually contains the betel leaf with two basic ingredients, either tobacco or areca nut or both, in raw or any processed form.

The betel quid, or paan, as consumed in various parts of the world, consists of,

• Betel leaf with areca nut and slaked lime. 
• Betel leaf with areca nut, slaked lime and tobacco, 
• Betel leaf with tobacco, but without any areca nut,
• Betel leaf with areca nut and other spices or ingredients, but without tobacco, 
• Betel leaf with areca nut, tobacco and other spices or ingredients

There is archaeological that the betel leaves have been chewed along with the areca nut since very ancient times. It is not known when these two different stimulant substances were first put together. In most countries, the mixture of both has a ceremonial and highly symbolic value.

In India, Burma, Bangladesh, Nepal, Sri Lanka and other parts of South Asia and Southeast Asia, the leaves are chewed together in a wrapped package along with the areca nut (which, by association, is often inaccurately called the "betel nut") and mineral slaked lime (calcium hydroxide). Catechu, called Kattha in Hindi, and other flavoring substances and spices might be added. The lime acts to keep the active ingredient in its freebase or alkaline form, thus enabling it to enter the bloodstream via sublingual absorption. The areca nut contains the alkaloid aercoline, which promotes salivation (the saliva is stained red), and is itself a stimulant. This combination, known as a "betel quid", has been used for several thousand years. Tobacco is sometimes added.

Betel leaves are used as a stimulant, an antiseptic and a breath-freshener. Betel quid with tobacco is strongly carcinogenic.

In India, the betel and areca play an important role in Indian culture, especially among Hindus. Many traditional ceremonies governing the lives of Hindus use betel and areca. For example, when paying money to a priest one might place money in a betel leaf.

The betel and areca also play an important role in Vietnamese culture. In Vietnamese there is a saying that "the betel begins the conversation", referring to the practice of people chewing betel in formal occasions or "to break the ice" in awkward situations. The betel leaves and areca nuts are used ceremonially in traditional Vietnamese weddings. Per tradition a groom might offer the bride's parents betel and areca, the leaf and the nut symbolizing the ideal married couple bound together. In Vietnamese the phrase "matters of betel and areca".

Nutritional composition of fresh betel leaf
If six Betel leafs are combined with a little bit of slaked lime is said to be equivalent  to about 300 ml of cow milk. it also rich in with the vitamin and mineral nutrition. The leaves also rich in with the enzymes like diastase and catalane besides a significant amount of all the essential amino acids except lysine, histidine and arginine, which are found only in traces.
For those, who have an illness problems, it is recommended try to treat this, by utilizing the betel leaf. It is very easy; you just boil betel leaves with boiling water and leave about one small cup to drink every day on a regular basis.

Betel leaf is traditionally used for the treatment of various diseases as Herbal medicines, like bad breath, boils and abscesses, conjunctivitis, constipation, headache, hysteria, itches, mastitis, mastoiditis leucorrhoea, otorrhoea, ringworm, swelling of gum, rheumatism, abrasion, cuts and injuries etc as folk medicine.

Further, the essential oil contained in the leaves possesses anti protozoan, antibacterial and anti fungal properties. So, this oil kills or inhibits growth of dreadful bacteria causing typhoid, cholera, tuberculosis etc. chewing of betel leaves produce a sense of well-being, increased alertness, sweating, salivation, hot sensation and energetic feeling with exhilaration.  It also increases the capacity of exercise physically, where as mental functions works more efficiently for a longer duration, at the same time it may produce a kind of psychoactive effect causing a condition of mild addiction leading to habituation and withdrawal symptoms. Further, the leaves are very nutritive and contain substantial amount of vitamins and minerals.

In spite of having the nutritive, stimulating and refreshing properties, an excessive consumption of betel leaves likewise any other edible items will also harmful particularly to the Teeth. Such harmful effects are exerted by the additional ingredients consumed along with the Betel leaves for making the quid more palatable and attractive. These include particularly, the tobacco or its allied products, which really call for a word of caution. That’s why the tobacco based quid’s may cause dental caries, alveolar, oral sepsis, palpitation, neurosis and even oral cancer also.

Health Benefits
From ancient times, the betel leaf has been used as an aromatic stimulant and anti-flatulent. It arrests secretion or bleeding and also serves as an aphrodisiac. It is used in several common household remedies:

Scanty or Obstructed Urination: The juice from the leaf is known to have diuretic properties and assists urination when taken with diluted milk.

Anti-Oxidant: The extract of betel leaves was, upon research, found to have free-radical scavenging properties that were greater than that of BHT (butylated hydroxyl toluene).

Inflammation: Arthritis and orchids (inflammation of the testes) are treated by local application of betel leaves. A warm betel leaf coated with a layer of castor oil is spread over boils to rupture them and drain them of pus. The leaf must be replaced every few hours.

Lumbago: A mixture of a hot poultice of the leaves or their juice with any oil (such as refined coconut oil) applied to the loin’s yields favorable results in lumbago (lower back pain).

Breast Milk Secretion: The application of leaves smeared with oil to the breasts is beneficial during lactation since the remedy helps increase the secretion of breast milk.

Respiratory Disorders: Cough and difficulty in breathing are helped by applying betel leaves that have been soaked in mustard oil and warmed, to the chest. Crushed betel fruit or berry mixed with honey relieves irritating cough.

Diabetes: Studies on the betel leaf show that it has anti-diabetic properties and helps in its treatment.

Weakness of Nerves: Juice from a few betel leaves with a teaspoon of honey makes a tonic for the treatment of nervous pains, nervous exhaustion and debility.

Headaches: The analgesic and cooling attributes of betel leaves help it relieve powerful headaches when applied externally.

Constipation: A suppository made from the stalk of betel leaf dipped in castor oil, and administered via rectum, instantly relieves constipation.

Wounds: When the juice from a number of betel leaves is applied to a wound and bandaged with a betel leaf, they are found to heal within 2-3 days.