MAJOR CHEMICAL CONSTITUENTS

The main constituents of kava kava rhizome include kavalactones (kavapyrones) kawain, dihydrokawain, methysticin, and dihyrdromethysticin; the alkaloids and amides 1-cinnamoylpyrrolidine, 1-(m-methoxycinnamoyl)-pyrrolidine, and cepharadione A; chalcones, flavonoids, steroids (sitosterol, stigmasterol, and stigmastanol); esters (e.g., bornyl cinnamate); aliphatic alcohols; and long chain fatty acids. Dried material should contain at least 3.5% kavalactones and good-quality rhizomes up to 8.3% kavalactones.

PRINCIPAL GYNECOLOGIC AND OBSTETRIC USES

ADDITIONAL USES

TRADITIONAL AND HISTORICAL USES

Kava kava use is deeply rooted in the ceremonial and daily recreational traditions of South Pacific Islanders, particularly Polynesia, Melanesia, and Micronesia, together known as Oceania, with heavy use found in Fiji, Samoa, and Tonga. Use spread to Australia via missionaries from the South Pacific, and it was traditionally also very popular in Hawaii, although a death penalty instituted for its use there eventually led to decreased consumption among Hawaiians. Legends abound regarding “the kava,” which is believed to be the child of their god of good seasons and rain, and patron deity of farmers. Kava kava use is accompanied by specific rituals, including the use of a special kava bowl (tanoa), strainer (tau’anga), and cup (ipu), also believed to be gifts from the gods accompanying the herb. Kava kava was traditionally taken as a beverage prepared as a cold infusion. The root is chewed, grated, powdered, or macerated and placed inside the kava bowl to which cold water is then added. This mash is steeped and strained repeatedly, then poured into cups for drinking. Kava kava is used in formal ceremonies such as political events, marriages, and births; at important and official meetings such as contract signings; and also more casually and informally

Kava Kava (Piper methysticum).

Photo by Martin Wall.

on social occasions; and even recreationally, for example, at the start of the day by old men, or at the end of a long work day. Reports say that is has also been used to cure illness, help soothe arguments, and even as part of ceremonies at which disputes are resolved or differences between enemies are reconciled. One might say it is considered the beverage of hospitality in the South Pacific.

Traditional medicinal indications for kava kava use include use as an intoxicant, a nervine, and neuromuscular restorative (e.g., calming the nerves, inducing relaxation and sleep, relieving headache, counteracting fatigue or weakness, and restoring muscle strength in asthma and rheumatism). It was used as a diaphoretic in the treatment of chills and head colds, and for asthma. Another important medicinal use was as a diuretic, particularly for difficulty urinating and the treatment of chronic cystitis, syphilis, and gonorrhea.

It was first described and named Piper methysticum, meaning “intoxicating pepper” in 1786, and was not highly used as a medicinal plant in Western botanical medicine. It was recognized by the Eclectics in the late nineteenth century as a local anesthetic, CNS depressant, and cardiac stimulant, and as a treatment for gonorrhea. In the early twentieth century the Eclectics cited its use for neuralgic conditions of the eyes, ears, and teeth, for edema, and for gastric atony and postsurgical anorexia. The herb was listed in the 20th to 24th editions of The United States Dispensatory of the United States of America (1918–1947) and the fluid extract had official status in the 4th and 5th editions of the National Formulary (1888–1926).

CLINICAL INDICATIONS

Herbal practitioners regard kava kava as a highly reliable anxiolytic, antispasmodic, analgesic, and neuroprotective herb, with mild topical anesthetic action. Treatment of anxiety and anxiety disorders is the most common clinical indication for kava kava; however it is also widely used for the treatment of neuromuscular tension, neuralgia, neurovegetative complaints associated with perimenopause and menopause, dysuria, urogenital pain, and hyperactive bladder.

IN VITRO, ANIMAL, AND CLINICAL DATA