Kava-Kava. Piper methysticum.

Related entries: Piper cubeba - Piperazine

Synonyms—Yakona, Ava Ava, Ava Kava, Kawa, Macropiper Methysticum.

CONSTITUENTS—

An active resin, or two resins of similar character, and a yellow, volatile oil. The resinous principle is permanent and probably contains the active principle of the plant.

PREPARATIONS—

Extractum Kava-Kava Fluidum. Fluid extract of Kava-Kava. Not miscible with water. Dose, from ten to sixty minims.

Solid extract of Kava-Kava, one part equals ten of the root. Dose, from two to six grains.

Specific Medicine Kava-Kava. Dose, from five to twenty minims.

Physiological Action—Dr. David Cerna made extensive experiments upon the action of the drug, which were published in The Therapeutic Gazette in January, 1891. His conclusions were as follows:

Kava-kava produces general anesthesia, and is an active local anesthetic, in that it diminishes, and finally destroys, the function of the afferent nerves, by affecting their peripheral ends.

Kava-kava diminishes, and eventually abolishes, reflex action, by influencing the spinal cord, and probably also the sensory nerves. The paralysis produced by Kava-kava is of spinal origin, and is due to direct action upon the cord.

Kava-kava, while increasing the force of the heart, diminishes the number of pulsations, by stimulating the cardio-inhibitory centers and ganglia, chiefly the former,

The drug lowers arterial pressure through an action upon the vagi. It afterwards elevates it, however, especially after previous division of the pneumogastrics, by a direct action on the heart.

Kava-kava at first stimulates, afterwards depresses and finally paralyzes, the respiration. The primary stimulation is due to excitation of the pulmonary peripheries of the vagi; the latter effect, to an influence exercised on the respiratory centers of the medulla oblongata.

Kava-kava, in small doses, increases slightly, and in large quantities diminishes the bodily temperature.

The drug increases notably the salivary secretion.

Specific Symptomatology—Its specific therapeutic value depends upon its influence upon the mucous membranes of the genito-urinary apparatus. It is profound in this influence, as it is probably eliminated by the kidneys to a certain extent unchanged. Its influence in reducing the quantity of blood in the capillary circulation is probably the cause of its action in reducing the inflammation in the mucous membranes of this apparatus. The writer has used it since 1882, and his experience confirms, other enthusiastic reports. It will cure gleet where all other remedies have failed. It will cure chronic gonorrhea more quickly and more satisfactorily than many other better known remedies.

Therapy—The agent was first introduced for the treatment of all forms of gonorrhea, but it will probably give better satisfaction, will show its prompt influence to a better advantage in the treatment of sub-acute forms or in the slow, persistent, and otherwise intractable forms, than in the acute variety. It is best given in full doses of from fifteen to thirty minims every two or three hours, in cold water. In the old, protracted gleety cases there will be no necessity of an injection or auxiliary treatment, but in the more acute or sub-acute cases, a mild injection or irrigation is needed, which with auxiliary agents, such as gelsemium or cimicifuga, to act upon the fever and nerve elements of the disease, will greatly facilitate its action.

It increases the tone and power of the sexual and urinary apparatus, and improves the general health and vigor of the patient. It is a mild but efficient diuretic, stimulating both the excretion and the secretion of the urinary constituents. It is of much value in catarrh of the bladder, in old and enfeebled cases relieving the symptoms promptly; in some eases restoring the strength and tone of the urinary organs. It relieves painful urination, overcomes strangury, and increases the power to expel the urine.

Morrill of Lincoln, Nebraska, is authority for the following statement as to the uses of this remedy: It is specially indicated where there is atony of the bladder, with a large quantity of residual urine, where the uric acid diathesis is pronounced. In prostatic troubles of old men, where the urine burns, and scalds, where there is hyperesthesia of the urethra and where the testicles and scrotum are pendulous, greatly relaxed and drag down upon the cord, which is tender, where the masseteric reflex is pronouncedly diminished, and where there is soreness or tenderness in the perineum.

The agent should be given well diluted, although it is not unpleasant in any vehicle. It will, however, derange the stomach, in some few cases, although it soothes the stomach usually, and is an active stomachic tonic.

The doctor gives it as routine treatment in gonorrhea, in combination with an alkali, usually the citrate of potash. In the treatment of urinary disorders he gives the following symptomatology: Uneasy sensation in the region of the bladder; an inclination to pull up or hold up the parts, and the symptoms relieved by wearing a suspensory. Pain in the urethra extending to the perineum, urine highly acid, causing smarting and burning, acute and chronic cystitis, prostatitis, with hypertrophy, and epididymitis, and other conditions depending upon atony of the genito-urinary organs.

Dr. Cleary has treated several cases of intolerable itching of the vulva with kava-kava one part, glycerine two parts, applying this freely. The results were very satisfactory. In a diabetic case, he obtained just as good results. I shall experiment with this for further local anesthetic effects.

I have recently had an experience in the treatment of an exaggerated case of pruritus of the vulva and anus, which remained persistently after repeated poisoning from rhus tox, had been finally cured. The patient avers that an extemporaneous dilution made at my direction, of one part of kava-kava in from two to six parts of water, as the occasion demanded, has been an ideal application for immediate— almost instantaneous relief—when the itching was unbearable. The nervous system had become so involved in this case that nerve sedatives internally were demanded.

In the nocturnal enuresis of the aged and feeble, and in children from temporary muscular weakness, it is a most satisfactory remedy, curing often when other remedies fail. It acts in perfect harmony with belladonna and strychnine in such cases.

Its diuretic influence has rendered it an important remedy in many cases of dropsy, the entire train of symptoms being quickly and satisfactorily relieved with its use. In those cases where the heart seems feeble and irregular in its action, its power and strength has increased and a cure resulted.

It increases the appetite actively, and improves digestion and assimilation to a satisfactory extent with a large percentage of the patients taking it, and may be given for this purpose in gastric atonicity. In some cases, in which the author has prescribed it, the agent has induced an almost inordinate appetite. It stimulates the entire function of digestion, in certain cases, to a satisfactory degree, correcting torpidity and functional inactivity of the glandular organs of the entire intestinal tract, increasing the peristaltic action of the intestines, overcoming constipation, and inducing normal and satisfactory bowel movement. It is curative in intestinal catarrh and in hemorrhoids.

Dr. Sherman, of Ohio, confirms the statements I have made, in previous editions of this work, concerning the influence of kava-kava upon the stomach and digestive apparatus, which I first observed in 1882, and adds to that the benefit of his own experience in the treatment of intestinal indigestion. There is a train of symptoms present when this condition has been of long standing which is promptly met with kava-kava.

He gives the following symptoms as immediately benefited with this remedy: There is scantiness and irregularity of the flow of urine, the patient's face looks full, sometimes pale, all the tissues seem to be slightly edematous, the feet and the legs more so than other tissues. The tongue is full and pale, the bowels regular or slightly constipated, with loss of appetite, and poor gastric or gastro-intestinal digestion. The patient feels languid, claims that he must force himself to do anything, and presents many of the appearances of Bright's disease, and yet the analysis of urine fails to find evidences of that disease. If this patient be put upon kava-kava, from twenty to thirty drops in water, four times a day, an improvement of all of the symptoms will be observed within the course of perhaps ten days. This improvement will continue until the patient is restored to perfect health.

The agent will relieve cerebral hyperemia, arterial sclerosis, and hematogenous jaundice. It will be found valuable in atony of the intestinal tract, especially if nervous phenomena seem to depend upon that condition.

The following is Dr. Morrill's treatment for acute rheumatism: Kava-kava five drams, cimicifuga three drams, citrate of potassium, four drams, elixir of pepsin, sufficient quantity to make four ounces. Give one dram well diluted every three hours. If there is profuse sweating, he includes hyoscyamus, two drams in the prescription, instead of the citrate of potassium. He wraps the joints in cotton, and insists upon rest in bed and an extreme non-nitrogenous diet. He gives no salicylates in acute rheumatism. He claims that this course will prevent all cardiac complications.

He believes much of the severity of the condition depends upon gastro-intestinal faults, and these must have constant attention.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.