Herbal Medicines in Hawaii from Tradition to Convention
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Herbal Medicines in Hawaii From Tradition to Convention Scott A. Norton MD, MPH, MSc* The stories of kava and chaulmoogra demonstrate the importance through its geologic maturation, activity, dormancy, senescence, of herbal products in ancient and recent Hawaiian medicine. Kava extinction, and subsidence. The island chain has no land connec is a psychoactive beverage that has been used ceremonially for tions; therefore all forms of life arrived here as colonists. Wind, millennia throughout the Pacific. It is a nonfermented depressant water, and airlifts of seabirds brought the founding members of that causes tranquil intoxication in which thoughts and memory Hawaii’s flora and fauna. In Hawaii’s isolation, the ancestral plants remath clear. Its broad pharmacologic activity led to use in Hawaii to treat skin disorders and later h Germany to treat gonorrhea. Kava and animals evolved into unique species, often quite different from is now available outside the Pacific bash as a relaxant, emerging as their ancestors. Relatively few ancestral species acquired a foothold a popular, albeit deritualized, natural product. In the late 19th on Hawaii and from few, we now have many descendant species. century, the maTh treatment for leprosy was chaulmoogra, extracted Hawaii has the world’s most richly endemic flora; nevertheless it is from Hydnocarpus seeds. Chaulmoogra had been a traditional a depauperate flora. treatment for skh diseases Th Ayurvedic and Chhese mediche. Many of the plants that outsiders most closely associated with Chaulmoogra from Asian markets was expensive and usually adul Hawaii are introduced. There are few native orchids, for example, terated so the USDA decided to plant Hydnocarpus h HawaII. Joseph Rock, a botanist at University of Hawaii trekked through and coconut palms were introduced by the ancient Polynesian southeastAsia collecthg fresh seeds to plant on Qahu. Rocks trees voyagers who settled Hawaii. The Polynesian settlers brought with provided chaulmoogra for leprosy patients on Molokai and else them 30 or so plants that were eminently useful in the ancestral where until it was replaced by dapsone. Chaulmoogra, once the homeland.”2 These include the staples for consumption, construc treatment for leprosy worldwide, is now nearly forgotten; kava, once tion, clothing, art, and medicine, such as breadfruit, taro, sweet poorly known outside the Pacific, is now a widely-used alternative potato, coconut, banana, sugarcane, hala, and noni (Table 1). Many medicine. Hawaii will probably conthue its role h the transition of of these have become naturalized and are now fully a part of the plants from traditional use to conventional use. Hawaiian landscape,2 such as coconut palms, wild ginger, and the Introduction state tree, the kukui. The Hawaiian Islands emerged from the Pacific seafloor over the past several million years. Each island arose as a volcano and passed Kava One of the thirty or so plants brought by the settlers, kava, has phannacological activity that led to its use in both traditional 3 both the ceremonies and in traditional medicine. Kava refers to plant and the beverage that is made from the plant. The kava beverage has psychoactive effects that produce a calm, tranquil effect but thoughts and memory remain clear. The plant probably originated in Vanuatu (the former New Hebrides) but, as Pacific mailing address: peoples migrated, they carried their most useful products with Scott A. Norton MD, MPH, MSc them.4 Kava became widely used in rituals throughout the Pacific’s *Chief of Dermatology RW Bliss Army Health Center three ethnogeographic regions: Polynesia, Micronesia, and Fort Huachuca AZ 85613 Melanesia. The plant has become naturalized on many high islands with rich soils but it is absent from coral atolls and from temperate ‘Assistant Professor of Medicine John A. Bums School of Medicine islands such as Aotearoa (New Zealand). University of Hawaii Western scientific attention to kava started with the Forsters, Honolulu, Hawaii 96822 father and son, who served as the naturalists on Cook’s second 5’6 They prepared the proper Linnean binomial, Piper ‘Assistant Professor of Medicine voyage. University of Arizona College of Medicine methysticum, which means “intoxicating pepper.” Kava is in the Tucson, Arizona 85724 family Piperaceae, meaning it is a true pepper closely related to The opinions expressed in this article black pepper and to the pepper leaf used in preparing betel quids. are those of the author and not necessarily Kava is a shrubby plant with jointed stems and heart-shaped those of the Department of Defense. This article is reprinted with slight revisions leaves. There are perhaps two-hundred varieties of the kava plant in from the Proceedings of the International the Pacific, based mostly on differences in stem morphology. The Symposium on Herbal Medicine 1-4 June 1997 Honolulu, Hawaii with permission varieties also differ in their potency. The psychoactive components of San Diego State University, 1997. are most concentrated in the lower stems and upper roots ofthe plant. HAWA6 MEDICAL JOURNAL, VOL 57, JANUARY 1998 382 Traditional Kava Preparation and Ceremonies of Western arrival, this skin disorder was a mark of prestige for only There are several traditional ways to prepare kava, differing by a few noble were able to spend their days in the consumption of kava. ethnogeographic region. The parts of the plant with the greatest Commoners, instead, fished or worked in the fields but some concentration of active ingredients are the lower stems and upper members of the highest castes participated in daily kava circles. In roots. These portions were gathered and prepared into the kava many Pacific societies, traditional healers induced kava dermopathy beverage according the to practices of the ethnogeographic region. to other skin diseases, most likely superficial fungal infections and In Polynesia, for example, a group ofyoung people, selected for their psoriasis. People with skin diseases were instructed to drink kava strong teeth, chewed the roots and collected the macerated root pulp until their skin became scaly; then the kava was withheld. The kava in a kanoa or kava bowl. Water was added and the turbid mixture was eruption reversed and the scales would shed, descending from the strained through the inner bark of the hau 4 tree (although in Hawaii, 8 head. As the dermopathy resolved so did, according to traditional the pounded fibers of a sedge, ‘ahu’awa, were 2). used Nowadays practice, the other skin disease. chewing is uncommon outside parts of Vanuatu. Kava is still The cause of kava dermopathy is unknown. Several explanations, prepared by young people, but using Western tools such as this some traditional, some modern, have been proposed. In Samoa and mortar and pestle made from a steel drum and a car axle or food Tonga, the explanation recounts a Tui Tonga (King of Tonga) who processors. night At in traditional villages in Fiji, Tonga, and other sailed to an outer island afflicted by drought and famine. The islands, one hears the thumping of kava being pounded, albeit with islanders had no food to offer as a gift so the local chief sacrificed modern modified techniques. his beautiful but leprous daughter. The Tui Tonga was honored by The traditional kava ceremony, on the other hand, has remained the sacrifice but declined to eat the flesh of the young girl. Instead, relatively unchanged for millennia. It is a ritual attended only by he instructed the girl’s father to bury her body behind her house. men, usually those of the higher castes. All members sit, usually From the burial site, the first kava plant emerged. Today, those who barefoot and cross-legged, on the ground. The presiding members drink the beverage made from kava will acquire the girl’s scaly, and honored guests have their places, as do the men who prepare, leprous skin.39 Western explanations are less colorful but no more mix, and serve the kava. Cups of kava are filled, passed to an supported by scientific evidence. Suggestions that kava dermopathy individual for consumption, returned, and refilled in several-to- is a form of pellagra (a dietary deficiency of niacin or tryptophan), dozens of rounds in an evening. The first Western illustration of a a photoeruption, or an acute allergic dermatitis are disproved by skin kava ceremony was prepared by John Webber, illustrator on Cook’s histopathology and other studies. Ruze suggested that kava may third voyage. interfere with cholesterol metabolism necessary for proper 3Kava is a powerful symbol of traditional culture in Pacific keratinocyte formation.’° This hypothesis warrants further investi society. This is reflected in the flag of the State of Pohnpei in the gation as a better understanding of cholesterol metabolism might Federated States ofMicronesia where the kava (sakau) cup is central influence the management of many more serious medical condi item. The watermark on Western Samoa’s paper currency is the tions. tanoa, or ceremonial kava bowl. But in this century, kava has been deritualized. On many Pacific islands, kava is no longer restricted to Pharmacology of Kava men of a certain class or for consumption during specified occa Kava extractcontains about fifteen compounds called kavalactones, sions. It is a social beverage consumed with those with whom you all of which are structurally and pharmacologically 4 unique. Kava’s wish to have warm social interactions. It is still consumed in a group neuropharmacologic effects are also unique which explains why setting; there are no solitary drinkers. The calming effects of the early Western descriptions of kava are so often muddled. Kava is beverage distinguish it from alcohol that is often accompanied by non-narcotic, non-opiate, nonfermented, nonalcoholic, disinhibition and violence, often severe domestic violence. For this nonhallucinogenic, and physiologically nonaddicting. The word reason, kava was introduced by Fijian missionaries into some narcotic, by the way, has both pharmacologic and legal definitions, Australian aboriginal communities to replace alcohol and the fre neither of which apply to kava.