Researcher Titcomb provided an erudite summary for this chapter (1948) when he wrote how Hawaiians found that kava was essential to good health. They used it to soothe the nerves, induce relaxation, for sleep and to counteract fatigue. In so doing, he marked out the antithesis of our modem lifestyle! We are "on edge," we are stressed, we're hyperactive, we're insomniacs and totally devoid of energy. We can almost write our own prescription for kava, if the Hawaiians were right!

Herbs, like Kava, are indeed useful for stress and other anxiety-related disorders (hence the group designation as: anxiolytics). To that end, it is important to arrive at a precise understanding of the nature of stress and nervous disorders. First of all, although these conditions are presented individually, it does not mean that they are necessarily distinct from one another. Indeed, many occur together and even change, back and forth. Details of a number of relevant anxiety and stress disorders are provided in the latter part of this chapter to help the reader identify where they might fit in. But first we need to look at the working of the central nervous system.

Conventional biochemistry has provided in-depth (but by no means complete) information on the workings of the central nervous system. We have identified neurotransmitters and their receptor sites, and can now exploit these by powerful drugs that follow the same pathways. In so doing, these drugs can increase the availability of a certain substance. On the other hand, by occupying a receptor site with a pseudo-substance, thereby effectively blocking them to a certain chemical, these drugs can cause a reduction of the level of a particular substance in the body.

Examples of such drug categories include: monoamine oxidase inhibitors (MAO's) and selective serotonin reuptake inhibitors (SSRI's) such as fluoxetine hydrochloride (Prozac). MAO's are usually the second-choice to tricyclic antidepressants because of a preponderance of side effects. Tricyclic drugs (like Amitryptihne) have been compared to the herb St. John's Wort in a number of trials.

Still, the success rate for dealing with depression by using drugs is often low, while the probability of side effects is quite high. For example, St. John's Wort, in preliminary findings, is promising (like many other herbal treatments) to be just the opposite: exhibiting a high success rate with a low incidence of side effects.

It may be too easy to assign herbs like kava and St. John's Wort to the same pathways as prescription drugs in order to satisfy certain factions. Certainly, even if the pathway is basically the same, the advantages and disadvantages are clearly different. Phytopharmaceuticals do not, simply, take over from existing pharmaceuticals. A paradigm shift must take place, so that the patient's needs are viewed differently and the selection of herbal treatments is undertaken from a whole new perspective.

The holistic view has always been somewhat different from the allopathic view. just as the patient is the focus, rather than the disease, this view appreciates that the mind (or central nervous system) does not operate in isolation from the body. Mainstream medicine is only now appreciating this fact, as Mind-Body Medicine, or with the poly-syllabic title of "'psychoneuro-immunology." The key feature in herbal treatment, one of the primary approaches within the holistic perspective, is balance, just like in Traditional Chinese Medicine, in which a balance of the two essential life-energies-the Yin and Yang-is sought.

With respect to the nervous system, the autonomic nervous system is sub-divided (for the convenience of a physiological understanding) into functional categories: sympathetic and para-sympathetic.

Back to Top

The sympathetic nervous system exerts control over our functional abilities, including our reaction to stress (the instinctual "fight or flight" mechanism). It has a very close link to areas of the endocrine system (e.g., the adrenal-pituitary axis), which serves to further exemplify the futility of trying to separate these two systems in clinical practice. Blood supply, glucose levels and heart rate are regarded as being under sympathetic control. It is said that people experienced in meditation are able to deliberately alter these functions.

Parasympathetic Nervous System

The parasympathetic nervous system basically has the opposite action of the sympathetic nervous system. It primes our body for growth and regeneration. It is more subtle and operates mostly at night, during rest and recovery. If the sympathetic system becomes too powerful, heart disorders and diabetes often develop.   If the parasympathetic system dominates, the person will be cold and lethargic.

Nervine Herbs

Back to Top

As we have seen, the nervous system can be overactive or underactive and there are herbal remedies to treat accordingly. Herbs which effect the "nervous system" are generally called "nervines." Specific herbs will act in a particular way, much like their pharmaceutical counterparts: restorative, antidepressant, etc. Nervine Relaxants calm the system; Nervine Stimulants stimulate it; Nervine Restoratives, or Tonics, tone the nervous system, keeping it in good working order.

Nervine Relaxants

The Nervine Relaxants are the closest natural alternative to tranquilizers. Care should be taken, however, not to go overboard, into a state of over-sedation.

Back to Top

In addition to Kava, there are other nervines like Chamomile, Hops, Lavender, Passion Flower and Valerian which act on the nervous system to calm and relax. Some of these herbs act on more than one part of the body to promote relaxation. As we all know from a long hot bath, a relaxed body encourages a relaxed mind. Kava has a dual action, working both on the nervous system and the muscle tissue as does Valerian.

Experts believe that the effects of kava are due to kava alphapyrones, which confer calmness and relaxation with enhanced mental activity without any of the side-effects of drugs or alcohol. The full chemical pathway for most of these herbs remains to be discovered. Some interact with the monoamine oxidase (MAO) system to prolong the action of certain neurotransmitters.

Nervine Stimulants

Stimulant herbs promote sympathetic functions. Cayenne, for example, is a nervine stimulant.

Nervine Restoratives

Nervous restoratives are medicines which tend to restore fine balance in autonomic function, either stimulating or restorative. One beauty of herbs is that they tend to provide whichever action the body requires (the term "Adaptogen" was developed specifically for ginseng for this very reason). They restore the normal balance, whether "up" or "down," or sympathetic or parasympathetic, respectively. Some herbs are renowned as "nutritives" for their ability to rebuild nerve tissue.

Anxiety

Anxiety is a state of uneasiness, characterized by worry, apprehension or fear. It begins as a normal reaction to a threat against emotional or physical well being. Anxiety is usually accompanied by physical sensations. It becomes problematic when it persists, or is not readily attributable to a known cause, and interferes with normal daily functioning.

Clinical trials in Germany used D, L-kavain, a purified kavalactone, at a dose of 44 milligrams daily. Scholing conducted a formal trial of eight-four patients who displayed symptoms of anxiety. Kavain improved a number of measurable factors, including: memory, reaction time and vigilance.

Lindenberg, directly compared kava with the pharmaceutical, oxazepam (a member of the more familiar group of Benzodiazepines) which is still available in the U.S. under the brand name: "Serax". The kavain group scored just as well as the oxazeparn group but was free from the known complications of this family of drugs, including addiction and side effects, such as: dizziness, drowsiness and even hepatitis!

Kinzler undertook a study with patients suffering from anxiety syndrome (1991). The Hamilton Anxiety Scale provided the standard. After completion of the month-long study, the kava extract group (100 mg t.i.d.) had a reduction in their anxiety, feelings of nervousness and physical manifestations (including: chest pains, dizziness, gastric irritation, heart palpitations and headache). The group was free of side effects and the degree of change reached statistical significance (it was totally objective and not subjective or the result of chance).

Lehman (1996) has published the most recent report on the subject of nervous disorders (specifically: states of anxiety, tension and excitedness). Patients received 100 mg of 70% standardized kava extract three times daily, over one month. He concluded that this kava protocol was clinically effective in reducing these states. In marked contrast to most pharmaceutical studies, no side effects were noted during this study.

This looks very positive, just as the Hawaiians had discovered, empirically, thousands of years ago. "But what if..." the kava puts you into a dream-like state throughout the day? Certainly, some authorities have warned against prescribing kava for patients who are already suffering from depression. It may deepen it for them. However, for those who are highly-stressed and may end up with a nervous breakdown, or become clinically depressed, kava seems to provide just the right amount of stimulation and mood enhancement.

Two studies, by Herberg and Munte, addressed these problems. To test whether kava would be associated with depressed mental function and/or impaired driving skills, they recorded event-related potentials with an EEG (electro-encephalograph) for a recognition memory test, consisting of words presented visually. The subjects taking kava showed a slightly increased word recognition rate and recorded a larger difference on the EEG tracings. Recommended levels of kava did not promote sedation but did stimulate mental acuity.

When Van Veen worked with pigeons (1938) he discovered that kava extract had an enhanced effect when it was given as an emulsion (lecithin and water). More recent work has confirmed lecithin's importance in brain function, via some of its phospholipids, notably phosphatidylserine (PS) and phosphatidylcholine (PC). This would lead someone to the conclusion that taking a blend of kava and lecithin, would constitute a "'smart nutrient"! Expect to see just such a product by the next time you go to your local health food store!

Overall, then, there is ample scientific support for the popular tradition of kava as the "'calming herb" of the South Pacific.

Stress

Back to Top

More and more Westerners are confronted by anxiety, burnout, depression and fatigue, which seem to be the price we pay for our complex, highly-stressed lifestyles. We all experience stress to a greater or lesser degree. A certain amount of stress is actually good for us. It is normal and even stimulating. However, an excessive amount can be harmful; more so when stress accumulates to a point where it starts to take over our lives.

There are all sorts of reasons why people suffer from stress. A change in a person's environment can cause it; it can be related to work, bereavement, or one's lifestyle; it can be brought on by something as simple as standing in a slow-moving line, or sitting in a traffic jam. Stress may be caused by worry: about business, or unpaid bills, or even having a disagreement with your significant other, or next door neighbor.

Mental stress affects the way our bodies function, but physical sources of stress must also be mentioned, which further compound the problem. Poor ventilation, smoking, uncomfortably high or low room temperatures, atmospheric pollution, the effects of electromagnetic waves from domestic, factory and office equipment (e.g., VDT's, microwave ovens, overhead power cables), chemical food additives and poor nutrition all take their toll on the modern person's ability to cope with their environment.

Back to Top

To the body, the cause of stress is unimportant-its reactive, or coping mechanisms, or what the experts call a "fight or flight response," are the same. The body prepares itself for the expected danger and increases its production of chemicals called stress hormones. This may result in rapid breathing, a heightening of all the senses, tensing of muscles and a rush of adrenaline.

Contrary to what we may think, stress is not a twentieth-century invention. It has been with us since the dawn of time. Imagine a Stone-Age man venturing out of his cave in his daily search for food. He is feeling calm, enjoying the moment. As he breathes in the cool air, a sense of well being envelops him. He pauses for a minute and takes in the scenery around him, totally relaxed. Suddenly, his serenity is smashed by a crashing noise in the forest. He shifts dramatically from a state of relaxation to one of tension, his heart pounding and muscles taut. As the rustling in the woods comes closer, his mouth becomes dry and a cold shiver goes down his spine. He looks around, picks up a sharp piece of rock, ready for the enemy. His mind instinctively considers the options: must he fight or can he flee?

Now the enemy comes into full view. It is a mountain lion which quickly disappears into the undergrowth upon sensing the presence of the caveman. As for the latter, his breathing eases and he returns to the relative safety of his cave. There are no clocks or deadlines providing his stress, only survival. Does he have fuel for the fire? Water to drink? Food to eat? Skins for warmth? A mate? He has survived this round. Perhaps he needs to dig a trap for the lion, or hunt it down, so that it won't surprise him again.

Compare that scenario to the twentieth century man who is easing his way into morning traffic on the freeway. Did he remember to fuel up? Is it time for his oil change? Is he going to spill his coffee? Will someone allow him on? Is traffic running smoothly? Will he be late? Did he remember everything in his briefcase? As he sits in the barely-moving traffic, he feels his anxiety build: he’s worried about being late, which will upset lunch and his afternoon schedule and he's still preoccupied with yesterday's deal that still hadn't closed. He'll have to miss his workout again. (Oh well, that's a good excuse. He doesn't enjoy it anyway.) He finally arrives at the office twenty minutes late, to find that his boss has left a threatening memo on his desk. His anxiety becomes palpable, as his heart pounds and muscles become taut. His mouth becomes dry, his head throbs and a cold shiver runs down his spine. He looks around, sights a golf club and resists the impulse to smash something with it. Instead he slams his office door, thumps his fist down hard on his desk, hurting himself in the process and, in pain and resignation, reaches into his desk drawer for a few aspirin ... better, make it three: "It's going to be one of those days," he sighs to himself. The concrete jungle isn't far removed from the first scenario, after all, is it?

Emotional trauma is the most common source of stress and the well-known Hohnes-Rahe stress-factor rating scale lists bereavement, divorce, relationship problems and financial difficulties as familiar examples. Even our kids are stressed, with school, homework, grades, over-loaded schedules, and little time to just "hang-out." Nowadays, instead of fleeing, or fighting, we tend to "stew" in our own chemical soup, which is why we suffer so much more than our ancestors. Once they had reached safety, or won the battle, the stress was over. They could go to sleep and wake up refreshed the next day. (Doesn't this sound exactly like a description of the traditional kava drinkers!)

Back to Top

Short term stress will not usually cause any long term problems. However, repetitive stress will gradually weaken the immune system and deplete the body of essential nutrients. Even trivial everyday problems will suddenly become unmanageable and grow out of all proportion. The person may feel tense, moody and hyperactive just sitting and watching a TV show. Over the long term, the damage is potentially serious. High blood pressure, high blood cholesterol levels and heart disease are all stress-related diseases.

Whether it is caused by physical or emotional factors, stress can lead to changes in the body secretions, especially by the neuroendocrine system, changes in blood circulation, and increased muscle tension. These changes in body chemistry increase susceptibility to physical illness, mental and emotional problems, and accidental injuries.

Back to Top

Stress in its twentieth century variety appears to affect so many disorders not the least of which are anxiety and insomnia. Any herbal remedy, like kava or valerian passiflora, which enhances calmness and relieves anxiety does have a direct connection with our stress levels, and consequently with many major degenerative and autoimmune disorders. It is essential therefore to understand the basis of stress to be able to enhance one's own healing potential.

We used to envy the friendly, relaxed images of islanders from the South Pacific. It now appears that this state was enhanced by drinking kava. Today, via kava products, we have much easier access to the same kavalactones.

Kava will not reorganize your life for you, or remove the stresses; however, in a slightly better mood and with the benefit of a good night's rest, your ability to deal with each stressor and every stressor, combined, may improve.