Positive Health Online

Devil's claw is a perennial plant, common in the southern and eastern parts of Africa, particularly the former Transvaal. In heavy rain it grows luscious leaves and beautiful, trumpet-shaped, red-violet blossoms. During the rainy season it stores water in its tubers, providing a reservoir for periods of drought. The plant grows on sandy soil and the tubers, which are of medicinal value, are harvested in the autumn. Care is taken to harvest only these as the roots are ineffective. The plant gets its common name from the tough, thorny barbs which grow on its fruit – Devil's claw is a translation of the German, Teufelskralle. A German farmer, G.H. Mehnert, introduced the herb into Europe having observed its use by the African peoples.

Devil's Claw tubers are dug up at the end of the rainy season and dried

A herbalist can treat arthritis with herbs in order to improve circulation,
reduce joint inflammation and relieve pain

Therapeutic Uses

Devil's claw has a long history of use in the traditional medicine of southern Africa. Various peoples there use it as a tonic, particularly to the digestive system, for arthritis and rheumatism, to reduce fevers, and for headaches. It is also made into an ointment and applied to sores, boils and ulcers. Hottentot, Bushman and Bantu women applied it during labour to relieve pain.(Warning: do not take during pregnancy) A decoction, made by simmering the tubers in boiling water, is normally drunk.

Current use in the Western world has focussed on its application to painful conditions of the musculo-skeletal system and digestive problems. It is frequently found in prescriptions for arthritis of different sorts, for rheumatic complaints and for low back pain, especially associated with spondylosis. Lumbago, sciatica, fibrositis, neuralgia and polymyalgia may benefit from the inclusion of Devil's claw in the prescription.

Of the principal constituents, the iridoid glycosides have been investigated, focussing in particular on the anti-inflammatory effects. The anti-rheumatic, analgesic, anti-arrhythmic and hypotensive actions have also been studied. As is often the case when a herb is studied in this way, the particular principle responsible for the plant's activity could not be identified, nor could its mode of action be related to standard models. Most non-steroidal anti-inflammatory drugs (NSAIDs) act by inhibiting prostaglandin synthesis. Several studies indicate that Devil's claw does not appear to act in this way.[1],[2]

The second major area of use is in the digestive system where it is used as a tonic. (Devil's claw is not used for patients with gasttritis or peptic ulcer.) Absorption of nutrients from the gut is improved and from that the body begins to be better nourished at all levels. The bitter taste is vital for this action, improving the function of the liver in absorption of nutrients and in cleansing and de-toxifying the body. The gall bladder is stimulated to release bile so that conditions such as constipation are relieved. Research in Germany has found improvement in conditions of the upper duodenum related to the pancreas[3] and clinical evaluation has indicated a marked reduction in raised cholesterol levels.

In a recent medical study, 118 patients with chronic back pain seeking treatment for acute attacks of pain were included in a 4-week randomised double-blind trial into the effectiveness of Devil's claw.

The supplementary use of a pain-relieving drug was permitted during the study. At the end of the trial 9 out of the 51 people receiving Devil's claw were pain free compared with 1 of the 54 receiving placebo. The Devil's claw group experienced greater reduction in pain generally than the placebo group, but this was considered of borderline significance statistically.[4]

Herbalist Approach

While this sort of trial can verify the traditional uses of herbs, it does not look into how a herbalist actually uses herbs. Looking at just one herb and applying the modern medical model of giving a substance, whether it is a drug or a herb, to a particular condition in the hope of finding a "magic bullet", is a hit and miss approach, and perpetuates the philosophy of treating the symptoms and not the person, and assumes that all patients are identical. Following on from this some people have found that taking Devil's claw as a single remedy is ineffective – this is usually in a freely available OTC form. Herbalists give a mixture of herbs which work together to give a synergistic effect and treat the whole person (body, mind, emotions and spirit) rather than using a single herb as a "magic bullet".

Let us take a herbalist's treatment of arthritis as an example of this different approach. Using herbs with different actions, circulation is improved so that the herbs reach the areas they need to. Inflammation in the joints is reduced, which will mean that pain is relieved. Toxins which have collected around the joint will be removed from the joint with the aid of the lymphatic system, and cleared from the body. Elimination will be helped and herbs given to help heal the damaged joints, repairing cartilage and improving the lubrication of the joint to prevent further damage from wear and tear. At the same time digestion will be improved to ensure that the goodness from the food reaches the parts of the body where it will be needed. As digestion improves the flora of the gut normalises which reduces the levels of toxicity in the body. Advice about diet and lifestyle will be given.

The herbalist will be looking at the whole person and how this problem impacts on the person, rather than concentrating on the physical signs and symptoms. The emotional aspects are always considered – for instance, with arthritis it is not uncommon to find a loss of confidence associated with the decrease in mobility, or depression from persistent pain and being unable to do things which used to be easy. As the body mends on a physical level patients often notice changes on the emotional and spiritual levels and begin to view their dis-ease in a different way. Herbs open up these levels in a gentle and gradual way, seeming to know when the person is ready to move on, when they are strong enough physically to do so. The patient may begin to develop a new relationship with plants, noticing where they grow and being more aware of them in general.

The treatment is a process involving a three-way interaction between the patient, the herbalist and the herbs. In other words the herbalist does not just give herbs for a condition to a patient who takes them passively. The patient is actively involved in the healing and eventually takes greater responsibility for their health.

A typical prescription containing 4–10 herbs, which together have the actions needed to fulfil all these functions, is made for each individual. As an anti-inflammatory, analgesic and digestive tonic, Devil's claw frequently finds a place in such a prescription.

Case Studies

Fiona, 50 years of age, has rheumatoid arthritis, which was of a typical presentation with pain affecting many joints, but worse on the left side. Her shoulders, elbows, wrists, fingers, jaw, knees ached continually and she was often awakened by pain at night. She was stiff in the morning, but this would ease by lunchtime. Her fingers were quite swollen but Fiona did not have the deformities which are often seen, although she had suffered from the condition for 15 years. She was depressed, which was her natural tendency. She had begun to have erratic periods, often heavy, and menopausal flushes. She had a history of frequent colds and sore throats.

The disturbance to her sleep was exacerbating the condition as it made her energies and vital force low. In this situation the body is unable to heal itself. Depression is common where sleep is disturbed and pain is present and this is also part of a circuit of energy disturbance – the person feels miserable because of pain, the misery means the brain does not release pain-relieving endorphins, so pain continues and the person feels more miserable, becomes more depressed and so on.

Fiona was given a mixture of herbs which improve immunity and circulation, reduce inflammation and help the kidneys which were a weakness, and to balance her menstrual disturbances. She returned two weeks later feeling a little better and with a little less pain. She was sleeping better and not waking so often. At this point I added oats (Avena sativa) as a tonic and to help her sleep, and lemon balm (Melissa officinalis) to raise her vitality and lift her spirits. A month later she was much less stiff and although her fingers still hurt at times, the pain elsewhere had eased considerably and she was often completely free of pain. She was sleeping fairly well, but did not always wake refreshed.

During the following month she had some severe pain and her hands became swollen. She had begun to get stiffer in the mornings. Interestingly she was sleeping well. She had suffered from hay fever during this time, which may explain the relapse as her system became overloaded. Her periods had settled and she was free of hot flushes.

At this point I included Devil's claw in her medicine. The stiffness disappeared within a month, the pains gradually disappeared and three years on she remains well, occasionally having medicine when she feels out of balance.

Dorothy's story is quite different. For three years she had suffered increasing pain in her toes, which extended to her knees when severe. Tests for gout were negative. Her toes were swollen and red, and the pain increased with activity and improved with rest, which is typical of osteo-arthritis. As a result she had stopped tap dancing and wearing high-heeled shoes. She was 54, and seven years earlier had some minor menopausal problems. She had varicose veins and brittle nails but was in good health otherwise. Twenty-five years before, she had suffered from digestive problems, which were believed to have been caused by an ulcer, but had been fine since then. At that time she had been under considerable stress as she was unable to conceive. Her digestion had settled when she adopted a baby.

I gave Dorothy a mixture which included Devil's claw and although this was adjusted in minor ways over the following months, the Devil's claw remained in the prescription. After 5 months of treatment, the swelling and redness had disappeared, and Dorothy was pain-free and able to walk her dogs again. In fact, she went dancing at Christmas with no ill effects, but the pain returned when she wore high-heeled shoes again. Clearly her feet did not appreciate the strain this put them under. After another month of medicine she was back to her usual activities and walking her dogs daily.

This should have been the end of the case, but Dorothy returned to me a year later, having fallen and injured her knee. She had seen another therapist about the injury but continued to have a lot of swelling and shooting pains in both legs. Again I gave her Devil's claw as part of a herbal prescription, and within a month the swelling had cleared and she was pain-free and feeling good. The dogs were happy too.

References

1. Whitehouse, L.W.: Can Med Assoc J 129, 249 (1983)
2. Moussard, C et al: Prostaglandins Leukotrienes and Essential Fatty Acids 46, 283 (1992)
3. Zimmerman, W.: Physikal Med u. Rehab 18 (1977)
4. Chrubasik, S et al: Phytomedicine 3, 1 (1996)

If you would like further information on the use of Devil's Claw or herbal medicine in general, please consult your local Medical Herbalist. To find a medical herbalist near you, visit the National Institute of Medical Herbalists and click on 'Find your nearest Herbalist'.