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Tools and Resources
Gout
| Introduction |
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Gout, also known as migratory arthritis, results from a long term disorder in purine metabolism. It is characterized by, high lithemia, repeated attacks of acute arthritis, sedimentation of gouty tophus, chronic arthritis with articular deformity, lesion of the kidney parenchyma, and formation of urate calculus. Based on an increase of uric acid in the blood as the cause, the disease can also be divided into two types: primary and secondary gout. Gout belongs to the category of “bi-syndrome” in traditional Chinese medicine.
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| Etiology/Pathogenisis |
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Gout, also known as migratory arthritis, results from a long term disorder in purine metabolism. It is characterized by, high lithemia, repeated attacks of acute arthritis, sedimentation of gouty tophus, chronic arthritis with articular deformity, lesion of the kidney parenchyma, and formation of urate calculus. Based on an increase of uric acid in the blood as the cause, the disease can also be divided into two types: primary and secondary gout. Gout belongs to the category of “bi-syndrome” in traditional Chinese medicine.
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| Primary Treatments with Medicinal Herbs |
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Dang Gui Nian Tong Tang
It was reported that a Dang Gui Nian Tong Tang decoction was used to treat 20 cases of gouty arthritis. The formula was composed of these single herbs: Qiang Huo (Notopterygium Root), Zhi Gan Cao (processed Licorice), Yin Chen (Oriental Wormwood), Huang Qin (Scutellaria), Fang Feng (Siler), Zhu Ling (Polyporus), Ze Xie (Alisma), Zhi Mu (Anemarrhena), Dang Gui (Dang Gui), Sheng Ma (Cimicifuga), Ge Gen (Pueraria), Ku Shen (Sophora Root), Dang Shen (Codonopsis), Cang Zhu (Atractylodes), and Bai Zhu (White Atractylodes). The results: After treatment, 13 cases had a significant improvement, 6 cases had some improvement, and 1 case did not respond to the treatment. The total effectiveness rate was 95%.(1)
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| Other Treatments with Medicinal Herbs |
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San Miao Wan
Lu Jin Zhong, et al. treated 30 cases of primary gout with a supplemented San Miao Wan pill. The formula comprised of Niu Xi (Achyranthes), Ze Xie (Alisma), Huang Bo (Phellodendron), Hu Zhang (Polygoni Cuspidati), Yi Ren (Coicis), Zhi Mu (Anemarrhena), Fu Shen (Hoelen Spirit), Ren Dong Teng (Lonicera Stem), Chuan Lian Zi (Melia), Cang Zhu (Atractylodes), and Gan Cao (Licorice). One dose of the formula in a decoction was administered daily, half in the morning and half in the evening. 10 days constituted as one therapeutic course. The results: After treatment, among the 30 cases, 25 had a significant improvement, and 5 had some improvement, with a total effectiveness rate of 100%.(2) Si Miao Yong An Tang
It was reported that 15 cases of acute gout were treated with a combination of oral administration of a Si Miao Yong An Tang decoction and external washing with the herbal solution. The supplemented Si Miao Yong An Tang decoction was made up of Ren Dong Teng (Lonicera Stem), Xuan Shen (Scrophularia), Dang Gui (Chinese Angelica Root), Niu Xi (Achyranthes), Mu Gua (Chaenomeles), Huang Bai (Phellodendron), Cang Zhu (Atractylodes), Du Huo (Pubescent Angelica Root), Jin Yin Hua (Lonicera Flower), Gan Cao (Licorice), Yi Ren (Coix), and Xi Xin (Wild Ginger). One dose of the supplemented formula in a decoction was administered daily at two oral takings in the morning and evening. The formula for external washing included Wei Ling Xian (Clematis), Huang Bai (Phellodendron), Cang Zhu (Atractylodes), Niu Xi (Achyranthes), Yi Ren (Coix), and Ren Dong Teng (Lonicera Flower). These herbs were decocted in water for soaking the foot. The results: After treatment, 9 cases were resolved and 6 had significant improvement.(3) Si Miao San
Meng Li Jie treated 32 cases of gout with a supplemented Si Miao San powder. The formula consisted of Yi Ren (Coix), Di Long (Lumbricus), Cang Zhu (Atractylodes), Huang Bai (Phellodendron), Chuan Niu Xi (Achyranthes (Chuan), Huai Niu Xi (Achyranthes (Huai), Hua Shi (Talcum), Luo Shi Teng (Chinese Starjasmine), Zhi Mu (Rhizoma Anemarrhenae), and Tu Fu Ling (Rhizoma Smilaci Glabrae). The ingredients were modified according to the individuals' symptoms. One dose of the formula in a decoction was administered daily with 10 days being one therapeutic course of treatment. The results: After treatment, 9 cases were resolved, 21 had significant improvement, and 2 did not respond to the treatment. The total effectiveness rate was 93.75%.(4) Liu Shen Wan
Su Zheng treated 46 cases of acute gouty arthritis with oral administration of Liu Shen Wan (a common classic formula in pill form) and modified Bai Hu plus Gui Zhi Tang decoction which consisted of Shi Gao (Gypsum), which was to be decocted first, Dan Shen (Salvia), Chun Gen Teng (Cissus pteroclada hayata), Yi Ren (Coix), Tu Fu Ling (Smilax), Zhi Mu (Anemarrhena), Gui Zhi (Cinnamon Twig), Cang Zhu (Atractylodes), Che Qian Zi (Plaintain Seed), Huang Bai (Phellodendron), Wei Ling Xian (Clematis), Bei Xie (Tokoro), Qin Jiao (Gentian Root), Niu Xi (Achyranthes), Quan Xie (Scorpion), and Bai Hua She (Oldenlanda). One dose of the formula in a decoction was administered daily. In addition, Liu Shen Wan was taken after being dissolved in cold boiled water, 10 pills each time, twice a day. 7 days were considered one treatment course. The results revealed that after 2 courses of treatment, 8 cases were resolved, 12 cases showed improvement, and 6 cases had no effect. The total effectiveness rate was 86.95%.(5)
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| Other Treatments |
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Combined internal and external treatment
It was reported that 55 cases of gouty arthritis were treated with the oral administration of supplemented Xuan Bi Tang decoction and external application of Bi Tong San powder and achieved decent results. The supplemented Xuan Bi Tang decoction consisted of Shi Gao (Gypsum), Zhi Mu (Anemarrhena), Fang Feng (Siler), Hua Shi (Talcum), Niu Xi (Achyranthes), Tao Ren (Persica), Gan Cao (Licorice), Can Sha (Silkworm Droppings), Yi Ren (Coix), Yin Hua Teng (Lonicera stem), and Wei Ling Xian (Clematides). One dose of the formula in a decoction was administered daily. 15 days constituted as one treatment course. The Bi Tong San powder consisted of Huang Bai (Phellodendron), Yin Hua (Lonicera Flower), Xi Xin (Wild Ginger), Cang Zhu (Atractylodes), Ru Xiang (Mastic), Mo Yao (Myrrha), Bing Pian (Borneol), etc. These herbs were ground into a powder and mixed with vinegar, and then applied to the affected area, twice a day. The results showed that after treatment, 29 cases were resolved, 20 cases had improved, and 6 cases had no effect. The total effectiveness rate was 89.1%.(6)
Medicated bath treatment with Chinese medicinal herbs
The therapeutic effect of a medicated bath on primary gout was observed in 82 patients who were divided into 52 cases of medicated bath group (treatment group) and 30 cases of warm water bath group (control group). After 3 weeks' treatment, both the total effectiveness rate and the significant effectiveness rate of the treatment group were superior to those of control group (P < 0.05 & P< 0.01). The results indicated that warm water bath could only relieve arthralgia, while medicated bath was capable of controlling clinical symptoms, and significantly lowering blood uric acid and blood sedimentation. In addition, the medicated bath had no side effects on the digestive system like the routinely used drugs for treating gout.(7)
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| Acupuncture & Acupressure |
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Wang Xiao Lin observed the therapeutic effect of acupuncture in the treatment of 36 cases of gouty arthritis with the acupoints of Ahshi-point, Tai Chong (LR 3), and Nei Ting (ST 44). Ahshi-point was pricked first with a three-edged needle to let out a few drops of blood. Then the corresponding point on the healthy hand was pricked. Tai Chong (LR 3) and Nei Ting (ST 44) were punctured. Ahshi-point was punctured with the encircling needling method. These acupoints were stimulated with the reducing method, once every other day. 15 days were considered one therapeutic course of treatment. After one course of treatment, 26 cases were resolved, 9 cases showed considerable improvement, and one case had no effect, with a total effectiveness rate of 97%.(8)
It was reported that 61 cases of gouty arthritis were treated with thermal acupuncture and achieved beneficial therapeutic effects. Zu San Li (ST 36), Gong Sun (SP 4), San Yin Jiao (SP 6), and Ba Feng (EX-LE 10) were punctured and after achieving needling sensations, the needle inserted in Zu San Li (ST 36) was moxibustioned 2 ~ 3 cones for about 30 minutes. Ba Feng (EX-LE 10) was stimulated with the reducing needling method. The treatment was conducted once a day. 7 days constituted one therapeutic course. In the control group, 32 cases of gout were treated with colchicine for 7 consecutive days. The results showed that in the treatment and control groups, 24 and 12 cases were resolved, 26 and 14 cases showed remarkable improvement, 8 and 3 cases showed some improvement, and 3 and 3 cases had no apparent effect, with the effectiveness rates being 95.1% and 90.6% respectively. There was a significant difference between the two groups in their resolve effect (P <0.01).(9)
Combined treatment with acupuncture and Chinese herbal medicines
In one report, 58 cases of gouty arthritis were treated. For the type of hyperactivity of the accumulated damp-heat, the herbs used were Cang Zhu (Atractylodes), Zhi Mu (Anemarrhena), Huang Bai (Phellodendron), Niu Xi (Achyranthes), Mu Gua (Chaenomeles), Can Sha (Silkworm Droppings), Fang Ji (Stephania), Sang Zhi (Mulberry Twig), Ren Dong Teng (Lonicera Stem), and San Qi (Notoginseng). For the type of stagnation of phlegm and blood stasis, the herbs used were Gui Zhi (Cinnamon Twig), Sang Zhi (Mulberry Twig), Fu Zi (prepared Aconite), Bai Jie Zi (White Mustard Seed), Chuan Xiong (Cnidium), Ji Xue Teng (Milettia), Cang Zhu (Atractylodes), Huang Bai (Phellodendron), Fang Ji (Stephania), Can Sha (Silkworm Droppings), Tu Yuan (Ground Beetle), Chuan Shan Jia (Anteater Scales), Ma Qian Zi (Nut-vomitive Poisonnut Seed), and San Qi (Notoginseng). Xue Hai (SP 1), Zu San Li (ST 36), Yang Ling Quan (GB 34), San Yin Jiao (SP 6), Tai Xi (KI 3), and Tai Chong (LR 3) were punctured and, with the exception of Xue Hai (SP 1), stimulated with the reducing needling method. The needles were retained for 40 minutes, followed by cupping over Xue Hai for 10 minutes. The results showed that 28 cases had significant improvement, 25 had some improvement, and 5 cases had no improvement. The total effectiveness rate was 94.6%.(10)
Yang Jin Hong and Luo Yong Li observed the therapeutic effects of acupuncture at San Yin Jiao (SP 6) etc. and external application of the Tong Feng mixture in treating 48 cases of acute gouty arthritis. The Tong Feng formula was composed of Qin Pi (Fraxinus), Da Huang (Rhubarb), Huang Bai (Phellodendron), Cang Zhu (Atractylodes), Niu Xi (Achyranthes), Ru Xiang (Mastic), Mo Yao (Myrrha), Mu Dan Pi (Moutan), etc. The effect of the formula was compared with that of Western medicine (colchicine and fenbide) in treatment of 31 other cases of acute arthritis in the control group. The results revealed that no significant differences were found between the two groups in their total effectiveness rates (P> 0.05), but the resolve rate of the treatment group was significantly superior to tha
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| Footnotes |
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1 Guo Long, et al. Treating 20 cases of migratory arthritis. Journal of Applied TCM. 2000;16(11):25.
2 Lu Jian Zhong, et al. Treating 30 cases of primary gout with modified San Miao Wan. Jiangsu Journal of TCM. 1998;19(11):31.
3 Ge Ming, et al. Treating acute gout with modified Si Miao Yong An Tang/Decoction combined with external washing with Chinese herbs. Hubei Journal of TCM. 1999;21(1):31.
4 Meng Li Jie. Treating 32 cases of gout with modified Si Miao San. Journal of Applied TCM. 1999;15(2):22.
5 Su Zheng. Treating 46 cases of gouty acute arthritis with Bai Hu plus Gui Zhi Tang/Decoction as main treatment. Guangxi Journal of Traditional Chinese Medicine. 1999;22(3):22.
6 Yang Zhu Wang. Treating gouty arthritis by combining external application and oral administration. Hubei Journal of TCM. 1998;20(6):35-36.
7 Rao Guang Li, et al. Examination on treating primary gout with medicated bath treatment with Chinese herbs. Guangxi Journal of Medicine. 1995;17(1):23-25.
8 Wang Xiao Lin. Treating 36 cases of gouty arthritis with acupuncture. Journal of Hunan College of TCM. 1999;19(2): 60.
9 Liu Xin. Treating 61 cases of gouty arthritis with thermal acupuncture. China Journal of Acupuncture. 2000;16(5):32-33.
10 Wang Ping, et al. Treating 58 cases of gouty arthritis with combination of herbs and acupuncture. Journal of Acupuncture Clinical Application. 2000;16(5):32-33.
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