Gout
Definition
Western
Gout is a multi-factorial disease affecting the flexibility or mobility of the joints. Acute gout involves inflammation of the joints, mainly that of the big toe, due to deposition of high levels of uric acid crystals while chronic gout involves the formation of monosodium urate (MSU) crystals1 at the joints resulting in persistent inflammation of the joints such as feet, ankle, knee, wrist or elbow joints.
Traditional Chinese Medicine (TCM)
Gout belongs to a sub-category of a disease, known as “Bi Zheng”. Such a disease is a result of the disruption to the blood and energy flow in the muscles surrounding the joints due to unhealthy lifestyle or environmental changes. It is characterised by sharp pains and aches accompanied by numbness, swelling, stiffness, deformities or inflexibility of the joints.
Types of Gout and Symptoms Displayed in TCM Context
Cold-induced Gout
Due to over-consumption of raw food or cold drinks or being in cold environment for long periods of time, which slow down the circulation and encourage deposition of materials in certain parts of the body. Symptoms are as below :
· Constant pain in the joints, the pain subsides with the application of heat to the affected area
· Inflexibility of the joints
· Feeling or fear of the cold
· Loss of appetite
Heat-induced Gout
Due to over-consumption of spicy or deep-fried foods, staying in damp or humid environment for prolonged periods of time. This overloads the blood and water circulatory processes, slowing down the circulation and encourages undesired deposition of materials in different parts of the body. Symptoms are as below:
· Pain, aching or sense of heaviness in the affected joint region
· Swelling, redness of the joints and the surrounding area
· Any contact with the joint can aggravate the pain while this pain can be subsided with the application of ice or cold pack
· Inflexibility of joints
Fever, sweating, feeling thirsty or emotional outbursts could also be seen
Causes from TCM Perspective
Lifestyle
· Being in damp, cold or humid environment for prolonged periods of time
· Over-consumption of cold, spicy or deep-fried foods
· Staying up late nights or overworking beyond rest time
Risk Factors from TCM Perspective
Inheritance
Every individual’s health status is unique, thus any disruptions to the energy flow or blood circulation due to predisposed genetic factors will put the individual more at risk.
Age
As one grows old, the body’s liver and kidney systems slow down considerably and would not be able to maintain their usual physiological functions, such as detoxification and excretion of waste matter from the body, thus making them more susceptible to this disease.
Treatments
Herbs can be used in prescriptions for consumption. For the different types of gout, different herbs are used for treatment 2, 14-15. These include:
1. Qin Jiao -秦艽
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English/ Common name
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Large-leaf gentian 3
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Latin species
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Gentiana macrophylla Pall.
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Park of plant used
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Roots
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Action/s
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Found to have anti-inflammatory 4 functions and relieves rheumatic-like pain 5.
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Precaution/s
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May cause nausea and vomiting
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2. Yi Yi Ren -薏苡仁
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English/ Common name
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Job’s tears 6
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Latin species
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Coix lacryma-jobi
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Park of plant used
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Seeds
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Action/s
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Helps relieve rheumatic pain 7and can prevent water retention in lower limbs 8.
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Precaution/s
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No significant side effects
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3. Qing Feng Teng – 青风藤
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English/ Common name
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Nil
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Latin species
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S. acutum(Thunb.) Rehd-et Wils. var. cinereum
S. acutum(Thunb.) Rehd-et Wils.
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Park of plant used
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Rhizomes
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Action/s
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Helps relieve rheumatic pain 9 and improve joint flexibility 10.
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Precaution/s
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May cause allergic reaction such as skin rashes and itchiness.
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4. Chuan Xiong –川芎
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English/ Common name
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Chinese lovage 11
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Latin species
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Ligusticum chuanxiong Hort
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Park of plant used
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Rhizomes
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Action/s
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Helps to improve blood circulation 12, 13 and relieves
fever brought upon by inflammation 12.
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Precaution/s
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Individuals on blood thinning medications or pregnant women should avoid taking.
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· Herbs can also be used to make topical creams for external relief 14.
· Acupuncture as an external form of treatment can also be applied 14, 15 to ease pains.
Test & Diagnosis
1. Blood tests to test for the levels of uric acid.
2. Joint fluid test and crystal identification
By drawing out fluid from the joints for analysis, the diagnosis could be used to confirm the presence of the needle-shaped MSU crystals through microscopic examination 17.
Home Remedies
Jobs’s tears + Green beans + Tangerine peel
a) Put all ingredients in a cooking pot and pour water till twice the height of the ingredients.
b) Bring to boil and simmer till both ingredients become soft.
c) Remove from heat.
d) Serve warm.
Dried lily buds (huang hua cai) + Winter melon + Lean pork meat + garlic
a) Marinate the lean pork meat with soy sauce and sesame sauce. Leave aside.
b) Soak the dried lily buds in water to soften them.
c) Add the garlic into a pot of water, bring to boil.
d) Add lean pork and cook for 8 to 10 minutes. When lean pork is almost cooked, add the winter melon and lily buds.
e) Boil till the winter melon and lily buds become soft.
f) Add salt to taste. Serve warm.
References
1. I Pande. An update on gout. Indian journal of Rheumatology September 2006, 1(2): pp60-65.
4. Hong Yin, Qiang Zhao, Feng-Ming Sun, Tai An. Gentiopicrin-producing endophytic fungus isolated from Gentiana macrophylla. Phytomedicine 2009, 16(8): pp793-97.
5. R.X. Tan, J.-L. Wolfender, L.X. Zhang, W. G. Ma, N. Fuzzati, A. Marston, K.Hostettmann. Acyl secoiridoids and antifungal constituents from Gentiana macrophylla. Phytochemistry July 1996, 42(5): pp1305-13.
8. Yang Yifan, Chinese Herbal Medicines: Comparisons and Characteristics, 2002 Churchill-Livingstone, London
10. Rachel W. Li, G. David Lin, Stephen P. Myers, David N. Leach. Anti-inflammatory activity of Chinese medicinal vine plants. Journal of Ethnopharmacology 2003, 85:pp61-7.
11. Jiang-Feng Yuan, Zhi-Qi Zhang, Zhi-Chao Fan, Jian-Xiong Yang. Antioxidant effects and cytotoxicity of three purified polysaccharides from Ligusticum chuanxiong Hort. Carbohydrate Polymers 2008 74:pp822-27.
12. Cheng Peng, XiaoFang Xie, Lan Wang, Li Guo, Tanlian Hu. Pharmacodynamic action and mechanism of volatile oil from Rhizoma Ligustici Chuanxiong Hort. On treating headaches. Phytomedicine 2009 16:pp25-34
13. W. L. Li, H.C Zheng, J. Bukuru, N. De Kimpe. Natural medicines used in the traditional Chinese medical system for therapy of diabetes mellitus. Journal of Ethnopharmacology 2004 92: pp1-21.
14. Tong Xu Guang. Clinical usage of traditional chinese medicine to treat gouty arthritis. Zhong Hua Xian Dai Zhong Yi Xue Zha Zhi. April 2010 6(2).
15. Zhang Shi-jun, Liu Jian-ping, He Ke-qiang. Treatment of acute gouty arthritis by blood-letting cupping plus herbal medicine. Journal of traditional Chinese medicine March 2010 30(1): pp18-20.
16. Ministry of Health Malaysia, Malaysian Society of Rheumatology, Academy of Medicine ofMalaysia. Management of Gout. Clinical practice guidelines October 2008, MOH/P/PAK/172.08(GU).