🌿 Folk Prescriptions

Gout is a systemic disease caused by purine metabolism disorder, leading to excessive uric acid production or reduced excretion, resulting in elevated serum uric acid levels. Uric acid crystals deposit in joints, periarticular tissues, subcutaneous tissue, kidneys, and vessel walls, causing corresponding lesions. It can affect joints, causing gouty arthritis; affect kidneys, causing gouty nephropathy; and affect vessel walls, leading to hypertension and cardiovascular disease. Clinically, attacks often occur suddenly at night, starting in the toes or metatarsophalangeal joints, followed by the thumb or metacarpophalangeal joints, and occasionally in ankles, wrists, knees, or shoulders. Attacks usually lack warning signs but are often triggered by trauma, surgery, prolonged travel, excessive alcohol consumption, overconsumption of seafood, mental stress, fatigue, or infection. During acute attacks, patients experience severe joint pain, marked swelling, red skin, and difficulty moving. Systemic symptoms may include fever (T38–39°C), palpitations, and headache. Acute episodes typically resolve within 3–10 days, with swelling subsiding and joint function returning to normal. Except for desquamation and pigmentation of the skin, no lasting traces remain. Recurrent attacks may lead to joint deformity, skin ulceration, and the discharge of white, powdery uric acid crystals, ultimately resulting in non-healing wounds, permanent joint pain, stiffness, and deformity. Uric acid crystal deposition in the kidneys is a major late complication, affecting about 10–20% of patients, potentially causing uric acid stones and hematuria or renal colic. Chronic renal edema, nephritis, and interstitial nephritis impair kidney function, leading to uremia and death. Uric acid deposits in vessel walls may cause hypertension and cerebrovascular disease. Tophi in the ears and joints vary in size—some as large as chestnuts, others as small as beans—skin color unchanged, hard as stone, and may rupture, discharging white, paste-like material.
Gout arises from either excessive uric acid production or reduced excretion. Causes of increased production include enzyme deficiencies leading to massive nucleic acid breakdown, and diets rich in purines such as organ meats, lean meat, legumes, and seafood. Reduced excretion is mainly due to kidney diseases. Treatment during acute phase aims to control or terminate attacks; during remission, inhibit uric acid production and promote excretion to prevent recurrence; in late stages, combine with surgical intervention to remove tophi and reconstruct joint function.
TCM views gout as caused by overindulgence in rich foods, internal generation of damp-heat, phlegm accumulation, and obstruction of qi and blood. It is differentiated into four types: Damp-Heat Descending, Blood Stasis Obstructing, Phlegm Accumulating in Meridians, and Liver-Kidney Deficiency. Damp-Heat Descending type presents with sudden redness, swelling, heat, and pain in feet and joints, fixed pain worsening at night, inability to walk, thirst without desire to drink, chest tightness, and irritability. Treatment focuses on clearing damp-heat. Blood Stasis Obstructing type features recurrent attacks, fixed pain, joint deformity, and limited mobility. Treatment emphasizes activating blood and resolving stasis, unblocking collaterals, and relieving pain. Phlegm Accumulating in Meridians type shows hard nodules around joints or tendons, or on earlobes—large as chestnuts, small as beans—skin not red, base diffuse, hard as stone, or ruptured discharging white paste-like substance without odor and not healing. Liver-Kidney Deficiency type appears in chronic gout with joint pain, muscle spasms, aggravated by movement, emaciation, fatigue, irritability, spontaneous sweating, dizziness, tinnitus, facial flushing, soreness in waist and knees, fatigue, dry mouth, irritability, poor appetite, and lack of hunger. Treatment focuses on nourishing liver and kidney.