What is gout? Gout is an acute or chronic arthritis caused by the abnormal distribution of uric acid crystals in the body and their deposition in the joints, which can lead to joint deformities in later stages. So what causes uric acid crystals in the body? Simply put, they are caused by a disorder of purine metabolism in the body, resulting in ineffective excretion of serum uric acid, which is deposited in the body and eventually forms urate crystals, which are white, elongated, and pointed crystals under the microscope, like a long, sharp sword. They are not easily deposited in the soft tissues of the body, but around the joints, causing gouty arthritis and forming the so-called “gout stones”. Gout stones tend to appear in painful joints, often around the ears, and in general, they are more likely to be found in areas of the body where the temperature is lower. Men are more likely to develop gout than women, and it is more likely to occur in middle-aged and older men. The incidence of gout is increasing due to the substantial improvement in the standard of living and changes in people’s habits in recent years. Gout attacks are painful and intense, like being bitten by a tiger, often occurring at night, with patients often waking up in the middle of the night in pain. Gout is self-healing, and attacks usually resolve within 7-10 days without any treatment. The interval between attacks can vary from a few months to several years. However, if gout is left untreated, the interval between attacks will gradually shorten and the attack period will gradually lengthen. In a retrospective study, after the first gout attack, 62% of people had a relapse after one year, 78% after two years, and 84% after three years. What factors can influence a gout attack? Epidemiologically, gout is more likely to occur in older men. For women, on the other hand, gout tends to occur in postmenopausal women. Whether this is related to women’s sex hormone levels is unclear. Diet plays a crucial role in the development of gout, and some people say that gout is “eaten” because it is closely related to the disruption of purine metabolism, which can be understood as the metabolic products of organic foods (such as fish, meat, shrimp, etc.) in the body, and these products can be turned into uric acid after a new round of metabolism. These products can be turned into uric acid. Why does uric acid accumulate in excess and form urate crystals that are eventually deposited and not cleared in time? One is that they are produced too much and too fast, and the body’s cleaning department (such as the kidneys) is overloaded and does not have time to clean them up; the other is that the cleaning department itself has a problem and cannot do the job, resulting in a disruption of purine metabolism. If this situation is not improved, over the years, the body’s cleaners will be overloaded for a long time and will go on strike one day. In fact, even among people with blood uric acid over 0.6 mmol/L, the incidence of gout is only 6 percent. How can we know the amount of purine in food in our daily life? Food can be divided into 3 categories. The first category is high purine food, containing 100mg-1000mg purine per 100g of food, such as liver, kidney, brain, pancreas and other animal offal, meat pies, broth, fish eggs, small shrimp, goose, etc. The second category is medium purine food, containing 90-100mg purine per 100g of food. The second group of food is food with medium purine content, containing 90-100mg of purine per 100g of food, such as beef, pork, lamb, shellfish, spinach, peas, mushrooms, lentils, asparagus, peanuts, etc. The third group is low purine food, such as milk, eggs, refined white flour, rice, cookies, fruits and vegetables other than those listed in the second group. The intake of purines should be strictly limited during the attack period of gout, and care should be taken not to freely consume foods containing high purines without restriction during the remission period. The so-called diseases of affluence that are becoming more and more common in modern times, such as obesity, hyperlipidemia, hypertension, and diabetes, can be a trigger for gout, and conversely, these diseases are also possible complications of gout. In addition to diet, mood swings and overwork are also triggers for gout attacks, so people with gout and hyperuricemia should pay particular attention to maintaining a calm state of mind and developing healthy eating and living habits. What medications are available to treat gout? Both Chinese and Western medicine treat gout, in general, by dividing it into two phases: the acute attack phase and the remission phase. In the acute attack phase, the affected area is often red, swollen and painful, and the pain is unbearable, due to the fact that the affected area at this time is equivalent to acute inflammation. Western medicine is used to use some anti-inflammatory and analgesic drugs, and even local injections of glucocorticoids to achieve the purpose of local anti-inflammation. Another drug for the acute phase of gout is called colchicine, which is used to hinder the progression of the disease by blocking a certain link in purine metabolism. It should only be used during acute attacks and not for long periods of time because this drug has a certain degree of toxicity and its toxic dose is very similar to the starting dose. In the remission phase of gout, allopurinol and ligarginum are commonly used to control the disease. Allopurinol lowers uric acid by inhibiting the production of uric acid, while Raglicen promotes the excretion of uric acid. It is important to note that these drugs should not be used during acute attacks, as they may further aggravate the gout during acute attacks. Why? Because when the acute attack of arthritis, the body adrenocorticotropic hormone suddenly increased, the amount of uric acid excreted by the kidneys increased, the blood uric acid fell, then use the uric acid-lowering drugs, the blood uric acid level will be rapidly reduced, so that the level of uric acid inside and outside the joint disparity, but the arthritis aggravated, the pain will naturally become more and more intense, just like the robbers of the home invasion added a lot of helpers. Therefore, it is still necessary to use medication carefully under the guidance of a professional doctor. In addition, commonly used drugs are alkaline drugs, such as baking soda, which are needed to balance the pH of urine when the urine pH is below 6.0. Chinese medicine treatment for gout is both unique and has few side effects. In the acute stage of gout, the evidence is generally that dampness and heat are toxic to the joints, and Chinese herbs are used to clear heat and dampness and detoxify the joints. In the remission period, the treatment method is to strengthen the spleen and benefit the qi, activate blood circulation and remove blood stasis. Chinese herbal medicines such as Fu Ling, Cichorium, Rhizoma Dioscorea, Silkworm and Lily have good effects on lowering uric acid. Chinese medicine can also be used to relieve pain through fumigation and acupuncture. What are the complications of gout? Gout is often combined with hyperlipidemia, obesity, hypertension and diabetes. Long-term excessive uric acid will not only damage the kidney structure and affect the kidney function, but also easily produce kidney stones. The severe pain during a gout attack is also an important trigger for myocardial infarction in heart patients. Therefore, although simple gout can be relieved on its own without any drug intervention, the damage caused to the body’s function can be immeasurable if treated negatively in the long run. What should I pay attention to when caring for a gout patient? Care of gout patients and treatment of gout patients is actually the same, we should start from the cause of gout, and find ways to inhibit or eliminate the influence of the cause, so as to reduce the number of gout attacks and prolong the interval between attacks. First of all, of course, is the dietary control, in addition to limiting the high purine diet, but also to encourage patients to eat more vegetables, fruits and other alkaline foods, such as potatoes, sweet potatoes, milk, citrus, etc., can promote the excretion of uric acid, but also supply a rich supply of vitamins and inorganic salts, in order to facilitate the recovery of gout. Special attention should be paid to the cooking method of food. A reasonable cooking method can reduce the amount of purine contained in food. For example, cook the meat first and discard the soup before cooking. In addition, chili, curry, pepper, mustard, ginger and other food spices can trigger an acute attack of gout and should be avoided as much as possible. Similarly, improper use of certain drugs can also trigger gout, such as aspirin, tachyphylaxis, VitB12, and sulfonamides can cause gout attacks, so gout patients must use these drugs under the guidance of a doctor. The intake of large amounts of water can serve the purpose of diluting urine and preventing stone formation, so drink more water to dilute urine, and the total daily intake of fluid should preferably be more than 2000ml, which is almost equivalent to the volume of a hot water bottle. During the acute attack of gout, the pain of the joints can easily cause anxiety and irritability; and the patient’s tension, excessive fatigue or strong mental stimulation can trigger gout. Therefore, it is also important for patients to regulate their emotions, to adopt a positive and correct attitude towards their disease, to keep their mood happy and to regulate their qi in order to enhance their immune function. Moderate exercise can prevent gout attacks, the amount of exercise is generally moderate exercise is appropriate, the type of exercise to walk, play tennis and other aerobic exercise with high oxygen consumption is good, should avoid strenuous exercise, because it leads to anaerobic enzymes, prompting lactic acid production accelerated, PH value dropped, and induced acute attacks. During the acute stage of gout, bed rest should be taken, the affected limbs should be elevated, and the affected parts should be protected from injury as much as possible. Generally, rest until the joint pain is relieved for 2 days and then resume activities, and gradually increase the amount of activities to promote the unblocking of tendons and veins and the smooth operation of qi and blood. In order to live peacefully with gout, it is necessary to pay attention to keeping warm, to ensure sufficient sleep, and to have a regular life and work.