Gout is a metabolic disease caused by disorders of purine metabolism, but the onset is markedly heterogeneous and can manifest as acute arthritis, gout stones, chronic arthritis, joint deformities, chronic interstitial nephritis and uric acid urinary tract stones in addition to hyperuricemia. Primary gout is mostly caused by congenital abnormalities of purine metabolism and often occurs in association with obesity, disorders of glycolipid metabolism, hypertension, atherosclerosis and coronary artery disease, while secondary gout is caused by certain systemic diseases or drugs.
Gout is a recurrent inflammatory disease caused by increased purine biosynthesis, excessive uric acid production or poor uric acid excretion, and deposition of urate crystals in synovial membranes, bursae, cartilage and other tissues. The disease is characterized by bifocal monohydrate uric acid crystals found in joint fluid and gout stones. It is most commonly seen in middle-aged and elderly men with obese bodies and postmenopausal women. With economic development and lifestyle changes, its prevalence is gradually increasing.
It occurs in various parts of the body, with severe pain in the joints, and the pain is unbearable, but soon the pain blows over like “wind” in 1-7 days, so it is called “gout”. It is common in women after menopause because estrogen inhibits the formation of uric acid; however, the rate of attacks increases after menopause. There is no direct relationship between hyperuricemia and the occurrence of gout, only that hyperuricemia has a higher possibility of gout occurring. Some people with hyperuricemia will never trigger gout in their lifetime, while some people will have their first gout within a week or a month of discovering hyperuricemia. After the first gout, there is usually an interval of 1-2 years, and also a 10-year interval (5%), during which active treatment is needed to prevent the formation of gout stones.
Causes of morbidity.
1. Causes of high uric acid.
Endogenous purines from oxidative decomposition of nucleic acids account for 80% of the total purines and exogenous purines such as food account for 20% of the total purines.
Eating food containing too much purine, and in the process of metabolism, the body fails to further metabolize purine into excretion that can be excreted from the kidneys through urine. If the blood is saturated with uric acid, these substances eventually form crystals and accumulate in the soft tissues. If there is a trigger for the release of uric acid crystals deposited in soft tissues such as joint membranes or tendons, then the body’s immune system may become sensitized and inflammation may result. If the concentration of uric acid in the blood is higher than this saturation point for a long time, it is called “hyperuricemia” in medical science.
2. Foods with high purine content.
(1) Animal offal such as brain, liver, kidney, heart and stomach. (1) Animal offal such as brain, liver, kidney, heart, belly, and dark meat, western-style thick meat soup, beef vegetarian, chicken essence, etc. Seafood; sardine, hamachi, herring (Herring), tooth scallop, multi-spring fish, scallop, sea cucumber, scallop, oyster, mussel, seiyu, shrimp, small dried fish, fish skin, fish eggs, etc. Goose meat, wild animals, etc..
(2) hard-shelled fruits such as peanuts cashew nuts and the like, wine (in excess).
(3) Young sprouting parts of plants generally contain moderate ingredients, should not eat more, cauliflower type, bean seedlings, bamboo shoots, beans.
3. Causes of gout.
Gout can be triggered by diet, weather changes such as sudden changes in temperature and pressure, trauma and many other aspects.
Drinking alcohol can easily trigger gout, because when alcohol is metabolized in the liver tissue, a large amount of water is absorbed, which strengthens the blood concentration, making the original already close to saturation of uric acid, accelerating the formation of crystals into the soft tissues, resulting in the body’s immune system overreaction (sensitivity) and inflammation, gout is known as the “king’s disease”, so the disease occurs in the nobleman’s For example, Kublai, the founder of the Yuan Dynasty, suffered from gout in his later years due to excessive alcohol consumption.
Some foods are metabolized and some of the derivatives can trigger the re-dissolution of uric acid crystals that have accumulated in the soft tissues, which can then trigger and aggravate arthritis.
4, men are prone to gout for the following reasons.
Gout disease at any age, can occur. However, the most common are middle-aged men over 40 years old. According to the latest statistics, the incidence ratio of men to women is 20:1. brain workers, fat people have a higher incidence.
The reasons why gout prefers men are
Women’s body estrogen can promote uric acid excretion, and has the effect of inhibiting arthritis attacks. Men like to drink alcohol, go to banquets, and eat food rich in purines and proteins, which increases uric acid in the body and reduces its excretion. Some doctors statistics, feast constantly, the incidence of 30%, often eat hot pot incidence also more.
This is because the raw materials of hot pot are mainly animal offal, shrimp, shellfish, seafood, and then drink beer, which naturally adds fuel to the fire. Investigation proves: shabu shabu a hot pot than a meal purine intake 10 times higher, or even dozens of times. A bottle of beer can double the uric acid. Hypertensive patients are 10 times more likely to suffer from gout. Gout, like diabetes, is a lifelong disease. The key is to control your diet, eat more alkaline foods that are low in purines, such as fruits and vegetables, and less acidic foods such as meat and fish, to eat a light diet, low in fat and sugar, and drink more water to facilitate uric acid excretion in the body.
Cautioned gout patients.
Men should not abuse alcohol, meat and fish should not be excessive. Once diagnosed with gout disease, meat, fish, seafood are among the restricted food. Spicy, stimulating food should not eat more, but also determined to quit drinking!
5. Pseudogout.
Pseudogout is a disease caused by the deposition of calcium pyrophosphate crystals in joint cartilage and its surrounding tissues with arthritis as the main manifestation, named because the symptoms are similar to gout, also known as calcium pyrophosphate deposition disease or cartilage calcification. The incidence increases with age, and the ratio of men to women is 1.4:1.
Etiology.
The etiology is unknown and may be related to genetics, trauma and metabolic disorders. The underlying etiology is calcium pyrophosphate deposition.
TCM diagnosis.
Gout is also known as “gout” in Chinese medicine, and has been discussed by doctors for many generations. Yuan? Zhu Danxi “Ge Zhi Yu Lun” has listed a special section on gout, cloud: “gout, most of the blood has been boiling since the heat, after or wading in the water or standing on the wetlands …… cold outside the fight, hot blood to get cold, sweat turbid stagnation, so the pain, the night is pain, line in Yang also.” Ming? Zhang Jinyue “Jinyue Quanshu? Foot gas” that the outside is Yin cold water damp, now the damp evil attacked the flesh and tendons; internal from the plain fat and sweet excessive, damp congestion of the lower jiao; cold and damp evil conjunctive depression and heat, stay in the skin …… lesion parts red swelling hot flashes, long then bone erosion. The clear? Lin Peiqin, “Classes of disease treatment”: “gout, pain paralysis one of the symptoms, …… at first because of wind, cold and damp paralysis of the yin part, for a long time will turn into heat to cause pain, to night more dramatic.” At the same time, the modern medicine of gout is also equivalent to the Chinese medicine of “pain paralysis”, “joint”, “foot gas” and other diseases.
Drug treatment.
At present, gout treatment is mainly based on clinical symptoms, mainly during the attack period to eat colchicine plus painkillers, in order to quickly reduce inflammation and relieve pain, and intermittent period to eat allopurine and other drugs to reduce uric acid, to prevent another attack. Basically, the western drugs used for gout have serious side effects and treat the symptoms but not the root cause, especially the highly toxic colchicine, which is about to be taken off the shelves in the United States because of its side effects.
Anti-inflammatory drugs for acute gout.
Diclofenac Sodium, also known as Diclofenac Sodium, is a non-steroidal anti-inflammatory pain reliever 25mg two to three times daily after meals, one to two tablets each time. For stomach problems, take as directed by your doctor.
Celebrex 200mg: one tablet once or twice daily with meals. Heart and stomach patients must take it as directed by their doctor.
Herbs that inhibit uric acid synthesis.
Pueraria Mirifica, Pseudostellaria, Gynostemma, Chasteberry, Cordyceps sinensis, fresh white foxglove, Coix seeds, Lycium barbarum, and Yiyuan Herbal Acid Reducing Tea are all herbs that have the effect of lowering uric acid.
Traditional Chinese medicine treatment.
Excerpts of several excellent prescriptions published in professional medical journals.
1, clear heat pain paralysis cream.
Gypsum Lonicera 30 grams, Zhi Mu, Huang Bai, Atractylodes, Huang Lian, Huang Cen, red peony, Yuan Hu, rhubarb, mountain gardenia (gardenia) 10 grams, grind, add vinegar to mix
2. Sihuang San.
Rhubarb, gardenia, yellow cypress, yellow cedar, etc., water mix.
3.Huang Bai San
Rhubarb, cypress, cypress leaf, zelenium, peppermint 10 grams each, mixed with honey.
4.Four-color powder.
Phellodendron Bark, Angelica Dahurica, Qing Dai, Safflower, 10 grams each with honey.
5.Golden powder.
Raw rhubarb, raw nancellus. Angelica dahurica, dahurica cypress, turmeric, each 10 grams, thick park, atractylodes, each 6 grams, Chen Pi licorice, each 4 grams, pollen 20 grams, vinegar blend.
6.Shedding pain.
Sheng Chuan Wu, Sheng Cao Wu, Qiang Wu, Dou Wu, Mu Xiang 6 grams. Hosin, dry ginger 12 g each, angelica 6 g, mixed with vinegar.
7.Yunnan Baiyao aerosol, available in pharmacies.
8.Lix Shen Wan: available in pharmacies, mixed with vinegar.
Acupuncture treatment.
1.Body acupuncture.
(1) Acupuncture points.
Main acupuncture points: in 2 groups.
1, feet three miles, Yanglingquan and Sanyinjiao.
2. Quchi.
Supporting points: in 2 groups.
1, medial ankle side: Taixi, Tai Bai, Dadun; lateral ankle side: Kunlun, Qiu Hui, Foot Lin Weeping, Shuang Bone.
2. Hegu.
(2) Treatment.
For lesions in the lower extremities, take the first group of each; for the upper extremities, take the second group of each. The main points are the main points, and the supporting points are added according to the location. The acupuncture needle is inserted with 1~1.5 inch No. 28 milli-needle, and after obtaining Qi, the twisting, lifting and inserting technique is used to supplement and diarrhea; the diarrhea method is used in the acute period, and the flat supplement and flat diarrhea method is used in the recovery period, and the needles are retained for 30 minutes. Needle is performed once every 10 minutes. Daily or every other day, 7-10 times for a course of treatment, the course of treatment interval of 3-5 days.
(3) Efficacy evaluation.
Criteria for differentiation of efficacy: clinically cured: symptoms and signs disappear, blood uric acid drops to normal, and no recurrence is seen within 1~1.5 years; effective: symptoms and signs basically disappear, blood uric acid drops, and the interval between attacks is significantly prolonged; ineffective: symptoms, signs and blood uric acid examination are not improved.
According to the above criteria, 70 cases were clinically cured, 9 cases were effective and 3 cases were invalid, with a total effective rate of 92.3%.
2. Blood pricking.
(1) Acupuncture points.
Main acupoints: in 2 groups. 1, A-Yi point, Tai-Chong, Nei-Ting, corresponding points; 2, Qu Chi, Yang Chi, Yang Xi, Tai-Chong, Qiu Hui, Tai Xi, Yang Ling Quan, Hai of Blood.
Location of the A-Yi point: the most obvious place of redness, swelling and heat pain.
Corresponding point location: the corresponding part of the A-Yi point on the healthy side of the hand.
Dietary therapy.
People with gout should pay attention to the following aspects in their diet.
1. Control the total caloric energy intake.
Control the daily total caloric energy intake and eat less carbohydrates. In addition, also eat less sucrose, honey, because they are high in fructose, will accelerate the production of uric acid. Vegetables such as young lentils, green fava beans and fresh peas contain high amounts of purines and should also be limited.
2. Restrict protein intake.
Use more milk, cheese, skim milk powder and eggs, which contain less purines; try not to eat meat, poultry, fish, if you must eat, you should boil the meat and discard the soup to eat. This is because purines are easily soluble in water and the content in soup is high. Although the protein content of soy products is high, gout patients should not eat them because of the high purine content, for example: soybeans, tofu, dried beans, etc. are forbidden to eat.
3. Limit purine intake.
Purine is a component of the cell nucleus, as long as the food containing cells contains purine, animal food has more purine content. To avoid or prohibit the consumption of animal offal, shrimp and crab, thick meat soup, edible mushrooms, seaweed, anchovies, sardines, clams, beans and beer and other high purine food.
4, eat more alkaline food.
Such as vegetables, potatoes, fruits (plums, lemons), etc. Polyphenol coffee can reduce the acidity of blood and urine. Watermelon and winter melon is not only alkaline food, more beneficial to gout patients.
5, drink more water to ensure the abundance of urine.
Usually should drink more plain water, mineral water, and fruit juice (do not drink strong tea, strong tea is easy to cause gout attacks), etc.
6. Reduce fat intake.
Eat less fat, because fat can reduce uric acid excretion. Gout with hyperlipidemia, fat intake should be controlled within 20% to 25% of total calories.
7. Limit salt intake.
The amount of salt eaten should be limited to 2 grams to 5 grams per day.
8, avoid drinking alcohol.
Alcohol has the effect of inhibiting the excretion of uric acid, long-term small amounts of alcohol can also stimulate increased purine synthesis, especially when drinking and then eating meat and poultry food, will double the intake of purine.
9, eat less chili and other seasonings.
Chili, curry, pepper, pepper, mustard, ginger and other spices can excite the plant nerves, inducing gout attacks, should be eaten as little as possible.
10, avoid eating hot pot.
This is because hot pot raw materials are mainly animal offal, shrimp, shellfish, seafood, and then drink beer, naturally adding oil to the fire. Investigation proved: shabu once hot pot than a meal purine intake 10 times higher, or even dozens of times. A bottle of beer can double the uric acid. Hypertensive patients are 10 times more likely to suffer from gout. Gout, like diabetes, is a lifelong disease. The key is to control your own diet, eat more alkaline foods containing low purine, such as fruits and vegetables, and less acidic foods such as meat and fish, so that the diet is light, low fat and low sugar, and drink more water to facilitate the excretion of uric acid in the body.
11.Nutrition distribution should be reasonable.
Under the premise of limiting the total calories, the distribution principles of the three major nutrients are: high carbohydrate, medium protein and low fat. ①Carbohydrates: rice and flour, including vegetables and fruits, should account for 55% to 60% of the total calories. This is also in line with the national diet, so that it can reduce fat decomposition to produce ketone bodies, which is conducive to urate excretion.
Drinking coffee can treat gout.
According to Xinhua News Agency, Washington, May 25 (Xinhua), a new large-scale investigation by U.S. and Canadian researchers found that drinking polyphenol coffee helps reduce the level of uric acid in human blood to achieve the effect of treating gout. Elevated levels of uric acid in the blood are a precursor to developing gout. Gout, a disease characterized by painful inflammation of the joints, is most common in adult men. Researchers from the University of British Columbia in Canada, Harvard Medical School in the United States and other institutions have found that daily consumption of polyphenol coffee can significantly reduce uric acid levels in the blood and treat gout. The research team selected nearly 46,000 men with a history of gout and followed them for 12 years. Statistical analysis found that those who drank polyphenol coffee had significantly lower uric acid levels in their blood and were less likely to develop gout compared to those who never drank it.