Gout is a group of diseases caused by disorders of purine metabolism and/or decreased uric acid excretion. Recurrent attacks of acute arthritis are the main clinical features of acute gouty arthritis, and the progression of the disease can lead to joint deformity. Professor Jin Shi, a famous veteran Chinese medicine practitioner in Jiangsu Province and a doctoral supervisor at Nanjing University of Traditional Chinese Medicine, has been in clinical practice for more than 40 years and believes that the acute phase of gout is mostly caused by “wind-dampness and heat”, and treatment is mostly based on clearing dampness and heat, activating blood circulation and removing blood stasis. Here is a theoretical analysis of Professor Jin’s ideas on treatment
1. Etiology and pathogenesis
1.1 Tracing the origin
The name of paralysis was first mentioned in Su Wen? Paralysis: “Wind, cold, and dampness come together to form a paralysis”. In addition to emphasizing that wind, cold and dampness are the causes of paralysis, it is also pointed out that the harmony between the couples and the body can affect the onset of the disease. In the Su Wen? In the “Forty-third Book of Paralysis”, the mechanism of heat paralysis is explained: “The heat is due to the fact that there is more yang energy and less yin energy. It is said that if the body is full of yang and the yin blood is not enough, the external evil entering the body will easily turn into heat paralysis from yang.
In the Han Dynasty, the book “Jin Kui Yao Yao” was published. The pulse evidence and treatment of the stroke calendar section disease” mentioned: “inch mouth pulse sinking and weak, sinking that is the main bone, weak that is the main tendon, sinking that is the kidney, weak that is the liver, ……, calendar section yellow sweat, so it is called calendar section”, “Rong Qi does not work, the guard does not act alone. The Rong and Wei are weak, the Sanjiao does not belong, ……, only the feet swell, yellow sweat, ……, it is also the calendar section”, pointing out that the disease is located in the tendons and bones, liver and kidney deficiency, Qi and blood deficiency for its internal causes. Another “tarsus Yang pulse floating and slippery, slippery is the valley Qi real, floating is sweating from the” indicates that the spleen and stomach damp heat, heat steam forced fluid, coup open drainage, sweating when the wind or long injury to take the cold can lead to calendar joints.
In the Sui and Tang dynasties, Chao Yuanfang wrote in “Treatise on the Origin of Diseases? The wind of the wind on its etiology and pathogenesis of the more detailed elaboration: “the wind of the symptoms, ……, from drinking wine coup open, sweating when the wind caused, but also blood deficiency, by the wind evil to get the wind, the wind through the joints, and blood fighting cross-attack, so pain, blood deficiency is sweating, the wind cold fight in the tendons, it can not flex and stretch “, the mentioned “drinking wine coup open, sweating when the wind” and gout attack triggers similar. And also cloud: “heat poison gas from the internal organs, attacked in the hands and feet, hands and feet are {heat, red, swelling, pain.” (The Treatise on the Origin of Diseases? The first time that the accumulation of heat and poison from the internal organs causes paralysis. The concept of “wind poison” was proposed by Sun Simiao in the “Prepared Emergency Thousand Gold Essentials”, pointing out that “if the wind is left untreated for a long time, the bones and joints will fall…, this is the poison of the wind”. This is the poison of the wind”, using “wind poison” to explain the pathogenesis of the disease, which laid the theoretical foundation for the treatment of paralysis in later times with wind-removing and detoxifying drugs.
Jin Yuan Zhu Danxi in the “Ge Zhi Yu Lun” listed a special section on “gout”, in the etiology of the disease, first proposed the problem of “phlegm”: “……, other prescriptions It is said that the evidence of Baihu calendar section, the majority of phlegm, wind-heat, wind-damp, blood deficiency”, and that “his gout, the majority of the blood has been boiling since the heat, after or wading in cold water, or standing on wet ground, or fan to get cool, or lying when the wind, cold and cold outside the fight, hot blood to get cold, sweat turbid condensation, so pain, night is pain, line in the yin also “The “Gout” is the cause of gout. Gout”) is the pathogenesis of gout, and this statement gave a great inspiration to later generations to apply the method of activating blood circulation and eliminating phlegm.
In the Ming and Qing dynasties, Yu Tuan believed that dampness and heat flowing into the joints was the pathogenesis of the disease: “Swelling and pain in the limbs and joints are fire and swelling is dampness, and they are also affected by wind and cold and start in the meridians, and dampness and heat flowing into the limbs and joints without end” (“Medical Zhengzhuan”). Zhang Jinyue’s “The Complete Book of Jinyue? The mechanism of the onset of the disease due to dietary indiscipline is emphasized in Zhang Jingyue’s “Foot Soreness”: “It is caused by excessive fat and sweetness, uncontrolled wine and liquor, or eating a lot of cheese and damp heat, causing heat to congest the lower jiao, injecting into the feet and shins, and gradually becoming swollen and painful, or even up to the hand joints”. Qing? Chen Qi in the “Medical Transmigration? Gout”, “Gout, there is pain but not swelling, there is swelling and pain, or the head of the red point, finger swelling like a mallet, all from the liver meridian blood less fire, heat extreme wind, ……”, and thus put forward “heat extreme wind “This is the view of internal injuries causing paralysis. The first of these is the “Gout”, a painful paralysis, …… because the wind, cold, and dampness paralyze the yin part of the body, and for a long time it turns into heat and causes pain, and at night it becomes more intense”, which explains the pathological changes of the wind, cold, and dampness that attack the body and turn heat into paralysis.
1.2 Analysis
1.2.1 Etiological analysis
The causes of gout are internal and external: external causes include wind, cold, dampness, heat, summer heat and other external evils or dietary disorders; internal causes include deficiency of endowment, deficiency of righteousness, including (the body is full of yang, contains dampness and breeds toxins, deficiency of external defense, deficiency of liver and kidney qi and blood, etc.). Professor Jin Shi simplifies them into two aspects.
1.2.1.1 Insufficient endowment and internal heat
In addition, if the spleen is responsible for transportation and transformation and the kidneys are responsible for opening and closing, if the spleen and kidneys are deficient, there will be no power of transportation and transformation, water and dampness will accumulate, and there will be no power to open and close the joints, so the dampness and dampness will be stagnant in the body and will turn into heat with time. Modern medical research has found that there are enzyme defects in the patient’s body, which also indicates that the lack of endowment is an important factor in the development of the disease.
1.2.1.2 Insufficient consolidation of the external guard and invasion of evil qi
Su Wen? The “Prickly method” says: “When the righteousness is stored inside, evil cannot dry up”, and “Suwen? All diseases are born” said: “wind and rain, cold and heat can not be deficient, evil can not hurt people alone, this must be because of the deficiency of evil thieves wind, and its body shape, the two deficient phase, is the guest of its shape”, emphasizing the deficiency of the right qi, the external guard is not solid, then vulnerable to the invasion of evil. Wind is the longest of all diseases, often with moisture invasion of the body, in the skin, the body is weak and unable to resist the evil out of the body, stagnant in the body, impeding the flow of Qi and blood. Most of the patients in this disease are male, masculine body, so the depressed evil is easy to turn heat from Yang; if the body already has depressed heat, and then triggered by external evil, fighting each other, the wind is good at walking, so it can lead to flow into the joints, dampness is most likely to block the qi, so it can make the qi and blood run more poorly.
1.2.2 Analysis of the pathogenesis
According to Jin Shi, the basic pathogenesis of this disease is that the external evil induces heat in the body, stagnating the meridians and paralyzing the joints, stagnating the qi and blood, and causing pain if it does not flow smoothly.
1.2.2.1 Dampness and heat are the basic pathological factors
The “Shennong Ben Cao Jing” has a cloud: “paralysis, wet disease also”, wet has the difference between internal and external, internal wet mostly by the spleen and kidney deficiencies, water transportation and distribution of the failure; external wet that is external dampness, more false wind as the handsome, invasion of the body, if wet evil trapped in the spleen, no power of health and transportation, can also lead to internal wet. Dampness for the disease is most likely to block the qi, can directly cause both qi stagnation and blood stasis, but also can be closed to heat. Heat is a Yang evil, its nature is urgent, if and dampness stagnation fight, burning tendons and veins can lead to the onset of disease; depressed heat is born, if you feel external evil, congestion of the meridians, the body by the heat steam blood no way to pass, back and forth attack, then see the joint pain is unbearable.
1.2.2.2 Stasis is an important pathological factor
”In addition to dampness and heat, which can affect the flow of qi and blood, stasis is also an important factor that cannot be ignored. There are three sources of stasis: when dampness is the disease, qi is suppressed, and qi stagnation does not allow the blood to run normally, hence stasis; when blood is burned by heat, it battles with dampness and heat, blocking the meridians and becoming stasis; when external evil paralyzes the skin and joints, qi and blood do not run smoothly, then stasis is formed. Blood stagnation and stagnation, and dampness and heat, blocking the arteries, and pain if they do not pass, resulting in severe pain in the joints with relatively fixed locations and pain at night. Dampness, heat and stasis often interact with each other, and stasis can intensify the blockage of qi, so that yang qi cannot be stretched and easily becomes heat, and water and liquid cannot be transported and transformed by qi and stagnate into dampness.
1.2.2.3 The nature of the pathology is based on deficiency and the symptoms are real, with more real than deficiency
The disease is located in the tendons, bones and joints, and the pathology is deficient in nature and real in nature. The deficiency of endowment and lack of external defense is the root cause, and the internal heat and external evil are the symptoms. Patients have a rapid onset, joint pain symptoms often reach a peak within a day, local redness, swelling and burning, severe pain, and cannot be touched, because the wind-damp and heat are fighting each other in the body, paralyzing the meridians and flowing into the joints, so that the stagnation of qi and blood does not run smoothly, and pain is caused by the lack of circulation; it can also be accompanied by fever and headache, yellow urine, red tongue with yellow coating and slightly greasy pulse, which are all manifestations of damp-heat.
2.Treatment rules and methods
2.1 Origin
Zhang Congzheng proposed that “paralysis is caused by damp-heat, wind-cold-dampness, and the combination of the three gases”, emphasizing that damp-heat is an important factor in causing paralysis, and advocating the timely use of sweat, down, and vomiting to attack paralysis at the early stage of the disease (Confucianism? The three methods of attacking paralysis with sweat, downward movement, and vomiting were advocated at the early stage of the disease (Confucianism?) Zhu Danxi believed that “among the six qi, damp-heat is the cause of nine out of ten cases” and created the effective formula Ermiao San to treat heat paralysis in which damp-heat is concentrated in the meridians. Gout”).
In the Ming dynasty, Zhang Jinyue believed that paralysis “with fire should be from clearing and cooling”, and pointed out that “those who have damp heat for the disease, must see the evidence of internal heat, slippery number of veins, before the treatment to clear the source, it is appropriate to two miao san and plus flavor two miao pill, danggui fever soup and so main. The first is to clear the fire, and then to regulate the qi and blood” (“Jing Yue Quan Shu? Wind Paralysis Evidence”).
In addition, he also used the theory of Wei-Qi, Ying-Blood and San-Jiao in the identification of paralysis, and proposed “heat in Ying” and “heat into Blood”. He also applied the theory of Wei-Qi, Ying-Blood and San-Jiao to the diagnosis of paralysis, and proposed the diagnosis of “heat in the Ying” and “heat in the Blood”, and considered that “new evil should be dispersed quickly, while old evil should be attacked slowly” and “deficient people with prolonged paralysis should nourish Liver, Kidney, Qi and Blood”. Wu Jutong pointed out in the book “Wenzhi Zhuanzhi? In the book “The Middle Jiao Chapter”, Wu Jutong pointed out the characteristics of the pathogenesis of “dampness and heat steam in the meridians” and created Xuan Piao Tang to treat rheumatism and heat paralysis. Li used to summarize the theory of heat paralysis and gout, and further played “dampness and heat, phlegm and fire, depression and death of blood in the meridians and limbs, all can be numb and paralyzed”, and proposed that the treatment of paralysis “in the early stage due to wind-damp heat, when the flow of the organs, do not quickly supplement, the disease is long, it is appropriate to eliminate blood stasis, nourish the new blood, and manage phlegm and fire … If the disease is prolonged, it is advisable to eliminate blood stasis, nourish new blood, and regulate phlegm and fire. The first of these was the “paralysis of the spleen. Wang Qingren proposed that “paralysis is caused by stasis of blood”, and in the “Correction of the Medical Forest”, it is said that “if blood is subjected to cold, it condenses into lumps, and if blood is subjected to heat, it boils into lumps”.
2.2 Analysis
According to the characteristics of this disease, which is caused by the combination of internal and external evil, and the rapidity of the disease and the seriousness of the disease, in order to quickly relieve the joint pain and alleviate the patient’s suffering, Professor Jin believes that the treatment should be based on “eliminating evil”, but “sweating and vomiting” is not appropriate, which may lead to However, “sweating and vomiting” should not be used, as it may aggravate gout due to drastic fluctuations in blood uric acid.
2.2.1 Clearing heat and relieving dampness
The “Medical Journal” cloud: “pain in the limbs and joints is fire, swelling is damp, and the wind and cold are also affected in the meridians, and damp heat is injected between the limbs and joints”, which shows that damp heat has an important influence on the development of this disease. According to the manifestation of the onset of the main evil, it is necessary to remove the evil, that is, “the heat is cleared, the damp is beneficial. Once the damp-heat is removed, the qi can be relaxed, the boiling blood can be tranquilized, the stagnation can not be transformed, it is difficult to glue, then the paralysis of the meridians can be removed, the qi and blood can be restored to flow, the swelling and pain can subside.
2.2.2 Promoting blood circulation and resolving stasis
Stasis is a pathological product formed during the evolution of the disease and is present throughout the course of the disease. Both dampness and heat can cause stagnation of qi and blood, and stagnation can also lead to the internal growth of dampness and heat, and can easily be agglutinated with both. In the treatment process, if the stagnation is not removed, one can still paralyze the vasculature and affect the flow of Qi and blood; the other is that “the more stagnation, the more depression”, and it is difficult to resolve the depression of Qi, and damp-heat still has a way to transform. Therefore, in addition to “clearing heat and dampness”, it is also necessary to “invigorate the blood and resolve blood stasis”. So that the stasis is removed, and the damp-heat sticking evil is easy to quickly dissolve, the meridians are unblocked, the blood flow is not blocked, joint swelling and pain can be removed in one fell swoop. In addition, the wind evil likes to carry dampness to induce heat and paralyze the blood vessels to cause this disease.
3.Conclusion
With the development of economy, the change of diet structure and living habits, the prevalence of gout in China is on the rise. Acute gouty arthritis is mainly manifested by severe pain and swelling of the affected joints. Based on the clinical thinking and experience of ancient medical doctors, Professor Jin Shi, on the basis of identifying the disease, grasping the main contradiction of joint swelling and pain, and combining the characteristics of its pathogenesis, believes that the acute stage of gout is mostly characterized by the evidence of “wind-dampness and heat”. The term “wind-damp” mainly refers to the external wind-damp and other six evil spirits, emphasizing that this is the causative factor of the disease. The word “yu” has the meaning of “stagnation and transformation, stagnation and stagnation”. The term “yu-he” refers to the heat of stagnation and stagnation that cannot be promoted. The term “wind-dampness and heat” indicates that this disease is a disease with internal heat and external wind-dampness, which is a combination of internal and external evil. Damp-heat and stagnation are important pathological factors in the development of the disease. The pathological nature of the disease is based on deficiency and stagnation, with more solid than deficiency, so the treatment is based on eliminating evil, and the treatment is to clear heat and dampness, invigorate blood and remove blood stasis.