Professor Chen Xiangjun is one of the first batch of famous Chinese medicine practitioners in Shanghai, and the third batch of famous old Chinese medicine practitioners’ academic experience inheritance class instructors in China. The author has been with the teacher for more than ten years, and has a brief glimpse of his experience in the diagnosis and treatment of rheumatism, and his experience in the treatment of gouty arthritis is summarized below for the benefit of his colleagues. 1, the understanding of the etiology and pathogenesis of gouty arthritis – spleen deficiency as the basis, dampness, heat, stasis and toxicity as the standard Gout belongs to the category of “paralysis” and “history of the joints” in Chinese medicine. At present, most of the Chinese doctors understand this disease as a damp-heat poisonous evil, emphasizing the evil and neglecting the positive deficiency, and its onset is mostly thought to be due to external damp-heat poisonous evil, or the wanton consumption of fatty, sweet and thick flavors, wine and cheese, containing damp-heat, which stagnates in the tendons, veins, muscles and joints, and is often treated with the method of dispersing wind, dispersing cold and removing dampness or clearing heat and detoxification, which can be a temporary success, but the long-term effect is not very satisfactory. Chen believes that although gout belongs to the category of “damp-heat paralysis” of paralysis, but it is different from the general damp-heat paralysis, the general paralysis is often on the basis of the weakness of the guard outside the feeling of wind, cold, damp-heat disease, resulting in pain when the meridians and joints are closed. However, the onset of gout does not seem to have much to do with external sensations, but the lack of diet is a very important cause, and many patients often crave a momentary appetite, or wantonly drink jelly or wantonly eat fatty sweet, resulting in the rapid appearance of red, swollen and painful joints, and each attack is closely related to the lack of diet. According to the ancestral medicine, the spleen is the essence of the posterior, the main limbs, joints and muscles, and the division of transportation and transformation. If the spleen and stomach are deficient or addicted to alcohol, wine, fat and sweet damage to the spleen and stomach, the transport and transformation is not healthy, the dampness and turbidity of the evil from within, stay and not go to accumulate long heat, heat into poison, flow in the joints and meridians, blood and Qi closed and blocked and disease. It can be seen that although the acute attack of the disease is characterized by severe pain in the joints, bright red skin, swelling and burning, and even fever and thirst, the cause of the disease should be attributed to the deficiency of the spleen. Starting from the root of the disease, clearing heat and dampness, detoxifying and draining turbidity, and at the same time strengthening the spleen and stomach is a treatment that takes into account both the symptoms and the root cause. In addition, from the viewpoint of meridian circulation, gout occurs in the first metatarsophalangeal joint of the foot, which is followed by the foot Taiyin spleen meridian. If the spleen is deficient, the meridian is not conducive to the development of gout. This further demonstrates the important role of strengthening the spleen in the treatment of this disease from the perspective of meridian theory. At the same time, in long-term clinical observation, Dr. Chen also found that patients with acute gouty arthritis showed signs of damp-heat, such as redness and swelling of the diseased joints, bitterness and stuffiness of the mouth and yellow tongue coating, and at the same time, there were often symptoms of spleen deficiency, such as poor appetite, fatigue, lack of energy, and weakness of the spirit, with a pale tongue and thin pulse, which further suggested that the essence of the disease was based on spleen deficiency, with damp-heat and toxic evil as the symptoms. Therefore, Dr. Chen believes that during the exacerbation phase of the disease, while resolving the dampness and toxicity, the method of strengthening the spleen should be used to balance the symptoms and the root cause; while during the remission phase, according to the principle of treating the root cause by slowing down, the main focus should be on strengthening the spleen, supplemented by resolving the dampness, thus better highlighting the characteristics of Chinese medicine in treating the root cause of the disease. As the ancient saying goes, “if the righteousness exists within, the evil cannot be dried up”. If the spleen is healthy, there is no place for dampness and heat, then the gout is less likely to recur. In some patients, a slight dietary disorder can lead to acute gouty arthritis attacks, but after a period of Chinese medicine treatment, even if the diet is slightly indulgent and the blood uric acid is significantly elevated, there is no obvious acute gouty arthritis attack, which shows the importance of strengthening the spleen in general, and further verifies that although the dampness and turbidity of the evil may stay for a short time, if the spleen is healthy, the evil can be removed before the heat is transformed, so that no serious disease will develop. The importance of the Spleen method 2. Specific application of the Fu Zheng method in the treatment of gouty arthritis: (1) Acute gout attacks are characterized by sudden onset of red, swollen and burning pain in the joints of the lower extremities, unbearable pain, like pins and needles, light day and heavy night, increasing pain with activity, some patients also have fever, headache and body pain, dry mouth and stool, red tongue with greasy coating, large pulse or stringiness, etc. Chen advocates that the treatment should not forget to seek the root of the problem, while clearing heat and dampness, detoxifying and draining turbidity, and at the same time strengthening the spleen and consolidating the root. The common formula uses Fu Ling and Dioscorea Z as the ruling herbs to drain the dampness and detoxify the toxins; the minister uses Atractylodes macrocephala and Huang Qi to strengthen the spleen and resolve the dampness; the adjuvant uses Zhi Bai, Rhubarb, Cyperus rotundus and Lonicerae to clear the dampness and heat, furthering the function of draining the dampness and detoxifying the toxins; the adjuvant uses Sang Sang Cha and Lycopodium to eliminate stagnation, and Red Flower to invigorate the blood and open the channels to facilitate the smooth flow of qi and blood and the opening of the veins and channels. Chen Shi’s choice of detoxifying drugs, especially the two flavors of Dioscorea Z and Tu Fu Ling, must be used in every prescription, is his experience is unique. Fu Ling is sweet and mild, mainly into the spleen and stomach two meridians, can help to ascend and descend the turbidity, detoxification and dampness, Shu meridians and channels of the function, so that the evil to be safe, at the same time through the meridians, stop paralysis and pain, both the symptoms and the original. Fu Ling has astragalus to support the right qi, mountain cichlid mushroom, Ligustrum, clear heat and detoxification, its effect is particularly effective. The “Justice of the Materia Medica” says: “Dampness and heat, can enter the ligaments, search and remove the dampness and heat of the contained poison”. Dioscorea Z is bitter, sweet and calm, and enters the kidney and bladder meridians, which is beneficial for clearing and removing turbidity. Both herbs have the function of removing dampness, detoxification and joint benefit. They were commonly used in ancient times to treat syphilis, gonorrhea, foot fungus, furuncles, carbuncles and swelling, and painful contracture of tendons and bones. (2) In the remission period, it is important to strengthen the spleen and prevent dampness and turbidity. In the remission period, the patient’s condition can be mild or severe, and in the mild case, the diet is as normal and there is no joint paralysis and pain, but in the slightly severe case, there is sometimes hidden pain and redness in the joints, or the swelling is persistent and does not subside, and if the diet is not careful, the gout will be acute. If the disease does not work, the water channels are not regulated, and if the spleen is deficient and the kidneys are not regulated, the limbs are swollen and the urine is not good. Therefore, Dr. Chen believes that the treatment of gout in remission must not be taken lightly, but must be prevented before it happens, focusing on strengthening the spleen and benefiting the qi, together with the dampness and drainage of turbidity, activation of blood circulation and elimination of blood stasis, in order to achieve the effect of long-term treatment. Commonly used formula is changed to raw Atractylodes macrocephala, raw astragalus, poria, raw rice kernel to strengthen the spleen and benefit the qi and dampness, at the same time to Huai Niu Knee to benefit the liver and kidneys; raw Shan Cha, Lycopodium to eliminate phlegm and stagnation; Tu Fu Ling, mountain mushroom, wild papaya to clear the remaining evil; adjuvant add chicken blood vine, Chuan Xiong blood circulation, to prevent long-term disease will be stasis, long-term disease into the complex. In conclusion, for the treatment of gout, Dr. Chen believes that once the diagnosis of gout is clear, treatment should adhere to the major method of strengthening the spleen, resolving dampness and detoxifying toxins. On the basis of this, the examination of the evidence and the right to change, the addition and subtraction of drugs, most of them can obtain the good effect of gradually draining the turbidity and stasis and steadily decreasing the blood uric acid, and then achieve the purpose of restoring the normal function of the inner organs to ascend and secrete turbidity. If the method does not know how to keep, the prescription is changed from time to time, or the treatment is stopped and continued, and the slight effect is lost patience, then the good effect is often difficult to term, the condition fluctuates every time, and even the previous work is abandoned, and the disease is aggravated. As mentioned above, the development of gout is closely related to the carelessness of diet. Western medicine has clearly defined this disease as a disorder of purine metabolism, so the patient is recommended to have a low purine diet. In addition to restricting the high purine diet with reference to modern medical research, Dr. Chen also suggested patients to eat more healthy foods such as rice kernel, yam, poria, lentils, etc., which strengthen the spleen and promote dampness, and to stay away from hot foods such as oil and frying, as well as fatty, sweet and greasy products that are easy to produce phlegm and dampness, so as to avoid the harm of fire and frying products that consume fluids and produce phlegm and heat and dampness, or sweet and greasy products that produce dampness and turbidity, which will block the dampness and phlegm and heat for a long time. The disease of gout is caused by the stagnation of the meridians. Therefore, Dr. Chen believes that for people with gout, regardless of the onset of the disease, attention to diet control is a link that cannot be ignored. The only way to properly liberalize the diet is to make the spleen healthy by strengthening the spleen and benefiting the qi, and to make the spleen healthy by promoting the flow of water and dampness.