Gout is a group of disorders of glancing metabolism, characterized by hyperuricemia and the resulting recurrent episodes of gouty acute arthritis, gout stone deposition, gouty chronic arthritis and joint deformity, and often involving the kidneys to cause chronic interstitial nephritis and uric acid kidney stone formation. Primary cases are classified into two categories: primary and secondary. The cause of primary cases is not clearly understood except for a few due to enzyme defects, and is often associated with hyperlipidemia, obesity, diabetes, hypertension, arteriosclerosis and coronary heart disease, and is a genetic disease. Secondary cases can be caused by kidney disease, blood disease and drugs. The disease is usually seen in men over 40 years old, but it also occurs in postmenopausal women. The disease often recurs due to a variety of factors, such as alcohol and food disorders, overwork, cold or infection, with more attacks in spring and autumn, and often suddenly at midnight. Except for those caused by drugs, most of the disease lacks etiological treatment, and therefore cannot be cured. Gout belongs to the category of “paralysis”, “joint wind” and “lumbago” in Chinese medicine.
Etiology]
The cause of gout is due to excessive consumption of fat and sweet, alcoholism, overwork, stress or wind, cold, dampness and heat, resulting in Qi and blood stagnation, phlegm and paralysis, and blockage of bone and meridian Qi.
The pathological changes are wind-heat evil, combined with dampness, combined evil for the problem; or the body Yang Yang Sheng liver exuberance, or wine and food disorder, containing phlegm heat, can lead to wind-damp-heat evil, or wind and phlegm heat, stagnation of meridians and joints, paralysis of qi and blood, and for wind-damp-heat paralysis. The wind and cold with dampness, attacked into the meridians, coagulation of qi and blood, the meridians do not pass, and the development of wind-cold damp paralysis. If the paralysis does not heal over time and the flow of qi and blood is not smooth, the phlegm and blood stasis will be chronic in the meridians, resulting in joint tingling, nodules and deformities. The evil loves to hurt the righteousness, and the deficiency of spleen and kidney yang eventually leads to the lack of power to fix the regimen, the lower discharge of essence, and the exhaustion of the body.
Diagnostic points]
1, middle-aged or older men with sudden onset of single joint redness, pain and restricted movement in the bunions, metatarsals, ankles and knees, or gout stones in the metatarsals, interphalangeal and metacarpals.
2, joint cavity puncture, take bursal fluid spin light microscopy, can find urate crystals; blood uric acid increased, may have kidney uric acid stones or proteinuria, as well as renal disease such as hyperalgesia.
[Classification of evidence
1. Symptoms of rheumatic heat paralysis: red, swollen, hot and painful toe joints, or wandering pain, or fever, sweating, irritability, sore throat. Red tongue with thin coating and string pulse.
Analysis of the symptoms: wind-damp-heat evil, attacking the body, injuring the body surface, then fever, sweating, sore throat; into the meridians, paralysis of qi and blood, then toe joints red, swollen and hot pain; wind induces damp-heat, running through the meridians, then wandering pain; red tongue. Thin moss, pulse string, for wind-damp heat paralysis signs.
2, wind-cold damp paralysis symptoms: cold pain and swelling in the toe joints, which is more acute when cold, but decreases when warm, with slightly red or non-red local skin. The tongue is light red, the coating is thin, and the pulse is tight.
Analysis of the symptoms: wind-cold dampness, attacked into the meridians, cold stagnation, so paralysis of Qi and blood, resulting in cold pain and swelling of the toe joints, in the face of cold more acute, with warmth will be reduced; cold injury to Yang Qi, blood transport failure, so the local skin is slightly red or not red; light red tongue, thin moss, tight pulse, the signs of wind-cold dampness paralysis.
3. Symptoms of phlegm and stasis: tingling pain in the joints, aggravated at night, frequent attacks, with nodules, deformed and swollen joints, and restricted movement. The tongue is dull and red, or there are petechiae, and the pulse is thin and stringent or astringent.
Analysis of the symptoms: sputum and stagnant blood stagnate in the meridians and channels, causing stagnation of qi and blood, resulting in tingling pain in the joints and nodules; sputum and stagnant blood is a yin evil, and at night when yang is insufficient, sputum and stagnant blood become more paralyzed, so the pain increases and the attacks are frequent; sputum and stagnant blood is chronic and knots in the meridians and channels, so the bones and joints are blocked by qi and blood, resulting in deformed and swollen joints and limited movement; dull red tongue or petechiae, and thin string or astringent pulse, which are signs of sputum and stagnant blood.
4.Spleen and kidney yang deficiency symptoms: pale face, unheated hands and feet, vague pain in the waist, sore legs, worse with labor, relieved when lying down, frequent nighttime urination, less energy. Pale tongue, thin white coating, sunken pulse.
Analysis of the symptoms: The evil love for a long time, injury to the right qi, deficiency of spleen and kidney yang, loss of qi and blood for warmth and transportation, white face, lack of warmth in the hands and feet; kidney deficiency, vague pain in the waist, soreness and weakness in the legs; spleen deficiency, intolerance of labor, heavy symptoms when laboring, reduced symptoms when lying down; deficiency of kidney qi, loss of consolidation, deficiency of kidney yang, inability to steam and gasification, therefore frequent nocturnal urination; loss of essence, exhaustion of the body, less energy and weakness; pale tongue, thin white fur, sunken pulse, all signs of spleen and kidney yang deficiency.
Treatment by type
1, wind-damp-heat paralysis treatment: dispel wind and clear heat, transform dampness and pass paralysis.
Prescription: Si Miao San plus flavor.
Atractylodes Macrocephalae 9 grams yellow cypress 12 grams cowberry 12 grams coix seed 30 grams Haitongpi 12 grams mulberry 30 grams wei lingxian 12 grams jinyinhua vine 15 grams? If the gout is very red, swollen and painful, add 15 grams of raw earth, 15 grams of red peony and 12 grams of dilong to clear heat and cool the blood and pass through the channels; if it is accompanied by fever, sweating and thirst, add 30 grams of gypsum (first), 10 grams of Zhi Mu, 6 grams of Gui Zhi and 15 grams of red peony to clear the air and cool the camp.
2, wind-cold dampness paralysis treatment: warming the meridians and dispersing cold, dispelling wind and dampness.
Prescription: Wu Tou Tang with flavor.
The formula is based on the following formula: 9 grams of Chuan Wu, 9 grams of Ephedra, 9 grams of Paeonia lactiflora, 12 grams of Astragalus membranaceus, 15 grams of Epiphyllum, 9 grams of Cinnamomum, 9 grams of Rhizoma Atractylodis Macrocephalae, 12 grams of Bupleurum, 12 grams of Radix et Rhizoma Glycyrrhizae, 6 grams of Glycyrrhizae.
3.Treatment of phlegm and stagnant knots: remove phlegm and stagnant blood stasis, clear the channels and disperse knots.
Formula: Peach-Hong Siwu Tang plus or minus.
Peach kernel 9 grams safflower 9 grams angelica 9 grams Chuanxiong 9 grams wei lingxian 12 grams piercing nail 12 grams white mustard seed 9 grams bile south star 9 grams whole scorpion 3 grams centipede 1 add and subtract according to the symptoms: if the joint pain is severe, add 6 grams each of Chuanwu and Cao Wu, and 3 grams of Hossein to warm and relieve pain; if the blood uric acid is high, add 9 grams of Phellodendron, 9 grams of Atractylodes, 30 grams of Coix seed and 15 grams of Fangji to clear and dispel the evil.
4. Treatment for deficiency of spleen and kidney yang: warming the spleen and kidney.
Remedies: Right Return Pill plus reduction.
Radix Rehmanniae 15g Yam 15g Cornus 10g Semen Cuscutae 15g Fructus Lycii 12g Eucommiae 12g Epilobium 10g Cinnamon Powder 2g (blended) Astragalus 20g Radix Codonopsis 12g Atractylodes 12g Radix Glycyrrhiza Uralensis 3g add and subtract with symptoms: for urinary tract stone, add Money Grass 20g, Sea Gold 10g (decoction), Dong Quizi 10g, Amber Powder 3g (blended), Chicken Neijin 9g to clear the stone; less nasal, loose stool In case of loose stools, add 5 grams of ginger, 6 grams of mucuna pruriens, and 3 grams of sandy nuts (later on) to warm the spleen and carry Yang.
Proprietary Chinese medicine
Hai Tong tablets 6g each time, 3 times a day.
【Simple formula
Atractylodes macrocephala 10 grams, Phellodendron chinensis 10 grams, Semen coicis 30 grams, Radix et Rhizoma nucifera 10 grams, decoction in water, 1 dose daily. Indicated for gout with red, swollen and hot pain in joints.
Astragalus membranaceus 30g, Atractylodes macrocephala 15g, Fructus Bupleurum 15g, Radix et Rhizoma Vesiculata 15g, Radix et Rhizoma Sibiricum 3g, decoction in water, 1 dose daily, for those with mild wind-cold and dampness paralysis of gout.
Other treatments
External treatment method: apply golden ointment externally to the swollen and painful joints, change the medicine once in 2-3 days, 10 days for a course of treatment. It is suitable for people with rheumatism and heat paralysis of gout.
Acupuncture: Acupuncture points such as Xiexi, Kunlun, Hangzhong, Yanglingquan, Hegu, Catarrh, Waiguan, Quchi, Kidney Yu, etc., selecting 2 to 3 points each time, with flat remedy and flat diarrhea, and keeping the needles for 15 minutes.
Food therapy: 30 grams of fresh grapes and 50 grams of rice, boil the congee together and take it every R to promote uric acid excretion.
Caution]
1, gout is often accompanied by obesity, hyperlipidemia, hypertension, coronary heart disease, diabetes and other diseases, and because hyperuricemia is easy to involve the kidneys, causing renal insufficiency, so should be timely treatment of hyperuricemia.
2, control the diet, avoid alcohol, forbidden to eat a variety of purine-containing animal offal, meat soup, as well as some high protein and high fat fish, beans.