Modern medicine considers “gout” to be a disease caused by disorders of purine metabolism and high serum uric acid levels due to hereditary or acquired causes. It is characterized by hyperuricemia, recurrent acute gouty arthritis, and chronic gouty arthritis that eventually involves the kidneys and develops into gouty nephropathy, and is a metabolic disease closely related to hyperlipidemia, diabetes mellitus, and hypertension. According to the clinical manifestations and evolution of gout, Chinese medicine classifies it as “paralysis”, “white tiger calendar”, “gout”, “wine wind” and “spleen disease”. When there is a change of evidence, it can be classified as “stone gonorrhea”, “lumbago”, “edema”, and “deficiency consumption”. When variation occurs, it can also be treated as “stone shower”, “lumbago”, “edema”, “deficiency consumption”, “Guange”, etc. 1. Insufficient real qi and imbalance of qi-chemistry are the pathogenesis of “gout”. ”Gout”, modern research mostly believes that primary hyperuricemia is hereditary, mostly due to abnormal purine metabolism caused by genetic gene lesions and resulting in imbalance in the synthesis and excretion of uric acid. The physical state determines the onset of the disease and its propensity to develop. Foreign scholars have proposed tuberculosis physique, stone physique, rickets physique, obesity physique, gout physique, and atherosclerosis physique, and searched for the causative genes of these diseases1. The doctrine of physique and genetics in Chinese medicine coincide. Wu Dehan, a medical doctor of the Qing Dynasty, said in the “Medical Science Series, the latter part of the Jin Pao Jue”: “To know that those who are prone to wind as a disease, the surface qi is deficient; those who are prone to cold as a disease, the yang qi is deficient; those who are prone to heat as a disease, the yin qi is decaying; those who are prone to food injury, the spleen and stomach must be deficient; those who are prone to labor injury, the middle qi must be lost. It is necessary to know that the day of illness is the time when the right qi is insufficient.” The strength of the body is the strength of the true qi, and to a certain extent reflects the deficiency, strength and weakness of the true qi. In the chapter of Ling Shu, “The true qi is received from the sky, and fills the body with grain qi”.
Li Dongyuan, “the spleen and stomach is empty, nine orifices do not pass” cloud: “true qi, also known as yuan qi, is Mr. and the birth of the essence of gas, non-stomach gas and can not be nourished. Stomach gas, grain gas also, glory gas also, luck also, clear gas also, Wei Qi also, angry also, Yang Qi also. And the weather, the earth, the popular, is the gas of the three jiao, divided into different words, in fact, one.” The
The Ling Shu, Ying Health Hui: “People receive gas in the grain, the grain into the stomach, to pass in the lungs, the prostitution of gas in the tendons. Food gas in the stomach, turbid gas to the heart, the prostitution of essence in the veins, pulse gas flowing through, the gas returned to the lungs, the lungs towards the hundred veins, the transmission of essence in the skin and hair. Hair veins together with the essence, traveling qi in the House, the House of the spirit of light, stay in the four Tibetan, qi returned to the power and balance.” “Drinking into the stomach, overflowing essence, upward transmission in the spleen. Spleen Qi disperses essence and returns to the lungs. The water channels are regulated and transferred down to the bladder. Water essence is distributed in all directions, and the five meridians are parallel.” The process of qi, blood, fluid and fluid produced by the true qi in the process of running and changing is called “qihua”. Due to historical limitations, the ancients could not detect metabolic diseases such as “gout” through tests for uric acid, blood sugar and blood lipids, and could only diagnose and treat them through clinical symptoms and the evolution of the disease. Qi chemistry is the most basic life activity of the body, which is in line with the concept of “metabolism” in modern medicine. The dysfunction of qi-chemistry includes the deficiency of real qi and the dysfunction of qi-mechanism. The qi movement of human organs is to rise and fall, which maintains the balance between the body and the external environment and the internal organs of the body. “Gout” is a type of metabolic disease formed by qi-chemistry dysfunction. The theory of qi chemistry is the basis for the treatment of metabolic diseases such as “gout”. 2. The malfunction of qi-transformation of the spleen and stomach is the pivotal mechanism for the formation and evolution of “gout”. The spleen and stomach are the pivot of qi flow, transporting up and down and maintaining the qi flow function of “clear yang out of the upper orifice and turbid yin going to the lower orifice”. If the spleen and stomach are injured, the transmission mechanism is unfavorable, and the clear yang does not rise, the turbid yin does not descend, and the clear and turbid interfere with each other, resulting in “gout” with symptoms such as tiredness, nausea and dullness, or even abdominal distension and vomiting. “Gout” is related to the congenital deficiency of true qi and the acquired loss of spleen health. It is also caused by the thick taste of wine and cream, which generates dampness and phlegm, and internal damp heat, which is injected into the flesh and joints and flows into the internal organs. The “spleen and stomach theory” said: “diet times, the spleen and stomach gas is injured, and the vital energy is not full, and all the diseases of the birth.” The “Su Wen Qi disease theory” cloud: “There is a disease mouth sweet, the disease name what? …… named spleen (disease). The spleen is the source of the essence of the spleen, and the fluid is in the spleen, so it makes the mouth sweet. This is the fat and beauty of the hair also. This person must be vegetarian sweet and more fat. Fat people make internal heat, sweet people make full, so its gas overflow, turning into thirst.” It is clearly proposed that uncontrolled diet and obesity can easily develop into spleen disease and turn into thirst, which coincides with the modern medical term “gout” combined with diabetes. It is reported that obesity, gout and diabetes are called the “triad”. The spleen and stomach are the basis of the latter, the root of qi transformation, the source of qi and blood biochemistry. If the spleen and stomach are healthy, they can transform qi and blood, fill the five organs, strengthen the muscles and fatten the couples. If the spleen is not healthy, the source of qi and blood will be lacking, the body will be weak and the organs will lose nourishment. The spleen resides in the middle jiao and transports water and dampness. If the spleen is not healthy, water and dampness will stay and develop into phlegm and dampness edema. “All dampness, swelling and fullness belong to the spleen. The kidney is the origin of the congenital, and the spleen is the origin of the acquired. The lack of congenital true qi and the weakness of the spleen and stomach affect each other, and as the disease progresses, the spleen and kidney become exhausted, and there is no power of qi-transformation, and “gout” combined with hyperlipidemia, diabetes and other variants appear. Dampness, phlegm and stagnation are produced as a result of dysregulation of the qi-transformation function of the spleen and stomach and obstruction of qi flow. On the basis of the deficiency of true qi, the clinical manifestations and many variants of “gout” are formed with spleen weakness and kidney deficiency as the basis and dampness, phlegm and silt as the symptoms. 3.Treat “gout” by nourishing true qi, strengthening the spleen, resolving dampness, eliminating phlegm and silt, and harmonizing the five organs. The pathogenesis of “gout” is deficiency of true qi, malfunction of transportation and transformation, and deregulation of qi-transformation. The treatment of “gout” should be combined with clinical typing and variation of evidence. According to its clinical manifestations and modern detection methods, “gout” is divided into hyperuricemia and variant evidence of “gout” (gouty nephropathy, uric acid kidney stones, hyperlipidemia, diabetes mellitus, etc.), and part of hyperuricemia may have no clinical symptoms but only elevated blood uric acid. In some cases of hyperuricemia, there may be no clinical symptoms but only elevated blood uric acid, which can be identified as kidney deficiency, spleen weakness and dampness within the body. In case of hyperuricemia with gouty arthritis, the treatment should be based on the different types of dampness, cold, heat and phlegm. Under the guidance of the principle of replenishing true qi and regulating the spleen and stomach, the damp-heat type (②) uses “Si Miao San” with added flavor, and the cold-damp closed-loop type uses “Job’s Tears Soup” with “Wu Tou Tang” with addition and reduction. For the type of phlegm and silt interlocking, use “Eliminate Phlegm Tang” combined with “Tao Hong Si Wu Tang” plus or minus. For the variation of gout (gouty nephropathy, uric acid kidney stones, hyperlipidemia, diabetes mellitus, etc.), use the medicine according to the clinical symptoms combined with the degree of deficiency of spleen, kidney and liver, and add and subtract according to the symptoms. Gout is based on weakness of the spleen and kidney, and dampness, phlegm and stagnation are the symptoms. The first treatment is to cultivate the true qi, regulate the qi flow, strengthen the spleen, resolve dampness, and remove phlegm and silt. The clinical manifestations of “gout” are often complex, so we should identify the main and secondary aspects, match the medicine with the evidence, focus on the normalization of the qi function, and remove the slug.