Gout is a group of disorders of purine metabolism in which congenital or acquired defects in the activity of enzymes involved in purine metabolism lead to excessive production of uric acid, too little uric acid excretion, or both, causing plasma urate concentrations to exceed the saturation limit. Usually, hyperuricemia is defined as greater than 420umol/L.
TCM etiology.
The ancient doctors believe that, due to the weakness of the body, the external guard is not solid, and then feel the external evil, internal and external due to the wind, cold, dampness and heat stay in the meridians and joints, and the lust resides in the veins, the evil entangled for a long time, blood stagnation into stasis, deep into the bones and now paralysis, if the paralysis is further developed, the disease evil depressed for a long time into heat or the disease evil from the shallow into the deep, from the meridians and into the internal organs then produce the corresponding internal organs lesions. If the disease is further developed, if the disease becomes heat and depressed for a long time, or if the disease is superficial and deep, and if it enters the internal organs from the meridians, then the corresponding internal lesions will occur.
Clinical manifestations.
1, asymptomatic hyperuricemia: many hyperuricemia can last a lifetime without symptoms, called asymptomatic hyperuricemia.
2. Acute gouty arthritis: It is the most common first symptom of primary gout, which usually occurs in the joints of the lower limbs, with an acute onset and obvious redness, swelling and heat pain in the joints and surrounding soft tissues. More than half of the patients have the first attack on the foot and thumb, while the ankle, knee, finger and wrist and elbow joints are the preferred sites. It may last for several days or weeks and may resolve spontaneously.
3, gout stone and chronic arthritis: increased uric acid deposition in the joints, inflammation repeatedly into the chronic stage and can not completely disappear, causing joint bone erosion defects and surrounding tissue fibrosis, so that the joint stiffness deformity, restricted movement. Uric acid crystals can be deposited in the tendons, tendon sheaths and skin connective tissue near the joints, forming yellowish-white, bulging redundancies of various sizes, which are called gout nodules, often occurring in articular cartilage, bursa, olecranon, tendon sheath, kidney interstitium, etc.
4, renal lesions.
(1) Gouty nephropathy: mild renal area soreness, early appearance of hematuria proteinuria, then increased nocturia, low specific gravity of urine and other phenomena, and finally the development of uremia from chronic azotemia.
(2) Acute uric acid nephropathy: symptoms of renal failure due to extensive obstruction of the tubular lumen by a large number of uric acid crystals, resulting in urinary flow obstruction.
(3) Urinary tract stones.
Laboratory and other tests.
1.Serum urate measurement: usually greater than 420umol/L is defined as hyperuricemia
2, urine uric acid measurement: normal diet 24-hour uric acid excretion below 3.6 mmol/L
3.Bursal fluid examination: in the acute stage, such as ankle, knee and other large joint swelling, bursal fluid can be extracted for rotating light microscopy, and the needle-shaped sodium urate crystals with double refraction can be seen in the white blood cells have diagnostic significance
4.X-ray examination: there may be bone changes after repeated attacks
5.Special examination of gout stone: biopsy of gout stone can be performed.
Diagnosis and differential diagnosis.
Diagnosis: middle-aged men or above, sudden onset of single joint redness, swelling and hot pain in toes, ankles and knees, with or without increased blood urate, should consider the possibility of gout; if colchicine treatment is effective, the diagnosis of gout can be made; if urate crystals are found in bursal fluid examination, the diagnosis can be established.
Treatment.
Western medical treatment.
1, dietary control: reasonable control of caloric intake, protein 0.8 ~ 1g/kg body weight per day, avoid fried food, avoid high purine food, such as animal offal, sardines, anchovies, seafood, beer, thick soup, high soup in hot pot, etc.
2.Treatment during acute attack.
(1) Colchicine.
(2) Non-steroidal anti-inflammatory drugs such as fentanyl, fotarine, etc.
(3) prednisone.
3.Interstitial and chronic treatment.
Lowering blood uric acid drugs: allopurinol, benzbromarone, etc.
4. Neutralizing uric acid: oral baking soda tablets or intravenous sodium bicarbonate.
Chinese medicine treatment.
In the acute stage, the disease is characterized by heat paralysis: rapid onset, painful joints, localized redness, swelling, burning, untouchable pain, unfavorable flexion and extension, slightly relieved by cold, mostly fever, bad wind, excessive sweating, vexation and thirst, red tongue, yellow coating, smooth pulse. Bai Hu Gui Zhi Tang combined with Xuan Paralysis Tang plus reduction.
In the later stage, most of the symptoms belong to Qi and Blood deficiency paralysis: repeatedly untreated, joint pain, sometimes light and sometimes heavy, no color, palpitation and sweating, dizziness and weakness, pale tongue, thin white fur, moist pulse. Benefiting Qi and invigorating Blood, tonifying the Liver and Kidney. Add reduction to Douwuxiaosheng Tang.
In the acute stage with marked redness, swelling and heat pain, topical golden ointment can be applied.
Prognosis.
The prognosis is fair with dietary control, regular blood uric acid checks and active treatment.
TCM modifications.
First of all, control the diet, avoid high purine food intake, eat more vegetarian food, drink more water and do not drink alcohol. Special attention should be paid to the prevention and treatment of gout by not taking painkillers for a long period of time. Gout stones blocked in the joints for a long time will lead to joint deformation and loss of function in the later stage, and gout stones obstructed in the kidneys will lead to pelvic effusion and affect kidney function, which needs active treatment.