Zhou Lamei’s Experience in Treating Gout

Xueni LIN, Lamei ZHOU, Lu JIA

Department of Rheumatology, Wuxi Hospital of Traditional Chinese Medicine, Wuxi 214000, China

Abstract Chief physician Zhou Lamei performs diagnosis and treatment according to syndrome differentiation, and proposes the method of combining internal treatment with external treatment of traditional Chinese medicine and paying attention to the adjustment of eating habits and lifestyle, which has certain advantages in relieving acute attack, reducing uric acid, reducing gout complications caused by disease development and reducing adverse reactions of western medicine, and is of great significance to the treatment of gout onset and hyperuricemia control.

Key words Gout treatment experience, Internal treatment of traditional Chinese medicine, External treatment of traditional Chinese medicine

1 Introduction

In recent years, the incidence of gout has increased rapidly, and its important basis is hyperuricemia[1-2]. In Asian countries, up to 26.1% of men and 17.1% of women suffer from hyperuricemia[3]. Wuxi is located in the Yangtze River Basin, where people eat more fish and meat. In addition to the modern lifestyle, the incidence of hyperuricemia is higher than the national average. There are about 700 000 hyperuricemia patients, including about 150 000 gout patients.

Gout is often characterized by repeated joint redness and pain, which gradually forms gouty tophus. Long-term attack can cause chronic arthritis, kidney damage and kidney stones. It is an independent risk factor for hypertension, diabetes, hyperlipidemia, coronary heart disease and cerebral infarction[4]. Gout is related to heredity, diet, medicine, exercise and metabolism.

The name of gout originated in Jin and Yuan Dynasties, and "damp phlegm" is an important factor in the study of gout syndrome differentiation and tongue manifestation. Damp-heat accumulation, phlegm turbidity block, blood stasis and heat block, liver and kidney yin deficiency and spleen deficiency and damp obstruction are five common syndromes of gout[5]. The proportion of those with phlegm-dampness and damp-heat in primary gout is higher than that of healthy people. Rheumatology has certain advantages in the treatment of gout and hyperuricemia with traditional Chinese medicine. Chief physician Zhou Lamei has certain experience in the treatment of gout and hyperuricemia, which is summarized as follows.

2 Treatment of gout and hyperuricemia with traditional Chinese medicine

2.1 Internal treatment of traditional Chinese medicine

2.1.1Oral administration of traditional Chinese medicine. Oral administration of traditional Chinese medicine requires individualization according to syndrome differentiation, and if the patient’s joint redness and pain are acute, it is judged to be in the acute stage of gout according to the red tongue with yellow and greasy fur and the rapid and slippery pulses. It is damp-heat syndrome based on syndrome differentiation of traditional Chinese medicine, and Xuanbi Decoction inTreatiseonDifferentiationandTreatmentofEpidemicFebrileDiseasecan be used for clearing heat and eliminating dampness, dispersing arthralgia and dredging collaterals.Forsythiasuspensa,Gardeniajasminoides,LysimachiachristinaeHance andPolygonumcuspidatumcan be used to clear away heat and toxic materials and promote diuresis;Coixseed andAtractylodeslanceacan be used to strengthen spleen and promote diuresis;Radixstephaniaetetrandraecan induce diuresis to alleviate edema;Pinelliaternatacan eliminate dampness and remove phlegm. Additionally,Herbasarcandraecan relieve swelling and pain;CynanchumpaniculatumBunge can eliminate dampness and relieve pain;Radixgentianaemacrophyllaecan eliminate wind and dampness and stop arthralgia. If the patient has no symptoms of acute attack of joint redness and pain, it is judged to be in the intermittent gout period or hyperuricemia period according to the light red tongue with white greasy fur and wiry and rapid pulse. It is mainly based on Bixie Shenshi Decoction inExperienceGainedinTreatingExternalDiseases, andSevenlobedyamrhizome,Coixseed,Phellodendronamurense,Alismaorientalis,Smilaxglabra, and Cortex Fraxini are mainly used to clear heat, promote diuresis and discharge turbidity. Modern pharmacology studies have found thatS.glabra,CortexFraxini, and Sevenlobed Yam Rhizome have uric acid-reducing effects.

2.1.2Gout tea prescription. Gout tea prescription is composed ofL.christinaeHance, Sevenlobed Yam Rhizome, cassia twig, Cortex Fraxini,etc.It is mainly used as a long-term tea substitute for middle-aged and elderly patients with hyperuricemia or gout intermission. It can reduce gout attack and western medicine dosage by clearing heat, invigorating spleen, promoting diuresis and reducing uric acid.

2.1.3Gout granules. Gout granules, composed ofL.christinaeHance,P.cuspidatum,C.paniculatumand turmeric, are taken after mixing them with water, and used for clearing away heat and toxic materials, promoting blood circulation and relieving pain during acute attack of gout joint swelling and pain. Or Sevenlobed Yam Rhizome, Cortex Fraxini,S.glabra,P.cuspidatum, Pseudobulb of Appendiculate Cremastra,etc.form granules which can be used for gout intermission or uric acid reduction treatment, especially for young gout patients who face difficulties in decocting and making tea.

2.1.4Gout turbidity and blood stasis prescription. Gout turbidity and blood stasis prescription, made by our department, is composed of Pseudobulb of Appendiculate Cremastra, Cortex Fraxini, stigma of corn,etc.Chinese medicine watered pills are taken orally to strengthen spleen and kidney, remove damp and toxin, and are suitable for patients with gout, hyperuricemia and mild creatinine elevation.

2.2 External treatment of traditional Chinese medicine

2.2.1External application of traditional Chinese medicine. Externally applied traditional Chinese medicine for clearing away heat, detumescence and relieving pain is mainly composed of Pseudobulb of Appendiculate Cremastra,P.cuspidatum, rhubarb, borneol,etc.Based on the basic theory of "transdermal absorption", it can quickly relieve the acute symptoms of joint redness and pain of patients. For gout patients with kidney involvement, gastrointestinal intolerance, drug allergy,etc., the use of oral drugs is limited, and external application of traditional Chinese medicine to detoxify and reduce swelling is a better choice.

2.2.2External soaking and washing with traditional Chinese medicine and joint cavity puncture for local treatment. External soaking with traditional Chinese medicines, such as Herba Sarcandrae,C.paniculatum,L.christinaeHance,P.cuspidatum,Sophoraflavescensvar.flavescens,etc., can clear away heat, promote diuresis, detoxify and reduce swelling, and it is suitable for patients with acute attack of joint redness and pain, who can not take oral drugs, injections and apply external plasters. At the same time, it can also be combined with local treatment with articular cavity puncture to achieve rapid pain relief.

2.3 Paying attention to lifestyle and eating habitsIn addition, Director Zhou Lamei pointed out that patients with gout and hyperuricemia should pay attention to lifestyle and eating habits; avoid catching cold and reduce inducing factors; pay attention to exercise methods to avoid severe exercise injury to joints and gout caused by failure to replenish water in time after sweating; reduce smoking and intake of high-sugar drinks, which can increase the risk of gout or hyperuricemia by about 30%; prohibit alcohol, as all kinds of alcoholic drinks such as white wine, red wine, yellow rice wine, medicinal wine and beer can cause hyperuricemia; prohibit all kinds of meat, seafood and soup-stock during the attack period; eat less fruits with high fructose content such as apples, lychees, persimmons and longans; eat beans and bean products such as bean curd, tofu and soybean milk in small quantities. The daily diet is mainly based on milk, eggs, vegetables and fruits with low fructose content, such as grapes, strawberries, cherries and plums.

3 Conclusion

Director Zhou Lamei believes that modern medicine has made great progress in treating gout, mainly with non-steroidal drugs, hormones, colchicine for anti-inflammatory and analgesic treatment and uric acid reduction. Western medicine treatment is still limited to some extent[6-7]due to patients’ recurrent attacks, long-term medication, adverse reactions and compliance[6-7]. Chief physician Zhou Lamei performs diagnosis and treatment according to syndrome differentiation, and purposes the method of combining internal treatment with external treatment of traditional Chinese medicine and paying attention to the adjustment of eating habits and lifestyle, which has certain advantages in relieving acute attack, reducing uric acid, reducing gout complications caused by disease development and reducing adverse reactions of western medicine, and is of great significance to the treatment of gout onset and hyperuricemia control.