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Gout is a disease caused by abnormal uric acid metabolism in the body, leading to the deposition of monosodium urate crystals in the joints, which triggers intense pain and inflammation. Its typical symptoms are sudden joint redness, swelling, heat, and pain, often occurring at the base of the big toe (medial aspect of the first metatarsophalangeal joint), ankles, knees, and other areas. Acute attacks frequently happen at night or in the early morning, and the pain level is often described as "so severe that even the wind blowing past feels painful".

• With changes in dietary habits, the prevalence of gout is rising globally, making it one of the most common inflammatory arthritides.
• Male patients significantly outnumber female patients, especially middle-aged and elderly men between 40 and 60 years old. The risk for women increases mostly after menopause.
• In Taiwan, due to refined diets and obesity issues, the proportion of gout patients is also increasing year by year. It is no longer the "Disease of Kings" of the past but a common lifestyle-related disease.

The severity of symptoms is not entirely positively correlated with blood uric acid concentration; it is also related to individual constitution and the local joint environment.

If gout recurs frequently and is poorly controlled, it may lead to the formation of tophi, joint deformity, increased burden on the kidneys, and cause kidney stones or renal impairment.

Discoveries of Modern Medicine

Gout is primarily due to abnormal "purine" metabolism in the body, leading to either excessive uric acid production or insufficient excretion, resulting in high blood uric acid levels and the formation of monosodium urate crystals deposited in the joints, soft tissues, and kidneys.

Common pathogenic factors are as follows:

• Dietary factors: Long-term consumption of high-purine foods such as red meat, organ meats, seafood (especially shellfish, sardines), as well as heavy intake of sugary drinks and alcohol (particularly beer and spirits).
• Genetic predisposition: Individuals with a family history of gout have a significantly higher risk of developing the disease.
• Obesity and Metabolic Syndrome: Obese individuals have faster purine metabolism, and insulin resistance can inhibit uric acid excretion, greatly increasing the risk of gout.
• Renal insufficiency: The kidneys are the main organs for excreting uric acid; decreased function directly leads to uric acid accumulation.
• Medication effects: Certain diuretics, anti-tuberculosis drugs, or low-dose aspirin may affect uric acid excretion.
• Other diseases: Conditions such as hypertension, diabetes, and psoriasis are often comorbid with gout.

The common sites for gout attacks are mainly related to the following factors:

• Lower temperature: The temperature at the extremities is usually lower. The solubility of uric acid decreases with temperature, making crystallization easier.
• Slower blood circulation: The feet are the farthest from the heart, with relatively slower blood circulation, making it easier for urate to deposit there.
• High physical stress: When walking or running, the joints of the legs and feet endure significant pressure and friction, prone to minor injuries, exposing active surfaces for urate crystal formation, or precipitating more urate crystals from body fluids. This can trigger a fierce attack by the immune system, causing acute inflammation.

Modern Medical Treatment

For acute gout attacks, the following measures are usually effective in providing relief:

• Anti-inflammatory and pain-relief medications: Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), colchicine, or corticosteroids to quickly control joint inflammation and pain.
• Local ice application: Can help vasoconstriction, reducing swelling and pain.
• Elevating the affected limb and rest: Reduces joint activity and load, promoting recovery.

For the chronic phase and treatment of hyperuricemia, the goal is to prevent recurrence:

• Urate-lowering therapy (ULT): Can be broadly divided into drugs that inhibit uric acid production and those that promote uric acid excretion. Long-term use is required to control uric acid levels within the target range.
• Lifestyle modifications: Weight control, regular exercise, adequate fluid intake.

These medications primarily control uric acid levels and acute symptoms, but potential side effects must be noted, and uric acid levels can easily rebound after discontinuation.

If the above methods are ineffective, or when dealing with comorbid issues:

• Tophus removal surgery: For patients with large tophi causing joint deformity, loss of function, or recurrent ulceration and infection.
• For refractory gout, comorbidities need to be assessed and medication strategies adjusted.

The Systemic View of Traditional Chinese Medicine (TCM)

Although the name "gout" did not exist in ancient TCM, based on its symptomatic characteristics, it can be categorized under Impediment Pattern, Joint-Wind, or White Tiger's Joint-Wind, implying pain so severe it feels like a tiger's bite, moving between the joints.

As part of the name of a disease, "wind" first indicates the "migratory nature" of the condition, describing pain that comes and goes quickly, like a gust of wind. Second, "wind" refers to external pathogenic factors such as "wind, cold, and dampness," which act as triggering factors. For example, when there is a sudden change in climate or temperature, or when the affected area is exposed to cold, uric acid crystals in the affected area suddenly increase, triggering pain.

TCM believes the key to this disease lies in "Root Deficiency and Branch Excess". Congenital insufficiency or acquired dietary irregularities damage the spleen and stomach functions, leading to impaired transportation and transformation, resulting in internal dampness turbidity. Persistent dampness turbidity congeals into phlegm, which flows into the channels and joints. If external pathogens like wind, cold, dampness, or heat are encountered, this causes qi and blood stagnation, leading to pain due to obstruction. Clinically, TCM formulates treatment plans by differentiating the specific "pattern". The following are several common patterns:

• Damp-Heat Obstructing the Collaterals: This is the most common pattern in the acute stage. Caused by overconsumption of rich, sweet, and fatty foods, generating damp-heat that flows into the joints. Symptoms include red, swollen, hot, and painful joints with severe pain, local burning sensation, possibly accompanied by fever, bitter taste in the mouth, and dark yellow urine. Treatment focuses on clearing heat, dispelling dampness, unblocking collaterals, and relieving pain.
• Static Blood Obstructing the Collaterals: Recurrent gout attacks lead to chronic disease entering the collaterals, causing qi and blood stasis. Symptoms include intense joint pain fixed in location, worse at night, with purplish-dark joint skin or swollen, deformed joints. Treatment focuses on activating blood, resolving stasis, transforming phlegm, and unblocking collaterals.
• Phlegm-Turbidity Obstructing the Collaterals: Spleen deficiency leading to impaired transportation, causing water-dampness to congeal into phlegm, which flows into the joints. Symptoms include joint swelling, soreness, numbness, local skin not red, possibly palpable subcutaneous nodules (tophi). Treatment focuses on fortifying the spleen to transform phlegm, resolving turbidity and stasis to unblock collaterals.
• Liver and Kidney Yin Deficiency: Chronic illness consumes yin and blood, leading to liver and kidney insufficiency, failing to nourish tendons and bones. Symptoms include lingering soreness and weakness in the joints after pain subsides, soreness and weakness in the lower back and knees, dizziness, and tinnitus. Treatment focuses on nourishing and supplementing the liver and kidneys, strengthening tendons and bones.
• Spleen and Kidney Yang Deficiency: Yang qi deficiency fails to warm the limbs, leading to internal cold-dampness retention. Symptoms include cold pain in the joints, swelling without redness, cold intolerance with cold limbs, worsening with exposure to cold. Treatment focuses on warming and supplementing the spleen and kidneys, dispersing cold and eliminating dampness.

Clinically, these patterns often coexist. For example, the acute phase often manifests with "Damp-Heat" as the branch, while the remission phase reveals the root of "Spleen and Kidney Deficiency" or "intermingled Phlegm and Stasis".

Acupuncture Treatment

Acupuncture is one of the characteristic therapies in TCM for treating gout. Its core concept is to "unblock the channels and collaterals, regulate qi and blood, clear heat and drain dampness, reduce swelling and relieve pain". TCM believes that joints are places where channel qi and blood converge; pathological products like damp-heat, phlegm, and stasis obstructing the channels are key to causing pain.

During treatment, the TCM practitioner will select corresponding acupoints for stimulation based on the patient's pattern and the location of the attack. In addition to selecting points around the local red, swollen, hot, and painful joint (avoiding the center of acute inflammation), distal points along the channels are often used, such as:

• Zusanli (ST36, leg), Yinlingquan (SP9, leg): These two points are key points for fortifying the spleen and dispelling dampness, fundamentally promoting water-dampness metabolism.
• Sanyinjiao (SP6, leg): Belongs to the Spleen Channel of the Foot-Taiyin, is the confluence point of the Liver, Spleen, and Kidney channels, able to regulate these three organs simultaneously and promote metabolism.
• Ashi Point (pain point): Needling at the most tender point around the joint can reach the diseased area directly and unblock local qi and blood.

Through the combination of distal and local points, acupuncture can effectively regulate the functions of the zang-fu organs, promote circulation, accelerate uric acid metabolism and the absorption of inflammatory substances, thereby relieving pain and swelling.

Besides traditional body acupuncture, the following methods are also commonly used in clinical practice:

• Pricking and Bloodletting: For acute attacks of the "Damp-Heat Obstructing the Collaterals" pattern, a small amount of blood can be let out by pricking around the most swollen and red joint with a bloodletting needle. This directly drains heat toxins and stasis from the collaterals, quickly achieving the effects of clearing heat, reducing swelling, resolving stasis, and relieving pain.
• Electroacupuncture: After needle insertion, connecting an electroacupuncture device provides continuous and stable stimulation, enhancing the analgesic and unblocking effects, especially suitable for chronic pain.

Acupuncture treatment can quickly relieve pain in acute gout and helps improve joint function and prevent recurrence in the chronic phase, serving as an adjunct therapy for constitutional adjustment.

TCM External Therapies

In clinical practice, patients with acute gout attacks often present with severe joint redness, swelling, heat, and pain, or joint enlargement and deformity due to chronic tophi deposition. In such cases, besides internal medication, TCM external therapies can act directly on the local area, providing another treatment pathway.

TCM external therapies involve applying medicinal ingredients with effects like clearing heat and detoxifying, reducing swelling and pain, and activating blood and resolving stasis, prepared into paste, powder, or wash formulations, directly applied to the affected area. This addresses the branch in acute situations. It is primarily targeted at patients with acute attacks suffering unbearable pain or local discomfort and swelling from tophi.

Common external medications include Golden Yellow Powder, Four Yellows Powder, etc., primarily composed of heat-clearing herbs like Coptis, Scutellaria, Rhubarb, combined with blood-activating and pain-relieving herbs like Frankincense, Myrrh. Applied to the affected area, the medicinal power penetrates the skin directly to the diseased location, effectively inhibiting local inflammation, promoting blood circulation, and reducing swelling and pain.

However, these external therapies primarily address the local "branch" symptoms. They do not resolve the root problem of internal generation of damp-heat and phlegm-turbidity and dysfunction of the zang-fu organs. They need to be combined with internal Chinese herbal medicine, acupuncture, and other treatments to address both the internal and external aspects, achieving long-term stability and improvement.

Acupressure

Massage the following acupoints for 3-5 minutes each time, until a sore, numb, or distended sensation is felt. This helps clear and drain damp-heat, unblock collaterals, and relieve pain, serving as daily health maintenance.

• Yinlingquan (SP9): On the inner side of the lower leg, in the depression posterior and inferior to the medial condyle of the tibia. He-Sea point of the Spleen Channel of Foot-Taiyin, key point for fortifying the spleen and dispelling dampness.
• Zusanli (ST36): 3 cun below the outer knee eye, one finger-breadth lateral to the tibia. Important strengthening and health-preserving point, can fortify the spleen and harmonize the stomach, drain dampness and reduce swelling.
• Sanyinjiao (SP6): On the inner side of the lower leg, 3 cun above the tip of the medial malleolus, posterior to the medial border of the tibia. Regulates the Liver, Spleen, and Kidney channels, promotes water-fluid metabolism.
• Taichong (LR3): On the dorsum of the foot, in the depression anterior to the junction of the 1st and 2nd metatarsal bones. Yuan-Source point of the Liver Channel of Foot-Jueyin, can soothe the liver and regulate qi, clear and drain damp-heat.
• Gongsun (SP4): On the medial border of the foot, anterior and inferior to the base of the 1st metatarsal bone. Luo-Connecting point of the Spleen Channel of Foot-Taiyin, can fortify the spleen and transform dampness, harmonize the stomach and lower turbidity.

Perform once in the morning and once in the evening. Persistence helps regulate constitution and prevent attacks.

Health Preservation and Wellness

• Dietary Regulation (Top Priority):
  • Strictly control intake of high-purine foods such as animal organs, certain seafood, and concentrated meat broths.
  • Control moderate-purine foods: other seafood (shrimp, crab), red meat (pork, beef, lamb), legumes (soybeans, black beans), asparagus, shiitake mushrooms, seaweed. Daily meat intake is recommended to be limited to about the size of one palm.
  • Avoid alcohol and sugary drinks, especially those high in fructose.
  • Eat plenty of fresh vegetables and low-sugar fruits (e.g., cherries may help lower uric acid).
  • Daily water intake: Body weight (kg) × 40cc (includes soups and other fluids from the diet). 80% of uric acid is excreted through urine; drinking more water helps uric acid excretion.
• Weight Management: Lose weight gradually, avoid rapid weight loss which can increase ketone bodies and inhibit uric acid excretion.
• Regular Exercise: Choose low-impact exercises like swimming, Tai Chi, brisk walking to avoid excessive joint stress and injury.
• Avoid Cold and Keep Warm: Avoid direct exposure of joints (especially the feet) to wind, cold, and dampness to prevent triggering acute attacks.

Summary

TCM views gout as a systemic metabolic disorder, not merely joint inflammation. It is closely related to congenital constitution, acquired dietary habits, and dysfunction of the zang-fu organs (especially the spleen, liver, and kidneys). Treatment starts with clearing and draining damp-heat, transforming phlegm and dispelling stasis to address the branch, and fortifying the spleen, boosting the kidneys, regulating and supplementing the liver and kidneys to secure the root. Through the combination of Chinese herbal medicine, acupuncture, external therapies, and lifestyle adjustments, the aim is to restore the body's metabolic balance, fundamentally reduce uric acid levels and the threshold for arthritis occurrence, achieving long-term effects of reducing attack frequency, preventing complications, and improving quality of life.