In conventional medicine, gout is a disease caused by prolonged purine metabolic disturbance, clinically characterized by hyperuricemia, repeated attack of acute arthritis, gouty tophus sedimentation, chronic arthritis with deformity of joints, pathogenic change of renal parenchyma and formation of the tophus.
The disease is grouped into two categories by different causes of increased uric acid in the blood, i. e., primary and secondary. Primary gout is caused by congenital purine metabolic disturbance, and secondary gout is caused by hyperuricemia due to increased uricopoiesis or hy- poeccrisia of uric acid, which is induced by other diseases or drugs.The disease may occur in people of any age, mainly between 30-40. Among the patients, 95% are male and usually have a family history of gout.
In natural health, because gout is clinically manifested as recurrence of redness, swelling, a burning sensation, pain, and limited flexibility of joints, as for the pathogenesis, this disease is externally caused by blockage of the jingluo following invasion of the body by exogenous pathogenic wind, cold and damp heat; and internally caused by deficient energy, overstrain, or exposure to wind while sweating and the weakened energy failing to protect the body from the exogenous pathogenic factors, giving rise to blockage of jingluo and stasis of energy flow. In a prolonged case, there may appear blood blockage and phlegm toxin, the problems will go into organic level, and it is more difficult to deal with.
Essentials for Diagnosis
- At the initial stage, it is symptomless, with only increased uric acid in the blood. In the acute phase, its typical manifestation is a sudden onset of arthralgia, and in most cases would suddenly be woken up by sharp arthralgia when sleeping. The affected parts are mostly the first metatarsophalangeal joint or other metatarsophalangeal joints with localized redness, swelling, a burning sensation, pain, and limited flexibility. When the greater joint is involved. There may be some exudate. In addition, such symptoms as chills, fatigue, poor appetite, and headache may appear. However, the symptoms mentioned above would be relieved in 1-2 weeks.
- At the chronic stage, there may be gouty tophus, deformity and rigidity of joints, and renal lesions.
- Laboratory examination shows uric acid in the blood increases to over 420 pmol/L. In a roentgenogram, a round or irregular transparent defective area be found in the bone substance of the joint adjacent to the osteochondral edge, which is characteristic of gout in X-ray examination.
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Syndrome Differentiation and Treatment
The pathological factors of this disease are chiefly dampness, phlegm and blood blockage therefore dispelling dampness, removing phlegm and e blood blockage are the basic treatment principles. However, dampness is classified into cold dampness and damp heat and different treatments should be adopted according to syndrome differentiation. At the later stage, the body fire energy is consumed too much and will be in low level, so, it is advisable to eliminate pathogenic factors and replenish the body fire energy as well.
Obstruction of hot dampness toxin in jingluo
- Chief Manifestations: Redness, swelling, a burning sensation and pain of the joints which is alleviated by cold, tenderness, or fever, constipation, dark yellow urine, yellow and greasy tongue coating.
- Therapeutic Methods: To clear away heat, dispell dampness, and remove obstruction in the collaterals.
Invasion of the collaterals by cold dampness toxin
- Chief Manifestations: Rigidity and deformity of the joints, limited flexibility, darkish red skin, aversion to cold and cold limbs, darkish tongue with ecchymosis, thin and white tongue coating.
- Therapeutic Methods: To warm jingluo, eliminate cold, remove dampness and activate the collaterals
Phlegm and Blood Blockage
- Chief Manifestations: Subcutaneuous nodules which are normal-colored, tenderless or ruptured, darkish tongue with occasional ecchymosis, thin and white tongue coating.
- Therapeutic Methods: To remove phlegm toxin, break blood blockage to improve the circulation.
Hot Dampness Toxin in KB(Kidney & Bladder)
- Chief Manifestations: Sandy stones in the urine, dripping urination, frequent urination, urgent urination, painful urination and colicky pain of the lower back and abdmen, even hematuria, red tongue with yellow coating.
- Therapeutic Methods: To clear hot dampness toxin in KB system, resolve stones is the key treatment rule in natural health way.
KB(Kidney & Bladder System) Fire Energy Low
- Chief Manifestations: Short breath, weakness, low appetite, nausea, bloated stomach, watery diarrhea, lower back and knee sore pain, aversion to cold, cold limbs, edema of the face and lower limbs, pale face, pale swollen tongue with white and thin tongue coating.
- Therapeutic Methods: To replenish KB fire energy is the key treatment rule while combining with the formula that could improve circulation.
Dietary guidance for patients with gout and hyperuricemia
General principle
Based on the principle of individualization, reasonable eating habits and a good lifestyle should be established, high-purine animal foods should be limited to control the energy supply ratio of energy and nutrients, maintain a healthy weight, cooperate with regular uric acid-lowering drug treatment, and conduct regular monitoring and follow-up.
Table A.1 Purine content of common animal foods
| Food Name | Purine content(mg/kg) | Food Name | Purine content(mg/kg) |
| Duck Liver | 3979 | River Crab | 1470 |
| Goose Liver | 3769 | Pork (Rump Tip) | 1378.4 |
| Chicken Liver | 3170 | Grass Carp | 1344.4 |
| Pork Liver | 2752.1 | Beef Jerky | 1274 |
| Beef Liver | 2506 | Yellow Croaker | 1242.6 |
| Lamb Liver | 2278 | Donkey Meat | 1174 |
| Chicken Breast | 2079.7 | Mutton | 1090.9 |
| Scallop | 1934.4 | Lean Beef | 1047 |
| Shrimp | 1874 | Pork Floss | 762.5 |
Table A.2 Purine content of common plant foods
| Food Name | Purine content(mg/kg) | Food Name | Purine content(mg/kg) |
| Dried Laver | 4153.4 | Soy Milk | 631.7 |
| Soy Bean | 2181.9 | Pumpkin Seeds | 607.6 |
| Green Beans | 1957.8 | Sticky Rice | 503.8 |
| Hazel Mushrooms(Dried） | 1859.7 | Pecans | 404.4 |
| Hericium erinaceus (dried) | 1776.6 | Regular Rice | 346.7 |
| Soy Flouer | 1674.9 | Fragrant Rice | 343.7 |
| Black Fungus(Dried) | 1662.1 | Green Onions | 306.5 |
| Yuba | 1598.7 | Kidney Bean | 232.5 |
| Bean Curd | 1572.8 | Millet | 200.6 |
| Red Bean | 1564.5 | Sweet Potato | 186.2 |
| Red KIdney Beans | 1263.7 | Carrot | 132.3 |
| Lactone Tofu | 1001.1 | Pineapple | 114.8 |
| Peanut | 854.8 | White Radish | 109.8 |
| Cashew | 713.4 | Cassava | 104.5 |
| Tofu Cubes | 686.3 | Grape Fruit | 83.7 |
| Water Tofu | 675.7 | Tangerine | 41.3 |
Foods that patients with hyperuricemia should not eat
Patients with hyperuricemia should avoid eating animal offal such as liver and kidney, shellfish, oysters and lobsters and other shellfish, as well as thick broth and gravy.Alcoholic beverages should also be contraindicated in patients with acute gout attacks, poor drug control, or chronic tophi arthritis.
- Animal foods with high purine content, such as beef, lamb, pork, etc.
- Fish food.
- Foods containing more fructose and sucrose.
- Alcoholic beverages of all kinds, especially beer and distilled spirits (liquor). The overall alcohol consumption should not exceed 2 alcohol units/day for men and 1 alcohol unit/day for women (1 alcohol unit is about 14g of pure alcohol). One alcohol unit is equivalent to 145mL of ABV12% red wine, 497mL of ABV3.5% beer or 43mL of ABV40% distilled spirits.
- Skimmed or low-fat milk and its products, 300 ml per day.
- Eggs, one egg per day.
- A sufficient amount of fresh vegetables should reach 500g or more per day.
- Encourage the intake of low GI cereals.
- Drink plenty of water (including tea and coffee, etc.), at least 2000 ml per day.
Weight management
Patients who are overweight or obese should lose weight slowly to achieve and maintain a normal weight.
Eating habits
Establish good eating habits. Eat regularly and quantitatively or eat small and frequent meals, and do not overeat or eat a lot of meat in one meal. Use less harsh seasonings. Seafood, meat, and high-purine plant foods can reduce the amount of purines after cooking and discarding the soup.
Recommended intake of energy and nutrients for patients with hyperuricemia
- Energy
Energy intake to achieve and maintain a normal body weight as the standard. Energy requirements should be estimated based on patient sex, age, height, weight, and physical activity. In the case of light physical activity (such as working in a sitting position), people with normal weight are given 25kcal/kg-30kcal/kg of energy per day, those who are underweight are given 35kcal/kg of energy per day, and those who are overweight/obese are given 20kcal/kg per day ～25kcal/kg energy; in the case of moderate physical activity level (such as electrician installation), normal weight people are given 30kcal/kg～35kcal/kg daily energy, underweight people are given 40kcal/kg daily energy, overweight/obese people Give 30kcal/kg energy per day; in the case of heavy physical activity (such as porters), normal weight people give 40kcal/kg daily energy, underweight people give 45kcal/kg～50kcal/kg daily energy, overweight/ Obese people are given 35kcal/kg of energy per day.
The body mass index (BMI) was used to determine the weight status. The standard was: BMl<18.5kg/m2 was underweight, 18.52 was normal weight, 24.02 was overweight, and BMI>28.0kg/m2 was obesity. - Carbohydrate
The energy provided by carbohydrates accounts for 50% to 60% of the total energy. Added sugar intake should be limited. Choose low GI foods. Encourage whole grain foods to account for more than 30% of the daily staple food. The daily dietary fiber intake should reach 25g-30g. - Protein
The dietary intake of protein is 1g/kg/d, and the energy provided accounts for 10% to 20% of the total energy. Food sources recommend dairy products and eggs. - Fat
The energy provided by fat accounts for 20% to 30% of the total energy throughout the day. People with obesity or metabolic syndrome should strictly limit their daily fat intake to no more than 25% of their total daily energy, and saturated fatty acids to no more than 10% of their total daily energy. For those with elevated plasma low-density lipoprotein cholesterol (>2.59mmol/L), the intake of saturated fatty acids should be less than 7% of the total energy. Trans fatty acids should be less than 1% of total energy throughout the day. The daily intake of linoleic acid and α-linolenic acid should account for 5% to 8% and 1% to 2% of the total daily energy respectively. The daily intake of monounsaturated fatty acids should account for 10% to 15% of the total energy.
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