April 20 is World Gout Day, which is also the "Gout Awareness Day". When it comes to gout, everyone is familiar with it: first, more and more people are getting sick, and gout has become the second largest metabolic disease in the mainland (second only to diabetes);
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Gout is gradually getting younger and should be taken seriously
There are more and more patients with hyperuricemia in mainland China, and there is a trend of younger people. Many patients have elevated uric acid and no symptoms. Many patients think that "it doesn't hurt anyway, I don't have gout, so I don't need to pay attention to it", but this view is actually very dangerous.
In addition, many people's understanding of gout is still on the surface, only pursuing pain relief, and they do not know that what is more serious than pain is joint destruction, kidney damage, and serious heart and cerebrovascular complications caused by long-term hyperuricemia.
02
Understanding of Chinese and Western medicine for gout
The name of the gout disease in traditional Chinese medicine was first seen in the "Treatise on Gout", which said: "Those who have gout are most likely to boil due to blood heat, and then they either wade in cold water, or stand in wetlands, or fan to cool down, or lie down in the wind." The cold is rubbed outside, the blood is cold, and the filth is condensed, so it hurts."
The records of gout-related symptoms can also be found in the related discussions of "Bi Syndrome", "Beriberi" and "White Tiger Calendar Wind" in traditional Chinese medicine. Some TCM experts believe that gout is a manifestation of "paralysis", and the occurrence of gout is mainly related to factors such as "dampness and heat", "phlegm turbidity" and "qi stagnation".
● Damp heat: Living in a humid environment for a long time, or eating too greasy, can easily lead to the accumulation of damp heat in the body, which blocks the meridians and affects the flow of qi and blood, thus causing gout;
● Phlegm turbidity: The spleen is the source of phlegm, and the lungs are the organ of phlegm. When the spleen is unable to regulate the water and dampness function, and the lungs cannot regulate the water channel to discharge phlegm normally, phlegm and turbidity will accumulate in the body, hindering the flow of qi and blood, and inducing gout;
● Qi stagnation: Poor mood, or sedentary and inactive for a long time will lead to stagnation of qi, poor blood flow, and the formation of gout.
From the perspective of modern medicine, gout refers to gouty arthritis, which is the deposition of uric acid crystals in the joints, which stimulates the formation of aseptic inflammation in the joints, which is manifested as redness, swelling, heat, and pain in the joints. Gouty arthritis is the first and most common occurrence in the first metatarsophalangeal joint, that is, the big toe joint, and as the disease worsens, the lower to the upper foot joint and knee joint will also be affected.
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Other influencing factors of gout
In addition to the factors mentioned in the above TCM theories, there are a number of other factors that may also influence the occurrence and progression of gout:
● Genetic factors: Studies have found that there is a certain genetic predisposition to gout. People with a family history of gout are at relatively high risk;
● Age and gender: Generally speaking, men are more likely to develop gout than women, and middle-aged and elderly people are also more likely to develop the disease. This may be related to changes in male hormones, physiology, and decline in kidney function;
● Lifestyle habits: Staying up late for a long time, drinking alcohol, high-sugar and high-fat diets and other bad lifestyle habits may increase the risk of disease;
● Other diseases: Chronic diseases such as hypertension, diabetes, and hyperlipidemia, as well as cardiovascular diseases such as obesity and heart disease, may increase the risk of gout.
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Uric acid is closely related to gout
Gout is essentially a metabolic disorder, which is directly related to hyperuricemia caused by purine metabolism disorders and decreased uric acid excretion in the body. In traditional Chinese medicine, it is related to the function of the liver, spleen and kidney.
The main movement of the spleen: the spleen is mainly cleared, and the stomach is mainly turbid. Uric acid is one of the "turbidities" in the blood, which requires the spleen and stomach to participate in the digestion and absorption of food and the excretion of residues.
Liver main excretion: promote the operation and distribution of blood and fluid, promote the transportation function of the spleen and stomach and the secretion of bile, all of which are conducive to the excretion of uric acid.
Kidney Yang is the Yang of the Whole Body: Promotes and regulates the gasification of other viscera. If the kidney essence is insufficient, the kidney yang is weak, which can easily cause unfavorable bladder gasification and untimely uric acid excretion.
Therefore, traditional Chinese medicine believes that the regulation of gout and hyperuricemia requires the simultaneous regulation of the liver, spleen and kidney, and timely treatment in metabolism and excretion to avoid accumulation in the body and cause gout attacks.
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Factors that predispose to gout
Many people think that gout is caused by eating. In fact, many people can't solve the problem of gout by relying on diet, and some people are malnourished and have high blood uric acid, and even the hungrier they are, the higher the uric acid.
In fact, diet is only one of the important factors that cause gout, and the direct cause of gout is hyperuricemia, but high uric acid does not necessarily cause gout. Gout is often induced under some conditions, such as: some daily life and eating habits, as well as the taking of certain drugs, are often easy to induce gout.
1. Sudden increase in uric acid
Such as overeating, especially eating high-purine foods such as animal offal, shellfish, hot pot, etc., and drinking a lot of alcohol at the same time.
2. Sudden decrease in uric acid
The most common is the first use of large amounts of uric acid-lowering drugs, when the blood uric acid drops rapidly and the urate crystals dissolve rapidly, which may produce some "microcrystals", thereby inducing gout.
3. Joint trauma Uric acid is easy to be deposited in injured joints.
4. Myolysis after strenuous exercise
5. Joint cold
When the joints are cold, uric acid is more likely to form crystals at low temperatures, inducing gout. Therefore, people with gout must pay attention and try to avoid blowing cold air directly against the air conditioner, especially at night. In particular, it is absolutely forbidden to get cold after drinking. You must be vigilant.
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How does Western medicine treat gout?
The treatment of gout is divided into acute exacerbation and remission, but acid-lowering therapy is the most important.
At present, joint swelling and pain are the most prominent symptoms in the acute attack stage, and the treatment during this period is mainly to quickly relieve pain and relieve symptoms.
1. Colchicine
Colchicine can be said to be a specific drug for the treatment of acute gout attacks. In general, the sooner you take it, the better the results. It is generally recommended to start taking the drug within 24 hours of the onset. Most patients have an effect within 24~48 hours.
Although this medicine has a good effect, it has great toxic side effects and can cause severe diarrhea. Therefore, the initial oral dose is generally 1mg, if there is no relief, you can take 0.5mg orally every 1-2 hours, and the total amount should not exceed 6mg within 24 hours. After remission, adjust to 0.5mg per day, 2-3 times a day, maintain it for a few days, and then discontinue the drug. You must take medicine under the guidance of a doctor.
2. Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs such as voltarin, ibuprofen, etc., which are more irritating to the gastrointestinal tract and may also cause liver and kidney damage. It is recommended to add gastrointestinal mucosal protectors when taking them, and avoid long-term use.
3. Glucocorticoids
Corticosteroids are not used as the first choice for pain relief in gout and are mostly used when colchicine or nonsteroidal anti-inflammatory drugs do not work completely or when drug use is contraindicated.
The remission phase is dominated by acid-lowering therapy. Urate-lowering drugs are usually started 2 weeks after the gout attack has resolved.
Current urate-lowering drugs are divided into two main categories according to their mechanism of action: drugs that reduce uric acid production and drugs that promote uric acid excretion.
(1) Inhibition of uric acid production
1. Allopurinol
It is necessary to pay attention to renal insufficiency, and allopurinol should be used with caution. Since positive HLA-B*5801 gene is a risk factor for adverse reactions with allopurinol, it is recommended that HLA-B*5801 gene testing be performed before treatment if conditions permit. Allopurinol is contraindicated if the result is positive.
2. Febuxostat
It is the drug of choice for gouty nephropathy. Patients with a history of cardiovascular disease or new cardiovascular disease should be used with caution and follow-up monitoring.
(2) Promoting the excretion of uric acid
1. Benbromarone
If you have kidney stones or renal impairment, try not to use it. It is important to note that drinking plenty of water to increase urine output is required during the medication, along with the addition of alkaline drugs such as baking soda.
All of the above drugs need to be taken in small doses, and you must choose a uric acid-lowering drug that is suitable for you under the guidance and evaluation of your doctor.
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TCM diet therapy for gout
Corn silk white grass root tea
Ingredients: 30g of corn whiskers, 30g of fresh white grass roots, 9g of honeysuckle, 3g of gardenia.
Method: Add an appropriate amount of water, soak for 30 minutes, decoction, and drink it as a substitute for tea.
Indications: Suitable for gout-rheumatic fever syndrome.
Orange peel tea
Ingredients: sand kernels 6g, orange peel 3g, ginger 6g, chicory 6g.
Method: Add an appropriate amount of water, soak for 30 minutes, decoction, and drink it as a substitute for tea.
Indications: Suitable for gout and rheumatic turbidity syndrome.
Orange peel raphane tea
Ingredients: orange peel 6g, sulforaphane seed 6g, hawthorn 12g, chicory 10g.
Method: Add an appropriate amount of water, steep for 30 minutes, decoction, and drink in multiple substitutions.
Indications: Suitable for gout and phlegm stasis syndrome.
Note: Use with caution in pregnant women
Winter melon and coix seed tofu soup
Ingredients: 50g tofu, 100g winter melon, 10g coriander, 9g coix seeds.
Method: Wash and cut the winter melon into pieces, cut the tofu into pieces, soak the coix seeds for 1 hour, chop the coriander, set aside, boil the coix seeds for 20 minutes, put in the winter melon and tofu and cook for 10 minutes, add an appropriate amount of salt, and sprinkle with coriander.
Indications: Suitable for gout-rheumatic fever syndrome.
Yam walnut kernel porridge
Ingredients: 50g fresh yam, 6g walnut kernels, 6g gourds, 40g rice, 2g jujubes.
Method: Rinse and soak the seeds for 1 hour, remove the core of the jujube, cut the yam into thin strips, and put it in the pot with the walnut kernels to boil with the rice.
Indications: It is suitable for gout, spleen and kidney deficiency syndrome.
Five-fingered peach desmodium tea
Materials and usage: 20 grams of five-finger peach, 15 grams of desmodium, add an appropriate amount of water to the clay pot, decoction for 30 minutes, and then use it as tea after removing the slag.
Efficacy: Promote qi and dampness, relax muscles and activate the body.
Application: During the remission period of gout, it can increase uric acid excretion, reduce blood uric acid level, and prevent the formation of tophi.
Parasitic sage
Ingredients: 30 grams of mulberry parasitism, 30 grams of powdered sprouts, 30 grams of lily. Usage: Add an appropriate amount of water to the above herbs and put them in a clay pot, decoction for 30 minutes, and then use them as tea after removing the slag. Application: Patients with gout with liver and kidney deficiency are manifested as local joint deformation, tendon and pulse tightness, unfavorable flexion and extension, soreness and weakness of waist and knees, dizziness and tinnitus, pale tongue, thin pulse or thin weakness.
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Traditional Chinese medicine acupressure to strengthen the kidneys and excrete uric acid
1. Taixi Cave
Taixi acupoint is the "Yangtze River" that gathers the vitality of the kidney meridian. Taixi acupoint is the original acupoint of the kidney meridian, so the ancients called Taixi acupoint "one of the nine acupoints of Huiyang", and believed that it has a very high function of returning to Yang and saving adversity. You don't have to stick to the method of massage, you can do it for about 5 minutes each time.
2. Qi Sea Cave
Qi Hai Acupoint is known as the sea of vitality of the human body, and regular massage or moxibustion Qi Hai Acupoint can warm yang and invigorate qi.
The method of massaging this acupoint is: tap this acupoint with your thumb, when you feel a feeling of soreness or a feeling of qi walking up and down in this acupoint, continue to knead and press for 10 minutes, you can massage this acupoint once a day.
3. Yongquan Cave
Yongquan acupoint, the "longevity acupoint" that nourishes the kidney and strengthens the element. Regular massage of Yongquan acupoint can stimulate kidney qi, dredge the meridians of the kidney meridian, reconcile the qi and blood of the kidney, adjust and improve the function of the kidney, so that the kidney essence is sufficient, the ears are bright and the eyes are clear, the energy is full and the walking is powerful.
Place the fingertips of your thumb or index finger on the springs in the center of your feet and rub them back and forth, 100 times a day.
4. Destiny Acupoint
The life-gate point is located in the waist, on the posterior midline, in the depression under the spinous process of the second lumbar vertebra. When acupressure, there is a strong tenderness sensation. It can improve the lack of kidney qi and the decline of energy, and has the effect of consolidating the foundation and cultivating the yuan.
5. Guan Yuan Acupoint
Guan Yuan acupoint, the place where the true yuan is sealed. Guan Yuan is an important acupuncture point for men's health care, which has the functions of tonifying the kidney and strengthening yang, replenishing deficiency and benefiting losses. It is also very simple to find Guan Yuan, on the midline of the human body, measure the distance of four fingers from the navel downward, which is the Guan Yuan acupoint.
During the massage, first take Guan Yuan as the center of the circle, and rub the left or right palm counterclockwise and clockwise for 3-5 minutes. Then, press the Guan Yuan acupoint with your breath for 3 minutes.
In addition to massage, moxibustion can be used on these acupuncture points.
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Gout diet should be avoided
Gout should be eaten as little as possible/not eaten:
1. Avoid eating seafood and offal in the acute stage of gout. These are typical high-purine foods. 2. Alcohol is prohibited, including but not limited to all kinds of alcohol. Beer, liquor, brandy, whiskey, wine, and cider are not suitable. Alcohol promotes endogenous uric acid production. 3. Carbonated drinks and fruit juices are prohibited. Fructose promotes endogenous uric acid production. 4. Do not drink seafood soup or hot pot soup in the acute stage of gout. They are high in purines. 5. Do not eat bacon and pickled products. 6. Chicken essence, monosodium glutamate, oil and salt are used sparingly.
7. Do not eat any food that you are allergic to certain foods or feel unwell after eating.
Gout can be eaten in moderation:
1. Low-purine diet is the mainstay. 2. Vegetables, fruits, eggs, and milk can be eaten. 3. Fish and soy products can be eaten in moderation. Do not eat tofu, fried and marinated snacks.
4. Priority is given to plain water, no juice and no alcohol.
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How to prevent gout recurrence
Once we understand the causes of gout, we can take steps to prevent the recurrence of gout:
● Adjust your eating habits: Avoid high-purine foods (such as organ meats, seafood, red meat, etc.), and eat more vegetables, fruits and low-fat foods. At the same time, maintain adequate water intake to help flush out uric acid from the body.
● Maintain good lifestyle habits: Avoid staying up late, drinking alcohol, and overexertion. Proper physical exercise to enhance physical fitness and improve blood circulation.
● Weight control: Being overweight and obese can increase uric acid production and decrease uric acid excretion, so maintaining a healthy weight is an important measure to prevent gout.
● Regular check-ups: For people with a family history of gout or other high-risk factors, blood uric acid testing and liver and kidney function tests should be done regularly. Once the problem is found, you should seek medical treatment in time.
● TCM treatment and conditioning: TCM advocates adjusting the overall physique, and conditioning the body through traditional Chinese medicine, acupuncture, guidance, cupping and other methods.
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epilogue
Gout is a disease that requires long-term management, and self-management, diet and lifestyle control are quite important. Through some lifestyle modification and management strategies, we can effectively control the condition and prevent the recurrence of gout.
At the same time, we also need to recognize that each person's constitution and condition are unique, so the treatment plan needs to be individualized. Under the guidance of your doctor, finding the most suitable treatment option for you is key. ■
[Source: Amo, Zheng'an Traditional Chinese Medicine, Rheumatism Leap Moon Theory, Guangdong Provincial Hospital of Traditional Chinese Medicine Service Account, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Nanfang +, etc.]