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Management of gout is accomplished by:
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treatment of acute attacks |
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prevention of future attacks |
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lowering serum urate levels |
Very occasionally surgery is employed to remove large or ulcerating z
Treatment of acute attacks of gout is aimed at providing relief of pain. Three groups of drugs are commonly employed: non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids. Treatment should be started as early as possible and aspirin and diuretics should be avoided. The choice of drug for a particular patient will depend on factors such as timing of attacks, other medication being taken and potential risk of side-effects.
NSAIDs
NSAIDs are the drugs most commonly used in patients who present with gout. Their mechanism of action is complex, but they are very effective. Examples of NSAIDs include indomethacin, diclofenac, ketoprofen and naproxen. Pain relief is usually achieved within two to four hours and treatment is continued for seven to 10 days until symptoms subside. NSAIDs can cause gastric side-effects (stomach-pain, bloating and bleeding) which limit their usefulness, especially in the elderly or those with a history of peptic ulcer disease.
Colchicine
Derived from the meadow saffron, colchicine produces a dramatic response in the treatment of gout, but it has a slow onset of action and causes vomiting and diarrhea in many patients. Colchicine is not an analgesic and has no effect on serum concentrations of uric acid or on its excretion. It is thought to work by reducing the body's inflammatory response to urate crystals. Colchicine is of little use in chronic gout or if many joints are involved. The optimal dose is close to that which causes side-effects and it should be used with great care in the elderly and the debilitated. Colchicine has a role in treating patients for whom NSAIDs are contra-indicated.
Corticosteroids
Corticosteroids (eg, hydrocortisone) given by injection into the joint can be a useful form of treatment for gout if only one or a few joints are involved. They work by relieving inflammation in the joints. Corticosteroids are not normally given by mouth in gout as they produce inconsistent results, but in certain circumstances (eg, in severe attacks affecting several joints, in kidney disease or heart failure, precluding the use of NSAIDs and colchicine) they may be useful.
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Treatment of bi-syndrome in TCM can involve the use of a combination of therapies, such as herbal remedies, acupuncture and qi-gong.
Bi-syndrome due to wind, cold and dampness evils
Therapeutic aim:To dispel wind, cold and dampness evils, and remove obstructions in the meridians.
Prescription: Modified Yiyiren decoction.
| qiang huo |
incised notopterygium rhizome |
| du huo |
double-teeth pubescent angelica root |
| fang feng |
divaricate saposhnikovia root |
| chuan wu |
common monkshood mother root |
| ma huang |
ephedra |
| gui zhi |
cassia twig |
| yi yi ren |
coix seed |
| cang zhu |
atractylodes root |
| dang gui |
Chinese angelica |
| chuan xiong |
Szechwan lovage root |
| sheng jiang |
fresh ginger |
| gan cao |
liquorice root |
In this prescription, qiang huo, du huo and fang feng help to eliminate wind and dampness evils; chuan wu, ma huang and gui zhi clear cold evil and warm the meridians; yi yi ren and cang zhu tonify the spleen and eliminate dampness evil; dang gui and chuan xiong improve blood production and activate blood circulation; and sheng jiang and gan cao tonify the spleen and middle burner.
Bi-syndrome due to wind, cold and heat evils
Therapeutic aim: To eliminate heat, wind and dampness evils, and remove obstructions in the meridians.
Prescription: Modified Baihu Guizhi decoction
| sheng shi gao |
unprocessed gypsum |
| zhi mu |
common anemarrhena root |
| gan cao |
liquorice root |
| jing mi |
polished round-grained rice |
| gui zhi |
cassia twig |
In this prescription, sheng shi gao, zhi mu, gan cao and jing mi clear the heat evil and help soothe its symptoms; and gui zhi eliminates the wind evil in the meridians.
Bi-syndrome due to phlegm and blood stagnation
Therapeutic aim: To expel wind evil, remove phlegm, blood stasis and obstructions in meridians.
Prescription: Modified Taohong drink
| tao ren |
peach seed |
| hong hua |
safflower |
| dang gui wei |
Chinese angelica |
| chuan xiong |
Szechwan lovage root |
| wei ling xian |
Chinese clematis |
In this prescription, tao ren and hong hua activate the blood and eliminate stasis; dang gui wei and chuan xiong activate the blood and improve blood production; wei ling xian eliminates the wind and dampness evils, and removes obstructions in the twelve meridians.
Bi-syndrome associated with liver and kidney damage
Therapeutic aim: To benefit the liver and kidneys, and remove the cold, wind and dampness evils.
Prescription: Modified Duhuo Jisheng decoction
| shu di huang |
processed rehmannia root |
| du zhong |
eucommia |
| niu xi |
achyranthes root |
| sang ji sheng |
Chinese taxillus herb |
| ren shen |
ginseng |
| fu ling |
Indian bread |
| gan cao |
liquorice root |
| dang gui |
Chinese angelica |
| chuan xiong |
Szechwan lovage root |
| du huo |
double-teeth pubescent angelica root |
| qin jiao |
large-leafed gentian |
| xi xin |
Manchurian wild ginger |
| gui zhi |
cassia twig |
In this prescription, shu di huang, du zhong, niu xi and sang ji sheng benefit the liver and kidneys, and also strengthen the bones and tendons; ren shen, fu ling and gan cao replenish the vital energy (qi) and tonify the spleen; dang gui and chuan xiong nourish the blood and regulate ying-fen ; du huo, qin jiao, xi xin and gui zhi eliminate the wind, cold and dampness evils and help relieve the bi-syndrome.
Acupuncture and moxibustion
This is generally indicated for chronic bi-syndrome that results in deficiency of vital energy (qi). For bi-syndrome caused by wind, cold and dampness evils, a combination of acupuncture and moxibustion is recommended. For bi-syndrome caused by wind, cold and heat evils, acupuncture alone is better.
The commonly used acupuncture points for pain relief are:
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Shoulder: jian-zhen and localized trigger-points |
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Wrist: yang-chi, wai-guan and he-gu |
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Elbow: he-gu, shou-san-li and qu-chi |
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Knee: yang-ling-quan and xi-yan duo |
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Ankle: zhong-feng, kun-lun, jie-xi and qiu-xu. |
Qi-gong
Qi-gong assists in regulating the meridians and anyone with bi-syndrome can benefit from it. It activates the blood circulation and helps restore the balance of yin and yang in the body. Performing qi-gong can increase muscle strength and relieve pain. It also helps rehabilitate damaged joints. Suggested types of qi-qong are fang-song gong and nei-yang gong.
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| Qi-gong is a breathing exercise that uses mental and physical training techniques for health maintenance and the prevention and treatment of disease. It uses the mind to control the breathing and spirit of the individual. |
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