Gout

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

Gout has the dubious distinction of being one of the most written-about diseases in literature. The picture of a corpulent 18th century gentleman reclining with his bandaged foot resting on a pillow is the classic caricature of gout, but sufferers of this metabolic arthritis see nothing funny in the picture. Gout can be painful and debilitating, and acute attacks are capable of producing excruciating arthritic pain. It can affect almost any joint, though the big toe is eventually affected in 90% of cases of gout.

Gout develops as a result of a condition of excess uric acid in the blood, called hyperuricemia, or from poor metabolization of uric acid by the kidneys. Medical conditions such as obesity, hypertension, diabetes, and sleep apnea predispose individuals to gout. These "predisposing factors," however, can be seen as symptomatic of physiological states that are common to all of them, including elevated blood and tissue acidity, poor circulation and hypoxemia (low blood oxygen), and low general vitality, generally as a result of advancing age. Together they conspire to precipitate out the spiky uric acid crystals that form in the big toe or other joints, and cause so much inflammation, pain, and joint sensitivity.

Gout has always been associated with indulgences in eating and drinking. Excessive rich food — meats, shellfish, fat, and alcohol — are usually singled out as the culprits. However, two sodas a day have been shown to double the chance of gout attacks, and beer drinking also causes flareups, and is dose-related. One 12oz. bottle daily will increase the chance of an attack of gout by 49%, two will double it, and so on.

Medical treatment for gout has three objectives: reduce pain and inflammation in acute attacks, prevent acute attacks, and reduce blood levels of uric acid. Treatment includes colchicine or other anti-inflammatories in the acute phase, and allopurinol and anti-inflammatories in the post-acute phase.

Chinese medical care for gout is philosophically close to its Western counterpart in that it describes gout as the tip, essentially, of a metabolic iceberg. Gout is considered to be a type of impediment, or blockage, condition, and virtually always involves a pattern of blood stasis. Alcohol and greasy, fatty, foods tend to congeal and produce internal dampness. Over time, this inhibits circulation in the extremities, and blood stasis is the inevitable result. It is this stasis — and severe subsequent lack of qi (tissue oxygenation) — that makes the condition so painful.

Gout has a long history in the Chinese medical literature, and acupuncturists are very familiar with the condition. In the clinic, herbal medicine and acupuncture are the treatments of choice. Herbal formulas are prescribed to reduce blood stasis, relieve pain and swelling, and improve overall health. Acupuncture is used to stimulate qi and blood, and relieve pain. In a recent clinical trial, acupuncture was compared with conventional medication (allopurinol). Overall, the acupuncture group showed greater improvement compared to the allopurinol group. A similar reduction of uric acid levels in the blood and urine of both groups was noted.