TCM and gout treatment...?

[meeks]

any of the TCMs on the board prefer any formulas at the chinese herb stores that can alleviate gout?

[Ron Panunto]

I take Allipurinol -no side effects that I know of.

[Doc Stier]

I have often used the Rehmannia 8 Formula with excellent results.

[Interloper]

Cherries (Bing, etc.) have been noted to reduce the amount of uric acid in the body. They are a natural diuretic, which may have something to do with it; the reason for its effect on uric acid levels is not certain. But, many people swear by cherry consumption as a way of managing gout when combined with sensible diet, exercise, etc. Something like 20 Bing cherries per day, either fresh or the pure juice (no apple juice additives) equivalent.

[meeks]

Is the 6 flavors formula effective? (Liu Wei Di Huang Wan)

[leifeng]

It might help if there is kidney yin deficiency but personally I think Liu wei dihuang wan is slow and too general in purpose. Something like Duhuo Jisheng tang might be more relevant but a TCM doctor needs to choose and modify the formula for your specific case.

[Kevin_Wallbridge]

One of the difficulties with the question is that Chinese medicine doesn't treat "diseases" (病) it treats syndromes of diseases (证). So gout may present in more than one way. Generally it is seen as presenting in one of four ways: as as wind-damp heat, a wind-cold damp, phlegm stasis obstruction or liver and kidney Yin deficiency. Each of these types will present differently and require a different formula. It is all about the purines building up in the body and so that is why Allipurinol is so effective. Chinese medicine goes after the underlying body climate as much as the painful obstruction of the joint so there are many formulae that can be effective.

In your case Meeks you are probably not old enough yet for "Rehmannia 8 Formula" (which is the original formula from which Liu Wei Di Huang Wan is derived but with Fuzi/aconite and Guizhi/cinnimon twig, in China its called 金匮肾气丸 Jinkui Shenqi wan. 八味地黄丸 Bawei Dihuangwan is usually a gynaecological formula with wuweizi/schisandra fruit and zhi huangqi/honey-fried astragalus and is used for hot flashes and night sweats or post-partum blood loss).

Given the food pictures you have shared on FB, you are far more likely to be suffering from damp heat in the liver meridian (is the tongue red or red on the sides? is there a coat on the tongue? is it thick and greasy or scanty and dry?). If the tongue coat is scanty and dry 白虎桂枝汤 Bai Hu Gui Zhi Tang is a typical formula for this. It has a large does of 生石膏/sheng shigao/gypsum which is very cold in nature and is well suited to heat that has developed from dietary overindulgence (there tends to be an accompanying level of heat in the stomach and 阳明 Yang Ming meridian with damp-heat gout). It has the added effect of toning down the cravings for the rich meaty foods that usually lead to this kind of gout. 知母/zhi mu/annemarhenae has a similar function and supports the Shigao's action. 桂枝/guizhi/cinnamon twig helps to ameliorate the intense coldness of the first two and help keep them from damaging the functional vitality of the body. Guizhi also helps create movement through the peripheral vessels and tissues helping to clear the painful blockages. Even though it is warm in nature it can still help in these cases; this is because even though the underlying cause is dampness and warmth, the big toe where the purines settle and crystallize is the coldest part of the body. While not ideal, the body can cope with a degree of swampy warmth for a while without too much long-term damage, but when the swamp congeals with cold you start to get a real problem. There is also honey-fried licorice in this formula, to harmonize the actions of the other herbs, and non-glutinous rice to help with damage to the body fluids.

So this formula is particularly used where the normal fluid physiology is starting to see real serious effects. In some cases the fluids are caught up in the swamp and so you can see dryness in other areas of the body (this usually shows as a desire for colder drinks, but them only taking the drink in small sips). It may also present as the dampness turning to dryness as the heat cooks the swamp away leaving a gooey mess in its wake. Gout is never the early stage, it always shows a real progression. That is the typical use of 白虎桂枝汤 Bai Hu Gui Zhi Tang.

If the development is actually still at an early stage (I mean the gout is in an early stage but the damp heat is well developed) and the tongue coat is still thick then the old chestnut of 龙胆泻肝汤 Longdan Xiegantang Dragon Bile Drain Liver Decoction, which is widely available, is often used.

[Michael]

Thanks for the great write-up, Kevin!

[leifeng]

As pointed out TCM needs more information to create a pattern of what is causing the disease so I still suggest going to a TCM doctor who can see your tongue, take your pulse and analyze the symptoms. The formulas that have been suggested are basic and usually need modification to be more effective. For example an important part of a formula dealing with Bi syndrome is adding the herbs that can narrow down the area like Niuxi or Duhuo.

[Doc Stier]

As a side note here, modern TCM is not the only method of Chinese/Oriental Medicine. Since most accredited schools and colleges of Oriental Medicine now either primarily teach or only teach TCM, the vast majority of professional, licensed acupuncturists encountered nowadays usually specialize in the practice of modern TCM. However, a number of older methods or systems of Classical Chinese Medicine also continue to be practiced by some, and a small number of schools still offer formal training in these methods.

Notably, these mehods include the Wu-Hsing Fa (Five Element Phases Method), the Tzu-Wu Liu Chu Liao Fa (Astrological Method), and the Ling Kuei Pa Fa (Mathematical Horary Points Method) as outlined in the essential classical medical texts generally thought to have originated in the latter part of the first millennium B.C., namely the Su Wen, Ling Shu and Nan Ching. Altough there are exceptions, most practitioners of the older classical methods and systems are people who were formally trained in Chinese Medicine by way of a long-term apprenticeship with an established practitioner and/or at traditional medicine schools in the Orient prior to the widespread establishment of TCM schools in China and in Western nations.

As such, the standardized Disease Syndrome method of modern TCM developed in the PRC during the past 60 years or so is definitely not the only method of employing acupuncture and Chinese medicinal herb formulas.

[Kevin_Wallbridge]

No need to make this political. I respectfully disagree with that framing of the history.

No matter the method for deriving the syndrome, it is the syndrome that is the key. I only posted the example formula to point how difficult the question actually was.

[Doc Stier]

Fair enough. And my comment was a personal opinion, not a political opinion. I have practiced the older methods I mentioned very successfully for more than 40 years time to date without using the TCM Disease Syndrome system of diagnosis or treatment. Just saying that there are in fact other methods of Chinese Medicine.

[leifeng]

@Doc: I agree with you to some extent especially regarding acupuncture but a lot of the things that are in the herb books are directly from the pragmatic parts of the classics and the modern guys just organized them. Baihu jia Guizhi is directly from Jin Gui Yao Lue and the symptoms it describes are Wind damp heat quite suitable for some forms of acute gout. It's not like Zhang Zhongjing was a communist or something.

[Doc Stier]

Hahaha! Similar to any observation of related martial art styles, the same core concepts and techniques are often employed in different ways. Intellectual knowledge and practical applications, as well as the empirical results that follow, generally reflect the practitioner's personal perspective and skill. Many paths ascend the same mountain, but some paths will always be better than others. As the old saying goes..."there's more than one way to skin a cat!"