I have tried both Chinese and Western medicine, but my uric acid still cannot be reduced? Is your gout refractory gout?
Generally speaking, after refractory tophi gouty joint inflammation has recurred for many years, it enters the chronic phase, and destructive arthritis appears with tophi , or it has progressed to uric acid nephropathy (kidney stones). At this time, if you use febuxostat or benzbromarone , the conventional treatment dose has been difficult to achieve the target of uric acid. Even with the addition of traditional Chinese medicine, uric acid still cannot be controlled within the target range, which has become a problem in the field of gout disease treatment. If
is understood from the perspective of traditional Chinese medicine, it belongs to the category of 尪abi.
The etiology and pathogenesis of refractory gout is very complex, but it is more closely related to the liver, spleen and kidneys
In fact, for refractory gout, asymptomatic hyperuricemia is an important pathological basis, and controlling blood uric acid levels is The ideal state is also the key to treatment.
Just as the master of traditional Chinese medicine Zhu Liangchun believes, gout is caused by internal obstruction of turbidity and blood stasis in the body, and the invasion of endogenous damp-heat and wind-cold-dampness evils is a common pathogenic factor.
If the evils of turbidity, stasis and blood stasis remain in the body for a long time without being cleared out in time, the evils of turbidity, stasis, dampness and heat may become more and more stagnant in the meridians and joints, becoming heavier and heavier, leading to joint deformity and even the formation of tophi.
Turbid blood stasis in the human body is the generation and stagnation of heat, which is closely related to the functions of the liver, spleen, and kidneys.
The liver governs dispersion, is responsible for the rise and fall of human qi, stores blood, and combines tendons in the body, with its essence in the claws. If the liver's purgative function is normal, the human body's qi mechanism will be smooth, qi and blood will be harmonized, and the meridians will be smooth. If the liver blood is insufficient and the liver's purgative function is abnormal, the tendons and arteries will not be nourished, and numbness of the limbs and nervousness may occur.
The liver and kidneys have the same origin, which is the relationship between mother and child organs. The kidney governs water, stores essence, and controls bones. Essence generates marrow, and marrow nourishes bones. It is the master of the internal organs. The essence in the kidneys is the foundation of human life activities. If the kidneys are full, the essence will be full and the muscles and bones will be strong. If the kidney qi is deficient, the essence will not produce marrow, and the marrow will not nourish the bones, which will lead to bone disease . Furthermore, the kidneys are water organs, and water-liquid metabolism depends entirely on the transpiration and gasification function of kidney essence. If kidney qi is deficient, water-liquid metabolism will be abnormal or stagnant, which will lead to , high uric acid, , edema and other symptoms.
Gout disease will recur, and long-term illness will often involve the liver and kidneys, causing the liver and kidneys to suffer. Insufficient liver and kidneys will in turn make gout lingering and difficult to recover.
From the perspective of Western medicine, we understand that gout has a certain tendency, which is closely related to the patient's kidney deficiency caused by congenital or acquired factors, which can cause abnormal water metabolism and bone metabolism, thereby leading to gout disease.
Finally, let me talk about the relationship between gout and the spleen.
The spleen and stomach are the foundation of the day after tomorrow. They govern the subtle transportation and transformation of water and grains. They are located in the middle burner and are the source of life for the human body's qi and blood. If the spleen and stomach are damaged and the healthy qi is damaged, the spleen and stomach will be unable to transport water and grains and distribute the essence to all parts of the body. As a result, qi, blood, body fluids, and water and dampness will stop internally, and blood stasis will inevitably occur internally, and phlegm and blood stasis will form. As a result, Qi and blood are not flowing smoothly, and the meridians are unfavorable, leading to gout.
It can be seen from the above that the metabolism of water and liquid depends on the transportation and transformation of the spleen, the clearing and purging of water and liquid depends on the transpiration and gasification of kidney qi, and it also depends on the dredging and purification of liver.
If the functions of the liver, spleen and kidney are imbalanced, water and liquid metabolism is abnormal, water and dampness are accumulated, dampness gathers and turns into phlegm, long-term stagnation generates heat, dampness and heat phlegm accumulates, and phlegm and dampness are all tangible evils and belong to yin evils. It is easy to attack the yin position, so gout disease often occurs in the lower limbs.
The spleen is the source of qi and blood biochemistry, governing blood, and the liver stores blood. The kidneys store essence . It can generate blood, control blood, and absorb blood. Blood can carry qi, and essence and blood have the same origin. If the functions of liver, spleen and kidney are imbalanced, there will be no source of Qi and blood, and Qi and blood will not flow smoothly. Qi stagnation will lead to blood stasis. Stagnation of Qi and blood will cause the joints, muscles and bones to lose their nourishment, leading to gout.
The early stage of gout is stagnation of Qi and blood, which causes pain due to blockage. If blood stasis persists for a long time, it will lead to pain without prosperity. Gout will also transform into a combination of deficiency and excess for a long time. It may not be cured for a long time and become refractory gout.
Refractory gout can be lingering and difficult to heal. Phlegm, blood stasis, and blood stasis are the pathological basis of refractory gout.
Now we know that the core pathogenesis of refractory gout is liver, spleen, and kidney deficiency, which leads to the biochemical movement of qi, blood, and water. Metabolic abnormalities produce phlegm-dampness and blood stasis. If the phlegm-dampness accumulates for a long time, it will fight with the blood stasis, and the stagnation will turn heat into poison. The three evils of phlegm, blood stasis and poison will combine with each other. Excessive heat will cause muscle pain, and even It leads to joint destruction and the formation of tophi, so the pathological material basis of refractory gout is phlegm, blood stasis, and toxins.
Lin Peiqin, a physician in the Qing Dynasty, clearly pointed out in "Syndrome-like Treatment" that if the paralysis does not heal for a long time, "there must be dampness, phlegm, sepsis and blood stasis stagnation in the meridians."
Professor Kao Xiliang of Shandong University of Traditional Chinese Medicine Professor Kao Xiliang also proposed that refractory gout It is believed that the pathogenesis of gout in the acute stage is the accumulation of heat in the organs and the internal poisonous evil, which occurs when there are incentives. The poison attacks the joints and heat poison suffers, the body fluids stagnate, the blood coagulates into blood stasis, and brews Produce phlegm and blood stasis. The core pathogenesis of gout intermittent period is the internal accumulation of poison.
Therefore, if we focus on the lingering and difficult-to-heal characteristics of refractory gout, if we can seize the core pathogenesis of liver, spleen, and kidney deficiency, and grasp the basic pathological basis of poison, phlegm, and blood stasis, we can relieve pain in the acute phase. , while in the remission period, strengthening the body and dispelling evil spirits, but the methods of clearing heat, diluting dampness, detoxifying, removing phlegm, removing blood stasis, strengthening the spleen, nourishing the kidneys and soothing the liver are used throughout the treatment of refractory gout, which will prevent gout attacks and will always be effective.
In short, our goal is: uric acid will no longer be high, gout will not occur, and stay away from kidney stones .
I have been popularizing headlines for more than a year. The more I communicate with fans, I gradually focus on metabolic diseases especially gout, because I can empathize with and deeply understand the joys, sorrows and joys of gout sufferers. Therefore, Dr. Jiang has a wish in 2022. He wants to recruit 1,000 gout patients who have been suffering from gout for many years to work with me to correctly lower uric acid and stay away from the shackles of gout. You can follow @TCM Dr. Jiang talks about gout and leave a message in the comment area or send a private message for one-on-one answers, personalized Develop a uric acid-lowering cocktail program. #将 Zero Zero Plan##Doctor Doka Super Group## unusual case#.
References for this article (pictures and texts are from the Internet and have been deleted): Zhong Qin and other articles in the 3rd issue of "Rheumatism and Arthritis" in 2016 "Experiences in treating refractory gout from the perspective of phlegm, poison and blood stasis".
