Acupuncture Continuing Education

Gout Treatments

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Gout 

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Sample 1

Introduction
Called the “disease of kings,” gout is a disease that may have changed the course of history. As early as 2640 BC, the Egyptians were describing the condition we now call gout. Later, Hippocrates referred to podagra (gout of the first metatarsophalangeal joint) as the “unwalkable disease.” Throughout history, gout has been associated with an opulent lifestyle. For centuries, it was mainly the privileged who could afford to consume the rich foods and excessive alcohol associated with gout or hyperuricemia…

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Sample 2

Biomedicine
Gout or gouty arthritis is a metabolic disease involving abnormally high levels of urates in the body. Gout is closely associated with hyperuricemia. Hyperuricemia is the term for elevated serum levels of urate or uric acid, and it can manifest as a primary or secondary disease. Primary hyperuricemia or primary gout involves increased production of purines either idiopathically or due to an enzyme defect. Purines metabolize into uric acid. Secondary hyperuricemia or secondary gout involves increased catabolism and turnover of purines. In both primary and secondary diseases, decreased renal clearance of uric acid occurs. Gout disease includes several conditions:

  • Acute gouty arthritis with severe joint inflammation
  • Crystals or tophi in the bones or soft tissue
  • Gouty nephropathy (Kidney disease)

In general, the disease occurs because of overproduction and/or excretion of uric acid and buildup of urate. Either too much uric acid is being produced or the kidneys are not properly handling what is produced. Uric acid is a metabolite of amino acids. Normally, about two thirds of the uric acid produced by the body is excreted in urine. The rest of the uric acid is eliminated through the …

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Sample 3

While pharmacological treatments are effective in treating gout, education is the key to managing and preventing the disease. Lifestyle changes are essential. According to the American College of Rheumatology, gout patients can have a good prognosis if they do several things:

  • Maintain an ideal body weight
  • Consume alcohol in moderation
  • Avoid purine-rich meats and fish
  • Avoid sugary and greasy (rich) foods


Common Foods with High Purine Content

  • Anchovies
  • Grains
  • Herring
  • Kidneys
  • Liver
  • Mackerel
  • Mussels
  • Sardines
  • Yeast …

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Sample 4

TCM Treatment of Gout
As a general rule of thumb, gout should be treated as a damp-heat condition. Poor diet and excess alcoholic beverage intake create damp and heat conditions that obstruct the Qi flow through joints. The function of the Spleen may be poor because of rich greasy foods and its ability to transform fluids is impaired. Diet and alcohol can also create damp-heat conditions in the urinary tract and Kidneys. In this case, the San Jiao, Kidney, and Urinary Bladder’s ability to handle turbid fluids is impaired. In both patterns, fluid transformation is impaired. Heat may be encased in dampness. With gout, consider treating based on these two patterns:

  • Damp-heat Painful Obstruction Syndrome Gouty Arthritis (Bi Gouty Arthritis)
  • Urinary Painful Obstruction Syndrome Gout (Lin Gout)


Diagnosis and Treatment
Differentiation is important for the two types of gout. So, before treating the case, the acupuncturist should determine if the patient is suffering more from a bi (joint) obstruction or urinary painful obstruction. Both cases involve damp-heat, but the acupoints used will differ. Also, the herbal formulas will differ.

  • Damp-heat Bi Gouty Arthritis: Initial acute attack or recurrent attacks, fixed pain, swelling, redness at a joint, obesity or overweight, dull complexion, scanty urine, dark urine, feeling of general heaviness, nausea, poor appetite, bloating
    T – Normal color or red with gray or thick, yellow greasy coat
    P – Slippery, wiry, fast
  • Lin Gout: Recurrent attacks, severe lower back pain, burning with urination, scanty urination, difficult urination, may discharge sand or stones, may have constipation, thirst for cold drinks, may have no desire to drink, nausea, no appetite, may be irritable
    T – Red color or thick, yellow greasy coat (especially in the rear)
    P – Slippery, wiry, fast


Acupuncture Treatment and Point Analysis
This section covers specific and basic points for treating the two gout patterns. Some basic points for either pattern include:

  • ST 40 – Luo Connecting point, resolves dampness and phlegm, calms the mind, treats any swelling anywhere in the body
  • SP 6 – Tonifies the Spleen and Stomach, resolves dampness, harmonizes the lower jiao, unblocks channels, stops pain
  • SP 9 – Resolves dampness (especially in the low burner), treats edema, alleviates retention of urine
  • GB 34 –Promotes the smooth flow of Qi, resolves damp-heat, relaxes sinews, unblocks the channels, treats bi syndrome pain
  • LI 4 – Unblocks...

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