Efficacious Formulas for the Treatment of Gout

Transcription

1 Efficacious Formulas for the Treatment of Gout by Simon A. Becker, Dipl. Ac & C.H. Introduction In Chinese Medicine, gout belongs to the disease category of wind damp impediment (feng shi bi). It results from an invasion of the fleshy exterior and channels and network vessels by wind, damp, cold, and heat evils. In turn, these evils block and obstruct qi and blood and channels and network vessels which causes the joints to become red, swollen, hot, painful, and malformed. Gout can be divided into an acute stage and a remission stage. Patterns of the acute stage are due to wind, cold, damp, heat, and/or a mixture of cold and heat. Patterns of the chronic stage are due to phlegm, stasis, qi and blood dual vacuity, and liver and kidney dual depletion. The following is a functional translation of three formulas published in Zhong Guo Zhong Yi Mi Fang Da Quan (Great Compendium of Chinese Medical Secret Formulas) 1. This three volume compendium discusses secret formulas for all specialties of Chinese medicine. The reason for inclusion of a formula into this compendium is that it has been shown to be of particular efficacy in the treatment of a particular disease. The short reference to clinical efficacy outlines either a case history or a summary of a study in which the corresponding formula had been used. One chapter in the nei ke (internal medicine) volume of the Zhong Guo Zhong Yi Mi Fang Da Quan addresses gout. Contrary to most of my other writing, I have preserved the gram amounts for the individual ingredients. However, I need to clearly point out that I did not do this so that practitioners can write the exact same formula for their gout patients. Rather, I have included the individual amounts so as to give practitioners a sense of the ratios between medicinals. Standard formulas out of books are almost never exactly correct for an individual patient without at least some modifications. Prior to prescribing a formula, therefore, the practitioner needs to ask him or herself about the importance of each ingredient vis-a-vis the patient s individual pattern. Accordingly, certain ingredients can be deleted and others must be added. Furthermore, besides serving as good base formulas for gout patients, these formulas also highlight which medicinals are most commonly used for certain disease patterns of gout. This helps practitioners to be better able to choose one s medicinals accurately. For example, the chronic stage of gout always includes some type of kidney vacuity. If the kidney vacuity tends to be one of yang insufficiency, then medicinals which invigorate kidney yang must be added. However, which medicinals from the kidney yang supplementing category are preferable for this particular disease? If one researches the formulas below, it becomes clear that medicinals such as Cortex Cinnamomi Cassiae (Rou Gui), Fructus Psoraleae Corylifoliae (Bu Gu Zhi), and Herba Cynomorii Songarici (Suo Yang) are not commonly used. Instead, the combination of Herba Epimedii (Xian Ling Pi) and Rhizoma Curculiginis Orchioidis (Xian Mao) seems to be preferable. Similarly, one realizes that Herba Siegesbeckia (Xi Xian Cao) is used more frequently than one would probably have expected. Xi Xian Cao is bitter and cold and enters the kidney, spleen, and liver channels. It has the function to dispel wind damp and disinhibit the sinews and bones. Xi Xian Cao is not one of the most common medicinals; however, it seems to be a leading medicinal in the treatment of damp heat patterns of gout. Lastly, all formulas below include at least one blood quickening medicinal, the most common one being Radix Salviae Miltiorrhizae (Dan Shen). This underscores the importance of considering that wind, damp, cold, and heat evils obstruct the channels and network vessels and will lead to blood stasis and the statement of fact that all prolonged diseases enter the network vessels and eventually lead to blood stasis. 1 Edited by Hu Xi-ming, 14 th Edition, Literary Collection Publishing and Distributing Company, Shanghai, 1997

2 Because Western medicine has relatively little to offer in the treatment of acute or chronic gout, it is my hope that modifications of the formulas below or information learned from them will help Chinese medicine practitioners to increase their treatment success in all their patients suffering from gout. Formulas Di Huang You Ling Fang (Rehmannia, Cornus, and Poria Prescription) Supplements the kidneys and boosts qi, quickens the blood and disinhibits urination. This formula mainly treats gouty renal pathology due to a dual vacuity of qi and blood. Uncooked Radix Rehmanniae Glutinosae (Sheng Di), 15g, Fructus Corni Officinalis (Shan Zhu You), 10g, Sclerotium Poriae Cocos (Fu Ling), 10g, Rhizoma Alismatis (Ze Xie), Radix Astragali Membranacei (Huang Qi), 15g, Radix Salviae Miltiorrhizae (Dan Shen), 15g, Herba Leonuri Heterophyllae (Yi Mu Cao), 15g, Ramulus Loranthi seu Visci (Sang Ji Sheng), 15g, Radix Gentianae Macrophyllae (Qin Jiao), 20g. Prepare as a water decoction. Modifications: For kidney yang vacuity with fear of cold, cold limbs, and cold pain in the lumbus and knees add Herba Epimedii (Xian Ling Pi), 10g, and Rhizoma Curculiginis Orchioidis (Xian Mao), 10g. For spleen qi vacuity with lumbar [? stomach duct] distension and sloppy stools, add Radix Codonopsitis Pilosulae (Dang Shen), 10g, and stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g. For pronounced heat [i.e., fever] with a dry mouth, yellow urination, and a rapid pulse, add Radix Scutellariae Baicalensis (Huang Qin), 10g, and Cortex Phellodendri (Huang Bai), 10g, or Fructus Gardeniae Jasminoidis (Zhi Zi), 10g. For hyperactive ascension of liver yang with dizziness and headache add Ramulus Uncariae cum Uncis (Gou Teng), 10g, Flos Chrysanthemi Morifolii (Ju Hua), 10g, and Rhizoma Gastrodia Elatae (Tian Ma), 10g. In the treatment of six cases of gout, two experienced a marked effect. This meant that their symptoms were dispersed, blood pressure was down to normal levels, serum creatinine was down to 1.8 mg, blood urea nitrogen was down to 200 mg/l, and blood uric acid was down to 60 mg/l or below. The other four cases experienced a turn for the better. This meant that their symptoms had all obviously lessened, blood pressure was down to 150/90 mmhg or below, and blood uric acid was down to 70 mg/l or below. Hong Yong-sen, Red Cross Research Hospital, Hangzhou, Zhejiang. Tong Feng Fang (Gout Prescription) Prescription 1: Clears heat and dispels dampness, frees the network vessels and stops pain. This formula mainly treats damp heat patterns of joint inflammation due to primary gout. Prescription 2: Dissipates cold and dispels dampness, frees the network vessels and stops pain. This formula mainly treats damp cold patterns of joint inflammation due to primary gout. Prescription 1: Rhizoma Atractylodis (Cang Zhu), 9g, Cortex Phellodendri (Huang Bai), 12g, Radix Achyranthis Bidentatae (Niu Xi), 12g, Cortex Erythrinae Variegatae (Hai Tong Pi) 2, 12g, Rhizoma Curcumae (Jiang Huang), 12g, Radix Clemetidis Chinensis (Wei Ling Xian), 12g, Herba Siegesbeckia (Xi 2 Cortex Erythrinae Variegatae (Hai Tong Pi) is bitter, acrid, and neutral and enters the spleen and liver channels. It has the function to dispel wind damp, free the channels and network vessels, and kill worms. Recommended dosage is 6 to 12 grams.

3 Xian Cao), 15g, Radix Illicis Pubescentis (Mao Dong Qing) 3, 30g, Caulus et Folium Kadsurae Coccineae (Hei Lao Hu) 4, 30g, Radix seu Ramulus et Folium Zanthoxyli Nitidi (Ru Di Jin Niu) 5, 30g. Take one ji daily. Cacumen Biotae Orientalis (Ce Bai Ye), 30g, Radix et Rhizoma Rhei (Da Huang), 30g, Cortex Phellodendri (Huang Bai), 15g, Herba Mentha Haplocalycis (Bo He), 15g, Herba Lycopi Lucidi (Ze Lan), 15g. Mix with honey and water and apply as a plaster externally to the affected area. Prescription 2: Ramulus Cinnamomi Cassiae (Gui Zhi), 10g, Radix Ligustici Wallichii (Chuan Xiong), 10g, Radix Notopterygii (Qiang Huo), 12g, Ramulus Mori Albae (Sang Zhi), 12g, Radix Gentianae Macrophyllae (Qin Jiao), 12g, Rhizoma Atractylodis (Cang Zhu), 12g, Radix Achyranthis Bidentatae (Niu Xi), 15g, Radix Salviae Miltiorrhizae (Dan Shen), 15g, Radix Stephaniae Tetrandrae (Fang Ji), 15g, Radix Glycyrrhizae Uralensis (Gan Cao), 6g. Prepared as a water decoction. Radix et Rhizoma Rhei (Da Huang), 30g, Flos Sophorae Japonicae Immaturus (Huai Hua), 30g, Herba Centellae (Ji Xue Cao) 6, 30g. This formula is administered as an enema. In the treatment of 12 cases, besides one case which did not experience any effect, 11 cases experienced improvement to a certain degree. Among these 11, the pain dispersed in 4, was obviously improved in 5, and improved somewhat in 2 cases. The time period until the pain improved was between 7 and 40 days with an average of 25 days. Reexamination of blood uric acid was decreased in 7 patients and did not change in 5 cases. Out of the 7 cases in which the urea nitrogen was increased initially, it decreased after treatment in 4 cases. Zhang Hui-chen Explanation: If this disease is not cured for a prolonged period of time, gouty calculi may accumulate deeply and lead to swollen and malformed joints and stubborn pain. This because prolonged diseases enter the network vessels, inhibit qi and blood, and cause static blood to congeal and stagnate. Thus, the treatment must include blood quickening and stasis transforming medicinals. If the swollen joints ulcerate, uric acid crystals exude. Thus, one must also include phlegm transforming medicinals which not only have the function to swiftly disperse the joint swelling and pain but also can lower the blood uric acid level. Zhang Shi Tong Feng Fang (Master Zhang s Gout Prescription) Prescription 1: Supplements and boosts the spleen and kidneys, softens hardness, and transforms phlegm. This formula mainly treats gouty renal calculi with a pattern of spleen and kidney dual vacuity. 3 Radix Illicis Pubescentis (Mao Dong Qing) is slightly bitter, sweet, neutral, and toxic and enters the lung and heart channels. It has the function to resolve toxins, clear heat, quicken the blood, free the vessels, diffuse the lungs, and stop cough. Recommended dosage is 30 to 90 grams. 4 Caulus et Folium Kadsurae Coccineae (Hei Lao Hu) is better know as Fan Tuan Teng. It is sour, sweet, and slightly warm and has the function to join bones, dissipate stasis, disperse swellings, and resolve toxins. Recommended dosage is 9 to 15 grams. 5 Radix seu Ramulus et Folium Zanthoxyli Nitidi (Ru Di Jin Niu) is acrid, bitter, warm, and slightly toxic. It has the function to dispel wind, free the network vessels, disperse swellings, and stop pain. Recommended dosage is 6 to 9 grams. 6 Herba Centellae (Ji Xue Cao), is bitter, acrid, and cold and enters the liver, spleen, and kidney channels. It has the function to clear heat, disinhibit dampness, disperse swellings, and resolve toxins.

4 Prescription 2: Warms and supplements kidney yang, disperses and disinhibits damp heat, dispels wind, and frees the network vessels. This formula mainly treats gouty renal pathology with a pattern of kidney yang insufficiency. Radix Pseudostellariae Heterophyllae (Tai Zi Shen), 15g, Cortex Moutan Radicis (Mu Dan Pi), 5g, stirfried Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Sclerotium Poriae Cocos (Fu Ling), 10g, uncooked Radix Rehmanniae Glutinosae (Sheng Di), 10g, cooked Radix Rehmanniae Glutinosae (Shu Di), 10g, Radix Dioscoreae Oppositae (Shan Yao), 10g, Rhizoma Alismatis (Ze Xie), 10g, Radix Angelicae Sinensis (Dang Gui), 10g, Herba Sargassi (Hai Zao), 10g, Herba Zosterae Marinae (Hai Dai) 7, 10g, Bulbus Fritillariae Thunbergi (Zhe Bei Mu), 10g, Semen Plantaginis (Che Qian Zi), 30g, Conchae Ostreae (Mu Li), 30g, Os Draconis (Long Gu), 15g. Prepare as a water decoction. Prescription 2: Semen Plantaginis (Che Qian Zi), 30g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Herba Epimedii (Xian Ling Pi), 30g, Rhizoma Curculiginis Orchioidis (Xian Mao), 10g, Rhizoma Anemarrhenae Asphodeloidis (Zhi Mu), 10g, Cortex Phellodendri (Huang Bai), 10g, Radix Dioscoreae Oppositae (Shan Yao), 10g, Rhizoma Alismatis (Ze Xie), 10g, Sclerotium Poriae Cocos (Fu Ling), 10g, Rhizoma Dioscoreae Sativae (Bei Xie), 10g, Fructus Chaenomelis Lagenariae (Mu Gua). Prepare as a water decoction. Simultaneously take Xi Xian Wan (Siegesbeckia Pills) 8 twice daily 1g each time. Two cases were treated with the above two formulas. The first patient took prescription one with some modifications according to his pattern. After 90 ji, urea nitrogen was down from 570 mg/l to 335 mg/l, creatinine was down from 5 mg to 2.8 mg, proteinuria went from a double plus (++) to one plus (+), and uric acid was at 92 mg/l after taking the medicinals. The other case was prescribed a modification of prescription two. After taking the medicinals for seven months, the patient s condition had stabilized, creatinine was down from 3 mg to 1.5 mg, carbon dioxide content was down from 44.8 mmol/l to 26.9 mmol/l, blood urea nitrogen decreased from 485 to 170 mg/l, and proteinuria went from a triple plus (+++) to a double plus (++). Zhang Tian, Chinese Medical School associated with the Shu Guang Hospital, Shanghai. Explanation: Patients suffering from chronic renal pathology due to gout have such symptoms as a yellow facial complexion, thin muscles, dizziness, lumbar aching, and scant intake, indicating a liver, spleen and kidney disease pattern. Thus, suitable treatment during the remission stage of the disease is to supplement and boost the liver, spleen, and kidneys. During acute effusions of the disease, the contending and changing of right and evil is unlimited; therefore, the main treatment method during this stage is to clear heat and transform damp turbidity. Because wind, cold, and damp evils mingle and, if depressed for a prolonged period of time, transform heat, one s treatment must also take combined heat and cold into consideration. Throughout the disease process of gout, wind evil invariably permeates; thus, it is invariably necessary to make use of wind dispelling as well as qi rectifying and blood quickening medicinals. Spleen vacuity engenders dampness; prolonged dampness depression leads to phlegm turbidity and to the arisal of gout nodules (tophi); therefore, one must also use hardness softening and phlegm transforming medicinals. Lastly, gout symptoms are related to the metabolism and besides simply treating the disease with medicinals, one must also regulate food and drink and avoid taxation damage and sexual intercourse. Of 7 Herba Zosterae Marinae (Hai Dai) is salty and cold. It has the function to soften hardness, transform phlegm, disinhibit water, and discharge heat. Recommended dosage is 4.5 to 9 grams. 8 The ingredients of Xi Xian Wan (Siegesbeckia Pills) are not known to the author. However, Siegesbeckia must be major ingredient in this formula.

5 particular importance is the avoidance of foods which are high in purines, such as animal organs. High purine leads to an elevation of uric acid and thus aggravates the disease condition.