Gout in Traditional Chinese Medicine (TCM)

Jonathan Clogstoun-Willmott

January 12, 2022

Gout in TCM was written about nearly 2000 years ago, so those ancient Chinese had problems just like us!

We now know it is a form of arthritis, caused by excess uric acid which gets deposited in the joints, often starting with that of the big toe.

Research and Gout in TCM

This page – gout in tcm – explains how it occurs from the point of view of traditional Chinese medicine: TCM Theory.

Research into gout in TCM? Lots! Click here.

In reading this page, be aware that various syndromes and ‘organs’ or ‘zang-fu organs’ are mentioned. Click the links to see what is meant.

Symptoms

The most common form of gout, at the big toe joint (or more accurately, at the first metatarsal-phalangeal joint) occurs with these symptoms:

Swelling
Inflammation – redness and heat
Sensitivity to touch and pressure
Pain: various kinds, including burning and excruciating

Secondary Causes of Gout in TCM

(Why Secondary? Because the following syndromes occur as a result of primary actions or factors, explained further down.)

The nature of the above symptoms, and where they occur, leads to the following diagnosis:

Swelling suggests Damp
Inflammation suggests Heat
Together they form Damp-Heat and in due course, Phlegm-Heat, which is when it becomes chronically swollen, hard and exquisitely sensitive
The location suggests problems mainly on the Spleen channel, but also the Liver and Kidney channels. The Spleen channel runs from the medial side of the big toe along the medial side of the arch of the foot then up the medial side of the leg. The Liver channel is parallel to the Spleen channel but starts on the lateral side of the big toe. The Kidney channel starts from underneath the big toe and the sole.
Since Damp and this first location of gout near the big toe are both ‘ruled’ by the Spleen, it suggests that diet is amongst the main culprits, although inherited genes and other factors are important.

There are other forms of gout in TCM, caused by internal underlying factors such as weakened Kidney energy, and external factors such as wind and cold. This page on gout in TCM doesn’t cover those: they are less common.

Diagnosis

The fact that there is so much heat in the symptoms, that the condition occurs suddenly, often without warning, and often at night, makes it a Yang excess condition.

That may explain, in terms of TCM, why it affects men in the ratio of 20:1 to women, and why it affects women more after their menopause, when the feminine or yin-like hormone oestrogen is no longer available to ward it off.

It also explains where to look for ways to improve it.

Primary Causes of Gout in TCM

Actions or factors that increase propensity to damp-heat are to blame. Gout sufferers and researchers have noticed:

Foods that damage the Spleen’s action and produce Heat:

Sweet food, especially foods and drinks containing fructose, a natural sugar found in fruit, but also in honey, molasses, cane sugar, high fructose corn syrup, beet sugar: in fact, just about all so-called ‘natural’ sweeteners.
Alcohol is another form of sugar but the result is the same for many, (most unfortunately).
Wheat rapidly turns into sugar, the more so when refined, ‘white’ flour. So do other grains, but wheat seems worse.
Foods high in purines are always assumed to be problematic but I believe these are less important than sweet foods, as above. However, known ‘heating’ foods, include red meat, for example. Read more about low-purine foods here.

Foods that lead to acidity in your system are also yang in nature…
… so read ‘The pH Miracle’ by Dr Robert Young.
Acid foods include many of those known to contribute to getting gout, such as red meat. But in that book you’ll read about much else too.

Factors that weaken the flow of Qi, and disrupt Spleen Qi:

When Qi stops flowing, problems accumulate, leading to what is called ‘Bi’-syndrome in TCM. In the gout example on this page, the form of Bi (‘blockage’) is that of Damp-Heat.
Lack of exercise, and emotional tension, both lead to stagnation of Qi. That means Qi doesn’t flow as it should, leading to blockage: Damp-Heat ‘bi’.
The primary source of Qi is your Lungs, and poor breathing habits, (often allied to lack of exercise and tension), greatly contribute to reduced Qi. One important way of recovering Qi is through good sleep, which is why Sleep Apnoea is a major cause of gout in many people, especially if they have a tendency to Damp. Snoring also hampers the flow of qi, leading to tiredness = qi deficiency and this can lead to Qi stagnation and blockage. Of course, if you exercise regularly, you’ll tend to breathe deeply, to some extent compensating for sleep apnoea and snoring.
Poor breathing habits lead to cell death, the catabolic results of which include more uric acid. This increases beyond the amount your body and your blood can handle, leading to their acidification – more yang. (Hence food suggestions see below.)

Too much sugar and lack of exercise also lead to Obesity and Diabetes but I don’t think they are the primary causes of gout. They are often parallel or ‘co’-consequences of poor diet and lifestyle habits.

Suggestions

You almost certainly need to change what you eat and, between attacks of gout, take more exercise – the kind that gets you out of breath, breathing deeply.

A table-spoonful of organic apple cider vinegar several times a day seems to help to combat blood acidity. Take it in a glass of warm water. Don’t add molasses. (Why? … sugar!…)

Apple cider vinegar helps some with gout — © Keechuan | Dreamstime.com – Right Foot With Painful Swollen Gout Inflammation Resting On Bed Photo

Foods that increase alkali (yin) and therefore reduce acid (yang) are beneficial for most people. Basically that means green vegetables, lettuce, non-citrus fruits, alfalfa sprouts, celery seeds, celery juice etc. Again, read ‘The pH Miracle‘.
Cut out junk food, fast food, sweet food and drinks. They harm your Spleen and they acidify you: too yang. (see British Medical Journal, 2008; 336: 309-12)
Beware foods that are too heating.
Beware foods that cause damp-heat. These are rich and greasy foods that weaken the Spleen and create Heat.
Drink lots of water. However, if you are yang-deficient, this could be a problem because you may find eventually that you get fluid build-up. (Yes, it is possible to have symptoms of damp-heat while also being yang deficient overall.) A ‘rough’ test of whether you are drinking enough water, or eating enough foods containing water, is the colour of your urine. If it is other than almost colourless or only slightly yellow, you may not be taking enough. (Don’t forget that some foods, like beetroot and B vitamins, and many medications, often affect urine colour: if so, the colour may be misleading. Also, ignore the colour the first time you urinate after a night’s sleep.)

Vitamin C for gout — Vitamin C – Photo by Vya Naturals

Vitamin C with bioflavanoids seem to combat acidity. You get it in green vegetables (as well as in fruit, but beware fruits high in fructose.) It is thought to reduce the liver’s generation of excess uric acid. Best taken in organic foods, including fruit – unless high fructose … or did I mention that?! However, you may need quite high doses for it to work for gout: between 3 and 5 grams daily, for which a supplement is necessary.
Avoid foods that contain purines. This includes tomatoes.
Foods rich in salicylic acid often help. Perhaps they crowd out the uric acid! Montmorency cherries have a good name.
Dandelion tea is anti-inflammatory and helps you excrete uric acid.
Burdock root, as a tea, also helps clear oedema swelling and reduce inflammation. (However, it’s not sold for its taste.)
Make sure you eat enough omega-3 type essential fatty acids. These are anti-inflammatory and help your body repair tissues. (Omega 6 oils are also essential to your diet but can increase inflammation. Most of us get enough Omega 6 but not enough Omega 3 oils.)
The whole vitamin B complex is needed, preferably from your diet, for proper digestion and all your body’s enzyme systems. This should include pantothenic acid B5, folic acid, and B12. As you grow older, you may become deficient in these, particularly of B12. Your doctor can check your blood for this.
Vitamin E is also highly beneficial. 400mg daily. Use the d-alpha-tocopherol form of it. Basically it improves circulation.
Avoid getting too tired because that makes your Qi flows less firmly, making the build-up of Bi ‘Damp-Heat’ more likely, eg during sleep (when your feet are warm, and your Qi at first low so many attacks come early on in the night).
Wind and Cold can also cause gout flare-ups. Wrap up well in windy or cold weather.
If you smoke, stop! It ruins your Lungs, and creates Heat. I think the same probably goes for electronic cigarettes.
Eat slowly, chewing well. Read Nutrition. (By the way, under Spleen, you may notice that raw foods are also discouraged. That is certainly true, but it’s the fructose that, for gout, is the main problem. However, raw vegetables are, theoretically in TCM, harder to digest than cooked vegetables. So chew well.)
Many medications, including antibiotics, weaken your Spleen and your Qi, and introduce secondary effects you don’t need. They may be a big contributing factor to your gout.
Here’s one for the brave. Research shows that those who do one particular action have lower levels of uric acid, at least for a while. So perhaps what you need is – deep breath – this! (For the research, click here.)

Finally, and importantly, find out whether you have sleep apnoea or tend to snore. If so, urgently get treatment, and preferably not with drugs. (Hint: acupuncture!) Poor lung action is I think a major cause of gout in TCM.

Treatment for gout in TCM

Gout in TCM is more often treated with herbs but acupuncture is very effective between flare-ups as it can directly clear damp-heat and tonify your Spleen energy.

What does this treatment aim to do?

Clear Damp and Heat … Damp-Heat and Phlegm
Clear any Qi Stagnation
Move Qi
Tonify and strengthen Qi, especially Lung Qi and Spleen Qi.
Educate on diet, breathing, exercise and lifestyle: very important!

Acupuncture points used would not necessarily be anywhere near the painful gouty joints. So when treating gout in TCM your acupuncturist would not be sticking needles into your red-hot toe!

In fact, inserting a needle into an inflamed joint would be considered very bad practice by most classically-trained or ‘traditional’ acupuncturists. We get good results using theories developed over thousands of years by very astute practitioners. Acupuncturists untrained in classical theory don’t know what they are missing.