Gout is a disorder of purine metabolism in which a high serum uric acid is found and there is deposit of urate crystals within joints causing exquisite pain and tenderness. The pharmacological treatment relies upon non-steroidal anti-inflammatory, drugs in the acute stage, and prophylactic drugs in the chronic state to control the level of circulating uric acid.
In traditional Chinese medicine an over-rich diet is thought to cause a build-up of damp and heat internally that causes phlegm to stagnate. There is also disturbance of the Spleen and Kidney. Treatment thus involves Spleen and Stomach acupuncture points (SP.3 and 6, and ST.36 and 40) to control heat and damp and reduce phlegm. Other local points are used according to the joint involved.
A case history is discussed illustrating the treatment and a series of 10 patients is reported in which there is a 70% success in reducing the chronic level of serum uric acid and the frequency' of acute attacks.
Key words
Acupuncture, Gout, Traditional Chinese medicine.
Introduction
Gout is a disease of protein metabolism with symptoms most commonly manifest at the first metacarpo-phalangeal joint, but it can affect almost any joint or combination of joints and the patient may exhibit systemic symptoms. The typical presentation of gout is as exquisite pain and tenderness in a red, hot and swollen big toe. The acute attack usually settles within a few days, but may last several weeks. It is caused by the deposit of urate crystals; a raised serum uric acid therefore supports a diagnosis of gout, but confirmation must be through finding crystals in synovial fluid on microscopy, as there are other causes of hyperuricaemia, such as renal disease and malignancy, and the uric acid is not always abnormally high in acute attacks. The erythrocyte sedimentation rate (ESR) is also raised in an acute attack. There are no x-ray changes in the early stages, but in the advanced stage gouty calculus is deposited near the joint surface and appears as round defects in epiphyseal areas.
GOUT AND PAIN IN BIG TOE
Gout is characterised by joint inflammation and pain both disorder are caused by deposit of sodium urate crystal in the joints because of high blood levels of uric acid...This causes attack of painful joint inflammation...
● Gout is more common in men then in women.
● usually Gout develops during middle age in men and after menopause in women.
● got is rare in younger people , but it is often more severe in people who develop the disorder before age 30.
● Gout often runs in families.
● Gout most often affects the joints in the feet particularly at the Base of the big toe.
● it commonly affects the other joints , ankle, knee, wrist and elbow..
● urate crystal may form in these joints because the joints are cooler than the central part of the body. Urate crystal form readily at cooler temperature.
● Gout affects the joints of the spine , hips or shoulder...
Gout is characterised by joint inflammation and pain both disorder are caused by deposit of sodium urate crystal in the joints because of high blood levels of uric acid...This causes attack of painful joint inflammation...
● Gout is more common in men then in women.
● usually Gout develops during middle age in men and after menopause in women.
● got is rare in younger people , but it is often more severe in people who develop the disorder before age 30.
● Gout often runs in families.
● Gout most often affects the joints in the feet particularly at the Base of the big toe.
● it commonly affects the other joints , ankle, knee, wrist and elbow..
● urate crystal may form in these joints because the joints are cooler than the central part of the body. Urate crystal form readily at cooler temperature.
● Gout affects the joints of the spine , hips or shoulder...
CAUSES OF DISEASE
● uric acid is a bye product of break down of nucleic acid .
● The body readily transform substances in foods called purines into uric acid.
● foods high in purines include
Anchovies
Asparagus
Consomme
Herring
Meat gravies and broths
Mushroom
Mussels
All organ meats
Sardines
Sweet breads
● the uric acid level in the blood becomes abnormally high when the kidneys can not eliminate enough uric acid in the urine.
● too much uric in the blood can result in urate crystal being formed and deposited in joints.
● combining a high purine diet with alcohol can worse matters.
● uric acid is a bye product of break down of nucleic acid .
● The body readily transform substances in foods called purines into uric acid.
● foods high in purines include
Anchovies
Asparagus
Consomme
Herring
Meat gravies and broths
Mushroom
Mussels
All organ meats
Sardines
Sweet breads
● the uric acid level in the blood becomes abnormally high when the kidneys can not eliminate enough uric acid in the urine.
● too much uric in the blood can result in urate crystal being formed and deposited in joints.
● combining a high purine diet with alcohol can worse matters.
SYMPTOMS :
● severe pain occurs suddenly in one or more joints , often at night ( probably because of the metabolic changes that occur when a person lies down.
● the pain becomes progressively worse and is often excruciating particularly when the joints moved or touched.
● the joints becomes inflammed it swells and feels warm , and the skin over the joints appears red or purplish, tight and shiny.
● there my be fever upto 102°F, chills, a general sick feeling and a rapid heart beat.
● the first few attack usually affects only one joint and last for a few days.
● the symptoms gradually disappear, joints function returns and no symptoms appear until the next attack.
● after sever attack, Gout can become severe and chronic and may lead to destruction of tissue and a joint deformity.
● over time, joint motion becomes progressively restricted by damage caused by deposit of urate crystal in the joints and tendons.
● hard lumps of urate crystals are first deposits in the joints lining or cartilage or in bone near the joints and then under the skin around joints.
● if untreated, tophi can burst and discharge chalky masses of urate crystal through the skin.
● tophi can also developed in the kidneys and other organs , under the skin on the ears, in the tough band extending from the calf muscles to the heel or around the elbows.
● severe pain occurs suddenly in one or more joints , often at night ( probably because of the metabolic changes that occur when a person lies down.
● the pain becomes progressively worse and is often excruciating particularly when the joints moved or touched.
● the joints becomes inflammed it swells and feels warm , and the skin over the joints appears red or purplish, tight and shiny.
● there my be fever upto 102°F, chills, a general sick feeling and a rapid heart beat.
● the first few attack usually affects only one joint and last for a few days.
● the symptoms gradually disappear, joints function returns and no symptoms appear until the next attack.
● after sever attack, Gout can become severe and chronic and may lead to destruction of tissue and a joint deformity.
● over time, joint motion becomes progressively restricted by damage caused by deposit of urate crystal in the joints and tendons.
● hard lumps of urate crystals are first deposits in the joints lining or cartilage or in bone near the joints and then under the skin around joints.
● if untreated, tophi can burst and discharge chalky masses of urate crystal through the skin.
● tophi can also developed in the kidneys and other organs , under the skin on the ears, in the tough band extending from the calf muscles to the heel or around the elbows.
DIAGNOSIS :
A high uric acid level in the blood , supports the diagnosis. However this is often normal especially during an acute attack.
A blood test may show increased number of white blood cells due to the inflammation caused by urater crystals.
treatment
A high uric acid level in the blood , supports the diagnosis. However this is often normal especially during an acute attack.
A blood test may show increased number of white blood cells due to the inflammation caused by urater crystals.
treatment
Group 1 : LIV 1, 3, SP 1, 3, 5, UB 54 (L&R)SEDATE ALL
Group 2 : LI 4, 11, ST 36, 44, UB 54, LIV 2, 4, 7, GB 21, 31, 34, 41, SP 2, 4, 5 (L&R) SEDATE ALL. ...
C.M.P of ND tone
C.M.P of JD sedate L&R
C.M.P of ND tone
C.M.P of JD sedate L&R
Dr.Sheikh Mumbai
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