Why will the combination of traditional Chinese and Western medicine plus clinical testing of dual acid indicators change the history of gout as an incurable disease?
Release time:
2020-03-10
Hippocrates (460-370 BC), the ancient Greek physician considered the father of Western medicine, was the first to describe gout, calling it "the disease that makes one unable to walk." He also argued that gout was the arthritis of the rich, while rheumatism was the arthritis of the poor. In his Aphorisms, he explained gout as follows: eunuchs are immune to gout, women only develop it after menopause, gout inflammation subsides within 40 days, gout is more common in spring and autumn, and rich food and wine are associated with its onset. He also proposed the "humoral theory," which laid the early theoretical foundation for the later exploration of hyperuricemia.
Hippocrates (460-370 BC), the ancient Greek physician considered the father of Western medicine, was the first to describe gout, calling it "the disease that makes one unable to walk." He also argued that gout was the arthritis of the rich, while rheumatism was the arthritis of the poor. In his Aphorisms, he explained gout as follows: eunuchs are immune to gout, women only develop it after menopause, gout inflammation subsides within 40 days, gout is more common in spring and autumn, and rich food and wine are associated with its onset. He also proposed the "humoral theory," which laid the early theoretical foundation for the later exploration of hyperuricemia.
Galen (129-199 AD), the second-greatest physician in ancient Greece, authored over 300 medical texts. He first described tophi (urate crystals) and attributed gout to sexual immorality, heredity, and the accumulation of body fluids. He emphasized diet, abstinence from alcohol, and sexual activity. He famously said, "Gout is the daughter of Dionysus and Venus." This theory was widely accepted in Western society and remained influential for 1,500 years, extending into the 17th century. During this period, the vast majority of gout sufferers were high-ranking officials, leading the Anglo-Saxons living on the British Isles to believe that "gout is the disease of kings and the king of diseases."
Note: Dionysus, the god of wine in ancient Greek mythology and one of the twelve Olympian gods, not only possessed the intoxicating power of wine but also possessed a powerful charisma through his gifts of joy and compassion.
Note: Venus, the goddess of love and beauty in ancient Roman mythology and one of the twelve Roman gods, promoted ancient civilization, established laws, and maintained world peace.
The English word "gout," translated into Chinese as "gout," also means "a drop," which evokes the ancient Greek physician Hippocrates' explanation of the pathogenesis of gout. He proposed the concept of the "four humors," which posited that drops of toxic humors seeped into the joints, causing severe joint pain. This interpretation of gout, for a considerable period, generally blurred the distinction between gouty arthritis and rheumatic arthritis.
It wasn't until the 17th century that the renowned British physician Thomas Sydenham (1624–1689) first distinguished gout as a distinct disease, separate from the broader rheumatic spectrum. Sydenham, who himself suffered from acute gouty arthritis at age 30, and with his long experience battling gout, accurately distinguished "gout" from other conditions, such as acute febrile arthritis in young adults (consistent with acute rheumatic fever), chronic disabling arthritis (possibly rheumatic arthritis), fibromyalgia, and chorea. His many papers detailed the symptoms and signs of gout, effectively giving gout its proper name.
In 1776, the Swedish chemist Scheele (1742–1786) demonstrated that urinary stones in gout patients contained an organic acid.
In 1797, British chemist Wollaston (1766-1828) removed a gouty nodule from his ear and separated uric acid from it. People then realized that the poison deposited in the joints and tissues was uric acid.
In 1798, French chemist Antoine Fourcroy (1755-1809) discovered the presence of this organic acid in urine and named it uric acid.
In 1824, renowned British physician Garrod used chemical analysis to detect high concentrations of uric acid in the blood of gout patients. He believed that the key to gout was excessive uric acid production. This marked a new understanding of gout.
In 1850, British physician Garrod Alfied (1819-1909) confirmed that gout patients had elevated uric acid levels in their blood. In 1855, he published the first monograph on gout, earning him the title "Father of Modern Gout."
In 1898, German chemist Emil Fischer (1852-1919), winner of the 1902 Nobel Prize in Chemistry, discovered that uric acid is derived from purine metabolism.
In 1912, chemists Folin and Denis first utilized the principle that uric acid can reduce phosphotungstic acid under alkaline conditions to measure serum uric acid levels.
In the 100 years that followed, aside from some improvements in serum uric acid testing methods, Western medicine made no substantial new advances in clinical gout diagnosis. Building on traditional medical theories, modern medicine, using microscopy, ultrasound, and imaging techniques, has further demonstrated that the process of gout attacks is characterized by "serum uric acid levels rising above saturation, the accumulation of monosodium needle-shaped uric acid crystals in the joint cavity, and the stimulation of neurons to produce unbearable pain."
However, these laboratory and clinical observations of the gout process cannot explain the lifelong absence of gout symptoms in the majority of patients with hyperuricemia.
Professor Wu Husheng of Beijing and Professor Gu Jieruo of Guangzhou have published monographs respectively proposing that "elevated uric acid levels are the most important biochemical basis for gout attacks."
This viewpoint revises the almost unchallenged argument, put forward by British physician Garrod in 1824, that "excessive uric acid production is the key to the onset of gout." It represents a significant advancement in Chinese clinical understanding of gout.
Excessive uric acid production and elevated uric acid levels are two physiological phenomena in the human body. Under normal circumstances, purine nucleotides in the body are oxidized by the liver to produce uric acid. Regardless of the amount produced, uric acid is excreted proportionally. More uric acid is excreted, and less uric acid is excreted, maintaining a dynamic equilibrium in the uric acid pool.
The body's renal uric acid excretion threshold is responsible for regulating uric acid levels throughout the entire process. Simply overproduction of uric acid generally does not cause elevated uric acid levels. If renal uric acid excretion is abnormal, uric acid clearance is reduced, and uric acid levels in the body inevitably rise. Therefore, there is no direct causal relationship between these two physiological phenomena: excessive uric acid production and elevated uric acid levels.
Professor Wu Husheng and Professor Gu Jieruo's revision of Dr. Gruder's argument led the authors (a team of engineers) of this book to focus on "renal hypouricemia" in their exploration of the internal causes of gout. This is a bold hypothesis proposed by non-medical clinical professionals based on monitoring data.
To date, no mainstream medical clinical institution, including the prestigious American College of Rheumatology (ACR), has explicitly proposed immune hypouricemia as the internal cause of gout.
Traditional Chinese Medicine defines gout as a "bi syndrome." Its pathogenesis is due to obstruction of Qi and blood, leading to a lack of nourishment for the tendons, veins, and joints. Its five-category treatment principle explicitly emphasizes nourishing the liver, protecting the kidneys, and strengthening the spleen, focusing on expelling pathogenic factors and protecting the underlying root cause, unblocking the meridians and removing dampness, and applying a dialectical approach to individualized treatment. Clearly, Traditional Chinese Medicine has directly identified the root cause of gout.
However, simply observing, listening, asking, and palpating the body cannot accurately distinguish gouty arthritis from rheumatoid arthritis. Even in patients with gout, severe joint pain can activate the body's immune system, making traditional diagnostic criteria such as yin deficiency, yang deficiency, damp-heat, and wind-cold highly susceptible to errors. Effective oral prescriptions for removing dampness and diuretics cannot prevent renal failure in gout patients without monitoring uric acid clearance.
Western medicine focuses on molecular research on uric acid, using chemistry as a guide for medicine. It views gout as a "toxin invasion" and treats it with "uric acid reduction," ignoring the fact that decreased uric acid excretion is a functional renal disease. Traditional Chinese Medicine focuses on nourishing the liver and kidneys, clearing blockages, and regulating organ balance as a treatment approach. However, it lacks biochemical data on uric acid excretion to verify treatment efficacy.
Thus, there are significant differences between Traditional Chinese Medicine and Western Medicine, each with its own limitations in the diagnosis and treatment of gout. With scientific advancements and the widespread adoption of clinical information technology, this perspective will shift. Traditional Chinese Medicine excels at protecting the kidneys and strengthening the foundation, while Western Medicine excels at controlling uric acid production and increasing uric acid excretion. Using dual acid indicators for clinical testing and real-time verification of treatment efficacy, the combined strengths of Traditional Chinese and Western Medicine for the prevention and treatment of gout hold a bright future. I believe this will soon become a clinical consensus.
By then, the gout god will lose his power, and hyperuricemia may persist in the world. However, the fundamental changes in gout's pathology will be effectively monitored and proactively controlled, and clinical cure of gout will become the norm.
To be continued...
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