Clinical Diagnosis and Treatment of Gout—December 3, 1995

Clinical Diagnosis and Treatment of Gout—December 3, 1995

Hyperuricemia accompanied by gouty arthritis (primarily affecting the metatarsophalangeal joints), with late-stage local redness, swelling, and deformity, often affecting the kidneys. Small gouty tophi can be seen beneath the skin, with elevated uric acid levels: men > 430 µmol/L, women > 350 µmol/L. Treatment: During the acute phase, oral colchicine at 1 mg, with dosing every two hours in case of severe attacks, 0.5 mg each time. The total dose should not exceed 6 mg, usually resolving within 48 hours. Afterwards, 0.5 mg once daily for maintenance; allopurinol at 100 mg, three times daily (side effects such as fever, rash, abdominal pain, and leukopenia may occur in some individuals, but recover upon discontinuation); probenecid at 0.25 g, three times daily, gradually increasing to a maximum of 2 g per day, with some individuals experiencing fever, rash, and gastrointestinal symptoms as side effects. These three medications can either reduce uric acid synthesis or increase uric acid excretion, but all have certain side effects (fever, rash, vomiting, leukopenia). Traditional Chinese medicine treatment: ① Compound Dang Gui Nian Tong Tang: Dang Gui, Chi Shao, Bai Zhu, Ren Dong, Qiang Huo, Du Huo, Fang Ji, Fang Feng, Papaya, Zhu Ling, Song Jie, Ge Gen, Yin Chen, Gan Cao (mnemonic: six pairs of Song Jie grass). ② Xiaotong Yin: Dang Gui, Chi Shao, Ni Xi, Gou Teng, Ren Dong Teng, Fang Ji, Fang Feng, Papaya, Sang Zhi, Zhu Ling, Ze Xie. ③ Che Qian Zi, Hong Hua, Sheng Ban Xia, Wang Bu Liu Xing, Da Huang, Hai Tong Pi, Cong Gen, Ai Ye, decocted for external washing. ④ Huang Bai, Du Huo, Sang Shen, Chi Xiao Dou, Wan Can Sha, Papaya, Wu Tong, Tu Fu Ling, Dan Shen.