CLINICAL APPLICATIONS

* Gout

* Gouty arthritis

 

WESTERN THERAPEUTIC ACTIONS

* Decreases the absorption and increases the elimination of uric acid and other unwanted substances

* Analgesic effect to relieve pain

* Anti-inflammatory effect to reduce swelling and inflammation

* Antipyretic effect to relieve burning sensations and reduce inflammation

 

CHINESE THERAPEUTIC ACTIONS

* Strengthens the Spleen and Stomach

* Drains damp-heat

* Opens the channels and collaterals

* Relieves pain

 

DOSAGE

Take 4 capsules three times daily. The herbal therapy should begin immediately upon noticing the first warning signs of gout. The dosage may be doubled on days one and two of herbal therapy to achieve faster onset of action. If necessary, this formula may be taken at reduced dosages for maintainance and prevention.

 

INGREDIENTS

Cang Zhu (Rhizoma Atractylodis)

Che Qian Zi (Semen Plantaginis)

Chi Shao (Radix Paeoniae Rubra)

Di Huang (Radix Rehmanniae)

He Zi (Fructus Chebulae)

Huang Bo (Cortex Phellodendri Chinensis)

Ji Xue Teng (Caulis Spatholobi)

Jin Qian Cao (Herba Lysimachiae)

Shi Gao (Gypsum Fibrosum)

Wu Bei Zi (Galla Chinensis)

Yi Yi Ren (Semen Coicis)

Ze Xie (Rhizoma Alismatis)

Zhi Mu (Rhizoma Anemarrhenae)

 

BACKGROUND

Gout is a form of arthritis that is characterized by sudden, severe attacks of pain, tenderness, redness, warmth and swelling (inflammation) in certain joints. Gout usually affects the large toe, but it can affect other joints in the leg (knee, ankle, and foot) and sometimes also joints in the arm (hand, wrist, and elbow). Gout is caused in part by excessive intake of food rich in uric acid, or decreased excretion of uric acid through the kidneys. As uric acid deposits in the joints, it causes severe pain known as gout.

 

FORMULA EXPLANATION

According to traditional Chinese medicine, gout is generally considered as bi zheng (painful obstruction syndrome) with damp-heat. The presence of damp-heat begins with the inability of the Spleen and Stomach to adequately transform and transport food, followed by accumulation of damp-heat blocking the channels and collaterals leading to severe pain. This correlates with the Western medicine concept of gout, which starts with improper diet followed by excessive accumulation of uric acid. Therefore, optimal treatment requires use of herbs to strengthen the Spleen and Stomach, drain damp-heat, open the channels and collaterals, and relieve pain.

        In this formula, Cang Zhu (Rhizoma Atractylodis) and Yi Yi Ren (Semen Coicis) strengthen the Spleen and Stomach to resolve dampness and swelling. Jin Qian Cao (Herba Lysimachiae), Ze Xie (Rhizoma Alismatis) and Che Qian Zi (Semen Plantaginis) drain damp-heat and help expel uric acid from the body through urination. Shi Gao (Gypsum Fibrosum), Zhi Mu (Rhizoma Anemarrhenae), Huang Bo (Cortex Phellodendri Chinensis) and Di Huang (Radix Rehmanniae) clear heat and sedate fire. Together they reduce the inflammation and burning sensation. Ji Xue Teng (Caulis Spatholobi) opens the channels and collaterals. Chi Shao (Radix Paeoniae Rubra) activates blood circulation and relieves pain. Lastly, He Zi (Fructus Chebulae) and Wu Bei Zi (Galla Chinensis) are two astringent herbs that reduce swelling and inflammation.

        In summary, Flex (GT) is a comprehensive formula that targets both the cause and the symptoms of gout. It incorporates herbs to strengthen the Spleen and Stomach, drain damp-heat, open the channels and collaterals, and relieve pain.

 

CAUTIONS & CONTRAINDICATIONS

* This formula should not be used in cases of deficiency and cold.

* This formula is not designed to treat acute gout attacks. It is formulated to prevent gout.

* Heat packs should not be used in patients with gout, as it is a condition characterized by heat.

 

CLINICAL NOTES

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Turtle pulse, a convex-shaped pulse that has a “tail” (a thin, forceful, pulse proximal to the chi position), is 3-D, but flat on the bottom, on the left chi.

* If the pulse is forceful, the condition is acute with more inflammation and greater pain.

* If the pulse is weak, the condition is chronic with less inflammation and pain.

 

SUPPLEMENTARY FORMULAS

* For severe pain, combine with Herbal ANG.

* With severe swelling and inflammation, combine with Astringent Complex.

* For gout in individuals with obesity, use with Herbalite to reduce body weight.

* For gout in individuals with diabetes, use with Equilibrium to control blood glucose levels.

* For gout in individuals with hyperlipidemia, use with Cholisma to reduce cholesterol and triglyceride levels.

* For gout in individuals with obesity and high cholesterol, add Cholisma (ES).

* For gout with kidney stones, add Dissolve (KS).

* With hypertension, add Gastrodia Complex or Gentiana Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Needle ah shi points using the sedating technique (counter-clockwise).

 

Classic Master Tung's Points:

* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.

* Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Sizhi (T 77.20). Bleed the affected area. The more the bleeding, the better the result.

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Gout

§ Big toe: Bleed Taichong (LR 3) area. Needle contralaterally Linggu (T 22.05), Sanchasan (T 22.17)*.

§ Knee: Bleed popliteal fossa. Needle Quchi (LI 11), Sanchasan (T 22.17)*.

 

Balance Method by Dr. Richard Tan:

* Use Dr. Tan’s Balance Method accordingly as determined by where the pain is (use mirror or image system). If the pain is in the big toes, needle around the thumb. If the pain is in the knees, needle the elbow. Needle the ah shi points.

 

Auricular Medicine by Dr. Li-Chun Huang:

* San Jiao, Endocrine, Kidney, Liver, Spleen, Coronary Vascular Subcortex, and corresponding points to the area of pain. Bleed Ear Apex.

 

NUTRITION

* Hai Zao (Sargassum) and Kun Bu (Thallus Eckloniae) are helpful, as they contain protein and vital minerals to reduce uric acid levels in the blood.

* Adequate amounts of vitamin C and bioflavonoids (3,000 to 5,000 mg daily) should be taken, as they help to reduce uric acid levels in the blood.

* Essential fatty acids are beneficial for gout, as they are needed to repair tissues and heal joint disorders.

* Since gout attack is caused by excessive deposit of uric acid in the joints, increased intake of food rich in uric acid will increase the risk of gout attacks. Purine-rich food should be avoided, including meat, soup (bone broth), gravies, meat extracts, seafood (anchovies, fish roes, herring, sardine, mussels), shellfish, internal organ meats (liver and kidneys), beer and other alcoholic beverages, spinach, asparagus, mushrooms, and cauliflower.

* Patients with gout should increase their intake of cherries, blueberries and strawberries, all of which are excellent in neutralizing uric acid.

* It is important to always consume an adequate amount of distilled water, and avoid tap water whenever possible. This will help flush out the uric acid crystals.

* After an attack of gout, it is recommended to eat only raw fruits and vegetables for about one to two weeks.

 

CASE STUDY

* Y.J., 63-year-old female, presented with arthritis and gout pain located throughout her feet, fingers, wrists, and arms. Objective findings included inflammation on the joints, redness and an inability to extend the joints. The pain was described as a sharp burning sensation. Blood pressure was 132/61 mmHg with heart rate of 73 beats per minute. The practitioner diagnosed this condition as qi and blood stagnation. Flex (GT) and Herbal ANG were prescribed. After taking the herbs and receiving acupuncture just a few times, the patient reported that her pain alleviated from a 9 to a 5 level. It was also noted that her range of motion had improved and was not as stiff as she was during the initial treatment. Submitted by J.C., Rosemead, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Flex (GT) is a comprehensive formula that treats various aspects of gout. It incorporates herbs that decrease the absorption and increase the elimination of uric acid. Furthermore, it contains herbs with analgesic effects to relieve pain, anti-inflammatory effects to reduce swelling and inflammation, and antipyretic effects to relieve burning sensations and reduce inflammation.

        Huang Bo (Cortex Phellodendri Chinensis), Jin Qian Cao (Herba Lysimachiae) and Ze Xie (Rhizoma Alismatis) are the key herbs in Flex (GT) for treating gout. Huang Bo (Cortex Phellodendri Chinensis) has a marked effect to treat gout. According to a study in subjects with artificially-induced gout, administration of Huang Bo (Cortex Phellodendri Chinensis) reduces serum uric acid levels and inhibits activities of liver xanthine oxidase for the treatment of gout.[1] The water extract of Jin Qian Cao (Herba Lysimachiae) has a potent hypouricemic effect to reduce plasma levels of uric acid in subjects with hyperuricemia.[2] Jin Qian Cao (Herba Lysimachiae) is also one of the most effective herbs to treat accumulation of uric acid crystals and stones in the body, such as gallstones, urinary stones, and bladder stones.[3]^,[4],[5] In addition, Ze Xie (Rhizoma Alismatis) has a marked effect to inhibit the formation of crystal and stones by downregulating the bikunin mRNA expression and decreasing the calcium oxalate formation in the kidney.[6] Furthermore, Che Qian Zi (Semen Plantaginis) and Ze Xie (Rhizoma Alismatis) have significant diuretic effects to flush out all these substances, including but not limited to sodium, potassium and calcium oxalate.[7]^,[8]^,[9],[10] Together, these herbs work to prevent and treat gout.

        Gout often occurs with pain, swelling and inflammation. Therefore, Flex (GT) uses many herbs with analgesic and anti-inflammatory effects. Zhi Mu (Rhizoma Anemarrhenae) shows significant anti-inflammatory action by inhibiting cyclo-oxygenase-2, inducible nitric oxide synthase and 5-lipoxygenase.[11] Huang Bo (Cortex Phellodendri Chinensis) has a marked effect to reduce inflammation by inhibiting the production of proinflammatory cytokines, including interleukin-1beta and tumor necrosis factor-alpha (TNF-α), in a dose-dependent manner.[12] Ji Xue Teng (Caulis Spatholobi) exhibits an anti-inflammatory effect through its inhibitory activities against a panel of key enzymes relating to inflammation, including cyclo-oxygenase, phospholipase, and lipoxygenase.[13] Che Qian Zi (Semen Plantaginis) shows a significant anti-inflammatory effect via its inhibitory effects on nitric oxide production in vitro.[14] Lastly, Di Huang (Radix Rehmanniae) has an anti-inflammatory effect to reduce swelling and inflammation.[15] The mechanism of action is attributed to its influence on the endocrine system. It has been shown that the use of Di Huang (Radix Rehmanniae) increases the plasma levels of adrenocortical hormones, even in the presence of dexamethasone.[16]

        In summary, Flex (GT) prevents and treats gout by decreasing plasma levels of uric acid via reduced absorption and increased elimination of uric acid.

 

COMPARATIVE ANALYSIS

Gout is a form of arthritis that is characterized by sudden, severe attacks of pain, tenderness, redness, warmth and swelling (inflammation) in some joints. Gout is caused in part by excessive intake of food rich in uric acid, or decreased excretion of uric acid through the kidneys. As uric acid deposits accumulate in the joints, they cause severe pain known as gout.

        Acute gout may be treated with colchicine, but use of this drug is not recommended as it may cause severe bone marrow suppression and possibly death. Non-steroidal anti-inflammatory agents (NSAID), such as Indocin (indomethacin), Motrin (ibuprofen), and Naprosyn (naproxen), are very frequently used to treat mild to moderate pain characterized by inflammation and swelling. However, they may cause such serious side effects as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. In short, drug treatment of gout is limited and less than satisfactory.

        Treatment of gout must focus on treating the symptom and the cause. In this formula, many herbs with strong analgesic effects treat pain. Furthermore, many herbs with draining effects flush out excess uric acid. Though herbs are not as potent as the drugs, they offer both short- and long-term improvement for treatment of gout.

        It is important to remember that optimal treatment lies not in use of drugs or herbs, but in commitment to make diet and lifestyle changes. Long-term success can be accomplished only if changes are made to decrease intake and increase elimination of uric acid.