Comprehensive Treatment of Gout with Traditional Chinese Medicine: A Modern Pathophysiological Perspective

This comprehensive review examines the role of Traditional Chinese Medicine (TCM) in the treatment of gout, an inflammatory joint disease caused by the accumulation of uric acid crystals. Gout affects approximately 4% of adults globally, with rising prevalence in developed countries, manifesting through acute attacks of severe pain, swelling, and erythema, especially in the first metatarsophalangeal joint. The research systematically analyzed literature from databases such as PubMed, CNKI, and Web of Science through 2024, including randomized clinical trials, observational studies, and mechanistic investigations on TCM interventions for gout. From the TCM perspective, gout is associated with patterns such as damp-heat accumulation, phlegm-blood stasis, and liver-kidney deficiency.

Treatment emphasizes syndrome differentiation and individualized care, aiming to restore systemic balance rather than focus solely on urate levels. Modern pharmacologic studies show that TCM interventions exert multi-target effects, including inhibition of xanthine oxidase, regulation of renal and intestinal urate transporters, suppression of NLRP3 inflammasome activation, and modulation of inflammatory cytokine networks. The clinical evidence reviewed indicates that TCM interventions — including classical herbal formulations such as Guizhi Shaoyao Zhimu Decoction (桂枝芍药知母汤), Simiao Powder (四妙散), and Tongfengshu Decoction (痛风舒汤) — showed significant improvements in inflammatory regulation, uric acid metabolism, symptom relief, and prevention of recurrences. Acupuncture studies, including Tongyuan techniques and cupping with bloodletting, showed greater reductions in pain and swelling and decreases in CRP and serum uric acid, with more durable therapeutic effects and fewer adverse events compared with conventional treatment alone.

Integration of TCM with modern medicine offers a promising synergistic approach in which Western pharmacotherapy rapidly controls inflammation and pain in the acute phase, while TCM contributes to metabolic regulation and prevention of recurrences in the remission phase. Mechanistic studies suggest that TCM modulates multiple pathophysiologic pathways simultaneously: it reduces uric acid production through inhibition of xanthine oxidase, promotes urinary excretion by regulating transporters such as ABCG2, URAT1, and GLUT9, suppresses NF-κB and NLRP3 inflammatory pathways, modulates immune cell activity such as macrophages, and protects renal function and joint structures. Important limitations include small sample sizes in many studies, methodological heterogeneity across trials, variable diagnostic criteria, and possible publication bias. Future research should prioritize well-designed multicenter trials with larger samples, standardization of diagnostic and therapeutic protocols, and mechanistic investigations that connect traditional syndrome differentiation with contemporary molecular biomarkers to strengthen the scientific basis of integrative strategies.