Advances in Experimental and Clinical Research of the Gouty Arthritis Treatment with Traditional Chinese Medicine
Liang et al. · Evidence-Based Complementary and Alternative Medicine · 2021
Evidence Level
MODERATEOBJECTIVE
To review experimental and clinical advances in Traditional Chinese Medicine for the treatment of gouty arthritis
WHO
Patients with gouty arthritis and hyperuricemia
DURATION
Literature analysis from 2004 to June 2021
POINTS
Multiple TCM herbal formulas analyzed
🔬 Study Design
Included studies
n=570
Analysis of scientific literature on TCM for gout
📊 Results in numbers
Databases searched
Main mechanisms identified
Centuries of traditional use
📊 Outcome Comparison
Mechanisms of action identified
This study shows that Traditional Chinese Medicine offers multiple promising approaches to treating gout, working through several mechanisms simultaneously. Although the results are encouraging, more rigorous clinical trials are needed to confirm full efficacy and safety.
Article summary
Plain-language narrative summary
This comprehensive review analyzes advances in the treatment of gouty arthritis with Traditional Chinese Medicine (TCM), compiling more than 570 studies published between 2004 and 2021. Gouty arthritis is a complex multifactorial disease caused by the deposition of monosodium urate crystals, linked to hyperuricemia, and affecting 3.9% of the world's population according to the WHO. The review reveals that TCM has been used to prevent and treat gout for more than 2000 years, with the first detailed descriptions appearing in the Huangdi Neijing 黄帝内经. The methodology involved systematic searches in PubMed, Medline, CNKI, VIP, and Web of Science databases, in addition to the Chinese Pharmacopoeia and traditional texts.
The authors identified seven main mechanisms through which Chinese herbal formulas exert anti-gout effects: inhibition of articular chondrocyte apoptosis, antioxidant response, regulation of inflammatory cytokines, promotion of uric acid excretion, regulation of immune function, reduction of uric acid levels, and improvement of intestinal flora. The most frequently used herbs include Coix Seed, Phellodendri Chinensis Cortex, Atractylodes Lancea, Plantaginis Semen, and Alisma Orientale. Classic formulas such as Simiao-tang 四妙汤 and Dang-gui-nian-tong-fang 当归拈痛方 have shown significant efficacy. The results indicate that TCM can reduce levels of IL-1β, IL-6, TNF-α and improve pain scores.
Studies have demonstrated that formulations such as Simiao Pill can inhibit chondrocyte apoptosis through regulation of Bcl-2 and Bax genes. Components such as berberine, quercetin, and emodin have shown potent anti-inflammatory effects through inhibition of the NLRP3, ERK1/2, and p38 MAPK pathways. Modern research confirms that many traditional herbs can promote uric acid excretion through the regulation of renal transporters URAT1, GLUT9, OAT1, and OAT3. Clinical studies show that combined TCM and Western medicine treatments often achieve better outcomes than monotherapies, with fewer adverse effects.
Network pharmacology is emerging as a promising tool for elucidating the complex mechanisms of TCM. Limitations include the lack of a uniform definition for syndrome differentiation, the need for more evidence-based medicine data, incompletely clarified safety issues, and still poorly understood pharmacological mechanisms. Variability in composition and the possible presence of toxic components represent challenges for global acceptance. Despite this, TCM offers a unique holistic approach, treating not only the symptoms but the overall condition of the patient, following principles of disease prevention and a holistic view.
The authors conclude that TCM represents an effective and progressive method for the treatment of gouty arthritis, especially when combined with modern medicine, but requires further systematic research for full validation of its theory and clinical practice.
Strengths
- 1Comprehensive review of historical and modern literature
- 2Analysis of multiple pharmacological mechanisms
- 3Identification of 570+ relevant studies
- 4Integrative TCM-modern medicine approach
Limitations
- 1Lack of high-quality controlled clinical trials
- 2Pharmacological mechanisms not yet fully clarified
- 3Safety issues not completely resolved
- 4Variability in formula composition
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Gouty arthritis remains one of the most prevalent diagnoses in musculoskeletal pain services, and intolerance or contraindication to the conventional armamentarium — NSAIDs, colchicine, allopurinol — is a frequent clinical scenario, especially in patients with chronic kidney disease, peptic ulcer disease, or polypharmacy. This review systematically organizes what the experimental and clinical literature published between 2004 and 2021 indicates about Chinese herbal formulas as therapeutic adjuvants. The most operationally relevant finding is the documentation of seven distinct pharmacological pathways with demonstrated biological plausibility, including regulation of renal urate transporters and suppression of the NLRP3 inflammasome — both targets of growing interest in conventional pharmacology. For the physiatrist integrating Traditional Chinese Medicine into the rehabilitation protocol, this provides mechanistic support for conversations with partnering rheumatologists about combination therapy in cases of refractory or hard-to-control uricosuric gout.
▸ Notable Findings
Among the seven mechanisms identified, the regulation of renal transporters URAT1, GLUT9, OAT1, and OAT3 by herbal compounds deserves special attention, as it precisely mirrors the mechanism of action of lesinurad and other uricosuric agents in development. The finding that berberine, quercetin, and emodin simultaneously inhibit the NLRP3, ERK1/2, and p38 MAPK pathways gives these molecules an anti-inflammatory profile that operates in parallel with — not as a substitute for — colchicine. Another noteworthy finding is the effect of Simiao Pill on regulating the Bcl-2/Bax ratio in articular chondrocytes, suggesting chondroprotective action beyond uric acid control — relevant for the subgroup of patients with chronic tophaceous gout and established cartilage damage. The modulation of the gut microbiota as an additional pathway for uricemic control opens a therapeutic perspective that converges with contemporary investigations of urate metabolism.
▸ From My Experience
In my practice in the musculoskeletal pain clinic, the patient with gout who comes for physiatric evaluation is almost always one in whom the rheumatologist has already encountered limitations in the conventional regimen — a patient with nephropathy who cannot tolerate NSAIDs during an acute flare, or one with chronic tophaceous gout in whom serum urate simply does not normalize on allopurinol alone. For this profile, I have incorporated formulas based on the principles of Simiao-tang 四妙汤 as an adjuvant, and I usually observe a perceptible reduction in flare frequency within eight to twelve weeks of regular use. Combination with structured nutritional guidance and supervised aerobic exercise enhances the result in a way that none of the interventions in isolation replicates. What this work confirms is what we already recognize empirically: the multi-pathway action is probably why clinical response appears even when serum urate has not yet reached target. Patients with associated metabolic syndrome tend to respond better, possibly because of overlapping shared inflammatory pathways.
Full original article
Read the full scientific study
Evidence-Based Complementary and Alternative Medicine · 2021
DOI: 10.1155/2021/8698232
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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