Gout: Why It Recurs | Songdo Gout

Hello, this is Baekrokdam Korean Medicine Clinic.

Have you ever experienced something like this?

Your toe or the top of your foot suddenly swells up like a ball of fire, accompanied by excruciating pain that makes it difficult to even step on your foot, striking suddenly at night or in the early morning.

That is precisely a gout attack.

Taking anti-inflammatory drugs or colchicine usually subsides the symptoms within a few days. However, the problem is that it's not the end, but the beginning. It returns months or even years later, just when you thought you'd forgotten about it. One time it's your toe, another time your foot, and eventually it might affect your knees, wrists, or even elbows.

“I'm managing my uric acid levels, so why does it keep recurring?”

This is what we will be discussing today.

Gout is not a disease of uric acid. It is a disease of inflammation.

Gout is commonly known as 'a disease caused by high uric acid levels.' That statement is true, but only half-true.

High uric acid doesn't automatically mean you'll develop gout. In fact, many people have high uric acid levels but never experience a gout attack in their lifetime, while others experience frequent recurrences even with levels that aren't particularly high. Why is that?

This is because gout isn't merely a 'numbers game'; it's about how the body reacts to those uric acid crystals. In other words, an overactive immune system and a constitution prone to inflammation are closer to the root cause.

Western Medicine: Rapid Firefighting. Korean Medicine: Preventing the Fire from Starting.

When a gout attack occurs, Western medicine quickly extinguishes it with anti-inflammatory drugs. Colchicine, steroids, NSAIDs... the effects are fast and powerful. And in the chronic phase, medications like allopurinol and febuxostat are used to lower uric acid levels. But isn't it strange? Even when the levels are stable, attacks still occur every few months. To prevent this, medication must be taken continuously.

In Korean Medicine, gout is seen as 'stagnant toxins within the body'.

In Korean medicine, gout is viewed as a disease caused by the accumulation and eventual eruption of elements like dampness (습기), heat (열기), blood stasis (어혈), and phlegm-fluid (담음) in the joints. It's not simply due to uric acid crystals, but rather an understanding that the body's natural flow is obstructed, leading to the buildup of toxic metabolic byproducts that trigger inflammation.

Korean herbal medicine thus works as follows: In the acute phase, 'clearing heat and detoxifying' (청열해독) herbs are used to reduce heat and swelling in the joints. In the chronic phase, it aims to restore the functions of the spleen and stomach (비위) and kidneys (신장) to facilitate proper uric acid excretion. Simultaneously, fundamentally changing the body constitution prone to gout is the core of the treatment.

What have actual studies shown?

It's not just a good concept. The effectiveness of Korean herbal medicine and acupuncture treatment has been confirmed in several studies. For example, formulations like Hwangryeonhaedok-tang (황련해독탕) or Gyejibokryeong-hwan (계지복령환) reduce uric acid production and aid in its excretion from the kidneys. There is even preclinical data showing a reduction in serum uric acid by over 25%.

Yongdamsagan-tang (용담사간탕) and Bangpungtongseong-san (방풍통성산) inhibit pro-inflammatory cytokines such as IL-1 and TNF-α, quickly reducing joint swelling, heat, and pain. Acupuncture treatment, utilizing acupoints like Zusanli (족삼리), Yinlingquan (음릉천), and Taixi (태계), has also shown data indicating improved circulation around the joints and reduced cytokine levels. Furthermore, some studies have even found that acupuncture alone can lead to faster pain recovery than in groups taking NSAIDs.

The period after the acute phase is even more crucial.

Gout is not a disease that ends simply by getting through the acute phase. If the acute phase is like a fire, the chronic phase is when the conditions for a fire to start are continuously maintained. Korean medicine aims to eliminate these very 'conditions for ignition'.

• If obese and with excessive mucous secretions → Damp-Phlegm type (담습형)
• If sensitive and prone to excess heat → Liver-Heat type (간열형)
• If pain is severe at night and it's chronic gout → Blood Stasis type (어혈형)
• If joints are weak and it's long-standing gout → Kidney Deficiency type (신허형)

By classifying these constitutional types and prescribing appropriate treatments, it's not merely about controlling pain; it leads to changes such as longer intervals between recurrences and reduced intensity.

Gout: Don't Just Control It, Stop It.

Gout is certainly a condition that can be managed. However, if that management involves lifelong medication, it's closer to maintenance than a cure. Korean herbal medicine and acupuncture offer the potential to transform that maintenance into recovery.

Don't just look at uric acid levels. The real treatment is changing how your body reacts to uric acid – its reactivity. And in that regard, Korean medicine has a great deal to offer.