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Gout : Causes
Western Medicine Chinese Medicine
The raised serum uric acid concentrations seen in gout can result from:

an increased production of uric acid
a decrease in uric acid excretion.

Increased production of uric acid occurs in up to one quarter of patients with gout and is common in diseases in which cells are dying and reproducing at a faster rate than normal, such as hemolytic anemia, psoriasis and Paget's disease. Rarely, an enzyme deficiency can cause an increased production of purines. These nitrogen-containing compounds are the metabolic precursors of uric acid.

The reason for decreased uric acid excretion is unknown, but it is thought that obesity, high blood pressure, an abnormally high concentration of fats in the blood, kidney insufficiency, alcohol intake and certain drugs may be involved.

Exercise, starvation, vomiting and toxemia of pregnancy can also be predisposing factors. In more than three-quarters of patients with gout, there is a genetic defect which prevents increased uric acid excretion in response to an increase in purine levels.

Click here to see the causes of gout from a TCM perspective

Gout mainly originates from the invasion and accumulation of pathogens in the meridians. This leads to a disturbance of blood and qi circulation in the limbs. Gout is considered to be caused by both endogenous (originating from inside the body) and exogenous (originating from outside the body) factors.

Exogenous causes
An invasion occurs of external pathogens, such as wind, cold, dampness and heat evils, and these then accumulate in the meridians and joints. TCM practitioners believe that wind, cold or dampness evils invade under the following conditions:

living or working in cold and damp environments
getting wet while recreating or being in the rain
working in water for long periods
abrupt changes in the weather, and
exposure to wind while sweating.

Also, when invasive pathogenic evils remain in the body for some time, they develop into internal heat evil. Accumulation of internal heat evil causes a more serious bi-syndrome.

Endogenous causes
Deficiency in vital energy (qi) or stress are considered endogenous causes. Deficiency of vital energy (qi) usually results from an imbalance between work and rest, innate weakness of the body, lack of physical exercise or recent recovery from chronic illness. When the protective qi is under-functioning, the skin and subcutaneous tissues are loosely bonded and exogenous pathogens take advantage of this to invade the body. They accumulate in the meridians and lead to stagnation of blood and qi.

If attacks of bi-syndrome are frequent and lengthy, meridian obstruction and blood stagnation leads to a disturbance in the metabolism of body fluids. Accumulated substances in the fluids are transformed into phlegm and the deeper organs become affected.