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Gout : Diagnosis
Western Medicine Chinese Medicine

Although serum urate levels are usually raised in cases of gout, high levels alone are not enough to confirm a diagnosis. Quite commonly, individuals with high serum urate levels never suffer with gout. To make a clinical diagnosis, it is necessary to establish the presence of urate crystals in fluid taken from the affected joint. This is done by examining the fluid under polarized light. Urates show up as needle-shaped crystals.

Sometimes, acute attacks of gout can occur when urate levels are normal. This usually only happens in patients who are receiving treatment for gout or are taking drugs that increase uric acid excretion.

X-ray examination of joints is of little use in diagnosing gout. In chronic cases, characteristic signs of erosion caused by tophi may be seen, but these are often indistinguishable from erosions evident in other forms of arthitis.




Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and symptom observation. Diagnosis is based on the traditional four examination techniques:

Questioning The TCM practitioner will establish the medical history of both the patient and his family.
Observation Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
Listening and smelling The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient's health.
Touching Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In gout, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:

Bi-syndrome due to wind, cold and dampness evils

From a TCM viewpoint, when the body's protective qi is weak, climatic and environmental factors (the exogenous evils such as wind, cold and dampness) can readily invade. They attack the superficial meridians and lead to stagnation of vital energy (qi) and blood. Although these three evils may make a combined attack on the body, one is usually dominant and different symptoms result:

Wind evil causes migrating pain involving most limbs and joints.
Cold evil results in localized and severe pain of the limbs and joints (which is relieved by heat and aggravated by cold) and impaired movement of the limbs.
Dampness evil produces heaviness and numbness of the limbs, impaired movement of limbs, joint swelling (but without heat and redness) and localized pain.

On examination, the tongue is coated in a white thin fur. The pulse is tense and wiry, or taut and moderate.

Bi-syndrome due to wind, cold and heat evils
In the conflict between the exogenous evils and vital energy (qi), much heat is produced and the exogenous evils of wind and cold may be transformed into heat evil. Individuals not only suffer from joint and limb discomfort, but also present with general heat symptoms, such as hot and red joints, fever, thirst and sweating. On examination, the tongue is red and covered with yellow fur. The pulse is slippery and rapid.

Bi-syndrome due to phlegm and blood stagnation
In recurrent bi-syndrome, internal damage leads to the formation of phlegm and blood stasis, and symptoms become more serious. Joint pain can worsen and joints become deformed or swollen and movement is impaired. There is severe pain and numbness in the limbs and nodules form beneath the skin. On examination, the tongue is bulky and pink, with bruising, and covered with white and greasy fur. The pulse is thready and uneven.

Bi-syndrome with associated liver and kidney damage
When the circulation of blood and qi is affected over a long period, vital energy (qi) becomes exhausted. The accumulated evils then commonly damage organs such as the liver and kidneys. Individuals usually present with internal damage: fatigue, pallor, shortness of breath, spontaneous sweating, improper joint movement, and soreness and pain in the loin region. On examination, the tongue is pink in color. The pulse is fine or fine and weak.