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Gout : Symptoms
   
Western Medicine Chinese Medicine

Gout is characterized by attacks of acute and searing pain in the affected joint, which becomes hot, red and swollen with shiny overlying skin and dilated veins. Gout may be acute or chronic (long term).

Acute gout
In more than 70 per cent of patients, the joint most commonly first affected is that at the base of the large toe. The ankle, knee, the small joints of the feet and hands, the wrist and the elbow are the next most frequently affected, in that order. The main skeleton or large joints such as the hip and shoulder are rarely involved.

The onset of an attack of gout may be slow or extremely sudden. The pain may be sufficient to wake a sufferer from sleep and attacks commonly start at night or in the early hours of the morning. Attacks can sometimes be accompanied by fever and preceded by anorexia, nausea and mood change. If untreated, attacks last a few days or weeks and then subside on their own. Local itching and skin flaking may follow.

Some patients only ever experience a single attack of gout, or have another attack only after an interval of many months or years. However, the tendency is for attacks to recur and to increase in frequency and duration so that they become more or less continuous. Acute attacks may follow dietary excesses, an increase in alcohol consumption, a starvation diet, use of diuretic drugs or by improperly monitored use of drugs used to treat gout. Trauma, excess exercise, surgery or severe illness can also precipitate an attack.

Chronic gout
In patients who experience recurrent attacks of gout, progressive cartilage and bone erosion can take place with deposits of urate crystals occurring in and around the joints and soft tissues. These deposits present as tophi and are often seen on the ears and elbows. If left untreated, a majority of patients with recurrent gout will develop tophi within 10 years and experience subsequent crippling degenerative arthritis.

Urate calculi and kidney disease
In a small number of patients, especially in hot climates, urate calculi (stones) develop and can cause renal colic and a decline in kidney function.

Urinary tract
 
The type or manner of pathogen invasion will result in different presentations of gout bi-syndrome. The main clinical presentation of the predominant invading pathogen is as follows:

Wind evil causes mobile or unstable joint pain (migratory-bi).
Cold evil results in localized joint pain (painful-bi).
Dampness evil produces numbness, heaviness, and swelling of joints and muscles (localized-bi).
Heat evil generates heat, redness and swelling in the joints and severe tenderness (heat-bi).

TCM practitioners are accustomed to examining the sufferer and categorize symptoms under special syndrome groups known as "disharmony patterns." Certain disharmony patterns present at different stages of gout and are classified as the following types:

Bi-syndrome due to wind, cold and dampness evils
The individual experiences painful joints and limbs, and in some cases severe localized joint pain. Other symptoms include limb heaviness, impaired movement of the affected joints and numbness in muscles. These symptoms will be aggravated during rain or damp weather.

Bi-syndrome due to wind, cold and heat evils
This type of bi-syndrome has an acute onset. The affected joints present with redness, swelling, heat and pain, and also severe tenderness. Relief can be provided with colder temperatures. Other symptoms include thirst, irritability and a fever that is not relieved by sweating.

Bi-syndrome due to phlegm and blood stagnation
This results from repeated attacks of acute bi-syndrome over many years. Individuals present with variable and frequent joint pain, swollen joints, and in severe cases joint deformity. Limbs cannot be flexed or extended and nodules form beneath the skin.

Bi-syndrome with associated liver and kidney damage
Individuals who suffer from long-term bi-syndrome will, without proper treatment, experience migrating bone pain, or soreness and heaviness in the limbs. In severe cases, joint deformity can occur. Symptoms can also include fatigue, pallor, shortness of breath, spontaneous sweating, improper joint movement, limb numbness, and soreness and pain in the loin region.