Gout‧痛風

Gout is a rheumatic disease caused by the deposition of uric acid crystals (monosodium urate) in tissues and fluids within the body. It can present itself in a number of ways, though the most common is a recurrent attack of acute inflammatory arthritis (a red, tender, hot, swollen joint). These crystals cause the joint to swell up and become inflamed. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected. Other joints, such as the heels, knees, wrists, and fingers may also be affected. Joint pain usually lasts between 2–4 hours, and during the night. An acute attack of gout will usually subside after five to seven days without treatment. However, 60% of people will have a second attack within a year. Those with gout are at an increased risk of hypertension, diabetes mellitus, metabolic syndrome, and renal and cardiovascular disease. This often accompanies an increased risk of death. 　　Hyperuricemia is the underlying cause of gout. This can occur for a number of reasons including: diet, genetic predisposition, or under-excretion of urate. Urates are the salts produced in uric acid. Renal under-excretion of uric acid is the primary cause of hyperuricemia consisting of about 90% of cases, while overproduction is the cause in less than 10%. About 10% of people with hyperuricemia develop gout at some point in their lifetimes. The exact cause is unknown. Gout may run in families. It is more common among men, women after menopause, and those who drink alcohol. People who take certain medicines, such as hydrochlorothiazide and other water pills, may have higher levels of uric acid in their blood. The condition may also develop among people with diabetes, kidney disease, obesity, sickle cell anemia (as well as other anemic conditions), leukemia, and other blood cancers. 　　There are several medications used to treat hyperuricemia, each with its own side effects.  Alkaline drugs, non-steroidal anti-inflammatory drugs, uricosuric drugs use, and drugs that inhibit the production of uric acids may be fast and effective; but will generate various side effects and even liver and kidney toxicity. On the other hand, Chinese medicine and acupuncture is a safer alternative with a reduced risk of toxicity and side effects. 　　Traditional Chinese medicine believes the disease is the result of greasy foods, which leads to internal pent-up heat and moisture. Wind and cold invades channels and collaterals, blocking the movement of qi and fluids. This causes stasis of moisture and heat that become phlegm which clogs the collaterals, causing swelling and burning pain in the joints. Traditional treatment seeks to clear heat and moisture; disperse phlegm; and remove stagnancy.  This will dredge the channels in order to stop pain while facilitating the functions of the Spleen and Kidneys. Patients are advised to avoid extreme fatigue, wind, and cold for the duration of the treatment.  Diets and lifestyles should to be controlled, while alcohol and smoking are discouraged.

痛風，關節內尿酸結晶引起的炎症性關節炎，導致腫脹和劇烈疼痛。隨著肥胖的流行，在過去的二十年，新的研究表明，痛風已成為美國常見疾病，它影響到在美國的約4330萬成年人，約佔總成年人人口的21％。其多見於男性，患病的風險也隨著年齡而增加。 　　高尿酸血症是引起痛風的主因。研究指出在男性身上，血尿酸濃度愈高者，出現痛風症狀的機會愈高，血尿酸濃度超過每9毫克/分升者，4.9%會出現痛風。近年的大型流行病學研究發現，痛風與飲酒（尤其是啤酒）及肉類（尤其是內臟）和海產攝取有關，亦有研究指出碳酸飲料及果糖也可能導致痛風。另一方面，維生素C，咖啡和奶制品則可能對阻止痛風的發生有所幫助。 　　臨床上一般可將痛風分為四期描述，但並不表示每位痛風病人都須依序經過這四個時期；痛風的四個分期包括(1)無症狀的高尿酸血症，(2)急性痛風關節炎，(3)間歇發作期，(4)慢性痛風關節炎等，腎結石可在第二至第四期發生。 　　痛風在中醫的辨證上，是由於脾腎功能失調，脾失健運，致使濕濁內生；腎分清泌濁的功能失調，則濕濁排泄障礙。此時若又酗酒暴食、勞倦過度等，則促使濕濁流注於關節、肌肉，造成氣血運行不暢而形成痺痛，也就是痛風關節炎。如濕濁之邪進一步傷於腎則可導致腎損害，就是痛風性腎病甚至慢性腎衰。 　　醫學證據也表明，痛風與代謝綜合徵相關，像是肥胖、胰島素抵抗、血壓高和高血脂等問題，還可能會增加心臟病發作和糖尿病風險。而在痛風的西醫治療方式，無論是抑制尿酸生成的藥物、鹼性藥物、非甾體類抗炎藥和排尿酸藥等的運用，確實是快速而有效的，但對患者都有產生著不同程度的副作用甚至肝腎毒性反應。相對於中醫治療，不論是在急性發作期的治療或是慢性期間的預防，中藥和針灸等治療手段都是相較安全且少副作用。