Hyperuricemia, defined as a serum urate (SU) level exceeding 7 mg/dL, has a prevalence of up to 20.2% in males and 20.0% in females among adults in the US. It can result from excessive urate production or, more commonly, inefficient renal excretion. When urate levels surpass the physiological solubility threshold, monosodium urate (MSU) crystals may form in tissues, leading to gout.
In Traditional Chinese Medicine (TCM), gout, known as “Tong Feng” (痛风), is attributed to a deficiency-type body constitution in combination with external pathogenic influences. Genetic factors, dietary habits, and lifestyle irregularities contribute to this constitution, while external pathogenic elements—Wind, Cold, Dampness, and Heat—exacerbate the condition. Heat-Dampness is the most common TCM classification for gout, and treatment focuses on eliminating these factors while relieving pain and inflammation.
Western medications for gout often cause side effects such as allergic reactions, gastrointestinal irritation, liver toxicity, and nephrotoxicity. Hence research has turned to alternatives such as TCM to mitigate this issue. Rhizoma Polygonum cuspidatum (Hu Zhang, 虎杖), whose primary active ingredient is Polydatin (PD), presents as a safe alternative. PD is able to downregulate xanthine oxidase (XOD) activity in the liver, lower malondialdehyde (MDA) levels and enhance the activity of antioxidant enzymes. In hyperuricemic mice, PD modulates urate transporters by suppressing GLUT9, URAT1 while upregulating ABCG2, OCT2, OAT1, and OAT3. Animal studies have shown that PD is non-toxic to the liver, kidneys, and cardiovascular system at doses up to 200 mg/kg. Clinical trials indicate that a 20 mg dose of PD administered twice daily for three months has no significant adverse health effects.
Other than Hu Zhang, a network pharmacology study on TCM herbal treatment of gout revealed that Radix Achyranthis Bidentatae (牛膝), Semen Coicis Albais (薏苡仁), Rhizoma Smilacis Glabrae (土茯苓), Cortex Phellodendron Amurense (黄柏) and Rhizoma Atractylodis Lanceae (苍术) form a core group of herbs which are commonly used. Clinical research involving patients with accumulated dampness-heat of acute gouty arthritis, have shown that these herbs are able to lower uric acid and decrease the rates of adverse reactions, in fact, combination therapy of both Western medicine and TCM yield the best results in terms of uric acid levels and adverse events, suggesting its safety and efficacy for short term treatment of gout. However, the sample sizes were relatively small and the trials were lacking in post-treatment follow up. Hence, further studies are needed to explore the effects of integrating TCM with Western medicine for long-term management of gout and hyperuricemia.
References
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