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Condition Treated / Pain Conditions

Gout

Gout is a disease of protein metabolism with symptoms most commonly manifest at the first metacarpo-phalangeal joint, but it can affect almost any joint or combination of joints and the patient may exhibit systemic symptoms. The typical presentation of gout is as exquisite pain and tenderness in a red, hot and swollen big toe. The acute attack usually settles within a few days, but may last several weeks. It is caused by the deposit of urate crystals; a raised serum uric acid therefore supports a diagnosis of gout, but confirmation must be through finding crystals in synovial fluid on microscopy, as there are other causes of hyperuricaemia, such as renal disease and malignancy, and the uric acid is not always abnormally high in acute attacks. The erythrocyte sedimentation rate (ESR) is also raised in an acute attack. There are no x-ray changes in the early stages, but in the advanced stage gouty calculus is deposited near the joint surface and appears as round defects in epiphyseal areas.

Treatment of the acute attack is with non-steroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac or indomethacin, together with rest of the affected part, avoidance of alcohol and purine-rich foods, and omission of drugs such as the thiazide diuretics that may raise serum uric acid.

Patients having recurrent attacks or evidence of chronic disease such as renal damage or joint tophi may need prophylactic treatment with the xanthine-oxidase inhibitor, allopurinol, or a uricosuric drug such as probenecid to reduce uric acid levels. Life-style modification is an essential element in treatment. There should be advice on weight loss, and reduction of alcoholic drink and protein consumption, particularly those rich in purine such as red meat, oily fish, beer and port wine. Gout in the elderly may be mistaken for osteoarthritis, and the differential diagnosis must include infective arthritis.

In traditional Chinese medicine an over-rich diet is thought to cause a build-up of damp and heat internally that causes phlegm to stagnate. There is also disturbance of the Spleen and Kidney. Treatment thus involves Spleen and Stomach acupuncture points (SP.3 and 6, and ST.36 and 40) to control heat and damp and reduce phlegm. Other local points are used according to the joint involved.

Acupuncture treatment

Traditional treatment is therefore aimed to clear heat and damp, disperse phlegm and remove stagnancy, dredge the channels to stop pain, and regulate the function of the Spleen and Kidneys. Patients should be advised to avoid over-fatigue, wind and cold for the duration of treatment, and the diet and lifestyle need to be controlled: alcohol and smoking should be reduced or given up.

We observe the following method in acupuncture treatment: The points Taibai (SP. 3), the Yuan (Primary) point of the Spleen channel, and Zusanli (ST.36), the He (Sea) point of the Stomach channel, are selected to strengthen the function of Spleen and Stomach, clear heat and remove damp. In addition, two complementary points are used: Fenglong (ST.40) reduces phlegm and dredges the channels, and Sanyinjiao (SP.6), the crossing point of the three yin channels of the foot, helps reinforce the Spleen and Kidney, regulate qi and blood, and also clears heat, removes damp, purges toxin and disperses stagnancy.

Local points are used according to the affected joint: Taichong (LR.3), the Yuan (Primary) point of the Liver channel, Taibai (SP.3), the Yuan (Primary) point of the Spleen channel, and Dadu (SP.2), the Ying (Spring) point of the Spleen channel, are selected to purge heat and toxins in the blood when joints of the foot are involved, and Waiguan (TE.5) and tender (ashi) points are used for disease in the joints of the hand.

The points are manipulated with a pinch skin method, but in acute cases a reducing method of lifting and thrusting is used. During convalescence, the method of even reducing and reinforcing is used. The needles are retained for an hour at each treatment and, in order to reinforce the effect, they may be electrically stimulated to the maximum intensity acceptable to the patient. The treatment is given daily or on alternate days, with ten treatments constituting a course. Advice on life-style changes, particularly diet and fluid intake, is also given.

Lifestyle

The American Dietetic Association recommends following these guidelines during a gout attack:

Drink 8 to 16 cups (about 2 to 4 liters) of fluid each day, with at least half being water.
Avoid alcohol.
Eat a moderate amount of protein, preferably from healthy sources, such as low-fat or fat-free dairy, tofu, eggs, and nut butters.
Limit your daily intake of meat, fish and poultry to 4 to 6 ounces (113 to 170 grams).

During symptom-free periods, these dietary guidelines may help protect against future gout attacks:

Keep your fluid intake high. Aim for 8 to 16 cups (about 2 to 4 liters) of fluid each day, with at least half being water. Limit how many sweetened beverages you drink, especially those sweetened with high fructose corn syrup.
Limit or avoid alcohol. Talk with your doctor about whether any amount or type of alcohol is safe for you. Recent evidence suggests that beer may be particularly likely to increase the risk of gout symptoms, especially in men.
Eat a balanced diet following the Dietary Guidelines for Americans. Your daily diet should emphasize fruits, vegetables, whole grains, and fat-free or low-fat milk products.
Get your protein from low-fat dairy products. Low-fat dairy products may actually have a protective effect against gout, so these are your best-bet protein sources.
Limit your intake of meat, fish and poultry. A small amount may be tolerable, but pay close attention to what types — and how much — seem to cause problems for you.
Maintain a desirable body weight. Choose portions that allow you to maintain a healthy weight. Losing weight may decrease uric acid levels in your body. But avoid fasting or rapid weight loss, since doing so may temporarily raise uric acid levels.

Pain Care Acupuncture Clinic is your local acupuncture office in Torrance, CA . specializing in treating injuries and chronic pain. Dr. Ming Chen and Dr. Lu Yang, Both acupuncturists who also the oriental medical doctor ( O.M.D. ) can pinpoint the cause of the injury and suggest the best treatment methods for you. You need our doctor to listen to the whole story and examine you, so that you can get started treating on your injuries or chronic pain and get you on the track toward recovery.

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