Gout is a form of arthritis caused by an increase in the production of uric acid and its deposition in the joints, kidneys and other tissues.  It is often characterized by acute onset with severe pain. It frequently affects the big toe (up to 90% of all cases), especially in the first attack. The concentration of uric acid in the body is a compound total determined by the amount eaten (in foods), how much the body produces, and how much is excreted in the urine. Excessive dietary intake of fatty foods or ingestion of alcohol or drugs often precedes gout attacks. However, 85% of cases are caused by failure to excrete sufficient urea via the urine (Stobo et. al., 1996). Standard allopathic treatment involves inflammation control with NSAIDS and uric acid control with Allopurinol or other drugs, along with avoidance of alcohol, fats, refined carbohydrates, and foods high in purine, such as organ meats (liver, kidney) and sardines (Emmerson, 1996).

All three systems of medicine suggest dietary restrictions. The importance of reducing purine-rich foods is clear. TAM doctors suggest dietary limitation of vinegar and burnt or fried foods, as well as avoidance of damp environmental conditions and over-eating.  TCM doctors pretty much agree, calling this a disease of heat and damp, so the heat and dampness diet can be followed.  It is also important to drink plenty of pure water, which has a natural diuretic effect. Gout and Diet.

An important clinical differentiation is whether the patient is an under-excreter of uric acid (85%) or an over-producer (15%). This is determined by testing the urine for uric acid levels. Under-excreters are treated with the drug Allopurinol, which works by blocking xanthine oxidase, the liver enzyme that produces uric acid while breaking down purines. Over-producers are treated with agents that stimulate urinary excretion of uric acid.  With that in mind, we can examine herbal alternatives.

Because it is necessary to stop the severe pain, acute gout attacks should be treated with strong anti-inflammatories whether herbal or pharmaceutical. In most cases it is best to use Western medicines to get through a crisis.  Steroid injections are commonly used. Mild anti-inflammatories may be used for long-term management, but not as the sole treatment. Any of the herbs from the heat-removing group or poison-removing group may be used for this purpose. One anti-inflammatory that is potentially very useful is bromelain, the anti-inflammatory and digestive herb.

Herbal Strategies to Inhibit Production of Uric Acid

Anecdotal reports indicate that eating large amounts of flavonoid-rich cherries (up to 1/2 pound per day) can be beneficial for gout (Murray, 1993). Several patients in the past have come in and told me this works for them. In fact tart cherry juice is now available in a lot of stores due to demand for its anti-inflammtory properties.  This makes sense, because numerous naturally occurring flavonoids have been tested which inhibit the effects of xanthine oxidase. These include those found in bupleurum root, green tea, capillaris root, tangerine peel, perilla leaf (zi su ye or P. frutescens) and kudzu (Aucamp et al., 1997, Chang et al., 1993, Duke, 1997). Quercetin has also been shown to do this (Nagao et al., 1999, Gariboldi et al., 1998).  The easiest herbal way to control uric acid production may be to eat cherries, drink green tea and watch your diet.

Herbal Strategies to Enhance Excretion of Uric Acid

Promoting excretion of uric acid through urination is a bit more problematic.  You cannot simply use any diuretic--you would have to use one that expels the uric acid. Thiazide diuretics, for example, commonly used to control high blood pressure, can increase gout risk and uric acid blood levels if prescribed in high doses (Gurwitz et al., 1997). The mini-doses of aspirin used to prevent heart attacks can slow uric acid excretion by 15% (Caspi et. al., 2000). I was unable to locate studies measuring the effect of different herbs on uric acid excretion, with the exception of some studies reported by Dr. Duke in his supurb book, The Green Pharmacy.  He reports that devil's claw (Harpagophtum procumbens), olive leaf tea (Olea europa), and stinging nettles (Urtica dioica) have some weak historical use data and pharmacological evidence showing they can increase urinary output of uric acid (Duke, 1997). However there are numerous diuretic herbs traditionally found useful for removing gouty accumulations. For this reason we can predict they stimulate removal of uric acid. (Some simple urine testing could easily determine the truth of this.)

• One of the best simple herbal treatments for gout is daily ingestion of celery seeds (Apium graveolens) (reported in Duke, 1997). TAM doctors also use these seeds to treat other forms of pain and swelling.

• Ayurvedic doctors use the protocol mentioned for osteoarthritis for gout, along with a standard TAM tonic called kaishore guggul, which contains guggul gum, guduchi stem and triphala. This tonic  has traditionally been used to increase uric acid excretion, and Dr. Mana has told me he has successfully used it on many patients (Bajracharya, 1979).

• Western herbs reputed to remove uric acid accumulations include cleavers (Galium aparine), hydrangea root (Hydrangea arborescens), buchu leaf (Barosma betulina), parsley root (Petroselinum crispum), parsley piert (Aphanes arvensis), and gravel root (Eupatorium purpureum).