Pathogenesis Evolution and Stage-based Treatment of Gout： An Exploration Based on Theory of ''Endogenous Dampness Leading to Bi Syndrome''
10.13422/j.cnki.syfjx.20260522
- VernacularTitle:基于“内湿致痹”理论探讨痛风的病机演变及分期论治
- Author:
Yingjie ZHANG
1
;
Fan YANG
2
;
Ruifang YANG
1
;
Zhuoming ZHENG
3
;
Siwei PENG
4
;
Yan XIAO
1
;
Peng CHEN
1
;
Youxin SU
5
;
Jiemei GUO
1
Author Information
1. School of Orthopedics and Traumatology， Fujian University of Traditional Chinese Medicine（TCM），Fuzhou 350122，China
2. School of Rehabilitation Medicine， Fujian University of TCM，Fuzhou 350122，China
3. First Clinical Medical College， Fujian University of TCM，Fujian University of TCM，Fuzhou 350004，China
4. Zhangzhou TCM Hospital， Fujian University of TCM，Zhangzhou 363000，China
5. Key Laboratory of Orthopedics & Traumatology of TCM and Rehabilitation，Ministry of Education，Fujian University of TCM，Fuzhou 350122，China
- Publication Type:Journal Article
- Keywords:
theory of traditional Chinese medicine;
gout;
endogenous dampness leading to Bi syndrome;
pathogenesis evolution;
stage-based treatment
- From:
Chinese Journal of Experimental Traditional Medical Formulae
2026;32(7):74-83
- CountryChina
- Language:Chinese
-
Abstract:
Gout is a crystal-associated arthropathy caused by the deposition of monosodium urate crystals and is closely related to purine metabolic disorders and impaired uric acid excretion. It is clinically characterized by hyperuricemia， recurrent joint swelling and pain， and tophus formation. The disease course is divided into three stages： The hyperuricemia stage， acute attack stage， and chronic gouty arthritis stage. Modern medicine has reached a consensus on its pathology， but traditional Chinese medicine （TCM） lacks a systematic stage-specific understanding of gout pathogenesis and its underlying mechanisms， making it difficult to guide precise syndrome differentiation and treatment. By integrating classical TCM theory， clinical practice， and modern medical understanding， and drawing upon descriptions of Bi syndrome caused by endogenous dampness and turbidity in classical texts such as Huangdi Neijing·Ling Shu and Synopsis of the Golden Chamber， our team proposes the pathogenic concept of gout as ''endogenous dampness leading to Bi syndrome'' and the core pathogenesis of ''spleen deficiency with internal retention of dampness-turbidity''. We systematically elucidate the evolution of pathogenesis across different stages and corresponding therapeutic strategies. This study posits that metabolic byproducts such as urate fall under the category of ''endogenous pathogenic dampness-turbidity''. When genetic or dietary factors lead to metabolic abnormalities， it manifests as ''spleen deficiency with impaired transport and transformation''， resulting in ''internal retention of pathogenic dampness-turbidity''. When damp-turbidity stagnates in the blood vessels， serum uric acid levels rise. When it stagnates in the viscera and limbs， monosodium urate crystals deposit in the joints. Triggered by precipitating factors， this leads to gout attacks—the core pathological process of ''endogenous dampness leading to Bi syndrome''. Based on this theory， the stage-specific pathogenic characteristics of gout are proposed： The hyperuricemia stage is characterized by ''spleen deficiency with impaired transport and transformation， internal retention of pathogenic dampness-turbidity''， the acute attack stage is primarily marked by ''dampness-turbidity and static heat obstructing the limbs and joints''， while the chronic stage is defined by ''spleen deficiency with internal retention of pathogenic dampness-turbidity， intermingled with phlegm-stasis binding''. The treatment principle centers on ''strengthening the spleen and draining dampness'' throughout all stages. During the hyperuricemia stage， treatment focuses on ''strengthening the spleen， draining dampness， and eliminating turbidity''. In the acute attack stage， the treatment should "strengthen the spleen， drain dampness， clear heat， eliminate turbidity， alleviate swelling， and relieve pain''. In the chronic stage， the treatments emphasizes to ''strengthen the spleen， drain dampness， transform turbidity， clear heat， resolve phlegm， and activate blood circulation''. This approach has yielded favorable therapeutic outcomes in clinical practice. This theoretical system clarifies the nature of gout as ''spleen deficiency being the root， dampness-turbidity being the secondary manifestation'' and systematically analyzes its pathogenesis evolution process and characteristics. The constructed stage-based treatment protocol has been validated through clinical and basic research， providing systematic theoretical guidance and a practical framework for the precise TCM management of gout， thereby promoting the modernization of TCM pathogenesis theory related to gout.
