Gout, Reasons for Recurrence | Songdo Gout

Hello, this is Baekrokdam Korean Medicine Clinic.

Have you ever had an experience like this?

Suddenly, your toes or the top of your foot swell up like a ball of fire, and extreme pain that makes it difficult to even step down arrives suddenly at night or in the early morning.

That is exactly what a gout attack is.

It subsides within a few days if you take anti-inflammatory drugs or colchicine. However, the problem is that this is not the end, but the beginning. It returns after a few months, or a few years, just when you've forgotten about it. Once in the toes, once on the top of the foot, and eventually even to the knees, wrists, and elbows.

“I am managing my uric acid levels, so why does it keep recurring?”

This is the topic we will discuss today.

Gout is not a disease of uric acid. It is a disease of inflammation.

Gout is commonly known as a “disease caused by high uric acid levels.” That statement is correct, but only halfway.

High uric acid does not unconditionally lead to gout. In fact, there are many people who have high uric acid levels but never experience a gout attack in their entire lives, and conversely, there are those who experience frequent recurrences even if their levels are not that high. Why is this?

It is because gout is not simply a ‘matter of numbers,’ but a matter of how the body reacts to those uric acid crystals. In other words, an overreaction of the immune system and a constitution that is easily ignited by inflammation are closer to the root cause.

Western Medicine is fast firefighting, Korean Medicine is preventing the fire from starting

When a gout attack occurs, Western medicine puts it out quickly using anti-inflammatory drugs. Colchicine, steroids, NSAIDs… the effect is fast and powerful. And in the chronic phase, drugs like allopurinol and febuxostat are used to lower uric acid levels. But isn't it strange? Even though the levels have stabilized, attacks still occur once every few months. To prevent this, medication must be taken continuously.

In Korean medicine, gout is viewed as 'toxic energy stagnating inside the body'

Korean medicine views gout as a disease where things like dampness, heat, blood stasis, and phlegm-fluid accumulate in the joints and burst. This is seen not simply because of uric acid crystals, but because the flow of the body itself is blocked, and toxic metabolites accumulate in those gaps to cause inflammation.

Therefore, herbal medicine works like this: in the acute phase, heat-clearing and detoxifying medicines extinguish the heat and swelling of the joints, and in the chronic phase, it restores the functions of the spleen, stomach, and kidneys to create a flow that allows uric acid to be excreted well. At the same time, the core of the treatment is to completely change the constitution that is prone to gout.

What results have actual studies shown?

It is not just a good concept. The effects of herbal medicine and acupuncture have been confirmed in several studies. For example, prescriptions such as Hwangryun-haedok-tang or Gyeji-bokryung-hwan reduce uric acid production and help its excretion through the kidneys. There is pre-clinical data showing that serum uric acid actually decreased by more than 25%.

Yongdam-sagan-tang and Bangpung-tongseong-san quickly reduce joint swelling, heat sensation, and pain by inhibiting cytokines such as IL-1 and TNF-α, which are inflammation-inducing substances. There is also data showing that acupuncture treatment using acupoints such as Zusanli, Yinlingquan, and Taixi improves circulation around the joints and lowers cytokine levels. In another study, there were results showing that acupuncture treatment alone led to a faster pain recovery rate than the group taking NSAIDs.

The period after the acute phase is more important

Gout is not a disease that ends just by getting through the acute phase. If the acute phase is a state where a fire has broken out, the chronic phase is a state where the conditions for a fire to break out are continuously maintained. Korean medicine seeks to eliminate these ‘conditions for ignition’ themselves.

• If obese with much mucous secretion → Phlegm-Dampness type
• If sensitive personality and high heat → Liver-Heat type
• If pain is severe at night and it is long-term gout → Blood Stasis type
• If joints are weak and it is long-term → Kidney Deficiency type

By dividing the constitution this way and using appropriate prescriptions, it does not simply control the pain, but creates changes where the interval between recurrences lengthens and the intensity weakens.

Gout, it should not be controlled, but stopped

Gout is clearly a controllable disease. However, if that control must be a lifelong method of managing it with medication, that is closer to maintenance than treatment. Herbal medicine and acupuncture treatment show the possibility of changing that maintenance into recovery.

Do not look only at uric acid levels. True treatment is changing how the body reacts to uric acid—changing that reactivity. And at that point, there is much that Korean medicine can sufficiently do.