Analysis of the rule of medication for internal administration of gout by traditional Chinese medicine based on Traditional Chinese Medicine Inheritance System

Yi-Hua Fan,Hong-Xia Xie,Ping Xin,Jin-Xiang Mao,Yu-Yan Zhang,Xin-Ju Li＊

1The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300382,China.

2Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China.

☯These authors contributed equally to this work.

Abstract Objective:Based on the TCMIS(traditional Chinese medicine inheritance system)V2.5 to explore the rule of medication used in internal TCM(traditional Chinese medicine)for gout in the national patent network.Method:Collect the internal administrations of gout in the national patent network,and enter them into the Chinese medicine inheritance system V2.5,adopt Frequency analysis,association rules,complex system entropy clustering and other data mining methods to analyse the internal traditional formula of traditional Chinese medicine for gout.Results:By inclusion,exclusion criteria,357 formulas are screened out,involving 494 medicine,63 medicine with frequency of use≥20,and 40 commonly used medicine pairs.The core medicine are:Huangbai(Cortex Phellodendri),Cangzhu(Rhizoma Atracylodis),Niuxi(Radix Acanthopanacis Bidentatae),Yiyiren(Semen Coicis),Tufuling(Rhizoma Smilacis Glabrae),Bixie(Rhizome Dioscoreae Hypoglaucae),Gancao(Radix Glycyrrhizae),Weilingxian(Radix Clematidis),Zexie(Rhizoma Alismatis),Danggui(Radix Angelicae Sinensis),Chuanxiong(Rhizoma Chuanxiong).There are 28 new combinations and 14 new formulas.Conclusion:In the national patent network,the internal traditional Chinese medicine for gout is based on clearing away heat and dampness,activating blood circulation to dredge collaterals,which provides reference for clinical treatment of gout.

Keywords:Gout,Internal Chinese medicine,Traditional Chinese medicine inheritance system,Medication rule

Background

Gout is a group of chronic diseases caused by various causes of purine metabolic disorders that increase serum uric acid[1].It is characterized by urate crystal deposition in joints and soft tissues,causing inflammation of synovium[2],resulting in joint pain,swelling and other symptoms,prone to repeated attacks and not easy to cure,affecting the work and life of patients,even psychological and mental problems,for the reason of long-term urate deposition,severe cases can lead to joint deformities and renal failure[3].In western countries,the incidence of gout is 1%～2% among women and 3%～6% among men[4],and the incidence of gout in China is about 1.1%[5].but the incidence is getting younger and younger,and the incidence is also increasing[6].Western medicine treatment is dominated by colchicine,non-steroidal anti-inflammatory medicine,glucocorticoids,uric acid excretion and inhibition of uric acid production[7].Studies have reported that these medicine can lead to rash,liver injury,digestive system injury and other adverse reactions[8].Gout is the diagnosis of modern medicine,but it has long been recorded in the ancient books of our country,such as Danxi Heart Law said:"Gout is limb pain." Chinese medicine uses acupuncture and moxibustion,bloodletting,traditional Chinese medicine and external use of traditional Chinese medicine to treat gout,and has achieved good results[9-10].But traditional Chinese medicine is often treated by syndrome differentiation,formula medicine is flexible,less agreement,not easy to be popularized and used.In order to provide a reference for future clinical use,the author is to study the law of treating gout by using traditional Chinese medicine in depth,and excavate the basic pathogenesis,basic treatment and core formula of treating gout.

Information and methodology

Formula source

This paper is from the National Patent Network search,available from URL：http//www.cdc.gov/ncidod/EID/eid.htm.search with the theme of "gout" and "traditional Chinese medicine",the time limit is from the construction of library to October 2019.

Inclusion criteria

National patent for treating gout using traditional Chinese medicine.The selected patent meets the diagnostic criteria for gout,and the medicine composition and dosage are clear.

Exclusion criteria

1.Gout with other diseases,such as diabetes,kidney disease,etc;

2.Hyperuricemia,no arthritis manifestations only;

3.Not pure Chinese medicine internal treatment,such as combined with other therapies or western medicine,health products,etc;

4.Patent for Chinese medicine extract treatment;

5.Patent whose medicine composition has not been written completely,just say such and such medicine and so on;

6.Formula for other ethnic minorities,such as Mongolian medicine,seedling medicine,etc;

7.Patent for repeated application.

Formula screening and standardized treatment

In the national patent network search obtained 901 articles,through the inclusion and exclusion criteria,screening the treatment of gout 357 formulas,including 494 Chinese medicine.The aliases,authentic medicinal materials and the medicinal materials obtained by different processing methods in the formula are all standardized according to the canonical names of "Chinese Medicine" and "Chinese Medicine Dictionary ".Such as honeysuckle vine recorded as Rendongteng(Caulis Lonicerae);raw barley,fried Coix seed unified recorded as Yiyiren(Semen Coicis);ginger Pinellia,Qing Pinellia unified recorded as Banxia(Rhizoma Pinelliae)and so on.

Formula input and check

The standard 357 formulas were input into the Chinese medicine heritage auxiliary platform(TCMISSV2.5),in the process,one person is responsible for input,the other person is responsible for checking to ensure that the excavated data is accurate.

Data analysis

Use the function of frequency statistics to arrange the selected 494 Chinese medicine in descending order according to the frequency of occurrence;then carries on the formula rule calculation,sets the support degree number to 35,confidence degree to 0.7,obtains the common compatibility combination and association rule of the medicine;after repeated debugging,finally selects the correlation degree to 10,punishment degree to 8,uses the entropy clustering analysis to analyze the data,evolves the new formula medicine core combination and the new formula.

Results

Frequency analysis of internal administration of TCM in the treatment of gout

Frequency statistical analysis was performed among the 494 Chinese medicine from the screening of 357 formulas of gout,according to the medicine frequency descending order,there are 63 traditional Chinese medicine in frequency≥20(Table 1).

Table 1 Chinese medicine of the frequency≥20

Nature-flavour and Channel Tropism analysis of internal traditional Chinese medicine

The results of the analysis showed that the main treatment medicine for gout were warm,cold and peaceful,and the proportion of the three kinds was 93.55%.The main flavor of the medicine was sweet taste,followed by bitter taste and symplectic taste,these three kinds accounted for 89.50% of the total medicine.Click on the traditional Chinese medicine Channel Tropism analysis,showing that liver,spleen,kidney and stomach were the main TCM channels for treating gout,accounting for 62.82% of the total amount of medicine(Table 2 and 3).

Table 2 Nature-flavour analysis of internal traditional Chinese medicine for gout

Table 3 Channel Tropism analysis of internal traditional Chinese medicine for gout

Table 4 Frequency of TCM combination for gout treatment with support degree 35

The rule analysis of gout formulas based on association rules

Set the support level to 35(medicine pairs appearing in no less than 35 formulas),the confidence level to 0.7,and then according to the descending order of frequency,40 commonly used medicine pairs(Table 4 and Figure 1)and 13 association rules(Table 5)were obtained.

Figure 1 Network display of medicine pairs for gout treatment

Table 5 Medicine association rules for gout treatment

Using the entropy clustering method of complex system to analyze the core combination

According to the debugging of the selected medicine,the correlation coefficient was set to 10 and the penalty coefficient to 8[11],and the core combinations of 28 new formulas were obtained(Table 6)

Table 6 Core combinations analyzed by using the entropy clustering method of complex system

New formulas analysis based on unsupervised entropy hierarchical clustering

There are 14 new formulas for the internal administration of traditional Chinese medicine to treat gout(Table 7).

Table 7 New formulas for gout based on unsupervised entropy hierarchical clustering

Discussion

Gout has the characteristics of invading the joint,blocking the meridian,lingering limbs and severe pain.The main clinical manifestations are limb joint pain,soreness and limited movement,so it belongs to the category of "arthralgia syndrome" and "White tiger Lijie" in traditional Chinese medicine.Shenghui Fang think gout is caused by deficiency of spleen and kidney,and improper diet,causing endogenetic turbid dampness,coupled with the attack of wind,cold,summer heat and dampness poison,when internal and external cause interact,it turns out to be turbid poison obstructing meridian.Waitai Miyao consider the etiology of gout is related to heat and poison attack in the limbs.Zhu Danxi put forward the treatment of gout from blood theory in Ge Zhi Yu Lun,it is believed that the main cause is maladjustment of qi and blood,blood deficiency heat generating.Lu zhizheng,a master of Chinese medicine,believed that the pathogenesis of gout is greasy diet,loss of spleen function,dampness and heat obstructing and coagulating in joints[12].Professor wang jianming proposed that the pathogenesis of gout is "deficiency,turbidity,heat,and blood stasis[13].However,professor zhang huangsheng believes that gout is mostly due to deficiency in origin and excess in superficiality,for the case of deficiency of the function of the lungs,spleen and kidney,the thick flavor food digest abnormally,the dampness produce in the body,and qi and blood stagnate,brewing internal toxicity and obstructing the meridians and collaterals[14].Thus it can be seen that the pathogenesis of gout is not unified,which is related to factors such as wind,cold,dampness,heat poison,dampness and heat blocking,spleen deficiency and dampness resistance[15].According to the summary of clinical experience,the author believes that although the etiology of gout is different,the basic pathogenesis of gout is dampness-heat stasis blocking the meridians,and the basic treatment method is heat and damp-clearing and blood-activating and meridians-dredging,which is quite similar to the viewpoint of professor Fan guanjie[16].Applications filed for the national patent network includes many physicians formulas,these formulas are often many doctors'clinical experience of crystallization for many years,worth learning from.Therefore,the author through the Traditional Chinese Medicine Inheritance System to dig formulas from the national patent network and analyze its basic pathogenesis and core medicine.By testing the evidence,discuss whether it is consistent with our theory,so as to provide some reference for clinician.

Medication frequency analysis

According to high frequency medicine analysis(Table 1),63 medicine of frequency≥20,of the top 12:Niuxi(Radix Acanthopanacis Bidentatae)(Radix Acanthopanacis Bidentatae),Gancao(Radix Glycyrrhizae),Cangzhu(Rhizoma Atracylodis),Huangbai(Cortex Phellodendri),Tufuling(Rhizoma Smilacis Glabrae),Yiyiren(SemenCoicis),Weilingxian(Radix Clematidis),Bixie(Rhizome Dioscoreae Hypoglaucae),Danggui(Radix Angelicae Sinensis),Fuling(Poria),Zexie(Rhizoma Alismatis),Chuanxiong(Rhizoma Chuanxiong).Among them,Niuxi(Radix Acanthopanacis Bidentatae)can promote blood circulation,tonify the liver and kidney,and strengthen the muscles and bones;Gancao(Radix Glycyrrhizae)has the function of invigorating spleen and invigorating qi,clearing heat and detoxifying,and harmonizing all these medicine;Cangzhu(Rhizoma Atracylodis)can dry and invigorate the spleen,dispel the wind and eliminate paralysis;Huangbai(Cortex Phellodendri)clear heat and dry dampness,detoxify fire detoxification;Tufuling(Rhizoma Smilacis Glabrae)detoxify and clear damp,make joints flexible;Yiyiren(Semen Coicis)remove dampness by promoting diuresis,invigorate the spleen and eliminate paralysis;Weilingxian(Radix Clematidis)can dispel wind and reduce phlegm,dredge meridians and relieve pain;Bixie(Rhizome DioscoreaeHypoglaucae)remove dampness in addition to eliminate paralysis;Danggui(Radix Angelicae Sinensis),Chuanxiong(Rhizoma Chuanxiong)invigorate blood circulation and remove blood stasis;Fuling(Poria)remove dampness and invigorate the spleen,promote the transport of the middle-jiao;Zexie(Rhizoma Alismatis)remove the lower-jiao dampness,they have a total of the effect of clearing heat,removing damp,promoting blood circulation and dredging meridians.Among them,Niuxi(Radix Acanthopanacis Bidentatae),Cangzhu(Rhizoma Atracylodis),Huangbai(Cortex Phellodendri),Yiyiren(Semen Coicis)are composed of Simiao pills,which comes from Cheng Fang Bian Du,has the function of clearing heat and promoting dampness,removing turbid and dredge meridians,it is commonly used clinically for gout by addition and subtraction and achieves good curative effect[17-18],studies have found that flavored Simiao pills can reduce joint swelling of rats,have the effect of anti-inflammation and analgesia[19].While Danggui(Radix Angelicae Sinensis),Chuanxiong(Rhizoma Chuanxiong),Fuling(Poria),Zexie(Rhizoma Alismatis)belong to the structure of Danggui Shaoyao powder,which has the function of promoting blood circulation and reducing dampness.Besides the top 12 medicine,there are other medicine have the function of dispelling wind,dredging meridians and relieving pain,to improve the joint swelling and pain with good efficacy,such as Haifengteng(Caulis Piperis Kadsruae),Jixueteng(Caulis Spatholobi),Mugua(Fructus Chaenomelis),Qinjiao(Radix GentianaeMacrophyllae),Rendongteng(Caulis Lonicerae),Sangzhi(Ramulus Mori),etc.In addition,Shancigu(Pseudobulbus Cremastrae seu Pleiones),containing colchicine,can quickly alleviate gout pain[20],moreover Cheqianzi(Semen Plantaginis)[21],Jinqiancao(Herba Lysimachiae)[22],Huzhang(Rhizoma Polygoni Cuspidati)[23]also have the effect of reducing uric acid.These high-frequency medicine have great similarities with the high-frequency medicine for the internal administration of TCM for the treatment of gout excavated from CNKI and WANFANG database,etc.From the side,it can also be concluded that the basic treatment of gout is to clear the heat,remove dampness,activate blood circulation and dredging meridians[24].

Nature-flavour and Channel Tropism analysis

According to the analysis of the flavour of traditional Chinese medicine(Table 2),the flavour of medicine for the treatment of gout is given priority to be "warm,cold,mild",including the most warm medicine,and most warm medicine has the effect of removing dampness and blood stasis,tonifying deficiency,cold medicine can clear heat.gout excess syndrome see more heat and damp,turbid phlegm and blood stasis,deficiency syndrome is given priority to be the spleen and kidney deficiency[25],which is consistent with pathogenesis and therapy of gout,deficiency in origin and excess in superficiality,treated with clearing heat,removing dampness,promoting blood circulation to remove blood stasis,and invigorating spleen and removing turbidity.The medicine flavour is "sweet,bitter,piquant" mainly,sweet(such as Baizhu(Rhizoma Atractylodis Macrocephalae),Yinyanghuo(Herba Epimedii))can invigorate the spleen and kidney,assist qi of body.Piquancy has the function of promoting qi and blood circulation,preventing qi from stopping and dampness stagnation,and the attack period of gout is dominated by pain.Tang rong-chuan,qing dynasty,said:"All pain,are from blood stasis and stagnation",so with Chuanxiong(Rhizoma Chuanxiong),Danggui(Radix Angelicae Sinensis),Yanhusuo(Rhizoma Corydalis)and other medicine to disperse stasis,dredge the meridians.Bitter can dry,clear away heat.For gout syndrome is damp-heat,more performance for joint redness and swelling heat pain,so treatment with clearing heat and removing dampness is useful.Channel tropism is mainly liver,spleen,kidney,according to the theory of traditional Chinese medicine,liver determines tendon,while gout is the inflammation of synovial membrane of the joints,which belongs to the category of tendon in traditional Chinese medicine.And when liver dysfunction occurs,qi and blood stagnates,it hurts.Kidney and spleen regulate the liquid transport and distribution,and when the spleen and kidney function is abnormal,then the wet turbidity is endogenous and decreased,for a long time it becomes toxic,blocked joints,which is consistent with the pathogenesis of bi syndrome of deficiency of spleen and kidney,the mixed turbidity poison and blood stasis block meridians and collaterals[26].

Analysis of TCM combination and association rules

According to the analysis of TCM combination of gout(Table 4),40 commonly used medicine pairs with the support degree≥35,among which the high-frequency medicine pairs in the top 10 are:Huangbai(Cortex Phellodendri)-Cangzhu(Rhizoma Atracylodis);Huangbai(Cortex Phellodendri)-Niuxi(Radix Acanthopanacis Bidentatae);Huangbai(Cortex Phellodendri)-Niuxi(Radix Acanthopanacis Bidentatae);Niuxi(Radix Acanthopanacis Bidentatae)-Cangzhu(Rhizoma Atracylodis);Niuxi(Radix Acanthopanacis Bidentatae)-Cangzhu(Rhizoma Atracylodis);Huangbai(Cortex Phellodendri)-Yiyiren(SemenCoicis);Huangbai(Cortex Phellodendri)-Yiyiren(Semen Coicis);Tufuling(Rhizoma Smilacis Glabrae)-Niuxi(Radix Acanthopanacis Bidentatae);Tufuling(Rhizoma Smilacis Glabrae)-Niuxi(Radix Acanthopanacis Bidentatae);Tufuling(Rhizoma Smilacis Glabrae)-Cangzhu(Rhizoma Atracylodis);Tufuling(Rhizoma Smilacis Glabrae)-Cangzhu(Rhizoma Atracylodis);Tufuling(RhizomaSmilacis Glabrae)-Bixie(Rhizome Dioscoreae Hypoglaucae);Tufuling(Rhizoma Smilacis Glabrae)-Bixie(Rhizome Dioscoreae Hypoglaucae);Niuxi(Radix Acanthopanacis Bidentatae)-Yiyiren(Semen Coicis);Niuxi(Radix Acanthopanacis Bidentatae)-Yiyiren(Semen Coicis);Cangzhu(Rhizoma Atracylodis)-Yiyiren(Semen Coicis);Cangzhu(Rhizoma Atracylodis)-Yiyiren(Semen Coicis);Tufuling(Rhizoma Smilacis Glabrae)-Yiyiren(Semen Coicis);Tufuling(Rhizoma Smilacis Glabrae)-Yiyiren(Semen Coicis).These pairs are composed of Huangbai(Cortex Phellodendri),Cangzhu(Rhizoma Atracylodis),Niuxi(RadixAcanthopanacis Bidentatae),Yiyiren(Semen Coicis),Tufuling(Rhizoma Smilacis Glabrae),Bixie(Rhizome Dioscoreae Hypoglaucae),which also belong to the architecture of Simiao Pawder,have clear heat-clearing,damp-removing,blood circulation-invigorating effect.It coincides with the basic pathogenesis of dampness-heat stasis blocking meridians and collaterals of gout which the author put forward.According to the analysis of association rules of gout medicine(Table 5),the top 5 confidence scores were Niuxi(Radix Acanthopanacis Bidentatae),Cangzhu(Rhizoma Atracylodis)-Huangbai(Cortex Phellodendri);Cangzhu(Rhizoma Atracylodis),Yiyiren(Semen Coicis)-Huangbai(Cortex Phellodendri);Yiyiren(Semen Coicis),Bixie(Rhizome DioscoreaeHypoglaucae)-Tufuling(Rhizoma Smilacis Glabrae);Cangzhu(Rhizoma Atracylodis),Bixie(Rhizome Dioscoreae Hypoglaucae)-Tufuling(Rhizoma Smilacis Glabrae);Huangbai(Cortex Phellodendri),Yiyiren(Semen Coicis)-Cangzhu(Rhizoma Atracylodis).The confidence degree of these medicine pairs is all above 0.75,which has high credibility.Among them,Niuxi(Radix Acanthopanacis Bidentatae),Cangzhu(Rhizoma Atracylodis)-Huangbai(Cortex Phellodendri);Cangzhu(Rhizoma Atracylodis),Yiyiren(Semen Coicis)-Huangbai(Cortex Phellodendri)are also composed of Simiao pills.It can be seen that Simiao pills are the core medicine for the treatment of gout,coinciding with the basic pathogenesis of dampness-heat stasis blocking meridians and collaterals.

According to the high frequency Chinese medicine combination(Table 1),network diagram of medicine pairs for treating gout was obtained(Extended Data Fig.1).These medicine in order of frequency are:Huangbai(Cortex Phellodendri),Cangzhu(Rhizoma Atracylodis),Niuxi(Radix Acanthopanacis Bidentatae),Yiyiren(Semen Coicis),Tufuling(Rhizoma Smilacis Glabrae),Bixie(Rhizome Dioscoreae Hypoglaucae),Gancao(Radix Glycyrrhizae),Weilingxian(Radix Clematidis),Zexie(Rhizoma Alismatis),Danggui(Radix Angelicae Sinensis),Chuanxiong(Rhizoma Chuanxiong).These medicine have heat-clearing and damp-removing,blood circulation-promoting and meridians-dredging effect.These medicine have high frequency and confidence,so the author believes that these medicine are the core medicine for the treatment of gout;Huangbai(Cortex Phellodendri)bitter,cold and sedimentary,is good at clearing heat and damp from lower energizer,in line with gout characteristics of heat and damp blocking toe joint;Cangzhu(Rhizoma Atracylodis)can dry and remove dampness,invigorate the spleen,promote middle-jiao transport functions,prevent the endogeny dampness and turbidness.Cangzhu(Rhizoma Atracylodis)combined with Huangbai(Cortex Phellodendri)has the effect of reducing uric acid[27];Niuxi(Radix Acanthopanacis Bidentatae),Yiyiren(Semen Coicis),Tufuling(Rhizoma Smilacis Glabrae)can remove dampness and arthralgia,ease tension of joint,and total flavonoids from Tufuling(Rhizoma Smilacis Glabrae)has certain anti-gout effect[28];Bixie(Rhizome Dioscoreae Hypoglaucae)remove damp and help Tufuling(Rhizoma Smilacis Glabrae)distinguish turbidity,also repel the wind and dredge channels,and total saponins from Bixie(Rhizome Dioscoreae Hypoglaucae)can cause uric acid excretion increase[29];Gancao(Radix Glycyrrhizae)clear heat and remove toxicity,mediate the medicine,also has anti-inflammatory effects[30];Weilingxian(Radix Clematidis)pass through twelve meridians,can remove all the limbs dampness,its triterpenoid saponins can inhibit cyclooxygenase-1(COX-1)and cyclooxygenase-2(COX-2),and play an anti-inflammatory and analgesic effect[31].Zexie(Rhizoma Alismatis)is the main medicine to promote diuresis,and it has anti-inflammatory effects[32],at the same time its alcohol extract is effective to uric acid reduction[33],The pair Danggui(Radix Angelicae Sinensis)-Chuanxiong(Rhizoma Chuanxiong)is medicine of clinical commonly used for promote blood circulation,and the pair have anti-inflammatory and analgesic effect,which can improve the symptoms of joint pain in patients with gout[34].Both in medicine test certificate,or modern pharmacological research,these medicine can accord with the pathogenesis of gout of TCM and western medicine.

3.4 New formulas analysis

According to the data mining method of entropy clustering analysis,28 core combinations of new formulas for the treatment of gout were obtained(Table 6),as also shown in the 14 new formulas(Table 7).Entropy cluster analysis is used to re-arrange and calculate the 494 medicine for the treatment of gout,to obtain the relationship between each traditional Chinese medicine and other medicine,and further obtain the core combination[35].These core combination is different from the high frequency medicine commonly used combination,the 14 new formula is also not in the original 357 square formula,by medicine of low frequency and special algorithm,excavate the potential law,it is the full and effective use of literature,avoiding some medicine of low frequency and highlighted effect to be filtered out by medicine of high frequency,is a complement to commonly used medicine.Among them,in the new formula 1,Baizhu(Rhizoma Atractylodis Macrocephalae)and Shudihuang(Radix Rehmanniae preparata)invigorate spleen and kidney,Shuqucao(cudweed)remove phlegm and dampness,Danshen(Radix Salviae Miltiorrhiae)invigorate blood and remove blood stasis,and Wubeizi(Galla Chinensis)detoxify and remove phlegm.The whole formula has the effect of invigorating spleen and tonifying kidney and activating blood and removing phlegm,which can be used to treat both symptoms and root causes in stable period of gout;in the new formula 2,Mutong(Caulis Akebiae),Digupi(Cortex Lycii Radicis),Huangjinggen(negundo chastetree root)clear heat and remove dampness,Qiancao(Radix Rubiae)and Sigualuo(Retinervus Luffae Fructus)invigorate the blood circulation and dredge the meridians,are for the acute phase of gout when dampness-heat-blood stasis stagrate joint;In the new formula 3,Haijinsha(Herba Lygodii),Baitouweng(Radix Pulsatillae)detoxicate and remove damp,Shihu(Herba Dendrobii)and Heidou(black soybean)tonify kidney and nourish Yin,can be used for gout acute phase of heat poisoning Yin syndrome;New formula 4 is Qianghuo sheng shi decoction structure,Qianghuo(Rhizoma et Radix Notopterygii),Baizhi(Radix Angelicae Dahuricae),Duhuo(Radix Angelicae Pubescentis),Fangfeng(Radix Saposhnikoviae)dispel wind and remove dampness,Danggui(Radix Angelicae Sinensis)and Chuanxiong(Rhizoma Chuanxiong)promote blood circulation for removing blood stasis,can be used to gout of wind and cold attack;in the new formula 5,Guizhi(Ramulus Cinnamomi)warm and dredge meridian,Fuling(Poria)invigorate the spleen and eliminate dampness,Qingpi(Pericarpium Citri Reticulatae Viride),Chenpi(Pericarpium Citri Reticulatae),Chuanbeimu(Bulbus Fritillariae Cirrhosae)regulate qi and remove phlegm,used for blocking phlegm and dampness in intermittent period of gout;in the new formula 6,Quanxie(Scorpio),Dilong(Pheretima)attack and dredge channels and collaterals,Taoren(Semen Persicae)and Weilingxian(Radix Clematidis)promote blood circulation for removing obstruction in collaterals,and Dannanxing(Arisaema Cum Bile)dissolve phlegm,can be used for joint deformity and stiffness and the formation of gout stone caused by phlegm and blood stasis block in the later stage of gout[36]; In the new formula 7,Quanxie(Scorpio)dredge channels and relieve pain,Ruxiang(Olibanum),Chishao(Radix Paeoniae Rubra),Qiancao(Radix Rubiae)promote blood circulation and relieve pain,using for the joint pain in acute phase of gout;New formula 8 Zexie(Rhizoma Alismatis)and Cheqianzi(Semen Plantaginis)clear heat and remove dampness,Zelan(Herba Lycopi),Taoren(Semen Persicae),Dahuang(Radix et Rhizoma Rhei)promote blood circulation and relieve pain,can be used in the acute phase of gout when joint is swelling,hot,and painful;In the new formula 9,Shigao(Gypsum Fibrosum),Zhimu(Rhizoma Anemarrhenae)is the white tiger decoction structure,in order to clear the heat,Danpi(Cortex Moutan)cool blood and promote blood circulation,Biejia(Carapax Trionycis)clear heat and nourish Yin to soften and resolve hard mass,using for acute joint swelling and obviously hot;New formula 10 is Simiao pills with heat-clearing,detoxifying,damp-removing Tufuling(Rhizoma Smilacis Glabrae)and Bixie(Rhizome Dioscoreae Hypoglaucae),and heat-clearing,detoxifying Qingdai(Indigo Naturalis),can be used in the acute phase of heat-damp syndrome;In the new formula 11,Luoshiteng(Caulis Trachelospermi),Qinpi(Pericarpium Citri Reticulatae Viride),Haitongpi(Cortex Erythrinae)can remove wind,remove dampness and dredging channels,Mantuoluo(Flos Daturae)remove wind and relieve pain,has a strong analgesic effect[37].It is suitable for patients with gout attack,when traditional Chinese medicine cannot relieve the pain;In the new formula 12,Gouqizi(Fructus Lycii),Tusizi(Semen Cuscutae)and Shanyao(Rhizoma Dioscoreae)tonify the liver and kidney,Jiaogulan(Herba Gynostemmatis),Gegen(Radix Puerariae)cleare heat and promot fluid production,using for the liver and kidney deficiency in the stable period of gout;In the new formula 13,Shancigu(Pseudobulbus Cremastrae seu Pleiones),Tufuling(Rhizoma Smilacis Glabrae),Bixie(Rhizome Dioscoreae Hypoglaucae)clear heat and remove damp,and is effective to uric acid reduction,Dahuang(Radix et Rhizoma Rhei),Sumu(Lignm Sappan)promote blood circulation and diminish swelling,can be used for patients with high uric acid when gout attacks;Formula 14 is the structure of Xuanbi decoction:Xingren(Semen Armeniacae Amarum)open lung qi and dredge channel,Lianqiao(Fructus Forsythiae),Cansha(Feculae Bombycis)clear heat and remove damp Tongjingcao promote blood circulation and diminish swelling,can also be used in the attack period of gout,suit the basic pathogenesis of heat-dampness and blood stasis.Based on the above new formula,it can be concluded that the internal administration of TCM for the treatment of gout is widely used,which varies according to different clinical stages,different syndrome types and different clinical manifestations,but all of them are the methods of clearing heat,removing dampness,activating blood and dredging collaterals.At the same time,the combination of treatment by stages and treatment by syndrome differentiation may be the future trend of the treatment of gout.

Conclusion

Through the above analysis,the author believes that the basic pathogenesis of gout is damp-heat and static blood blocking the meridian.Patients with spleen deficiency,or none-moderation diet,endogenetic downward diffusion of damp turbidity,and for a long time,heat grows into poison,qi and blood stagnate,damp turbidity,phlegm,heat and blood cementing,blocking the meridian,causing joint swelling pain.The most common clinical symptom of gout is the first metatarsophalangeal joint is red,swollen,hot and painful,whose location is between the "dàdū" and"tàibái" of the spleen meridian.It can also indicate that gout is related to the spleen.Due to the heavy and turbid dampness,it is easy to obstruct the qi movement,and the spleen is trapped by dampness,forming a vicious cycle,so the disease is stubborn and easy to relapse.The basic therapy of gout is clearing heat and removing damp,promoting blood circulation for removing obstruction in collaterals.Core medicine are:Huangbai(Cortex Phellodendri),Cangzhu(Rhizoma Atracylodis),Niuxi(Radix Acanthopanacis Bidentatae),Yiyiren(Semen Coicis),Tufuling(Rhizoma Smilacis Glabrae),Bixie(Rhizome Dioscoreae Hypoglaucae),Gancao(Radix Glycyrrhizae),Weilingxian(Radix Clematidis),Zexie(Rhizoma Alismatis),Danggui(Radix Angelicae Sinensis),Chuanxiong(Rhizoma Chuanxiong).On this basis,we can add and subtract based on syndrome differentiation in clinic.For example,red swelling is obvious,add Zhimu(Rhizoma Anemarrhenae),Jinqiancao(Herba Lysimachiae),Dahuang(Radix et Rhizoma Rhei),Rendongteng(Caulis Lonicerae),etc;Joint pain is obvious,add Quanxie(Scorpio),Dilong(Pheretima),Sanqi(Radix Notoginseng),Zhichuanwu(Radix Aconiti preparata),etc;Uric acid is very high,add Huzhang(Rhizoma Polygoni Cuspidati),Cheqianzi(Semen Plantaginis),Shancigu(Pseudobulbus Cremastrae seu Pleiones),Dahuang(Radix et Rhizoma Rhei),etc;For spleen deficiency,add Huangqi(Radix Astragali),Baizhu(Rhizoma Atractylodis Macrocephalae),Guizhi(Ramulus Cinnamomi),etc; If spleen deficiency for a long time,with kidney deficiency,add Duzhong(Cortex Eucommiae),Gouqizi(Fructus Lycii),Shudihuang(Radix Rehmanniae preparata),etc; Joint deformity,with the formation of gout stone,add Dannanxing(Arisaema Cum Bile),Chuanshanjia(Squama Manitis),Biejia(Carapax Trionycis),etc.In this paper,the law of the use of TCM in the treatment of gout was analyzed,and it was further confirmed that the main use of TCM in the treatment of gout was heat-clearing,dampness-removing,blood-activating and collaterals-dredging.The core medicine and new formulas summarized provided a reference for the clinical treatment of gout,but their value still needs to be further verified by clinical practice and basic research.