Research Progress of External Treatment of Acute Gouty Arthritis with Traditiona

Guoqing ZHAO, Lamei ZHOU

Wuxi Hospital of Traditional Chinese Medicine, Wuxi 214000, China

Abstract External application of traditional Chinese medicine has a long history and definite curative effect on gout. By searching the latest literature on the treatment of acute gouty arthritis by external treatment of traditional Chinese medicine, the research progress of external treatment of acute gouty arthritis in recent years was summarized. According to the existing research results, the external treatment of Chinese medicine in the treatment of acute gout has better efficacy and higher safety, and has a broad application prospect.

Key words External treatment of traditional Chinese medicine, Acute gouty, Research progress

1 Introduction

Acute gouty arthritis is a non-specific inflammatory disease, its pathological mechanism is the deposition of sodium urate crystals in joints and surrounding soft tissues caused by the disorder of purine metabolism, which induces the production of a large number of pro-inflammatory cytokines and triggers the acute inflammatory response. The clinical manifestations of this disease are sudden acute swelling, heat and pain in the joints within a short time, which is easy to relapse and seriously affects the quality of life of patients.

Traditional Chinese medicine theory believes that the disease belongs to the category of "Bi Syndrome", "multiple arthralgia" and "weak foot", it is mainly related to the deficiency of innate endowment, the acquired taste of gluttony, the injury to the spleen over time, or the dysfunction of the spleen and kidney in old age, and the inducements of diet, fatigue, exogenous factors, environment and so on. The main pathogenesis is the accumulation of phlegm and dampness, resulting in heat, arthralgia and obstruction of collaterals. Traditional Chinese medicine has a long history in treating gout and its curative effect is definite. Oral Western medicine has a variety of side effects, such as non-steroidal anti-inflammatory drugs, glucocorticoids,etc.External treatment of traditional Chinese medicine has its unique advantages in the treatment of acute gout. In recent years, some new progress has been made in the external treatment of traditional Chinese medicine.

2 Progress of external application of traditional Chinese medicine

2.1 Clinical research

2.1.1The application of prescription treatment. Zhu Miaofenetal.[1]applied Ruyi Jinhuang Powder combined with oral colchicine to treat patients with gout, and the results showed that Ruyi Jinhuang Powder combined with oral colchicine had no difference in efficacy compared with simple colchicine, but the combined treatment had a faster effect. Wang Yinghui[2]applied Ruyi Jinhuang Powder combined with indomethacin oral treatment, and the results showed that the efficacy was better than that of indomethacin oral treatment alone. Liu Junhuaetal.[3]applied the combined application of Jiawei Wuling Powder and Ruyi Jinhuang Powder in the treatment of patients with gout, and the results showed that the combined application could effectively reduce the levels of ESR and UA, with few adverse drug reactions. Chen Guangetal.[4]applied red light irradiation combined with external application of Sanhuang Powder in the treatment of acute gout patients, and the results indicated that red light irradiation combined with external application of Sanhuang Powder had advantages compared with colcoline alone, and the serum uric acid, eryocyte sedification rate and C-reactive protein levels of patients were significantly decreased compared with those before treatment. Huang Bixianetal.[5]added borneol and mirabilite to the Sanhuang Powder prescription for external application and applied them evenly on the swollen and painful areas of patients, achieving good clinical efficacy.

2.1.2Self-designed prescription treatment. Cheng Wenguang[6]applied Shuang Bai San Mi to treat the affected area, which was composed of raw rhubarb, Cacumen Platycladi,EupatoriumjaponicumThunb.,MenthahaplocalyxBriq.,etc.After 7 d, the symptoms of the patient were relieved, and the levels of IL-1 and IL-8 in serum were significantly decreased compared with those before treatment. Li Lietal.[7]showed that the internal administration of Qingrechushi Decoction and external application of Zhongtongxiao in the treatment of acute gouty arthritis with dampness-heat accumulation can relieve pain, swelling and activity function, and reduce CRP and ESR levels in patients. Wu Shuqiongetal.[8]self-made gout ointment (the drug was composed of rhubarb, Cortex Phellodendri, Plantaginis Herba, cattail pollen, Cacumen Platycladi,Gardeniajasminoides, Smilacis Glabrae Rhizoma,PhrymaleptostachyaL. subsp.asiatica(Hara) Kitamura,Sargentodoxacuneata, frankincense and myrrh) combined with non-steroidal anti-inflammatory drugs in the treatment of acute gout patients, the results showed that the efficacy and safety were better than non-steroidal anti-inflammatory drugs. Du Junhongetal.[9]applied Zhenggu Powder (the drug was composed of safflower, gardenia, angelica, frankincense, myrrh, ephedra, Resina Draconis,LedebouriellaseseloidesWolff, the root ofDahurianangelica, Rhizoma Drynariae,ArisaemaconsanguineumSchott, teasel root andAcaciacatechu) to treat gout patients, which can improve the symptoms of joint pain and swelling, significantly reduce the level of serum C-reactive protein, and has the same curative effect as oral colchicine tablets, but less adverse reactions. The study of Du Minetal.[10]showed that compared with diclofenac diethylamine emulgel, the external application effect of Zihuang Zhitong Powder (drug composition includes gardenia, rhubarb,Phellodendriphellodendri, Zanthophorum, mint,Atractylodestractylodes, Radix Cyanoxactyl, Semen Coicis) was better than diclofenac diethylamine emulsion.

2.2 Experimental studyChen Xinghuaetal.[11]observed the clinical efficacy of Ruyi Jinhuang Powder combined with oral diclofenac sodium, Ruyi Jinhuang Powder and oral diclofenac sodium in the treatment of acute gout, the three schemes all can reduce the levels of IL-8 and IL-1β in the blood, and the combination of the two schemes has the best therapeutic effect. Yu Jingetal.[12]applied external application of Bizhong Xiaosan(which is composed ofAtractylodeslancea,Phellodendronamurense,Taraxacummongolicum, borneol,etc.) to treat gout model rats, which could reduce the levels of serum IL-1, IL-8, IL-6 and TNF-α in rats. Dong Weietal.[13]applied Dianzhonglou Babu agent externally to the affected area in model rats, which could decrease the level of serum IL-1β and significantly alleviate the degree of joint swelling in rats. Liu Yingetal.[14]applied Qufeng Zhitong Decoction orally and Zhitong external application (composed ofRhubarb,Phellodendronphellodendron, Radix Scutellariae, Rhizoma Bletillae, Fructus Mume and borneol) in the treatment of acute gout, and the results showed that combined treatment could improve the clinical symptoms of patients and reduce the levels of UA, ESR, CRP, IL-1β, IL-6, IL-17 and TNF-α.

3 Fumigation and wash treatment

Su Pan[15]applied the fumigation and wash treatment of Kushen and Huangbai Decoction (composed ofSophoraflavescens,Phellodendronphellodendron, Caulis Spatholboi,TribulusterrestrisL., Cortex Acanthopanacis,LithospermumerythrorhizonSieb. et Zucc.,etc.), which can improve the clinical symptoms of patients, and significantly reduce the levels of BUA, CRP, and ESR. Lin Bailong[16]applied Simiao Powder (composed ofAtractylodonistractylodonis,Phelloxphellodonis,Phellodonismolluscoides, Radix Axiata, Coix seed, red peony root, honeysuckle,etc.) fumigation and washing combined with oral treatment with western medicine, and the efficacy was better than that of the control group, and the levels of IL-6 and TNF-α in patients were significantly decreased.

4 Acupuncture and moxibustion therapy

4.1 Acupuncture therapyWang Jiao[17]performed plum needle percussion combined with oral Baihu plus Guizhi decoction treatment on local Ashi point of acute gout patients, and the results showed that the efficacy was better than that of the control group, and the serum IL-18 level of the patients could be reduced. Xu Na[18]took Zusanli, Sanyinjiao and Yinlingquan acupoints on both hind legs of the rabbit model and treated them once a day for 7 d, the results indicated that acupuncture could improve the symptoms of joint spirit, gait, redness, swelling, heat and pain, and the levels of IL-1β and TNF-α in synovial fluid were significantly decreased after treatment. Sun Jungangetal.[19]compared patients with colchicine group by pricking treatment (taking Point A Shi as the center of the affected area and doing scattered and interval pricking treatment), and the results showed that there was no significant difference in curative effect between the two groups, and serum TNF-α, IL-2 and IL-8 of patients were significantly decreased.

4.2 ElectroacupunctureJin Yarong[20]showed that electroacupuncture has a good analgesic effect, and can reduce the production of uric acid and promote the excretion of uric acid. Qiu Li[21]used electroacupuncture to Sanyinjiao and Zusanli of model mice, once a day for consecutive 7 d, and the western medicine group took colchicine orally, the results showed that electroacupuncture treatment of acute gout may be related to the down-regulation of NOS2, IL-1β and NLPR3 expression, the conversion of macrophages from M1 pro-inflammatory phenotype to M2 anti-inflammatory phenotype, and the inhibition of inflammatory response induced by MSU crystals. Zhang Zengfuetal.[22]compared electroacupuncture combined with benzbromarone in the treatment of patients with dampness and heat stasis gout with oral benzbromarone, and the results showed that the combined treatment could improve overall health, physiological function, physiological function, body pain and social function, and the mechanism may be related to the inhibition of NLRP3 inflammasome and its protein.

4.3 Heat needleFang Xiaoyietal.[23]compared the treatment of acute gout with oral etocoxil and colchicine by using meridian fluid injection and fire acupuncture, suggesting that the clinical symptoms of the patients were significantly improved and the serum uric acid level was reduced. Xie Liqinetal.[24]treated acute gout model rats with fire needles, and took the main acupoints of the affected limbs once a day (incongrated inner chamber, inter-line, Hegu, Quchi, Yanglingquan,etc.), indicating that the synovial inflammatory cell infiltration of the rats was reduced, and the level of IL-1β was significantly reduced.

4.4 Pricking blood therapyLiao Jiaxinetal.[25]showed obvious advantages in pain relief, reduction of VAS score, ESR, CRP and incidence of adverse reactions through meta-analysis. Wu Xiyanetal.[26]performed transdermal bloodletting on patients with acute gout (selecting A Shi point and distal Jing point at the affected joint), and the swelling and pain of the patients’ joints were significantly alleviated, and IL-6 and IL-8 levels were also reduced, which was better than that in the colcoline group.

5 Conclusions

According to traditional Chinese medicine, the etiology of gouty arthritis is mainly that the patients like to eat fat, sweet and thick taste, and the dampness and heat accumulate and invade the meridians, dampness and heat coagulate phlegm, blood stasis block, phlegm and blood stasis block limb joints. Although the curative effect of Western medicine is exact, there are many adverse reactions. External treatment of acute gouty by traditional Chinese medicine not only has excellent analgesic effect, but also can reduce uric acid and inhibit inflammatory reaction. Therefore, we still need to better improve the clinical efficacy of external treatment of traditional Chinese medicine in the treatment of gouty arthritis, relieve the pain of patients, understand the mechanism of treatment, and better serve patients.