Outline:
Gouty arthritis is a disease mainly characterized by repeated attack of acute sharp pain, redness and swelling in the joint, hyperuricemia and formation of tophus. It is often caused by obstruction of qi and blood resulting from blockage of joint meridians by phlegm-dampness-stasis-heat due to deficiency of kidney-qi and failure of the spleen in transformation and transportation. Pathologically, it is a lesion and aseptic inflammation because of precipitation of urate in the joint capsule and synovial burca, chondral substance, kidney, subcutaneous tissues and the other tissues caused by disturbance of purine metabolism. The disease may be classified into primary and secondary ones. The primary cases are related to familial heredity,?while the secondary cases may be caused by kidney diseases, hematopathy, malignant tumor, etc..

Major points for diagnosis
1. The patient has a history of familial heredity or kidney diseases, hematopathy and malignant tumor.

2. At the stage of acute arthritis, there are local redness, swelling and pain. The pain mostly attacks at night and abates after daybreak. And the sharp articular pain often awakens the patient. During the period of attack, there is usually fever and the body temperature is between 38℃ - 39℃. There may be no subjective symptoms during the intermission, but the symptom may appear again several months or several years later.

3. There is local tenderness in the joint. Tophus node can be felt in some patients in the ear lobe, or subcutaneous tissues around joint or bone.

4. More than 416 μmol/L of blood uric acid is of diagnostic significance. But, a simple hyperuricemia without articular or renal lesions is of no important clinical significance. At the stage of acute attack there are leukocytosis and faster blood sedimentation. The tophus presents needle-shaped crystal on microscopic examination. The test of tophus urate is positive.

5. X-ray film can reveal a shadow of soft tissue swelling around the joint, a little condensation of bone substance in the edge of joint, chiseled bone defect around the joint with a clear margin, and normal structure of bone substance near the defective area. At the late stage, there occur retrograde changes of arthritis such as narrowing of joint space, irregular joint surface, formation of osteophyte in the edge of joint, and sometimes there appears shadow of calcification of tophus.
 
Herbal therapy
Internal treatment based on syndrome differentiation
1) Syndrome of accumulation of damp-heat
Main symptoms and signs:
Sudden onset of redness, swelling and heat in the small joints of feet, pain aggravated by pressure and alleviated by coolness, fever, thirst, restlessness, deep yellow urine, red tongue with yellow-greasy coating, slippery and rapid pulse.

Therapeutic methods:
Clearing away heat and dampness, expelling wind and dredging collaterals.
    
Recipe and herbs:
Modified Tongyong Tongfeng Decoction. Specifically, Zhinanxing ( Rhizoma Arisaematis Praeparata ) 10 g, Cangzhu ( Rhizoma Atractylodis ) 10 g, Chuanxiong (Rhizoma Ligustici Chuanxiong) 10 g, Longdancao ( Radix Gentianae ) 10 g, Qianghuo ( Rhizoma seu Radix Notopterygii ) 10 g, Zexie ( Rhizoma Alismatis ) 10 g, Huanghai ( Cortex Phellodendri ) 10 g, Fangji ( Radix Stephaniae Tetrandrae ) 10 g, Baihuasheshecao ( Herba Hedyotidis Diffusae ) 15 g, Dilong ( Lumbricus ) 10g and Gancao ( Radix Glycyrrhizae ) 3 g.

(2) Syndrome of blockage of stasis and heat
    
Main symptoms and signs:
Stabbing pain, redness, swelling and deformity of joint with impaired movement, purplish skin with hardness on palpation, or hard nodes around the focus, purplish tongue with ecchymoses and thin-yellow  coating,  thready-choppy  or  deep-stringy pulse.
    
Therapeutic methods:
Promoting blood flow to remove the stasis, removing heat and blockage.
   
Recipe and herbs:
Modified Huayu Tongbi Decoction. Specifically, Danggui (Radix Angelicae Sinensis) 10 g, Danshen ( Radix Salviae Miltiorrhizae ) 15 g, Moyao ( Myrrha ) 10 g, Shengdihuang ( Radix Rehmanniae) 10 g, Honghua ( Flos Carthmi ) 10 g, Chishaoyao ( Radix Paeniae Rubrae ) 10 g, Zhidahuang (Radix et Rhizoma Rhei Praeparata ) 10 g, Dilong ( Lumbricus ) 15 g, Huanghai ( Cortex Phellodendri ) 10g, Weilingxian (Radix Clematidis) 10 g and Gancao (Radix Glycyrrhizae ) 3 g.

(3) Syndrome of stagnation of turbid phlegm  
Main symptoms and signs: Aching, numbness and pain in the joint with swelling around it, or hard nodes, no redness of skin, puffy complexion, vertigo, enlarged tongue with white-greasy coating, moderate or stringy-slippery pulse.
    
Therapeutic methods:
Removing blood-stasis and dredging collaterals, resolving turbid phlegm.
    
Recipe and herbs:
Modified Taohong Decoction.Specifically, Taoren ( Semen Persicae ) 10 g, Honghua ( Flos Carthmi ) 10 g, Zhinanxing ( Rhizoma Arisaematis Praeparata ) 10 g, Baijiezi ( Semen Sinapis Albae ) 6 g, Moyao ( Myrrha ) 10 g, Quanxie ( Scorpio ) 3 g, Wushaoshe (Zaocys) 10 g, Chuanshanjia (Squama Maniris Pentadactylae ) 10 g, Yanhusuo ( Rhizoma Corydalis) 15 g, Dilong ( Lumbricus ) 15 g, Qinjiao ( Radix Gentianae Macrophyllae) 10 g and Gancao (Radix Glycyrrhizae ) 3 g.

External therapy:   
Waike Xiaoyan Paste, or Ruyi Jinhuang Powder, or Zhenggu Liquor may be applied topically.

Physical therapy:
Ultrashort wave, or magnetic field, or infrared therapies may be used as the auxiliary ones. Or ion-introduction therapy with liquor prepared with Shancigu (Pseudobulbus Cremastrae seu Pleiones) 10 g and Shengnanxing ( Rhizoma Arisaematis) 10 g immersed in 75% alcohol may also be used.