Gout and Hyperuricemia - Master Zhu Liangchun’s Xiehua Zhuoyu Tang (Draining-Transforming Turbid-Stasis Decoction)
14. Gout and Hyperuricemia - Master Zhu Liangchun’s Xiehua Zhuoyu Tang (Draining-Transforming Turbid-Stasis Decoction)
I. Zhu Liangchun, first National Master of TCM. This formula is his core formula for gout treatment.
Pathomechanism
Gout patients are often stout in build, fond of alcohol and rich heavy foods, spleen transport fails to function well, clearing rising and turbid descending lose authority, dampness-turbidity internally generates and stagnates obstructing the blood vessels, combining with blood to form turbid stasis. Turbid stasis retained in the meridians causes joint pain and swelling, nodules and deformity, severe cases lead to ulceration and discharge of fatty paste; when stagnant and transforming into heat, red swelling and burning pain; when damaging the spleen-kidney, lower back pain and hematuria, prolonged cases block the triple burner presenting critical guan-ge syndrome. Zhu Liangchun emphasized that dampness-turbidity is not received from external but generated internally, truly not wind pathogen acting, hence called “turbid-stasis bi” not “gout.”
Formula Composition
Composition: Smilax Glabra 45g, Raw Coix Seed 30g, Cimicifuga 30g, Dioscorea Hypoglauca 30g, Gentiana Macrophylla 15g, Eclipta 15g, Alisma 15g, Red Peony 15g, Earth Pile Bug 10g
Efficacy: Draining-transforming turbid-stasis, dispelling bi and unblocking collaterals
Indications: Turbid-stasis bi (gout), dampness-turbidity stasis internal obstruction pattern
In the formula, Smilax Glabra heavily used at 45g for draining dampness, excreting turbidity, clearing toxicity as sovereign; Dioscorea Hypoglauca clarifies and separates the turbid, Raw Coix Seed fortifies the spleen and percolates dampness to assist sovereign herb in providing an outlet for turbid pathogen; Cimicifuga circulates through all twelve meridians to unblock collaterals and stop pain, Gentiana Macrophylla dispels wind, clears heat, relaxes sinews, the two herbs guide drugs to the bi site. Eclipta activates blood and percolates water, Alisma drains dampness and clears heat, Eclipta and Alisma used together means activating blood and draining dampness in parallel, treating water and blood simultaneously. Red Peony cools the blood and scatters stasis, Earth Pile Bug breaks blood, removes stasis, searches out and enters collaterals, so turbid stasis dissolves, old eliminated and new promoted. The whole formula promotes draining turbidity and transforming stasis simultaneously, providing outlet for turbid pathogen and passage for stasis obstruction, two pathways dispersing and combined attack.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Draining turbidity and clearing toxicity | Smilax Glabra 45g, Dioscorea Hypoglauca 30g, Raw Coix Seed 30g | Smilax Glabra heavily used for draining dampness, excreting turbidity, clearing toxicity, lowering uric acid; Dioscorea Hypoglauca clarifies and separates turbid; Coix Seed fortifies the spleen and percolates dampness to assist turbid pathogen excretion |
| Unblocking collaterals and dispelling bi | Cimicifuga 30g, Gentiana Macrophylla 15g | Cimicifuga circulates through twelve meridians, unblocks collaterals and stops pain; Gentiana Macrophylla dispels wind, clears heat, relaxes sinews, guides drugs to the bi site |
| Activating blood and percolating water | Eclipta 15g, Alisma 15g | Eclipta activates blood and percolates water, Alisma drains dampness and clears heat, treating water and blood simultaneously so turbid stasis disperses through water passages |
| Transforming stasis and searching out | Red Peony 15g, Earth Pile Bug 10g | Red Peony cools blood and scatters stasis, Earth Pile Bug breaks blood, removes stasis, searches out and enters collaterals to dissolve turbid stasis obstruction |
Smilax Glabra dosage is the key pairing point of this formula. Zhu Liangchun’s Smilax Glabra dosage for gout treatment ranges from 30g to 60g; during acute attacks increased to 60g to strengthen the draining turbidity power, during remission periods reduced to 30g to maintain the formula gradually. Once prepared as “Gout Effervescent Powder” with six years of systematic observation, most cases showed significant symptom improvement within 2-3 days of taking, continued use could achieve complete recovery.
Modifications
| Concomitant Pattern | Modified Herbs | Treatment Intent |
|---|---|---|
| Stagnation transforming to heat | Add Humulus japonicus 30g, Polygonum cuspidatum 30g, Sanmiao Pill 10g (decocted in wrap) | Clearing and draining collaterals, draining turbidity, clearing toxicity while clearing dampness-heat |
| Severe unbearable pain | Add Scorpion 3g, Centipede 2 pieces, Pinellia 15g, Ferula 10g | Insect herbs search out and open stasis, stop pain, strengthen analgesic effect |
| Diffuse swelling obvious | Add White Silkworm 12g, White Mustard Seed 10g, Processed Bile 10g | Clearing phlegm, scattering nodules to accelerate swelling reduction and pain relief, turbid-stasis with phlegm treated together |
| Nodules hard | Add Processed Pangolin Scale 6g, Dung Beetle 10g, Wasp Nest 10g | Breaking nodules, opening stasis, softening hardness and reducing swelling, facilitating lowering of blood uric acid |
| Acute with heat predominance | Add Raw Rehmannia 20g, Cold Gypsum 30g, Anemarrhena 12g | Clearing heat and unblocking collaterals, suitable for those with obvious red swelling and burning pain |
| Acute with cold predominance | Add Processed Aconite 6g, Processed Kusnezoffia Aconite 6g, Cinnamon Twig 10g, Asarum 3g | Warming meridians, dispelling cold, reducing swelling and stopping pain, suitable for those whose pain is aggravated by cold |
| Body weak kidney deficient | Add Prepared Rehmannia 15g, Psoralea 10g, Drynaria 10g, Raw Astragalus 30g | Supplementing the kidney, strengthening sinews and bones, supporting healthy qi; for prolonged disease with body weakness, draining turbidity without forgetting to stabilize the foundation |
| Lower back pain with hematuria | Add Lysimachia 30g, Lygodium Spora 15g, Cowslip 15g, Imperata Cylindrica 30g | Clearing urinary difficulty, dissolving stones, stopping bleeding, preventing gouty kidney damage |
Modifications reflect Zhu Liangchun’s consistent approach of “firmly holding the draining-transforming turbid-stasis principle, flexibly adjusting based on the pattern.” During acute periods, Smilax Glabra and Dioscorea Hypoglauca dosages are increased, and heat-clearing or meridian-warming herbs are added depending on whether heat or cold predominates; for body-weak patients, kidney-supplementing and bone-strengthening herbs are used as auxiliaries. Throughout, draining-transforming turbid-stasis remains the guiding principle.
V. Summary
Xiehua Zhuoyu Tang uses Smilax Glabra 45g heavily as sovereign for draining turbidity and lowering uric acid, Dioscorea Hypoglauca and Coix Seed assisting turbid pathogen excretion, Eclipta and Alisma treating water and blood simultaneously, Red Peony and Earth Pile Bug transforming stasis, searching out and dissolving obstructions, Cimicifuga and Gentiana Macrophylla unblocking collaterals and guiding drugs to the bi site. Three methods: draining turbidity, transforming stasis, and dispelling bi, all used together. Zhu Liangchun’s gout treatment firmly holds the “draining-transforming turbid-stasis” principle, modifications are flexible without changing the guiding principle. It is the core formula for managing recurrent turbid-stasis bi and persistently elevated uric acid.
References:
[1] Zhu Liangchun. TCM Clinician - Zhu Liangchun. China TCM Press, 2006.
[2] China TCM Report, April 21, 2021, Page 5, “National Master Zhu Liangchun: Gout Treatment Experience”
[3] Guangdong TCM Apprenticeship Education Research Center, “National Master Zhu Liangchun’s Gout Decoction Special Formula”
14. 痛風、高尿酸血症—國醫大師朱良春「洩化濁瘀湯」
一、朱良春首屆國醫大師，本方為其治痛風核心方。
病機
痛風患者多形體豐腴、嗜酒喜進膏粱厚味，脾運失健，升清降濁無權，溼濁內生滯阻血脈，與血相結而為濁瘀。濁瘀滯留經脈則骨節腫痛、結節畸形，甚則潰破滲溢脂膏；鬱閉化熱則紅腫灼痛；損及脾腎則腰痛尿血，久則壅塞三焦呈關格危候。朱良春強調溼濁不受於外而生於內，實非風邪作祟，故稱”濁瘀痺”而非”痛風”。
方藥組成
組成：土茯苓 45g、生苡仁 30g、威靈仙 30g、萆薢 30g、秦艽 15g、澤蘭 15g、澤瀉 15g、赤芍 15g、地鱉蟲 10g
功效：洩化濁瘀，蠲痺通絡
主治：濁瘀痺（痛風），溼濁瘀滯內阻證
方中土茯苓重用45g利溼洩濁解毒為君，萆薢分清泌濁、生苡仁健脾滲溼助君藥給濁邪以出路；威靈仙通行十二經脈通絡止痛，秦艽祛風清熱舒筋，二藥引藥達於痺處。澤蘭活血利水、澤瀉利溼洩熱，澤蘭澤瀉同用則活血與利溼並行，水血同治。赤芍涼血散瘀，地鱉蟲破血逐瘀搜剔入絡，使濁瘀溶解推陳致新。全方洩濁與化瘀並舉，給濁邪出路、給瘀滯通道，兩路分消合擊。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 洩濁解毒 | 土茯苓 45g、萆薢 30g、生苡仁 30g | 土茯苓重用利溼洩濁解毒降尿酸，萆薢分清泌濁，苡仁健脾滲溼助濁邪排洩 |
| 通絡蠲痺 | 威靈仙 30g、秦艽 15g | 威靈仙通行十二經通絡止痛，秦艽祛風清熱舒筋引藥達痺處 |
| 活血利水 | 澤蘭 15g、澤瀉 15g | 澤蘭活血利水，澤瀉利溼洩熱，水血同治使濁瘀從水道分消 |
| 化瘀搜剔 | 赤芍 15g、地鱉蟲 10g | 赤芍涼血散瘀，地鱉蟲破血逐瘀搜剔入絡溶解濁瘀結滯 |
土茯苓劑量是本方配伍要點。朱良春治痛風土茯苓用量從30g至60g不等，急性發作期加重至60g以強化洩濁之力，緩解期減至30g守方緩圖。曾以此方製成”痛風沖劑”經六年系統觀察，多數病例服藥2-3天症狀顯著改善，繼續服用可獲痊癒。
隨證加減
| 兼證 | 加減藥物 | 立法用意 |
|---|---|---|
| 蘊遏化熱 | 加葎草 30g、虎杖 30g、三妙丸 10g（包煎） | 清洩利絡，洩濁解毒兼清溼熱 |
| 痛甚難忍 | 加全蠍 3g、蜈蚣 2條、延胡索 15g、五靈脂 10g | 蟲類搜剔開瘀定痛，增強止痛效力 |
| 漫腫明顯 | 加殭蠶 12g、白芥子 10g、陳膽星 10g | 化痰散結加速消腫緩痛，濁瘀夾痰同治 |
| 結節堅硬 | 加炮穿山甲 6g、蜣螂 10g、蜂房 10g | 破結開瘀軟堅消腫，利於降低血尿酸 |
| 急性偏熱 | 加生地黃 20g、寒水石 30g、知母 12g | 清熱通絡，適於紅腫灼痛明顯者 |
| 急性偏寒 | 加制川烏 6g、制草烏 6g、川桂枝 10g、細辛 3g | 溫經散寒消腫定痛，適於遇寒痛劇者 |
| 體虛腎弱 | 加熟地黃 15g、補骨脂 10g、骨碎補 10g、生黃芪 30g | 補腎壯骨扶正，久病體虛洩濁不忘固本 |
| 腰痛尿血 | 加金錢草 30g、海金沙 15g、小薊 15g、白茅根 30g | 通淋化石止血，防痛風性腎損傷 |
隨證加減貫穿朱良春”堅守洩化濁瘀大法不動、因證靈活出入”的思路。急性期加重土茯苓萆薢用量並據偏熱偏寒配清熱或溫經藥，體虛者佐補腎壯骨，始終以洩化濁瘀為主導方針。
五、小結
洩化濁瘀湯以土茯苓45g重用洩濁降尿酸為君，萆薢苡仁助濁邪排洩，澤蘭澤瀉水血同治，赤芍地鱉蟲化瘀搜剔溶解結滯，威靈仙秦艽通絡引藥達痺處，洩濁化瘀蠲痺三法並舉。朱良春治痛風堅守”洩化濁瘀”大法，隨證加減靈活出入而不改主導方針，是濁瘀痺反覆發作、尿酸居高不降的辨治核心方。
參考文獻：
[1] 朱良春.中醫臨床家——朱良春.中國中醫藥出版社,2006
[2] 中國中醫藥報,2021年4月21日第五版《國醫大師朱良春：治療痛風經驗》
[3] 廣東中醫師承教育研究中心《國醫大師朱良春教授痛風湯特效處方》