Gout (also called metabolic arthritis and known to Ayurveda as Vatarakta) is a disease due to a disorder of uric acid metabolism in the blood. In this condition, monosodium urate or uric acid crystals are deposited on the articular cartilage of joints, tendons and surrounding tissues due to elevated concentrations of uric acid in the blood stream. This provokes an inflammatory reaction of these tissues. These deposits can often increase in size and burst through the skin to form sinuses discharging a chalky white material.
The classic picture is of excruciating, sudden, unexpected, burning pain, swelling, redness, warmness and stiffness in the joint. Low-grade fever may also be present. The patient usually suffers from two sources of pain: firstly, the crystals inside the joint cause intense pain whenever the affected area is moved. Secondly, the inflammation of the tissues around the joint also causes the skin to be swollen, tender and sore if it is even slightly touched. For example, a blanket or even the lightest sheet draping over the affected area could cause extreme pain.
Gout usually attacks the big toe (approximately 75 percent of first attacks); however, it also can affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. In some cases, the condition may appear in the joints of small toes that have become immobile due to impact injury earlier in life, causing poor blood circulation that leads to gout.
Patients with longstanding hyperuricemia can have uric acid crystal deposits called tophi (singular: tophus) in other tissues such as the helix of the ear. Uric acid stones commonly also form in the kidney.
Symptoms thus almost always include an excruciating, sudden burning pain, redness and swelling in joints (particularly the big toe); occasionally, low-grade fever, nausea, flatulence,
vague and travelling abdominal pains, loss of appetite, constipation and highly colored and scant urine may be seen.
Causes may include an impairment of digestion due to intake of incompatible foods (particularly an excessive intake of proteins), non-elimination of metabolic wastes from the body, hereditary factors, age and gender (rarer in females), and climate.
In terms of treatment, the first choice is for treatment via an alteration of dietary regimen. Low oxalate and low-uric acid forming foods and a low meat diet is to be encouraged. High fiber, low protein foods should be emphasized, old rice (but not fresh rice), wheat, moong dal, garlic, onion, bitter gourd, papaya and green banana are beneficial. Sour and salty tasting foods and heavy and fried foods are to be avoided. Rhubarb is a specific food remedy for gout, as are sweet cherries and their juice. It is critical in the treatment of Gout that the patient is kept well hydrated.
Herbal medicines specifics for the treatment of gout include Lashun (Garlic), Guggul (Commiphora mukul) and Shallaki (Boswelia serrata) as well as Guduchi (Tinospora cordifolia) the last of which is applied in all conditions of aggravated ranjakapitta and pitta in the blood. The compound of Sunthi (Ginger), Kumari (Aloe vera) and Guduchi is a specific and especially effective formulation commonly used in treating gout.
In terms of lifestyle management, the patient should not perform any fast-paced exercise, but moderate exercise is to be encouraged, and idleness and a sedentary lifestyle avoided. Exposure to cold wind and rain, and cold-water bathing are strictly contra-indicated. Abhyanga is beneficial and the yoga asanas known as the Forward Bend and Lotus positions are particularly useful in treating gout.