The Gout, part 2

Updates (and reflections) on suggestions specific to The Gout: be aware of your triggers and try to calm your trigger finger (by drinking lots of fluids-not-alcohol-coffee-or-tea, altering your diet, using cherry juice and using some kind of diuretic, like celery seed or stinging nettle, as necessary).

If your trigger gets fired, do (painful!) direct bleeding (lancet or thick gauge acupuncture needle) technique at the site of the gout pain, and/or along the spleen and liver meridians (especially at fire/spring points, luo points and xi-cleft points). Also guzzle cherry juice, looking for a bowel movement that will herald the breaking of the "fever" that accompanies attacks of The Gout. When I am having a gout flare, I quit drinking my typical black tea and instead drink cherry juice in hot water – I pretty much only drink water or cherry juice during a flare. I haven't tried turmeric yet, as was suggested above, but I will the next time I have an attack and will report back – turmeric moves blood, so is perfectly consistent with the stagnant blood pain that accompanies The Gout. Other than turmeric, I've personally tried and survived every suggestion published on this blog, but the only ones I continue to use are: bleeding; cherry juice; green and/or stinging nettle tea; and occasionally baking soda in water. Plus I’ve stopped drinking alcohol and coffee and am much more cautious about eating foods with very concentrated flavors, like beans, smoked or organ meat, gravies and chocolate.

Also try to identify the source – in my case, familial, so associated with my kidney qi, but also lifestyle, so associated with spleen qi. The Gout seems to run in families, but if you have a certain kind of really bad family luck, you end up with a rare kidney disease (like in the recently attached nih.gov article) which causes decline of the kidneys accompanied by gout. With this bad luck, you end up with gout that, in Chinese terms, is completely caused by the kidneys themselves. This may seem obvious to a westerner: "Yeah, uric acid, urine, the kidneys, duh?!" But Chinese medicine sometimes sees things in a less straightforward way, which nevertheless sometimes explains and successfully treats conditions that otherwise frustrate us. For instance, although western ideas of kidney and bladder function and uric acid make sense, treating the kidneys and bladder doesn’t usually do anything to help with The Gout. The Chinese kidney meridian starts in the sole of the foot, and circles around behind the inner ankle bone and up the inner leg, and the bladder meridian runs down the center of the back of the leg, into the lateral ankle and foot, and ends on the lateral side of the little toe nail. Although The Gout can ultimately affect any or all joints, it is not particularly associated with the sole of the foot or the inner ankle, nor is it commonly associated with the little toe. It is, instead, very much associated with the big toe, especially the inside of the big toe, where the spleen meridian is located.

Along with its partner, the stomach, the spleen is the primary organ of digestion (most westerners assume that the Chinese are actually referring to the pancreas when they talk about the spleen). Its meridian starts near the medial proximal corner of the big toe nail, then continues over the bunion, along the inside of the arch of the foot, above the inner ankle bone and up the inner leg, knee and thigh. It continues up the torso to the lateral chest, then drops into the center of the ribcage (under your bra strap, more or less) on the side of the body. The spleen is associated with making energy and blood out of food, it likes things that taste good, including sweets, and it is associated with thought, or concentration. Boundaries are particularly important for the spleen, from "How many girlfriends should I have?" to "How much of this delightful beer should I drink?" to "How much of this random blogger's advice should I take?" Reaching your boundaries but not overflowing them is a big spleen concept. However, typically in Chinese medicine the tendency to "overflow" would be associated with the spleen's partner, the stomach. The spleen is thought to be essentially incapable of excess – it would typically only be deficient, because of its constant output of energy in the areas of ingestion, digestion and elimination of both food and ideas. Conceptually, anything can be excessive or deficient, but in practice, the organs have overwhelming tendencies toward one or the other. And the spleen is almost always deficient. But in the case of The Gout, the pounding, fixed pain tells us that it's blood stagnation, which is an excess condition. The spleen is associated with the formation of blood, and if the body is doing something funky in how it makes blood (what science describes as the build-up of uric acid in the blood, with concentrated uric acid precipitating in the affected joint space), then sense could be made of this blood-making digestive organ-related blood stagnation backing up into the meridian, especially if certain foods seem to act as triggers.

What might make the spleen develop such an unusual and intense blood stagnation? Long known as "the rich man's disease," gout has become much more democratic in recent generations. Among other things, a diet that has historically been considered to be "rich" (with plenty of meat, alcohol, seafood, strongly flavored gravies, chocolate and coffee) has become pretty easy to attain for lots of people – and all of these foods are known to trigger attacks of The Gout. My feeling as a periodic sufferer of The Gout is not that I am too rich, but that problems arise when all my wealth becomes concentrated in just 1% of my body. Given that the foods that trigger The Gout all tend to have very concentrated flavors, and given that the spleen is responsible for “concentration” in a mental sense, this seems to be the direction of the unusual excess spleen pattern. In traditional Chinese culture, very few people would have had the luxury of either eating all those rich foods or indulging in lots of mental activity – most people would be busy planting crops and eating the fruits of those labors. In modern America, though, very few of us are planting crops and eating them – most of us are using computers, writing blogs, or otherwise trying to make our living with very concentrated mental activity. And while we’re engaged in all this intense mental activity, we’re eating lots of yummy, concentrated flavor foods… even if we’re not getting fat, we may be eating lots of stuff that is just too rich for our spleens to handle day after day, year after year. Like most accumulations in Chinese medicine, The Gout is part of the curse of middle age – things you could get away with when you were younger you no longer can. Furthermore, during middle age is when you are laying the groundwork for your old age – reining your excesses in, but hopefully leaving yourself some room to enjoy life in healthy and sustainable ways. Try to accept the limitations of the physical and learn from them, not just rail against them. Life is perfect just as it is – it is up to us, as living, thinking creatures, to understand and work with it, not to constantly, willfully try to bend life to our desires.

Which brings us back to the kidneys, which the Chinese associate with the will. Like the spleen, the kidneys are almost never considered to be in excess, and it would be hard to imagine how someone could have too much will to survive… until you think of “willfulness,” and “willful destruction of property,” and “willful ignorance.” Many people who suffer from The Gout have plenty of will, but sometimes it’s misdirected – that is, instead of having a healthy will to survive, and so cutting out some of the foods that contribute to a painful condition, the will is instead directed to “Drink my beer like I always did, dammit, no matter what anyone says!” One might applaud such a spirit, and I do, right up to the point where it becomes self-defeating and counter-productive. My current hypothesis is that The Gout is on the continuum that ends up at pancreatic cancer (spleen luo blood stagnation), so it is not merely pain that is being risked by such a strong display of willfulness, but possibly, ultimately, The Gout sufferer’s life.

Our bodies know things our minds don't, until the mind experiences something like The Gout and has an opportunity to learn. It is seductive to cling to the thing that “makes sense” to our mind, and most western training and thinking is strongly biased toward the mind. In addition, understanding the body’s messages can be difficult, especially because in some cases its message is pretty unflattering. But we don’t know as much as we think we do, and sometimes it is necessary to release what we think we know in order to learn something new. The body is expert in this painful, bubble-bursting style of education.