Advances in the treatment of hyperuricemia with traditional Chinese medicine

doi:10.5246/jcps.2024.05.029

Abstract

Abstract:

Hyperuricemia (HUA), a prevalent metabolic disorder, is closely associated with the development of various diseases. Within Chinese medicine literature, HUA is not explicitly labeled; instead, it falls under categories like “Lijie”, “arthralgia syndrome”, and “gout”. Conversely, modern medical practitioners classify it as “turbid bi” and “Gaozhuo”, among others. Western medicine approaches to treating HUA often involve singular methods with potential toxic and side effects. In contrast, traditional Chinese medicine (TCM), guided by holistic principles and dialectical treatment theories, offers the advantage of multifaceted effects and a broad spectrum of therapeutic targets. This paper aims to review recent research in the application of TCM for the treatment of HUA, providing a foundational basis for clinical diagnosis, treatment, and further investigations in this field.

Key words: Hyperuricemia, Metabolic diseases, Traditional Chinese medicine

Supporting:

Gong Fang, Wenxi Li. Advances in the treatment of hyperuricemia with traditional Chinese medicine[J]. Journal of Chinese Pharmaceutical Sciences, 2024, 33(5): 381-395.

References 91

[1]	Fang, G.; Li, W.X.; Zhang, J.; Ke, Q.H.; Zhu, X.G.; Long, L.H.; Li, C.H. Safety and tolerability of available drugs for hyperuricemia: a critical review and an update on recent developments. J. Chin. Pharm. Sci. 2022, 31, 397.
[2]	Li, C.C.; Gong, S.X.; Xu, J.; Zhang, X.M.; Xu, S.S.; Zhang, H.J.; Zhang, T.J.; Liu, C.X. Research progress in chemical constituents and pharmacological effects of Plantago Seed and prediction analysis of quality markers. Chin. Herbal. Med. 2018, 49, 1233–1246.
[3]	Wang, J.; Xu, B.B.; Zeng, J.X.; Ren, G.X.; Zhang, L.; Zhu, J.X.; Wang, X.Y.; Liang, J.; Xie, X.X.; Zou, H. Electrochemical biosensor screening of xanthine oxidase inhibitors in Plantago Seed. J. Pharmaceutical. Anal. 2017, 37, 1215–1222.
[4]	Zeng, J.X.; Xu, B.B.; Wang, J.; Bi,Y.; Wang, X.Y.; Zhong, G.Y.; Ren, G.; Zhu, J.X.; Li, M.; Zhu, Y.Y. Verbascum glycosides and isophorbasin glycosides in Plantago chinensis reduce serum uric acid in mice with acute hyperuricemia Level and its mechanism. Chin. Patent Med. 2016, 38, 1449–1454.
[5]	Li, S.Y. The clinical experience of Plantago Seed in the treatment of gout. Digest World Latest Med. Informa. 2016, 16, 168–183.
[6]	Chen, J.; Sun, M. Study on the effect of combined use of Psyllium tea and conventional western medicine in the treatment of acute gouty arthritis. Contemp. Med. Rev. 2015, 13, 7–9.
[7]	Zhang, M.B.; Feng, G.Y.; Luan, Z.Z.; Li, L.; Guo, Y.H. Research on the anti-gout mechanism of Polygonum cuspidatum based on molecular docking method. Liaoning J. Tradit. Chin. Med. 2016, 43, 2164–2165, 2238.
[8]	Ye, M.G. Effect of Polygonum cuspidatum on the expression of uric acid transporter in renal tubules of rats with hyperuricemia. Zhejiang J. Tradit. Chin. Med. 2019, 54, 917–919.
[9]	Hou, J.P.; Wang, Y.J.; Yan, Y.F.; Wang, B.; Meng, J.G. Experimental study of Polygonum cuspidatum extract against hyperuricemia in animals. West. J. Tradit. Chin. Med. 2012, 25, 21–24.
[10]	Zheng, D.Y.; Liu, J.C. Treatment of 43 cases of acute gouty arthritis with Hongteng Huzhang Decoction. J. Tradit. Chin. Med. 2013, 54, 250–251.
[11]	Pan, T.S.; Lin, Z.R.; Lin, Y.; Peng, W. 50 Cases of gouty arthritis treated by self-made polygonum Cuspidatum Gout Decoction. Chin. Nat. Folk Med. 2017, 26, 97–98.
[12]	Xiao, Y.; Li, G.Z. Advances in research on the pharmacological effects of Yam rhizome. Shanxi Tradit. Chin. Med. 2018, 34, 54–56.
[13]	Chen, G.L; Zhu, L.R.; Na, S.; Li, L. The effects of total saponins of acini on chronic hyperuricemia and renal tubular uric acid transporter 1 expression in rats. Chin. J. Chin. Materia Medica. 2013, 38, 2348–2353.
[14]	Zhang, L.L. Clinical analysis of 28 cases of gouty arthritis treated with yam rhizome. Chin. Foreign Med. 2019, 38, 184–186.
[15]	Liu, Y. Research on the anti-gout effect of berberine and its derivatives. Jiamusi Univ. 2014.
[16]	Wang, Y.; Yang, R.; Shan, L.; Yuan, J. The efficacy and safety of berberine combined with benzbromarone in the treatment of hyperuricemia with gout. China Modern Med. Applicat. 2018, 12, 3–6.
[17]	Wu, L.; Chen, M.; Wu, Y. The effect of berberine on hyperuricemia. Chin. J. Integr. Tradit. Chin. West. Med. 2010, 30, 659–662.
[18]	Liu, Y.J. Study on the effect and mechanism of baicalin on hyperuricemia nephropathy. Wuhan Univ. Light Industry. 2020.
[19]	Wang, M.; Zhao, J.; Zhang, N.; Chen, J.H. Astilbin improves potassium oxonate-induced hyperuricemia and kidney injury through regulating oxidative stress and inflammation response in mice. Biomed. Pharmacother. 2016, 83, 975–988.
[20]	Wang, Y. The effect of myricetin and puerarin on hyperuricemia and its significance. Inn. Mongolia Tradit. Chin. Med. 2010, 29, 9–10.
[21]	Yu, R.L.; Chen, S.H.; Lu, G.Y.; Tong, H.N. Effects of Pueraria lobata extract on uric acid and blood lipids in hyperuricemia model rats. J. Zhejiang Univ. Tradit. Chin. Med. 2011, 35, 455–458.
[22]	Wang, Q.; Zhao, L.H.; Di, S. The clinical application and dosage of Astragalus membranaceus. Jilin Tradit. Chin. Med. 2018, 38, 1450–1454.
[23]	Zhong, Y.L.; Zhan, L.X.; Yu, Y.Q. Astragalus Simiao Powder in the treatment of 50 cases of hyperuricemia. Jiangxi Tradit. Chin. Med. 2014, 45, 57–58.
[24]	Liu, H.; Li, Z.G.; Zhang, P.Y. Clinical observation of Huangqi Baoxin Decoction in the treatment of chronic heart failure with hyperuricemia. China Emerg. Tradit. Chin. Med. 2017, 26, 1651–1654.
[25]	Dong, Y. Separation, purification, activity study and application of flavonoids from Glycyrrhiza glabra leaves. South China Univ. Technol. 2016.
[26]	Zhang, R.C.; Zhong, L.B.; Liang, H.Q. Zhou, J.F. The effect and mechanism of isoliquiritin on the inhibition of xanthine oxidase. Chin. J. Gerontol. 2015, 35, 4757–4759.
[27]	Sun, M.; Liu, C.Y.; Fu, W.Q.; Tang, Y.D.; Liu, X.C.; Sun, J.Q.; Zhao, J. Study on the therapeutic effect and mechanism of Lycium barbarum extract on chronic hyperuricemia. Chin. National Folk Med. 2017, 26, 35–37.
[28]	Wu, J. Application of rat model of acute gouty arthritis and hyperuricemia to study the effect of Achyranthes bidentata in Sanmiao Pill prescription. Anhui Med. Univ. 2015.
[29]	Liu,Y.; Meng, Z.Q.; Zhang, C.F.; Yang, Z.L. Preliminary experimental study on uric acid-lowering effect of Salvia miltiorrhiza. Strait Pharm. 2013, 25, 27–29.
[30]	Zhang, J.Y.; Liu, Y.T.; Tang, H.J. Enzyme kinetics and molecular docking of the interaction between natural product Salvianolic Acid A and xanthine oxidase. J. Anhui Univ. Eng. 2019, 34, 1–5+60.
[31]	Yin, H.F.; Dai, P.; Chen, L.Y.; Ma, S.W.; Yang, Z.L. Experimental study on the effect of turmeric on lowering uric acid. Pharm. Clin. Res. 2011, 19, 134–135.
[32]	Chen, L.; Wang, Q.; Liu, C.M. Screening of xanthine oxidase inhibitors in traditional Chinese medicine turmeric by ultrafiltration mass spectrometry. Application of mass spectrometry in medical research. Chinese Chemical Society Mass Spectrometry Professional Committee: Chinese Chemical Society. 2017:1.
[33]	Chen, Y.L. The effect of curcumin on the expression of TGF-β1 and NF-κB in the kidney tissue of hyperuricemia rats. Zhengzhou Univ. 2018.
[34]	Li, Y.; Chen, J.; Li, P. Xanthine oxidase inhibitory activity of phenolic acids and flavonoids in honeysuckle. J. China Pharm. Univ. 2011, 42, 407–411.
[35]	Shen, Q.R. Screening of traditional Chinese medicine xanthine oxidase inhibitors and study on inhibition kinetics. Nanchang Univ. 2015.
[36]	Guo, Q.L.; Zhang, H.H. Research progress of Chinese herbal medicine for the prevention and treatment of hyperuricemia in both medicine and food. Diet Sci. 2019, 2, 138.
[37]	Fei, Q.; Xue, W.L.; Zhao, Y.X.; Zhao, L. Ultrasonic enzymatic hydrolysis to extract galangin from Galangal and its uric acid-lowering activity. Food Res. Dev. 2018, 39, 50–56.
[38]	Hu, M.; Liu, J.W.; Song, Y.; Zeng, N. Study on the effect of evodialine on hyperuricemia in quail. Pharm. Clin. Chin. Materia Medica. 2014, 30, 38–40.
[39]	Yu, S.H.; Song, H.P.; Gao, W.; Zhang, H. Study on the inhibitory activity of flavonoids in safflower on xanthine oxidase. Chin. Nat. Folk Med. 2017, 26, 23–26.
[40]	Tang, Y.X.; Zhu, L.L.; Zhang, H.; Tan, H.S.; Fu, W.W. Study on the chemical constituents of Papaya branches that inhibit the activity of xanthine oxidase. World Chin. Med. 2016, 11, 1150–1153.
[41]	Zhu, L.L; Chen, B.J. In vivo and in vitro uric acid-lowering effects of total saponins of Aesculus hippocastanum and its effect on uric acid transporter in mice with hyperuricemia. New Chin. Med. 2018, 50, 41–44.
[42]	Gong, X.; Chen, G. Research status of rhubarb topical treatment of gouty arthritis. Jiangxi Tradit. Chin. Med. 2017, 48, 78–80.
[43]	Yang, X.F.; Huang, C.B.; Xu, H.M.; Wang, W.J. Research progress on the mechanism of rhubarb in the treatment of gout. Hubei J. Tradit. Chin. Med. 2018, 40, 54–57.
[44]	Zhu, J.X.; Zhu, Y.Y.; Luo, G.M.; Zeng, J.X.; Shi, J.J.; Xu, F.F.; Wang, X.Y.; Wu, B. Gardenia extract reduces blood uric acid levels in mice with acute hyperuricemia and its mechanism. Anhui Agric. Sci. 2011, 39, 22317–22318.
[45]	Zhu, J.X.; Zeng, J.X.; Luo, G.M.; Zhu, Y.Y.; Wang, X.Y.; Wu, B.; Shi, J.J.; Xu, F.F. Study on the effective parts of Gardenia for lowering uric acid. Chin. J. Exp. Prescript. 2012, 18, 159–161.
[46]	Zhao, X.M.; Tan, C.H.; Zhang, H. Inhibition of cat’s silk extract on xanthine oxidase. Pharm. Clin. Chin. Materia Medica. 2009, 25, 45–47.
[47]	Lan, L.L. Study on the protective effect and mechanism of kidney tea on hyperuricemia and gouty nephropathy. Guangzhou Univ. Tradit. Chin. Med. 2016.
[48]	Huang, Y.X.; Cai, Y.J.; Wu, B.H. The effect of kidney tea on blood uric acid levels in mice. World Clin. Drugs. 2016, 37, 744–747.
[49]	Cao, R.Z.; Zhang, S.Y.; Dai, Y.; Zhu, J. Research on the mechanism and mechanism of total coumarin from Qinpi on reducing serum uric acid level in mice with acute hyperuricemia. Liaoning J. Tradit. Chin. Med. 2010, 37, 362–363.
[50]	Liu, Y.; Zheng, L.Y.; Cui, L.R. Research on the mechanism of anti-hyperuricemia of Gentiana in rats. Chin. Med. Inn. 2013, 10, 143–144.
[51]	Zhang, W. Study on the uric acid-lowering active ingredients of Aspergillus sinensi. Shanghai Ins. Pharm. Ind. 2017.
[52]	Huang, X.J.; Li, Y.J.; Li,J.; Xu, X. The total flavonoids of Salvia officinalis inhibit the production of inflammatory factors in pain model mice and cause analgesia. Food Sci. 2014, 35, 240–243.
[53]	Liu, D.; Zhu, J.B.; Wang, Y.H.; Ding, Y.; Kou, Z.N.; Xiao, W. A preliminary study on the potential mechanism of Ginkgo biloba extract in the treatment of gout based on network pharmacology. Chin. Herbal. Med. 2016, 47, 2693–2700 .
[54]	Cheng, H.Y.; Zhu, J.X. Ginkgo biloba extract lowering uric acid and inhibiting xanthine oxidase. Bulletin Tradit. Chin. Med. 2013, 12, 61–63.
[55]	Chen, P.P.; Tang, X.Z.; Wang, L.N.; Luo, M.; Lin, H.Q. Efficacy of Ginkgo biloba extract on chronic hyperuricemia nephropathy. Chin. J. Int. Tradit. Chin. West. Med. Nephrop. 2001, 11, 644–645.
[56]	Chai, J.X. In vitro activity of flavonoids from Eucommia ulmoides leaves and its preventive and therapeutic effects on hyperuricemia in rats. Nanchang Univ. 2012.
[57]	Zhu, C.; Xu, Y.; Liu, Z.H.; Wan, X.C.; Li, D.X.; Tai, L.L. The anti-hyperuricemic effect of epigallocatechin-3-gallate (EGCG) on hyperuricemic mice. Biomed. Pharmacother. 2018, 97, 168–173.
[58]	Ren, Q.L.; Liao, C.C.; Liu, J.G.; Fan, Q.; Wang, M.; Wang, Q.; Wang, B.L.; Hu, H. Effects of tea polyphenols on uric acid levels and liver and kidney tissues in mice with hyperuricemia. Modern Agric. Sci. Tech. 2020, 13, 200–202, 206.
[59]	Pang, M.X.; Fang, Y.Y.; Chen, S.H.; Zhu, X.X.; Shan, C.W.; Su, J.E.; Yu, J.J.; Li, B.; Yang, Y.; Chen, B.; Liang, K.L.; Hu, H.M.; Lv, G.Y. Gypenosides inhibits xanthine oxidoreductase and ameliorates urate excretion in hyperuricemic rats induced by high cholesterol and high fat food (lipid emulsion). Med. Sci. Monit. 2017, 23, 1129–1140.
[60]	Zhang, Y.; Jin, L.J.; Liu, J.C.; Wang, W.; Yu, H.Y.; Li, J.; Chen, Q.; Wang, T. Effect and mechanism of dioscin from Dioscorea spongiosa on uric acid excretion in animal model of hyperuricemia. J. Ethnopharmacol. 2018, 214, 29–36.
[61]	Zhu, L.R.; Dong, Y.F.; Na, S.; Han, R.; Wei, C.Y.; Chen, G.L. Saponins extracted from Dioscorea collettii rhizomes regulate the expression of urate transporters in chronic hyperuricemia rats. Biomed. Pharmacother. 2017, 93, 88–94.
[62]	China Pharmaceutical University. The use of total phenol extracts of Viola vulgaris in the treatment of hyperuricemia: CN201110157059.8 [P]. 2011-10-12.
[63]	Du,W.D.; Li, G.F.; Chen, H.F.; Zhong, Y.Q.; Yang, J.; Zhang, W.G. Based on network pharmacology to explore the anti-gout/hyperuricemia mechanism of Viola. Chin. Med. Mater. 2021, 02, 429–436.
[64]	Wu, L.X.; Liang, H.; Zhao, Y.X.; He, H.M.; Liang, X.M.; Zhou, W.H.; Zhen, H.S.; Huang, M.Q.; Liu, X.H. The effect of hirudin on the expression of urate transporters OAT1, URAT1 and GLUT9 in hyperuricemia rats. Chin. Herbal. Med. 2020, 51, 5776–5780.
[65]	Lin, H.; Yuan, L.X.; Gao, L.H.; Li, L.; Niu, Y.F. The effect of mangiferin on the expression of blood uric acid and purine metabolism-related enzymes in hyperuricemia mice. Chin. J. Exp. Formulas. 2019, 25, 55–59.
[66]	Lu, G.F.; Qiu, Z.K.; Chang, S.Z.; Guo, J.; Lin, H.; Ye, D.D.; Li, P.; Lu, J.; Lin, Z. Effects of total flavonoids from corn silk on renal uric acid excretion in rats with gouty nephropathy. Chin. Patent Med. 2018, 40, 1373–1376.
[67]	Tan, C. Experimental study on the effect of Qiu Chubi Decoction on serum uric acid in hyperuricemia model and the expression of uric acid transporter protein OAT1 and URAT1 mRNA in mouse kidney. Nanjing Univ. Tradit. Chin. Med. 2014.
[68]	Wang, H.Y. Based on the TLR/MyD88/NF-κB pathway to explore the molecular mechanism of Liaochubi Decoction on gouty arthritis rats. Nanjing Univ. Tradit. Chin. Med. 2016.
[69]	Su, Z.M. A clinical study on the treatment of gouty arthritis with damp-heat accumulation syndrome with chubi decoction. Nanjing Univ. Tradit. Chin. Med. 2014.
[70]	Wu, S.J. Study on the mechanism of Guizhi Shaoyao Zhimu Decoction in the treatment of gout. Shanxi Acad. Tradit. Chin. Med. 2014.
[71]	Wang, Y.H.; Fang, S.B.; Li, Y.Y.; Zhou, R. Based on Toll-MyD88 signaling pathway to study the mechanism of Guizhi Shaoyao Zhimu Decoction in the treatment of gouty arthritis. Chin. J. Exp. Form. 2016, 22, 121–126.
[72]	Fang, S.B.; Wang, Y.H.; Li, Y.Y.; Zhou, R. Based on the NLRP3 inflammasome signaling pathway to study the mechanism of Guizhi Shaoyao Zhimu Decoction in the treatment of gouty arthritis. Chin. J. Exp. Form. 2016, 22, 91–95.
[73]	He, X.H.; Xu, Z.X.; He, Y.T. Modified Guizhi Shaoyao Zhimu Decoction in the treatment of 30 cases of gouty arthritis. Chin. J. Exp. Form. 2013, 19, 326–328.
[74]	Huang, Y.H.; Zhu, J.X.; Lin, T.X. Observation on the curative effect of Daqinjiao Decoction in the treatment of acute gouty arthritis. J. Tradit. Chin. Med. 2013, 41, 115–116.
[75]	Zhang, J. Effect of modified Daqinjiao Decoction on Serum IL-1β, TNF-α and VEGF levels in AA rats. Heilongjiang Univ. Tradit. Chin. Med. 2007.
[76]	Li, D.Y. Experimental study on the effect of compound Sisieges siege capsules on hyperuricemia and gouty kidney injury in rats. Heilongjiang Univ. Tradit. Chin. Med. 2007.
[77]	Yu, X.F.; Sun, G.C.; Fan, X.W. Effect of compound herba siegesbeckiae capsule on expression of inflammatory factors in synovium of acute gouty arthritis. World Latest Med. Inf. 2016, 16, 28–29.
[78]	Wei, Z.B.; Xu, C.; Liu, S.; Song, F.R.; Liu, Z.Q.; Qu, X.B. Metabonomics study of the effects of traditional Chinese medicine formula Ermiaowan on hyperuricemic rats. J. Sep. Sci. 2018, 41, 560–570.
[79]	Zhu, F.F.; Yin, L.; Ji, L.L.; Yang, F.; Zhang, G.J.; Shi, L.; Xu, L. Suppressive effect of Sanmiao formula on experimental gouty arthritis by inhibiting cartilage matrix degradation: an in vivo and in vitro study. Int. Immunopharmacol. 2016, 30, 36–42.
[80]	Xie, Z.J.; Wu, H.X.; Jing, X.Q.; Li, X.Y.; Li, Y.S.; Han, Y.M.; Gao, X.F.; Tang, X.P.; Sun, J.; Fan, Y.S.; Wen, C.P. Hypouricemic and arthritis relapse-reducing effects of compound tufuling oral-liquid in intercritical and chronic gout: A double-blind, placebo-controlled, multicenter randomized trial. Medicine. 2017, 96, e6315.
[81]	Wu, J.J.; Li, L.Y.; Peng, J.Y. Study on the mechanism of Jianpi Shenshi Recipe on renal protection of hyperuricemia rats. Hera. Tradit. Chin. Med. 2017, 23, 25–27.
[82]	Mao, G.S. Study on the effect and mechanism of the method of strengthening the spleen and releasing turbidity on serum URAT1 and GLUT9 levels in patients with gout. Anhui Univ. Tradit. Chin. Med. 2017.
[83]	Jia, J.Y. The curative effect of the method of strengthening the spleen and releasing turbidity on primary gouty arthritis and the effect of serum IL-18 and TGF-β. Anhui Tradit. Chin. Med. 2016.
[84]	Zhao, H.L. Experimental study on the mechanism of Liuwei Tongfeng Decoction in preventing and treating gouty arthritis. Shandong Univ. Tradit. Chin. Med. 2009.
[85]	Su, Y.X.; Lai, Z.; Zheng, L.P.; Lin, J.M.; Wu, F.H.; Zhou, J.S.; Wang, H.M.; Xu, S.L. Effect of Tongfengning Granules on Serum Xanthine Oxidase Activity of Chicken Gout Model. Fujian Tradit. Chin. Med. 2006, 2, 41–42.
[86]	Wang, X.; Xue, N.; Chen, Z.; Yu, W. Study on the mechanism of Fangji Huangqi Decoction on reducing uric acid and renal protection in mice with hyperuricemia. Chin. J. Chin. Materia Medica. 2020, 45, 5248–5255.
[87]	Ding, K.; Cao, W.F.; Zhang, Y.Y.; Tian, S.; Wu, Q. Effect of Qushidizhuo Decoction on Uric Acid Transporter in Rats with Hyperuricemia. Chin. J. Pathophysiol. 2019, 35, 1514–1520.
[88]	Ran, Y.; Yan, X.C.; Li, L.; Zhou, Y.C.; Dang, Z.B.; Hu, S.P. Pharmacodynamic-observation of Tongbi Jiangzhuo Decoction in the treatment of hyperuricemia rats. World J. Int. Tradit. Chin. West. Med. 2020, 15, 1441–1444.
[89]	Zhang, E.F.; Yin, Z.; Yang, L.B. Effect of Jianpi Qingre Lizhuo Decoction on kidney function in rats with gouty nephropathy. Chin. Patent Med. 2020, 42, 2459–2463.
[90]	Shen, J.Y.; Yang, Q.; Liu, N.; Zhang, Y.L.; Peng, J.Y. Effect of Yishen Jianpi Xiezhuo Decoction on renal function and renal pathological changes in rats with gouty nephropathy. J. Yunnan Coll. Tradit. Chin. Med. 2020, 43, 1–6.
[91]	Xie, X.W.; Wang, C.L.; Xu, S.H.; Li, D. P.; Lu, L.T. Effects of Lonicera japonica Gout Granules on MMP-3 and LP-PLA2 in Gouty Arthritis Model Rats. Chin. J. Orthope. Traumatol. 2016, 24, 6–8, 13.