The role of Western herbal medicine in the treatment of gout

Gout has been recognised as a clinically distinct disease for over four millennia. It is one of the most prevalent inflammatory arthropathies and a true crystal deposition disease. Current consensus holds that its management in primary orthodox healthcare is sub-optimal. This study aimed to identify whether herbal medicine offers an effective alternative or complementary approach for managing patients with acute and chronic gout.Three approaches were taken: a survey of medical herbalists to gauge contemporary approaches; historical and contemporary texts were scrutinised to identify any herbs indicated for gout; and an evidence review to establish the current evidence base for the herbal treatment of gout.While gout was not a frequent presentation in practice, the majority of medical herbalists surveyed had treated it at some point in time. Moreover, most reported herbal medicine had a definite benefit for patients with gout, usually taking effect within one or two months. In general, the herbs used in clinical practice were mainly chosen for their ability to eliminate uric acid (Apium graveolens, Urtica spp, Taraxacum officinale) or as anti-inflammatories (Harpagophytum procumbens, Filipendula ulmaria, Salix spp, Betula spp, Curcuma longa and Guaiacum spp.). There was some agreement in the more popular herbs cited for gout in herbal texts and prescribed by practitioners, and given the lack of scientific evidence identified, suggests herb choice was largely influenced by traditional use.A paucity of evidence was highlighted regarding the effectiveness of Western herbal medicine for gout, a single clinical trial was identified; however, it was of poor quality with unclear or high risks of bias.Given the effectiveness of herbal medicine in treating patients with gout reported by practitioners, together with the lack of a strong evidence-base identified in this study, further research is warranted. Practice-based evidence, such as the systematic collection of clinical treatment outcomes in practice, together with large, well-designed pragmatic clinical trials are required to establish the effectiveness of herbal medicine in the treatment of gout.