I have been reading a biography of Wilkie Collins, the Victorian novelist who was a close friend of Charles Dickens and who was best known for The Woman in White and The Moonstone, suffered from gout for much of his adult life.
When Collins travelled to America in 1873–74 however, hoping to experience the same success there that Dickens had done, something remarkable happened. He found that his health improved dramatically. The dry winter climate of the eastern United States particularly impressed him. After returning to England, he told Lucy Walford:
“I did not have an ache or a pain all the time. As for gout, it left me entirely for the time being.”
He went so far as to say that he would recommend America to people suffering from “rheumatic gout.”
Collins was making a personal observation rather than a medical theory. Nevertheless, his experience raises an interesting question from the perspective of Traditional Chinese Medicine: what role does the environment play in gout?
In Chinese medicine, gout is commonly understood through the concepts of Dampness, Heat, Phlegm and Blood Stasis. In an acute attack, the pattern may particularly resemble Damp-Heat lodged in the joints.
Interestingly, modern research also suggests that weather can influence the likelihood of gout attacks — although the relationship is more complicated than simply saying that “damp weather causes gout.”
Gout and Dampness in Chinese Medicine
Chinese medicine does not understand gout simply as an excess of uric acid.
Instead, the practitioner considers the person’s overall pattern: digestion, metabolism, diet, constitution, fluid regulation, circulation and the characteristics of the painful joint.
One of the most common patterns associated with gout is Damp-Heat.
Dampness in Chinese medicine refers to a pathological accumulation of fluids and metabolic heaviness. It is often associated with a feeling of heaviness, sluggishness, swelling and a tendency for symptoms to persist rather than resolve quickly.
Heat adds another dimension.
When Dampness combines with Heat, the result may be inflammation, redness, swelling, burning pain and a hot, acutely tender joint.
This gives the classical Chinese medical description of a gout attack a distinctive character: red, swollen, hot and intensely painful.
A systematic review and meta-analysis published in 2023 found that among people with gout, Damp-Heat and Phlegm-Dampness constitutions were particularly common. Damp-Heat constitution accounted for approximately 28% of the gout patients represented in the studies included in the analysis, while Phlegm-Dampness accounted for approximately 23%.
This does not mean that every person with gout has the same Chinese medicine diagnosis. TCM diagnosis is individual, and other patterns — including Blood Stasis and underlying Qi deficiency — may also be important.
Does Damp Weather Make Gout Worse?
This is where the story of Wilkie Collins becomes particularly intriguing.
Collins associated his improvement with the dry climate of America and his deterioration with the English climate. From a Chinese medicine perspective, one might naturally think of this in terms of Dampness.
But it would be too simplistic to say that modern science has demonstrated that humidity causes gout.
Research has found that weather does affect gout attacks, but the relationship is complicated. One study following 632 people with gout found that higher temperatures were associated with an increased risk of recurrent attacks. It also found a non-linear relationship with humidity: both very high and very low humidity appeared to carry greater risk than moderate humidity, with the combination of high temperature and low humidity showing the strongest association.
This is important because it reminds us that the Chinese medicine concept of Dampness is not simply a synonym for atmospheric humidity.
Dampness is a diagnostic concept within a particular medical system. It describes a pattern of pathological accumulation and impaired transformation and transportation, rather than merely the amount of water vapour in the air.
Nevertheless, patients sometimes notice very clear relationships between their symptoms and the weather. Collins was certainly not alone in making such observations. And Chinese medicine has traditionally paid considerable attention to the influence of climatic factors on health.
Damp-Heat and the Acute Gout Attack
In an acute gout attack, the presentation may strongly resemble the Chinese medicine pattern of Damp-Heat.
The affected joint may be:
- extremely painful
- red
- swollen
- hot
- difficult to move
- sensitive even to light touch
From a TCM perspective, Heat contributes to the redness, inflammation and burning quality, while Dampness contributes to swelling, heaviness and the persistence of the obstruction.
The term Bi syndrome is also relevant. Bi refers broadly to painful obstruction of the channels and joints caused by the obstruction of Qi and Blood.
Different forms of Bi may be associated with different pathogenic influences, including Wind, Cold and Dampness. When Heat predominates, the clinical picture changes accordingly.
The aim of treatment is therefore not simply to “treat gout”, but to determine what pattern is present in the individual patient.
Diet, Digestion and Dampness
Chinese medicine also pays particular attention to digestion and the production and regulation of fluids.
A tendency towards Dampness may be associated with dietary excess, impaired digestive transformation and a constitution in which fluids are not properly transported and transformed.
This is one reason why dietary history can be important in a TCM consultation for someone with gout.
The practitioner may ask about alcohol, rich foods, appetite, digestion, bowel movements, thirst, energy levels and other symptoms rather than looking at the painful joint in isolation.
This does not replace the biomedical understanding of gout. Uric acid metabolism remains fundamental to the condition, and people with gout should receive appropriate medical assessment and treatment.
Rather, Chinese medicine provides another framework for understanding why two people with apparently similar levels of uric acid may present with quite different symptoms and constitutional patterns.
Acupuncture and Chinese Herbal Medicine
Acupuncture is sometimes used alongside conventional medical treatment for gout, particularly for pain and inflammation.
A 2023 systematic review and meta-analysis of 12 randomised controlled trials found that acupuncture, either alone or alongside conventional treatment, was associated with reductions in pain in gouty arthritis. However, the authors judged the certainty of the evidence to be very low, because of limitations including small studies, lack of blinding and risk of bias.
Chinese herbal medicine has also been studied extensively. A systematic review identified 57 trials involving more than 4,500 people, but concluded that the quality of the evidence was generally poor and that better-designed studies were needed.
There has also been considerable research into the traditional treatment principle of clearing Heat and removing Dampness. A systematic review of 69 trials involving 5,915 participants found possible benefits for inflammatory markers, serum uric acid and clinical outcomes, although the limitations of the underlying trials mean that these results should be interpreted cautiously.
In practice, Chinese medicine treatment should therefore be regarded as complementary rather than a replacement for appropriate medical management of gout.
What Can We Learn From Wilkie Collins?
Perhaps the most interesting thing about Collins’s experience is not whether dry weather literally “cured” his gout.
It is that he noticed a relationship between place, climate and his body.
This way of observing illness is quite characteristic of traditional Chinese medicine. A TCM practitioner does not necessarily regard the patient’s symptoms as independent of their surroundings. Sleep, diet, season, climate, work, emotional state and physical constitution may all form part of the clinical picture.
Collins experienced something that made him ask a simple question: Why am I so much better here?
Chinese medicine has been asking questions of this kind for centuries.
It is important not to force the two systems into agreement. Collins’s improvement in America does not prove that atmospheric Dampness causes gout, and modern research does not establish Dampness as a biomedical mechanism.
But the two perspectives can sit beside one another.
The modern medical description of gout focuses on urate crystals, inflammation and metabolic risk factors. Chinese medicine describes patterns such as Dampness, Heat, Phlegm and Blood Stasis.
Both, in their different ways, encourage us to look beyond the isolated moment of pain and ask what circumstances make this person’s symptoms better or worse?
For Wilkie Collins, at least, the answer seemed to involve the climate.
And perhaps it is no coincidence that a novelist should have noticed the setting.
After all, in Collins’s books, the atmosphere is rarely just atmosphere. It is part of the story.
References
- Zhang Y, et al. Relation of Temperature and Humidity to the Risk of Recurrent Gout Attacks. American Journal of Epidemiology. 2014.
- Jiang Z, et al. The Correlation between Traditional Chinese Medicine Constitution and Hyperuricemia and Gout: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. 2023.
- Li X, et al. Evaluating the Efficacy and Adverse Effects of Clearing Heat and Removing Dampness Method of Traditional Chinese Medicine by Comparison with Western Medicine in Patients with Gout. Evidence-Based Complementary and Alternative Medicine. 2018.
- Li X, et al. Chinese herbal medicine for gout: a systematic review of randomized clinical trials. Clinical Rheumatology. 2013.
- Acupuncture for gouty arthritis: A systematic review and meta-analysis of randomized controlled trials. European Journal of Integrative Medicine. 2023.
- Wilkie Collins, The Letters of Wilkie Collins; and biographical accounts of his 1873–74 American reading tour.
Leave a Reply