Gout

Qiaoyun Liu et al. (2026) · Frontiers in endocrinology

This systematic review and meta-analysis of 56 randomized controlled trials (4,605 participants) examined whether herbal formulae containing Smilax glabra, known in Chinese as Tufuling, help people with acute gout. Gout is a painful inflammatory arthritis caused by uric acid crystals depositing in joints. In traditional Chinese medicine, many acute flares are classed as dampness-heat accumulation, a pattern defined by red, swollen, hot, painful joints and dark urine, and treated by clearing heat and resolving dampness. The authors also used computer-based network pharmacology to predict which plant compounds and proteins might explain the effects. All 56 trials took place in China and enrolled adults, with ages ranging from 18 to 80 years, diagnosed with gout and the dampness-heat pattern. Participants received a Tufuling-containing herbal formula, sometimes with external applications or acupuncture, either alone or added to standard drugs such as NSAIDs, colchicine, allopurinol or benzbromarone, for 14 days or less. Comparison groups received the standard drugs alone. Pain was measured on a 10-point visual analog scale, and blood uric acid, C-reactive protein and erythrocyte sedimentation rate (inflammation markers) were also tracked. Herbal formulae added to standard drugs reduced pain by 0.94 points on the 10-point scale (a modest but statistically significant gain across 17 trials), raised the chance of a treatment response by 15% (risk ratio 1.15), and lowered blood uric acid by 57 micromoles per litre. Herbal formulae alone did not beat standard drugs for pain (a 0.33-point difference, not significant) but did lower uric acid. Adverse events, mostly stomach and intestinal complaints, totalled 73 in herbal groups versus 161 in comparison groups, all mild to moderate. Certainty of evidence was rated low to moderate, and heterogeneity was very high for pain (I² = 93.2%). Network analysis predicted 49 gout-related protein targets for Tufuling, centred on PTGS2, IL1B, PPARG and TP53 (proteins governing inflammation and metabolism), and docking suggested diosgenin binds PTGS2 strongly (-11.6 kcal/mol). The authors suggest Tufuling-based formulae may be a useful adjunct in acute gout, but the evidence carries clear limits. Most trials lacked blinding and trial registration, all came from China, treatment lasted at most 14 days, a quarter of trials did not report adverse events, and only four reported follow-up. The findings do not extend to chronic gout or other traditional patterns, and the network predictions are untested hypotheses. The authors call for larger, rigorous trials with longer follow-up and laboratory validation of the predicted targets.

Monika Kujawska et al. (2019) · Journal of ethnobiology and ethnomedicine

This historical review examined Bryonia alba (white bryony), a vine in the cucumber family, tracing its use across northern and central-eastern Europe from antiquity through the twentieth century. The authors, an ethnobiologist and an ethnologist, worked from written and oral sources rather than a clinical study, covering Sweden, Denmark, Germany, Poland, Belarus, Ukraine, Romania and the Balkans. White bryony's root closely resembles the root of mandrake (Mandragora officinarum), a plant with an extensive European magical and medicinal reputation; the paper's central finding is that this resemblance let bryony function as mandrake's cheaper stand-in, inheriting much of its folklore in the process. Rather than enrolling participants, the authors searched historical floras, pharmacopoeias, ethnographic monographs, and travel accounts for every mention of the plant, then sorted findings into categories: ritual and folk-belief use, food, folk and historical medicine, ethnoveterinary practice, and ornamental planting. They cross-checked, where sources allowed, whether a given account referred to B. alba or its close relative B. dioica, and separated practices documented only in printed herbals ("booklore") from those recorded as living oral tradition passed between households. Across independent sources, root preparations were repeatedly recorded for oedema (fluid swelling, called dropsy at the time), convulsions and epilepsy, intestinal worms, wounds, and rheumatic pain — a 1792 Swedish account describes juice collected from a hollowed-out root curing oedema and treating worms, convulsions and headache, while twentieth- and twenty-first-century accounts from Serbia and Kosovo describe the same root used as a purgative, diuretic and topical anti-rheumatic agent. The authors cite phytochemical literature attributing these effects to cucurbitacins (bitter plant compounds), also linked elsewhere to antitumor activity, while stating plainly that historical claims for epilepsy specifically lack sufficient supporting study. Toxicity is dose- and season-dependent: freshly harvested summer root contains the more toxic cucurbitacin I, and the berries carry a cited lethal dose of roughly 15 for a child and 40 for an adult. The authors report that medicinal use had become obsolete across Scandinavia, Germany and western Slavic regions by the twentieth century, surviving only in isolated Balkan communities in Serbia and Kosovo. The authors present this decline as an unusual case: a plant of substantial historical medicinal and magical importance that today survives mainly as an ornamental garden relic or, in North America, as an unrelated invasive weed. Because the review synthesizes historical and ethnographic records rather than testing the plant directly, it offers no controlled data on safety or effectiveness, and the authors themselves flag some recorded folklore as possibly the invention of root sellers rather than genuine tradition. Future work, the authors suggest, could extend this same source-based method to B. dioica across German-, Latin- and Celtic-speaking Europe.