Abstract： Refractory gout （RG） is characterized by a prolonged course， persistent difficulty in healing， and numerous complications. Due to issues with patient treatment adherence，modern medicine has shown limited efficacy in treating RG. The turbid toxin theory shares many similarities with the pathogenesis of RG. Guided by the turbid toxin theory，this study analyzes the etiology and pathogenesis of RG and proposes treatment principles for three syndromes： imbalance of clear and turbid，toxic pathogen attacking the collaterals，and comorbidity of turbid and toxin. The study explores the application of rattan medicinals and stone-expelling medicinals，flexible prescription selection，syndrome differentiation，and symptom-based modifications，providing new clinical treatment approaches for RG.