Gout is a chronic，progressive，and disabling metabolic disease closely related to hyperuricemia and urate deposition.This article aimed to systematically review the records of gout at various stages in ancient Chinese medical texts，clarify the development of traditional Chinese medicine(TCM) understanding，and outline the knowledge and characteristics of gout during different periods，thereby providing TCM theoretical support for in-depth research and clinical prevention and treatment of gout.By reviewing 106 TCM texts，including medical theories，prescriptions，materia medica，and medical cases from the pre-Qin to the Ming and Qing dynasties，the TCM understanding of gout was summarized，including disease names，symptoms，etiology and pathogenesis，and treatment methods，to explore its developmental origins.In the pre-Qin period，TCM texts sporadically recorded symptoms，disease names，and(or) etiology and pathogenesis of gout at various stages.From the Han to the Sui and Tang dynasties，medical practitioners expanded on disease names，symptoms，and etiology and pathogenesis，and proposed various internal and external treatments，marking the formation of gout theory.During the Song，Yuan，Ming，and Qing dynasties，discussions on syndrome differentiation，differential diagnosis，and dietary taboos enriched this theory.TCM understanding of gout began in the pre-Qin period，with theoretical formation from the Han to the Sui and Tang dynasties，and further development during the Song，Yuan，Ming，and Qing dynasties，gradually forming a relatively comprehensive TCM theoretical system for gout.