Rheumatic fever is an allergic disease which occurs as a delayed
sequel to group A hemolytic streptococcal infection. It involves
in connective tissues of the heart, joints, skin and vessels. It
appears most commonly in school-age children, and between the
ages of 20¡ª30. Repeated recurrences of rheumatic fever may
cause valvular damage and eventually a chronic rheumatic
valvular disease. In TCM, this disease belongs to the categories
of "bi zheng" (arthralgia-syndrome) and "xin bi" (obstruction of
the heart qi).
Main
Points of Diagnosis
According to the revised Jones criteria for the diagnosis of
rheumatic fever, if there is an evidence of group A
streptococcal infection 1¡ª4 weeks previous to the rheumatic
attack and if cases manifest 2 major criteria or one major
criterion and 2 minor criteria listed below, the diagnosis of
rheumatic fever can be established.
1. Major criteria
(1) Carditis: This includes endocarditis, myocarditis and
pericarditis, manifested as tachycardia, cardiac enlargement,
attenuation of the first heart sound and the presence of a
systolic and diastolic murmurs (Coomb's murmur) at the apex area
of heart. Pericardial friction rub may be present.
Electrocardiogram may show various kinds of arrhythmia, among
which various degrees of conduction block are of the greatest
significance.
(2) Migratory polyarthritis: The large joints of the extremities
are most frequently affected. The affected joints are red,
swollen, hot and tender. The acute arthritis subsides without
sequel.
(3) Erythema annulare.
(4) Subcutaneous nodules.
(5) Chorea.
2. Minor criteria
(1) Fever: Fever is mild or moderate accompanied with hidrosis,
weakness and weight loss.
(2) Elevated erythrocyte sedimentation rate, positive C-reactive
protein or increased white cell count.
3. The evidence of recent streptococcal infection
(1) There was angina, acute tonsillitis and others 1¡ª4 weeks
prior to the onset of rheumatic fever. Or the throat swab
culture is positive for group A hemolytic streptococci.
(2) Elevation of antistreptolysin (ASO) titer > 500 units,
elevation of antistreptokinase (ASK) > 80 units or elevation of
antihyaluronidase titer (AHT) > 128 units. Other nonspecific
serum components may also have changes.
Differentiation and Treatment of Common Syndromes
1. Wind-Dampness-Heat Syndrome
Main Symptoms and Signs: Redness, swelling, heat sensation and
pain of the joints which is too painful to be touched but
relieved by cold, inability to move, restlessness and discomfort
in the chest, sometimes accompanied with fever and thirst, red
tongue with dry and yellow fur, slippery and rapid pulse.
Therapeutic Principle: Dispelling pathogenic heat, removing
obstruction in the channels and dispelling pathogenic wind and
dampness.
Recipe: Modified White Tiger Decoction Added with Cinnamon Twig.
gypsum
anemarrhena rhizome
polished round-grained non-glutinous rice
licorice root
cinnamon twig
coix seed
honeysuckle stem
mulberry twigs
phellodendron bark
red peony root
All the above herbs are to be decocted in water for oral
administration.
When the case is accompanied with erythema annulare and
subcutaneous nodule, the above recipe should include the
following ingredients: red sage root 15g, safflower 10g and
arnebia root 10.
2. Wind-Cold-Dampness Syndrome
Main Symptoms and Signs: Persistent arthralgia of the
extremities aggravated by cold and relieved by warmth, pale
tongue with whitish thin and greasy fur, floating and slow
pulse. If the pain is migratory, involving more joints, it its
mainly due to pathogenic wind. If the pain is comparatively
aggravated and localized accompanied with a feeling of cold in
the affected region, it is chiefly due to pathogenic cold; if
the involved joints is marked by heavy sensation, numbness or
swelling ,it is mainly due to pathogenic dampness.
Therapeutic Principle: Dispersing pathogenic wind, cold and
dampness.
Recipe: Modified Decoction for Treating Rheumatic or Rheumatoid
Arthritis.
notopterygium root
pubescent angelica root
cinnamon twig
large-leaf gentian root
Chinese angelica
ligusticum rhizome
futokadsura stem
spatholobus stem
mulberry twigs
All the above herbs are to be decocted in water for oral
administration.
In cases mainly due to pathogenic wind, 12 grams of clematis
root and 10 grams of ledebouriella root should be added; In
cases chiefly due to pathogenic cold, 3 grams of prepared
Sichuan aconite root, 3 grams of prepared wild aconite root and
6 grams of licorice root may be employed. as for cased mainly
due to pathogenic dampness, 30 grams of coix seed and 12 grams
of atractylodes rhizome are to be added. When the disorder is
accompanied with chorea, 12 grams of white peony root, 12 grams
of achyranthes root, 10 grams of gastrodia tuber and 20 grams of
uncaria stem with hooks are to be included. When the case
becomes chronic marked by repeated attacks and aggravated
arthralgia, it is advisable to overcome it with the addition of
10 grams of frankincense, 10 grams of myrrh, 12 grams of
earthworm and 6 grams of scorpion. When there are symptoms of
deficiency and weakness of both qi and blood as well as
deficiency of the liver and kidney caused by delayed recovery,
the above recipe should also include 15 grams of astragalus
root, 12 grams of codonopsis root, 12 grams of eucommia bark and
15 grams of loranthus mulberry mistletoe.
3. Deficiency of Qi and Yin
Main Symptoms and Signs: Palpitation, shortness of breath, chest
stuffiness or chest pain, insomnia, arthralgia with slight
swelling, red tongue with whitish thin fur, thready and rapid
pulse.
Therapeutic Principle: Tonifying qi and nourishing yin, removing
pathogenic dampness and obstruction in the channels.
Recipe: Pulse-Activation Powder with additional ingredients.
codonopsis root
ophiopogon tuber
schisandra berry
Chinese angelica
red sage root
coix seed
arborvitae seed
tetrandra root
chaenomeles fruit
All the above herbs are to be decocted in water for oral
administration.
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