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 20-30. 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 1-4 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 1-4 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.
Dr. Ming's TCM Medical Center,
Hua Xi Xiao Yuan, Hutian
Developing Area,
Huaihua city, Hunan province
China