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Rheumatic Fever

1. Overview and Causes
2. Symptoms
3. TCM Effectiveness and Evaluation
4. Common Syndromes and Treatments in TCM
  a. Wind-dampness-heat Syndrome
  b. Wind-cold-dampness Syndrome
  c. Deficiency of Qi and Yin
5. Healing by Other Therapies
  a. Qigong and other
  b. Medicated diet
  c. Life style
6. Psychological Adaptation


1. Overview and Causes

Rheumatic Fever is a severe disease affecting children and young adults. It is a complication of an upper respiratory tract infection caused by the bacteria "Haemolytic streptococci". It involves the connective tissues of the heart, joints, skin and vessels and appears most commonly in school-age children, and between the ages of 20-30. Repeated recurrences of rheumatic fever may cause valvular (heart valves) 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)

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2. Symptoms

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 prior 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.

(a) Major criteria
1. Carditis: This is inflammation of the heart, manifested by breatlessness, palpitations (noticeable and irregular heartbeat) , chest pain, heart enlargement etc.
2. Migratory polyarthritis: Inflammation of the large joints, esp. of the extremities. The affected joints are red, swollen, hot and tender.
3. Erythema marginatum: Red blotches on the skin.
4. Subcutaneous nodules: Raised lesions which can be felt, under the skin.
5. Chorea: Spasmodic, unintentional movements.

(b) Minor criteria
1. Fever: Fever is mild or moderate accompanied with weakness and weight loss.
2. Arthralgia (pain in joints), Elevated ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) or Leucocytosis (increased white cell count).

(c) The evidence of recent streptococcal infection.


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3. TCM Effectiveness and Evaluation

It may be better to treat rheumatic fever by combination of western medicine and TCM. The therapy of TCM may relieve clinical symptoms as well as improve the function of immune system.

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4. Common Syndromes and Treatments in TCM

This ailment, according to TCM, has different syndromes. The treatment for these syndromes using herbal medicine and acupuncture is shown below.

Syndrome (a)
Wind-dampness-heat Syndrome

Main symptoms and Signs: Redness, swelling, hot sensation and pain in joints (joints may be too painful to be touched but pain is relieved by cold), inability to move, restlessness and discomfort in the chest sometimes accompanied with fever and thirst. The tongue would be red with dry with yellow fur, while the pulse is rapid.

To treat by Herbal medicine
Therapeutic principle: Herbal medicine can help dispel pathogenic (disease producing) heat, removing any obstructions in the channels and dispelling pathogenic wind and dampness.

Prescription/Formula: Modified White Tiger Decoction added with cinnamon Twig gypsum, Gypsum Gibrosum 30g anemarrhena rhizome, Rhizome Anemarrhenae 12g polished round-grained nonglutinous rice 12g licorice root, Radix Glycyrrhizae 6g cinnamon twig, Ramulus Cinnamomi 6g coix seed, Semen Choices 30g honeysuckle stem, Caulis Lonicerae 30g mulberry twigs, Romulus Mori 30g phellodendron bark, Cortex phellodendri 10g red peony root, Radix Paeniae Rubra 10g large-leaf gentian root, Radix Gentianae Macrophyllae 15g.

All the above drugs are to be decocted in water for oral administration. When the case is accompanied with erythema marginatum and subcutaneous nodule, the above recipe should include the following ingredients: red sage root (Radix Salviae Miltiorrhizae) 15g, safflower (Flos Carthami) 10g and arnebia root ( Radix Arnebiae seu Lithospermi) 10g.

  

To treat by Acupuncture and Moxibustion
  

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Syndrome (b)
Wind-cold-dampness Syndrome

Main symptoms and signs: Persistent arthralgia of the extremities aggravated by cold and relieved by warmth. The tongue is usually pale with whitish thin and greasy fur, and while the pulse is slow. If the pain is migratory, involving more joints, it is 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.

To treat by Herbal medicine
Therapeutic principle: Herbal medicine disperses pathogenic wind, cold and dampness.

Prescription/Formula: Modified Decoction for treating Rheumatic or Rheumatoid Arthritis. notopterygium root, Rhizoma seu Radix Notopterygii 10g pubescent angelica root, Radix Angelicae Pubesentis 10g cinnamon twig, Ramulus Cinnamoni 10g large-leaf gentian root, Radix Gentianae Mocrophyllae 12g Chinese angelica, Radix Angelicae Sinensis 10g chuanxiong rhizome, Rhizoma Ligustici Chuanxiong 10g futokadsura stem, Caulis Piperis Futokadsurae 30g spatholobus stem, Caulis Spatholobi 30g mulberry twigs, Ramulus Mori 30.

  

To treat by Acupuncture and Moxibustion
 Prescription: Shenmen (HT 7), Neiguan (PC 6), Xinshu (BL 15), Zusanli (ST 36), Pishu (B 20).

  

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Syndrome (c)
Deficiency of Qi and Yin

Main symptoms and signs: Palpitation (noticeable and irregular heartbeat), shortness of breath, chest stuffiness or chest pain, insomnia, and arthralgia with slight swelling. The tongue will be red with a thin, whitish fur, while the pulse is rapid.

To treat by Herbal medicine
Therapeutic principle: Tonifying qi and nourishing yin, removing pathogenic-dampness and obstruction in the channels.

Prescription/Formula: Pulse-activation Powder with additional ingredients dangshen, Radix Codonopsis Pilosulae 15g ophiopogon root, Radix Ophiopogonis 10g schisandra fruit, Fructus Schisandrae 10g large-leaf gentian root, Radix Gentianae Macrophyllae 10g Chinese angelica , Radix Angelicae Sinensis 10g red sage root, Radix Salviae Miltiorrhizae 15g coxi seed, Semen Coicis 15g arborvitae seed, Semen Biotae 10g tetrandra root, Radix stephaniae Tetrandrae 12g chaenomeles fruit, Fructus Chaenomelis 10g. All the above drugs are to be decocted in water for oral administration.

In case mainly due to pathogenic wind, 12 grams of clematis root (Radix Clematidis) and 10 grams of ledebouriella root ( Radix Ledebouriellae) should be added; In case chiefly due to pathogenic cold, 3 grams prepared sichuan aconite root (Radix Aconiti Preparate), 3 grams of prepared wild aconite root ( Radix Aconiti Kusnezoffii Praeparata) and 6 grams of licorice root ( Radix Glycyrrhizae) may be employed; As for cases mainly due to pathogenic dampness, 30 grams of coix seed (Semen Coicis) and 12 grams of atractylodes rhizome (Rhizoma Atractylodis) are to be added; When the disorder is accompanied with chorea, 12grams of white peony root (Radix Paeoniae Alba ), 12 grams of achyranthes root (Radix Achyranthis Bidentatae), 10 grams of gastrodia tuber (Rhizoma Gastradiae) and 20 grams of uncaria stem with hooks (Ramulus Uncariae cum Uncis) are to be included; When the case becomes chronic, marked by repeated attacks and aggravated arthralgia, it is advisable to overcome it with the addidtion of 10 grams of frankincense (Resina Olibani), 10 grams of myrrh (Myrrha), 12 grams of earthworm (Lumbricus) and 6 grams of scorpion (Scorpio);When there are symptomps of deficiency and weakness of both qi and blood as dificiency of the liver and kidney caued by delayed recovery, the above recipe should also include 15grams of astragalus root ( Radix Astrogali seu Hodysari), 12 grams of dangshen (Radix Codonopsis Pilosulae), 12 grams of cucommia bark (Cortex Eucommiae and 15 grams of loranthus mulberry mistletoe (Ramulus Loranthi)

  

To treat by Acupuncture and Moxibustion

  

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5. Healing by Other Therapies

(a) Qigong and other therapies

For effect of Qigong on the Blood Circulation System, click here.

Generally speaking, Qigong is good for healing effect of this specific ailment, however individual results may vary. It improves the flow of the qi and the circulation of the blood, so you'll experience more energy, but, you won't see/ feel any immediate effects, as with many exercises and therapies, it takes a few weeks or even months of practice before you'll see any significant improvements.

The following types of Qigong may help:

For the information of different types of Qigong ,just click a link above.

This information is for education purpose only. We strongly advise you seek a licensed Qigong master to learn the correct ways to conduct these exercises before attempting them.


(b) Medicated diet
1. For those who suffer fromPharyngitis:
 Schizonepeta(Jingjie) 9g, Platycodon Root(Jugeng) 12g, Liquorice(Gancao) 6g,
Wrap them with a piece of gauze and cook them to get the tea, remove the dregs. Add Polished Round-Grained Rice(Jingmi) 60g into the decoction to make gruel for eating. Take a dose a day and serveral doses successively.
2. For those who suffer from Tonsillitis: Subprostrate Sophora Root(Shandougeng) 9g, Belamcanda Rhizome(Shegan) 9g, Capejasmine(Zhizi) 9g. Cook them in water. Drink a dose a day.
(c) Life style
1. Keep the living environment clean.
2. Avoid getting wet or cold.
3. Take precaution against Influenza.
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6. Psychological Adaptation to a Chronic and Severe Illness
One encounters different health problems in the course of one's life. Some problems are acute yet minor and often improve by themselves or yield to simple self-management. Severe and acute conditions often necessitate the help of health professionals who may provide fast relief with specific interventions. However, when the condition is chronic, the management required is quite different.

Please click the following button to learn "Psychological Adaptation to a Chronic and Severe Illness".

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Acknowledgments:
Healthphone.com greatly acknowledges the support and dedication of our
Healing Centre Panel, without whom this section would not be possible.

We also greatly acknowedge Ms. Najaf Munir, MBBS, for her editorial support. Ms. Munir simplified the highly technical medical documents into easy-to-read documents, for the enjoyment and education of our numerous visitors.