Rheumatic fever is a non-purulent disease of systemic connective tissue associated with group A R hemolytic streptococcal infection, used to be one of the main diseases endangering the life and health of school-age children and adolescents, the following by me to you to organize the relevant knowledge, I hope it can help you!
Diagnosis and treatment: should first holistically observe the different conditions of the whole course of rheumatic fever at all stages, combined with the theory of traditional Chinese medicine systematic analysis. The disease begins with a feeling of wind and heat, warm toxins, belonging to the category of Chinese medicine "warm disease"; wandering body pain, arthralgia belonging to the "walking paralysis"; acute rheumatic arthritis belongs to the "rheumatic heat paralysis"; chronic rheumatic arthritis belongs to the "rheumatic heat paralysis"; the "rheumatic heat paralysis" belongs to the "rheumatic heat paralysis". Chronic rheumatic arthritis mostly belongs to "wind-cold dampness paralysis" or "blood stasis paralysis"; carditis belongs to "heart paralysis". Therefore, in clinical diagnosis and treatment, we should be flexible and not stick to one end. According to the therapeutic principle of "Cold for Heat", the general treatment of wind-dampness fever is still based on the clearing method, and then according to the different etiologies and pathologies at different stages of the disease, the treatment is based on the different causes and mechanisms of the disease. It can be combined with wind dispersal, detoxification, dampness elimination, cold dispersal, blood cooling, phlegm elimination, blood circulation, Yin nourishment, blood nourishment, or a combination of several methods.
①Wind-heat paralysis:
The main symptom: wind-heat invasion, the warmth of the evil uptake, the onset of the disease is more rapid and easy to change. Initially, fever, sore throat, dry mouth and thirst and other symptoms of wind-heat attack; followed by wandering pain in the muscles and joints, regional redness, swelling, heat, pain and accompanied by a generalized fever or dampness and heat vaporization and adhesion of the phenomenon. If heat is prevalent, the joints are red, swollen and painful, with obvious burning sensation and fever, with erythema visible on the panels, red tongue, yellow dry tongue coating and slippery pulse. If the wind is prevalent, the muscles and joints show wandering pain, or sweating and wind, the tongue is red, the moss is thin and yellow, and the pulse is floating or slippery.
Treatment: clearing heat and removing toxins, dredging wind and clearing channels.
Prescription: Yin Qiao San plus reduction.
Yinhua 15g, forsythia 15g, peppermint 6g, fried burdock 9g, blue root 30g, rehmannia 30g.
Added and subtracted: if the swelling and pain in the throat is severe, add zhebeimu, shoots, almonds, stiff silkworms. If the fever is severe, add Pueraria lobata, Chaihu, Scutellaria baicalensis, and reuse gypsum. If the joints are red, swollen and painful, add Bai Hu Gui Zhi Tang: gypsum, Zhi Mu, Gui Zhi, white peony, Lonicera japonica, fried mulberry branches, dandelion, late silkworm sand, old stork grass, etc. If the heat and toxicity are blazing, add zhebeimu, shotgan, almonds, stiff silkworms. If the heat and toxin are blazing, choose the Qingdian and septic toxin drink or the Hua Ban Tang to add and subtract. For those with dampness prevalence, add Huo Park Xia Ling Tang. If the wind is prevalent, add Fangfeng, Gentiana Macrophyllae, Rutuxia, Weiling Xian and so on.
Clinical experience: This is a case of wind-dampness fever at the beginning of the disease, due to the wind-heat evil offense, the onset of the disease is rapid, rapid change, high fever, in addition to sore throat, soon appear panel erythema and joints red, swollen and hot pain, and may have sepsis. If correct and timely treatment can be given in this period, it is the key to stop the development of the disease and the transformation of the disease. Properly handled, the disease can be cured or reduce the involvement of the joints and the heart, therefore, the clinic should be particularly vigilant and should not be confined to a single method. The prescription should also pay attention to not purely cold, easy to cause cold closed evil heat, penetration of the product must not be prepared.
② Damp heat paralysis:
Symptoms: body heat, not Yang, heavy body, limbs and joints pain or redness and pain, or rheumatism nodules, subcutaneous pain, or rash fusion into an irregular plaque, or body swelling, yellow and red urine, sticky stools, red tongue, yellow moss thick and greasy, slippery pulse.
Treatment: dissolve dampness and clear away heat, and propagate the meridians.
Prescription: Xuanpao Tang, Ermiao San, Sanren Tang plus reduction and customization.
Atractylodes macrocephala 20g, Cyperus rotundus 9g, Fenghui 10g, almond 10g, Coix lacryma 20g, Talcum officinale 30g, Inulin 15g, Silkworm sand 15g, Chuan hyssop 10g, Poria 10g, Chuan ge xue xue 10g, ze diarrhea 10g.
Addition and subtraction: joints are swollen obviously and pain, can be added to the use of blood-activating medicines such as chickweed vines, angelica sinensis, and so on, to take the blood line the meaning of the water, and at the same time, the available Ground jinzhao 200g, verbena 50g, mulberry branches 100g, decoction regional bath.
Clinical experience: dampness is a yin evil, accumulated as water, gathered into a drink, condensed into phlegm, flowing into the joints. It is heavy and sticky, easy to block the qi, heat damage to the joints, internal organs, the condition is prolonged and difficult to heal. The first treatment is to regulate the internal organs and qi, flexible use of warm, dry, chemical, Xuan, through, seepage and other wet method, or a combination of methods, the upper, middle and lower triple jiao treatment, Xuan, transport, seepage of the lower and the implementation of the middle jiao as the focus. The qi of the internal organs should be taken care of by the lung's purging and lowering, the spleen's transportation, the liver's excretion, the kidney's opening and closing, and the qi of the triple jiao.
3 Heat paralysis with cold and dampness:
Symptoms: the body contains heat, wind, cold and dampness, resulting in heat paralysis with cold and dampness, the joints of the regional red, swollen, hot and painful, but also have a bad wind and fear of cold, warmth, then comfortable, joints in the morning stiffness, after the activities of the alleviation of the red tongue, moss, or yellow-white interspersed with the pulse, string tight or slippery.
Treatment: dissolve dampness and clear heat, dispel wind and cold.
Prescription: Gui Zhi Paeoniae Zhi Materia Medica Soup and Ephedra Almond Coix lacryma Glycyrrhizae Soup chemically modified.
Guizhou Zhi 10g, Cannonball Epimedium 6g, Ephedra 6g, Fenghuang 10g, Almond 10g, Atractylodes Macrocephalae 10g, Coix lacryma 30g, Paeonia lactiflora 12g, Zhimai mother 10g, Chicken-blood vine 15g, Lonicera japonica 15g.
Added and subtracted: add Chuanwu, Caowu for severe pain and coldness. Add gypsum and danshi for heavy heat. Add Astragalus and Anti-Hematitis Soup for deficiency.
Clinical experience: although the disease is wind-cold damp-heat mixed for the disease, but there is still a prevalence or the problem of co-occurrence; to what is the main, the treatment is also focused. Cold and warm and use, the chemical through the application of both, anti-support complementary, clear open guide, judging the situation, choose the good and take it.
4 phlegm stasis heat paralysis:
The main symptom: joint swelling and pain, skin fever, long time; or joint deformation, adverse activities; or subcutaneous nodules, erythema purplish dark, dark tongue, teeth marks, white or yellow-white tongue moss and sticky, the pulse of the strings slippery number.
Treatment: dissolve phlegm and clear heat, remove blood stasis and clear the channels.
Prescription: phlegm and blood stasis paralyzing pain soup.
Gui Zhi 9g, Poria 15g, Nanshing 9g, Zhe Beimu 12g, Angelica sinensis 10g, Cannonballia 12g, Fritillariae Cirrhosae 10g, Phellodendron Bark 10g, Phellodendron Bark 10g, Verbenas 30g, Lonicera japonica 30g, Lupinus edulis 20g.
Added and subtracted: Add Fenghi, Coix Seed in case of heavy dampness. Add Dang Pi and Zhi Mu for heavy heat. If the pain is severe, add made frankincense and made myrrh, or add made strychnine powder 1g to be taken, or use big black ant powder 3g to be taken. Qi deficiency plus astragalus.
Clinical experience: dampness and condensation into phlegm, the disease into the blood stasis, the formation of phlegm and blood stasis conjunction, is the key to this evidence. Combining phlegm and stasis elimination is the main method. Although there is a heat evil, supported by cooling blood and dispersing blood, XuanTuan paralytic obstruction products, and not too much use of cold, lest treatment of blood stasis anti-stasis, careful.
5 Yin deficiency heat paralysis:
Symptoms: low-grade fever, afternoon hot flashes, fatigue, dry mouth and thirst, nosebleeds, palpitations, irritability, joints and muscles swelling and burning pain, pulse is fine, the tongue is bright red, less moss.
Treatment: Nurturing Yin and clearing heat, energizing the meridians.
Prescription: consistent decoction plus reduction.
Shengdi 12g, Beisha ginseng 30g, wolfberry 12g, maitake 10g, Angelica sinensis 10g, white peony 12g, Zhimu 10g, tortoise board 15g, old stork 30g, silky gourd 20g, the ground bone skin 10g.
Added and subtracted: insufficient heart qi, qi and yin two injuries, add xiyangshen, schizandra, Huang Jing. If the heart is upset and does not sleep, add jujube kernel, raw keel, oyster, gall star. For dry stools, add shouwu and peach kernel.
Clinical formula: consistent decoction plus reduction.
Shengdi 12g, Beisha ginseng 30g, wolfberry 12g, maitake 10g, Angelica sinensis 10g, white peony 12g, Zhimu 10g, tortoise board 15g, old stork grass 30g, silky gourd 20g, the skin of the earth bone 10g.
Added and subtracted: the heart qi insufficiency, qi and yin two injuries, add xiyangshen, schizandra, Huang Jing. If the heart is upset and does not sleep, add jujube kernel, raw keel, oyster, gall star. For dry stools, add shouwu and peach kernel.
Clinical experience: wind and dampness heat to yin deficiency and yang heat prevalence stage, mostly due to Yin deficiency in the body or heat injury. At this time, the damage to the heart yin is also heavy, is the focus of care, must always pay attention to the clinical signs due to myocarditis, such as panic, chest pain, shortness of breath. And there may be bleeding tendency due to the heat of camp blood. In recent years, due to the excessive and inappropriate application of hormones, clinical signs of external swelling and internal Yin injury can be seen, which is very tricky to regulate.
6 Blood deficiency and heat paralysis:
Subjects: withered and white face, dizziness, panic, fatigue, shortness of breath, low-grade fever, arthritis swelling and pain, but not obvious, pale tongue, thin yellow moss, and fine pulse.
Treatment: tonifying and activating blood, nourishing yin and clearing heat.
Prescription: Four Substance Soup flavored.
Donggui 15g, chuanxiong 9g, white peony 12g, 12g of ripe earth, astragalus 15g, 10g of gelatin *** melted to serve ****, 15g of chicken blood vines, 6g of roasted licorice, 30g of Lonicera.
Added and subtracted: qi deficiency is serious, add xiyangshen, ginseng, accompanied by the kidney qi deficiency, add the preparation of shouwu, sanghongsheng, and so on. For joint paralysis, add 1g of Dilong and strychnine powder.
Clinical experience: long illnesses injure the gas and blood consumption, blood deficiency will have gas deficiency. When replenishing blood, do not forget to replenish qi, replenish qi can not hurt yin, yin can not be stagnant and greasy spleen and stomach, replenishment can not be hindered by the external penetration of the evil.
7 camp heat heart paralysis:
Symptoms: persistent low or moderate fever, light day and night, body heat and early cool, sweating; palpitations, precordial discomfort, dull pain or burning pain; panel erythema, subcutaneous nodules, or ocular scleral congestion and nasal hemorrhage; or even pallor, respiratory distress, edema and other symptoms; tongue red or dark red, tongue moss white thick or yellow-white interspersed with the pulse is slippery or fine or sizzling or junction generation.
Treatment: clear the camp and detoxify, save the heart and open paralysis.
Prescription: ginseng beads to save the heart Dan.
9g of American ginseng, 20g of Salvia miltiorrhiza, 15g of bitter ginseng, 1g of pearl powder***punch***, 20g of fleabane, 10g of maitake, 6g of Schisandra chinensis, 12g of Radix et Rhizoma Shengdi, 12g of XuanShen, 10g of Danshi, 9g of Acorus calamus, 10g of Ulmus, 10g of Rhizoma Dioscoreae, 10g of Rhizoma Dioscoreae. At this time, the damage to the heart yin is also serious and is the focus of care, and attention must always be paid to the clinical signs that appear due to myocarditis, such as panic, chest tightness and pain, shortness of breath, etc. The heart yin may be damaged due to the heat of Ying and Blood. And there may be bleeding tendency due to the heat of camp blood. In recent years, due to the excessive and inappropriate application of hormones, clinical signs of external swelling, internal Yin injury, treatment is very tricky.
Aetiology of rheumatic fever
The idea that the pathogenesis of this disease is related to group A hemolytic streptococcal infection has been generally accepted. The pod membrane of the streptococcal organism is composed of hyaluronic acid, and the human synovial membrane and joint fluid hyaluronic acid protein between the existence of *** the same antigenic, can resist the phagocytosis of leukocytes and play a protective role. group A streptococcal protein antigen and the human heart valves and brain and other tissues, there are cross-antigens, which can cause cross-immune reaction. This cross-reactivity is important in the pathogenesis of rheumatic fever valve lesions. Streptococci produce a variety of extracellular toxins that also play an important role in their pathogenicity.
In addition, there is a genetic predisposition to the development of rheumatic fever. The incidence of the disease is higher in members of the same family than in families without rheumatic fever, and it is higher in monozygotic twins than in dizygotic twins.