I. Chinese medicine treatment
(1) Discriminatory treatment.
First of all, we should observe the different conditions of rheumatic fever at each stage of the whole course of the disease as a whole, and analyze it systematically with the theory of traditional Chinese medicine. The disease starts with the feeling of wind-heat disease evil, warm poison upward, belongs to Chinese medicine “warm disease” category; wandering body pain, joint pain belongs to “walking paralysis”; acute rheumatic arthritis is mostly “rheumatic heat paralysis” Chronic rheumatic arthritis is mostly “wind-cold damp paralysis” or “blood stasis paralysis”; heart inflammation is “heart paralysis”. Therefore, in the clinical diagnosis and treatment, we should be flexible and not stick to one end. According to the treatment principle of “heat is cold”, the general treatment of rheumatic fever is still based on the clear method, and then treated separately according to the different etiological factors at different stages of the disease process. It may also be used to remove wind, detoxify toxins, dissolve dampness, disperse cold, cool the blood, remove phlegm and remove blood stasis, nourish yin, nourish blood, or combine multiple methods.
(1) Wind-heat paralysis.
The main symptoms: wind-heat invasion, warm evil upwards, the onset of the disease is more rapid and changeable. The initial symptoms are fever, sore throat, dry mouth, thirst and other symptoms of wind-heat attack; followed by wandering pain in the muscles and joints, localized redness, swelling, heat, pain and generalized fever or damp-heat vaporization. In cases where heat is prevalent, the joints are red, swollen and painful, with obvious burning sensation and fever, red spots on the skin, red tongue, yellow dry tongue coating, and slippery pulse. If the wind is prevalent, the muscles and joints are painful in a wandering manner, or sweating and vicious wind, with a red tongue, thin yellow moss and a floating or slippery pulse.
Treatment: Clearing heat and detoxifying the toxin, draining the wind and clearing the channels.
Remedy: Yin Qiao San plus or minus.
Yin Hua 15g, forsythia 15g, peppermint 6g, fried burdock 9g, panax quinquefolium 30g, rhizome 30g.
Addition and subtraction: For severe throat swelling and pain, add zhebeijian, eucommia, almond and stiff silkworm. For heavy fever, add Pueraria Mirifica, Radix Bupleurum and Scutellariae, and reuse raw gypsum. If the pain and redness of the joints are obvious, use Bai Hu Gui Zhi Tang with addition and reduction: Sheng Shi Fa, Zhi Mu, Gui Zhi, Bai Shao, Lian Dong Vine, Fried Mulberry Branch, Dan Pi, Evening Silica, Old Stork, etc. If the heat and toxicity are strong, add or subtract Clear Distemper and Defeat Poison Drink or Chemical Spot Soup as appropriate. For those with dampness, Huopu Xia Ling Tang can be added as appropriate. If the wind is prevalent, add Fangfeng, Gentiana, Datura, Weilingxian, etc.
Clinical experience: This is the initial onset of rheumatic fever. Due to the upward movement of the wind-heat evil, the onset of the disease is rapid, with rapid changes and high heat potential. Proper treatment at this stage is the key to stop the development and transformation of the disease, and can cure or reduce the involvement of joints and heart. The prescription should also pay attention to not purely cold, easy to cause the cold to close the evil heat, the penetrating products must not be prepared.
②Damp-heat paralysis.
The main symptoms: body heat does not rise, the body is heavy, the limbs are annoying pain or redness and pain, or rheumatism nodules, subcutaneous hard pain, or red rash fusion into irregular patches, or body swelling, urine is red, stool is sticky, the tongue is red, coating yellow thick greasy, the pulse is slippery.
Treatment: To resolve dampness and clear heat, and to promote the circulation of the meridians.
Prescription: Xuan Piao Tang, Er Miao San, San Ren Tang with addition and subtraction.
Atractylodes Macrocephala 20g, Phellodendron Bark 9g, Fructus Paniculatus 10g, Almond 10g, Coix Seed 20g, Slippery Rock 30g, Inula 15g, Sericea 15g, Chuan Niu Knee 10g, Poria 10g, Chuan Ge Xie 10g, Ze Xie 10g.
Addition and subtraction: For obvious and painful joint swelling, blood activating herbs such as henbane and angelica can be added to take the meaning of blood circulation and water conservancy, while 200g of ground elder, 50g of verbena and 100g of mulberry branch can be used in a local bath with water.
Clinical experience: Dampness is a yin evil, accumulates and becomes water, gathers and becomes drink, condenses and becomes phlegm, and flows into the joints. Its nature is heavy and sticky, easy to block the qi, heat damage to the joints, the internal organs, the disease is prolonged and difficult to cure. The treatment should first regulate the qi of the internal organs, the flexible use of warmth, dryness, chemistry, propagation, ventilation, infiltration and other treatment of dampness, or a combination of multiple methods, the upper, middle and lower jiao with the same treatment, propagation on, transport, infiltration, and the focus on the middle jiao. The qi of the internal organs should be taken care of to the purification of the lung, the transportation of the spleen, the draining of the liver, the opening and closing of the kidney and the qi of the three jiao.
(3) Cold-damp-heat paralysis.
The main symptoms: the body contains heat, and then feel wind, cold and dampness, resulting in heat paralysis with cold and dampness, localized redness, swelling and heat pain in the joints, and also see a vicious wind and fear of cold, warmth will be relieved, joint stiffness in the morning, reduced after activity, red tongue, white or yellow-white coating, tight or smooth pulse.
Treatment: To resolve dampness and clear heat, dispel wind and dispel cold.
Radix: Gui Zhi Shao Yao Zhi Mu Tang and Ma Huang Almond Coix Coix Glycyrrhiza Glabra Tang.
Gui Zhi 10g, Gunpowder 6g, Ephedra 6g, Bifeng 10g, Almond 10g, Atractylodes 10g, Coix Seed 30g, Paeonia lactiflora 12g, Zhi Mu 10g, Gynostemma 15g, Lonicera 15g.
Addition and reduction: Add Chuan Wu and Cao Wu for cold pain. Add raw gypsum and dandan bark for heavy heat. For deficiency, add Astragalus and Fangji Tang.
Clinical experience: Although the disease is a wind-cold damp-heat mismatch, but there is still a partial bloom or a combination of the problem; to what is the main, the treatment also has some emphasis. The use of cold and warmth, chemistry and passages, counter-supporting each other, clearing and guiding, judging the time and situation, choose the good and take it.
(4) Phlegm-stasis-heat paralysis.
Main symptoms: swollen and painful joints, feverish skin, persistent; or deformation of joints, unfavorable movement; or subcutaneous nodules, red spots with purple and dark color, dark tongue with teeth marks, white thick tongue coating or yellow and white interspersed and sticky, slippery pulse.
Treatment: Eliminate phlegm and heat, dispel blood stasis and promote circulation.
Remedy: Phlegm-Stasis Paralysis and Pain Soup.
Gui Zhi 9g, Fu Ling 15g, Nan Xing 9g, Zhe Bei Mu 12g, Angelica Sinensis 10g, Gunpowder Armor 12g, Ground turtle worm 10g, Ginger Yellow 10g, Veronica officinalis 30g, Lonicera japonica 30g, Deer Artemisia 20g.
Addition and subtraction: Dampness is heavily added with Fangqi and Coix Seed. For heat, add Dampness, Zhi Mu. For pain, add Boswellia and Myrrh, or add 1g of powdered strychnine, or 3g of powdered black ants. Add Astragalus for Qi deficiency.
Clinical experience: Dampness condenses into phlegm, and the disease evil enters the ligament and becomes stasis, forming a phlegm-stasis junction, which is the key to this evidence. Combined application of phlegm and elimination of stasis is the major method. Although there is heat, we should use cool blood to disperse blood and promote paralysis, and we should not use too much cold to avoid treating the stasis and counteracting it.
(5) Yin deficiency heat paralysis.
Symptoms: low fever, afternoon hot flashes, tiredness, dry mouth, thirst, nasal bleeding, palpitations, irritability, swelling and burning pain in the joints and muscles, fine pulse, bright red tongue with little moss.
Treatment: Nurture yin and clear heat, clear the channels and activate the channels.
Remedy: Consistent Decoction with Addition and Reduction.
Addition and subtraction: For those with deficiency of heart qi and qi-yin, add Radix et Rhizoma Ginseng, Fructus Schisandrae, Rhizoma Polygonati. If the heart is troubled and sleepless, add jujube seed, raw keel, oyster and bile star. For dry stool, add Radix et Rhizoma Shou Wu, Peach kernel, etc.
Clinical formula: Consistent Decoction with Addition and Reduction.
Addition and subtraction: For those with deficiency of heart qi and qi-yin, add Radix et Rhizoma Ginseng, Fructus Schisandrae, Rhizoma Polygonati. If the heart is troubled and sleepless, add jujube seed, raw keel, oyster and bile star. For those with dry stool, add Shou Wu and Tao Ren.
Clinical experience: rheumatic fever to the stage of yin deficiency and yang heat, mostly due to yin deficiency of the body or heat and injury to fluid. At this time, heart yin damage is also heavy, is the focus of care, must always pay attention to the clinical signs due to myocarditis, such as heart panic, chest pain, shortness of breath. It may also have a tendency to bleed due to the heat of the blood. In recent years, due to excessive and inappropriate application of hormones, clinical signs of external swelling and internal yin injury can be seen, which is very difficult to regulate.
(6) Blood deficiency and heat paralysis.
Main symptoms: atrophy and whiteness, dizziness, panic, weakness, shortness of breath, low fever, joint swelling and pain but not obvious, pale tongue, thin yellow coating, thin pulse.
Treatment: Tonify Blood and invigorate Blood, nourish Yin and clear heat.
Formula: Siwu Tang with Addition.
Radix Angelicae Sinensis 15g, Rhizoma Ligustici Chuanxiong 9g, Radix Paeoniae Alba 12g, Radix Rehmanniae 12g, Radix Astragali 15g, Radix Aconiti 10g (melted and blended), Radix Rehmanniae Sinensis 15g, Radix Glycyrrhiza Uralensis 6g, Radix Lonicerae 30g.
Addition and subtraction: for heavy Qi deficiency, add Radix et Rhizoma Ginseng, Radix prunus ginseng. For joint paralysis, add Di Long and 1g of strychnine powder for dosing.
Clinical experience: Long-term illness injures Qi and consumes Blood, and Blood deficiency must be accompanied by Qi deficiency. When replenishing blood, do not forget to replenish qi; replenish qi should not harm yin; replenish yin should not stagnate the spleen and stomach; replenish should not hinder the penetration of evil.
(7) Ying-heat heart paralysis.
Symptoms: persistent low or moderate fever, light day and heavy night, hot and cool body, sweating; palpitations, discomfort in the precordial region, stuffy pain or burning pain; erythema of the skin, subcutaneous nodules, or scleral congestion and nasal bleeding; or even pale face, dyspnea, swelling; red or dark red tongue, thick white or yellow-white tongue coating, smooth or fine pulse or disease or knotted generation.
Treatment: Clearing the Ying and detoxifying the toxin, saving the heart and opening the paralysis.
Remedies: Ginseng and Zhu to save the heart.
The formula: Ginseng 9g, Danshen 20g, bitter ginseng 15g, pearl powder 1g (punch), flea shui 20g, maitong 10g, Wu Wei Zi 6g, raw earth 12g, Xuan Shen 12g, Dan Pi 10g, calamus 9g, Yu Jin 10g, Tian Zhu Huang 10g. will: rheumatic fever to yin deficiency and yang-heat phase, mostly due to vegetative yin deficiency or heat and injury to fluid. At this time, heart yin damage is also heavy, is the focus of care, must always pay attention to the clinical signs due to myocarditis, such as heart panic, chest pain, shortness of breath, etc.. It may also have a tendency to bleed due to the heat of the blood. In recent years, due to excessive and inappropriate application of hormones, clinical signs of external swelling and internal yin injury can be seen, which is very difficult to regulate.
(6) Blood deficiency and heat paralysis.
Main symptoms: atrophy and whiteness, dizziness, panic, weakness, shortness of breath, low fever, joint swelling and pain but not obvious, pale tongue, thin yellow coating, thin pulse.
Treatment: Tonify Blood and invigorate Blood, nourish Yin and clear heat.
Formula: Siwu Tang with Addition.
Radix Angelicae Sinensis 15g, Rhizoma Ligustici Chuanxiong 9g, Radix Paeoniae Alba 12g, Radix Rehmanniae 12g, Radix Astragali 15g, Radix Aconiti 10g (melted and blended), Radix Rehmanniae Sinensis 15g, Radix Glycyrrhiza Uralensis 6g, Radix Lonicerae 30g.
Addition and subtraction: for heavy Qi deficiency, add Radix et Rhizoma Ginseng, Radix prunus ginseng. For joint paralysis, add Di Long and 1g of strychnine powder for dosing.
Clinical experience: Long-term illness injures Qi and consumes Blood, and Blood deficiency must be accompanied by Qi deficiency. When replenishing blood, do not forget to replenish qi; replenish qi should not harm yin; replenish yin should not stagnate the spleen and stomach; replenish should not hinder the penetration of evil.
(7) Ying-heat heart paralysis.
Symptoms: persistent low or moderate fever, light day and heavy night, hot and cool body, sweating; palpitations, discomfort in the precordial region, stuffy pain or burning pain; erythema of the skin, subcutaneous nodules, or scleral congestion and nasal bleeding; or even pale face, dyspnea, swelling; red or dark red tongue, thick white or yellow-white tongue coating, smooth or fine pulse or disease or knotted generation.
Treatment: Clearing the Ying and detoxifying the toxin, saving the heart and opening the paralysis.
Remedies: Ginseng and Zhu to save the heart.
Addition and subtraction: When acute heart failure occurs in rheumatic fever cardiac inflammation or endocarditis, it should be changed to Ginseng and Longmu Tang, and combined with Chinese and Western medicine to save the patient.
Clinical experience: This symptom is equivalent to myocarditis in the acute stage of rheumatic fever. The cause of the disease is dampness and toxicity, the pathological product is phlegm and stasis, and the result is organic damage to the heart, which is often lifelong once it occurs. Therefore, the treatment of this stage is of vital importance to the prognosis and regression of the disease. The clinical observation is that dampness and toxicity cause heat in the blood to be real, and the evil heat consumes qi to be deficient. Due to the deficiency of qi, the body qi is not solid, and it is easy to feel the evil and the disease is recurrent, so the treatment is often both attack and supplement. For some inpatients, the so-called combined Chinese and Western medicine treatment currently used has good starting point and desire, but due to excessive infusion and improper use of hormones, it is often contrary to what is desired, resulting in further complication of the disease. Clinical still advocate antipyretic and analgesic plus antibiotics plus Chinese medicine, in order to obtain good results.
Second, acupuncture therapy.
Since rheumatic fever joint damage mostly has redness, swelling, heat and pain, so only acupuncture without moxibustion, the technique is mainly diarrhea. Acupuncture points to follow the main meridian, or take the A is point, avoid joint cavity deep stabbing strong stab.
① milli-needle.
A. Main acupuncture points are Quchi, Yanglingquan, lumbar Yangguan, Huanjiao, Diaphragmatic Yu and Blood Sea for heavy wind, Kidney Yu and Guangyuan for heavy cold, Yinlingquan and Sanyinjiao for heavy wet, Dazhi, Fengshi and Kunlun for heat. Retain the needles for 15-30 minutes and twist once every 5 minutes in one direction during the retention period.
B. Take acupuncture points according to the evidence and follow the meridian: for wind paralysis, take Fengchi, Fengfu, Di Yu, He Gu and Taichong; for cold paralysis, take Dazhi, Jingmen, Taichong and Zhongzhu; for damp paralysis, take Taibai, Sansili, Zhigou and Houxi; for heat paralysis, take Quchi, He Gu and Taichong; at the same time, take acupuncture points according to the location of the lesion. The acupuncture is performed according to the conventional operation, using the method of flat tonic and flat diarrhea, and the needles are retained for 20 minutes. 1 time/d, 6 times for 1 course of treatment.
C. Take foot Sanli, Yinlingquan, Yanglingquan, with A-Yi points as appropriate. The main point of wind-cold dampness paralysis is used with the burning mountain fire technique, and the main point of wind-dampness heat paralysis is used with the transdermal technique. 1 time/d, 10 times for 1 course of treatment.
②Trigeminal needle.
Formula 1: at the periphery of the lesion.
Methods: Use the peri-prick bloodletting method. Use the trigeminal needle to pierce the skin around the lesion, pierce the bleeding, if the bleeding is not smooth, after the needle with cupping cupping suction, to bleeding as degree. Once a week, to the extent of healing.
Formula 2: Guizhong, Quze, or 2 to 3 veins are revealed at points near the lesion.
Method: Use puncture to release blood. First, rub the acupuncture point or the vein near the lesion to make the blood accumulate in one place and facilitate the operation. Then puncture with a trigeminal needle to make the right amount of bleeding. It is advisable to have more for a strong body and less for a weak body. 1 to 2 times a week, as long as it is healed.