Rheumatic fever is a delayed, nonsuppurative sequel of upper respiratory infection with group A streptococci. The dis-ease is characterized by inflammatory lesions involving primari-ly the joints, heart, and subcutancous tissues; its pathogenesis remains obscure. The clinical manifestations include pol-yarthritis, carditis, subcutaneous nodules, erythema margina-turn. and chorea in varying combinations. In its classic form, the disorder is acute, febrile, and largely self-limited. Howev-er, damage to heart valves may be chronic and progressive, causing cardiac disability or death many years after the initial episode.
Etiology The development of acute rheumatic fever (ARF) requires antecedent infection with a specific organism, the group A Streptococcus, at a specific body site, the upper respiratory tococcal acute glomerulonephritis, has never been shown to cause rhcumatic fever.
Strains representing a number of the more than 80 M pro-tein scrotypes of group A streptococci are capable of causing ARF. There is a substantial body of evidence to indicate,however, that group A streptococci vary in their rhemnato-genic potential. Analysis of epidemics of ARF caused by a vari-ety of serotypes shows a striking absence of certain highly prevalent types and an overrepresentation of types 5 and 18 and a number of others. Reports from the preantibiotic era document epidemics of streptococcal tonsillitis, even among rheumatic subjects, in which ARF failed to appear. Prospec-tive studies in which postsreptococcal acute glomerulonephritis and ARF occur simultaneously in the same indigent population suggest that the streptococcal strains responsible for each se-quel are serotypically distict.
Streptococci epidemiologically associated with recent ARF outbreaks in the United States belong to the classic "rhcumato-genic" serotypes and often exhibit mucoid colonial morpholo-gy.
1. Wind-dampness-heat Syndrome:
Clinical manifestations: Redness, swelling, heat sensation and pain of the joints which is too painful to be touched but re-lieved 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 method: Dispelling pathogenic heat, remov-ing obstruction in the channels and dispelling pathogenic wind and dampness.
Recipe : Modified White Tiger Decoction Added with Cin-namon Twig.
Ingredients:
Gypsum Gibrosum 12g
Rhizoma Anemarrhenae 12g
Polished Round-grained Nonglutinous Rice 6g
Radix Glycyrrhizae 6g
Ramulus Cinnamomi 30g
Semen Coicis 30g
Caulis Lonicerae 30g
Ramulus Mori 10g
Cortex Phellodendri 10g
Radix Paeoniae Rubra 15g
Radix Oentianae Macrophyllae 30g
Admimstration: All the above drugs are to be decocted in water to get 200--300ml of decoction. Take equal poitions in the morning and in the evening.
Modification: When the case is accompanied with erythe-ma annulare and subcutaneous nodule, the above recipe should include the following ingredients:
Raidx Salviae Miltiorrhizae 10g
Flos Carthami 10g
Radix Arnebiae seu Lithospermi 15g
