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RHEUMATIC FEVER

GENERAL

Clinical Manifestations	Rheumatic fever (acute rheumatic fever) is a disease that can affect the Heart, joints, brain, skin and vessels. Rheumatic fever can develop if strep throat and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics are key to preventing rheumatic fever. Signs and symptoms: Carditis; including endocarditis, myocarditis and pericarditis Tachycardia Cardiac enlargement Systolic and diastolic murmers at the apex of the Heart Pericardial friction rub Migratory polyarthritis mostly of the large joints of the extremities The affected joints are red, hot, tender and swollen Erythema annulare Subcutaneous nodules Mild or moderate fever Sweating Weakness Weight loss Elevation of antistreptolysin
Treatment Principle
Herb Formulas
Points

WIND-COLD WITH UNDERLYING QI AND YANG DEFICIENCY

Clinical Manifestations	Slight fever Strong chills Anhidrosis Headache Cold extremities Fatigue with a constant desire to lie down Drowsiness Pale face Lassitude Low voice Weak voice T: Pale C: White P: Floating, big and forceless or Deep and forceless
Treatment Principle	Tonify Yang Augment Qi Release the Exterior Induce sweating
Herb Formulas	Zai Zao San
Points

QI STAGE HEAT

Clinical Manifestations	High fever Profuse sweat Generalized weakness Severe chills Aversion to Heat Red face Severe thirst with a strong desire to drink Irritability Anxiety Pruritis Headache Toothache Gum bleeding Epistaxis Dry lips Dry tongue Dry mouth May be sensitive to Cold in the upper back Polyuria Delusions Eye congestion Burning sensation on the skin Abdominal fullness without resistance Dry, course skin May be heavy labored breathing Delirious speech (serious cases) T: Red tip and sides C: Yellow, dry or white P:Flooding and forceful or Large and forceless or Slippery and rapid
Treatment Principle	Clear Qi Stage Heat Drain Stomach Fire Generate Fluids Alleviate thirst
Herb Formulas	Bai Hu Tang modified For Lung and Stomach Heat: Zhu Ye Shi Gao Tang
Points

QI STAGE SUMMERHEAT INJURES THE LUNG CHANNEL

Clinical Manifestations	Fever Mild thirst Unclear head Blurred vision Lightheadedness Slight distention of the head T: Pink or Slightly red C: Thin and white P: Maybe soft or Soft and rapid
Treatment Principle	Resolve Summerheat Clear the Lungs Clear Heat
Herb Formulas	Qing Luo Yin
Points

BLAZING FIRE IN THE QI, YING AND XUE STAGES

Clinical Manifestations	High fever worse at night Severe irritability Restlessness Thirst Delirium Faint indistinct purpura and erythema Insomnia Dizziness Vertigo Maculae Eyes that are open or closed for a prolonged period of time High fever Bleeding Hematemesis Epistaxis Hemoptysis Hematochezia Hematuria Purplish-red or black skin rashes (maculae) Forgetfulness Irritability Chest pain Black, tarry stools Abdominal distension and fullness Thirst with an inability to swallow Menorrhagia Mania Delirium Desire to rinse the mouth with water without swallowing it Black tarry stools Hematuria T: Scarlet with prickles or Scarlet and dry or Deep purplish C: Little P: Thready and rapid or Rapid
Treatment Principle	Clear Heat Cool the Blood Drain Fire Relieve Fire toxicity Nourish the Yin Dispel Blood Stasis Stop bleeding
Herb Formulas	Qing Ying Tang + Xi Jiao Di Huang Tang Qing Wen Bai Du Yin For a fever with profuse sweating or post-febrile stage with Qi and Yin Deficiency: Sheng Mai San Zhu Ye Shi Gao Tang Yi Wei Tang For uneasiness in the precordium with palpitations: Sheng Mai Sanmodified For localized infections: Liu Shen Wan internally + Bing Peng San topically
Points

XUE STAGE HEAT

Clinical Manifestations	High fever Confusion of mind Delirium Mania Dark yellow urine Excessive skin rashes all over body Hemorrhage: Hematemesis Hemoptysis Epistaxis Hemafecia Hematuria T: Deep red, dry or Purple red C: None P: Rapid or Thready and rapid or Thready and feeble
Treatment Principle	Cool the Blood Dispel Heat and Toxins from the Xue Stage Promote Blood Circulation
Herb Formulas	Xi Jiao Di Huang Tang
Points	To clear Heat and Toxins: Bleed the Jing Well points, DU-14, LI-11, ST-44 To promote Blood circulation: SP-10, UB-17 To treat hemafecia: SP-1, ST-25, ST-37 To restore consciousness: DU-26, K-1 To nourish Yin: KI-3, SP-6 To calm the Shen: HT-7

WIND-DAMPNESS

Clinical Manifestations	Heavy, painful head Generalized sensation of heaviness Back pain Generalized pain or muscle ache Difficulty bending or rotating trunk Mild fever Slight aversion to Wind and Cold Dizziness Anorexia Anhidrosis Stiffness of the neck Sciatica Chest oppression Chills No perspiration Aversion to Cold Lassitude Scanty urination T: Pink C:White or Greasy and white P: Superficial or Superficial and slow or Superficial and soft or Superficial and tight
Treatment Principle	Dispel Wind Eliminate Dampness Relieve the Exterior Alleviate pain
Herb Formulas	Qiang Huo Sheng Shi Tang With Qi Deficiency: Wang Qiang Huo Sheng Shi Tang
Points

WIND-COLD-DAMP

Clinical Manifestations	Persistent arthralgia of the extremities, aggravated by Cold and relieved by warmth T: Pale C: Thin, white and greasy P: Floating and slow With Wind predominant: Pain moves around and involve more joints With Cold predominant: Surrounding area feels cold With Damp predominant: Heaviness of the area Numbness Swelling
Treatment Principle	Disperse Wind, Cold and Dampness
Herb Formulas	Juan Bi Tang modified
Points

WIND-DAMP-HEAT

Clinical Manifestations	Redness, swelling, Heat and pain in the joints The joints are too tender to be touched The pain is alleviated by Cold Inability to move Restless and discomfort in the chest Maybe fever thirst T: Red C: Yellow and dry P: Slippery and rapid
Treatment Principle	Clear Heat Dispel Wind and Dampness Unblock the channels
Herb Formulas	Bai Hu Tang modified Bai Hu Jia Gui Zhi Tang modified San Ren Tang + Si Miao Wan Jia Wei Xuan Bi Tang Shi Re Bi Tang Shen Qiang Huo Sheng Shi Tang
Points

HEART YANG DEFICIENCY

Clinical Manifestations	Rheumatic fever Cold extremities Spontaneous perspiration Weak breathing Shortness of breath Dizziness An extremely pale face Intolerance of Cold Cold abdominal pain Loose stools Upset stomach T: Pale P: Minute (almost imperceptible)
Treatment Principle	Restore Yang Strongly tonify Yuan Qi Rescue Qi from collapse due to Vanquished Yang
Herb Formulas	Shen Fu Tang
Points

YIN DEFICIENCY WITH DEFICIENCY FIRE

Clinical Manifestations	Low-grade fever in the evening or Nightly fever or Afternoon tidal fever Five Sole Heat Malar flush Steaming bone fever Anxiety Restlessness Night sweats Irritability Insomnia Excessive dreams Dry mouth and throat with a desire to drink Scanty, yellow urine Emaciation Lethargy Red lips Dry skin Thirst T: Red and dry C: Little or None P: Thready and rapid
Treatment Principle	Clear Deficiency Heat Reduce tidal fever
Herb Formulas	Qing Gu San
Points

QI AND YIN DEFICIENCY

Clinical Manifestations	Palpitations Shortness of breath Chest stuffiness Chest pain Insomnia Arthralgia with slight swelling T: Red C: Thin and white P: Thready and rapid
Treatment Principle	Tonify Qi Nourish Yin Remove Dampness Unblock the channels
Herb Formulas	Sheng Mai San modified
Points

QI AND BLOOD DEFICIENCY

Clinical Manifestations	Fatigue Loose stools Poor appetite Dizziness Pale face Weak voice Shortness of breath Reluctance to speak Sweating with little or no exertion Palpitations Insomnia Dry skin Dry hair Poor memory Paleness Scanty periods T: Pale or Pale, thin and dry C: Thin and white P: Weak or Thin and choppy
Treatment Principle	Tonify Qi Nourish the Blood
Herb Formulas	Bu Zhong Yi Qi Tang modified
Points