|
Conception
Herpes zoster,
otherwise known as shingles, is an infection of the nerves
that supply certain areas of the skin. The condition is
characterized by a cluster of painful vesicular eruptions.
In Chinese medicine, it is known as Che Chuan Chuang
(snake cluster sores). According to western medicine, herpes
zoster is caused by the varicella-zoster virus.
Signs and
symptoms
Prodromal
symptoms of chills and fever, malaise and poor appetite may
occur for about 3-4 days before the classic skin lesion
appears. A burning sensation and pain occurs along the site
of the future skin lesion. On about the fourth or fifth day,
characteristic clusters of vesicles on an erythematous base
appear. The cutaneous distribution follows the route of the
affected nerve(s) and the associated pain may be severe. The
skin lesion occurs most often in the thoracic, abdominal and
loin regions and spreads unilaterally. The serous fluid in
the vesicles is initially clear, but then becomes cloudy 4-5
days later. The vesicles begin to dry and scab on about the
fifth day after appearance. Other areas that may be affected
by herpes zoster include the face, eyes, chest, and the
medial side of the upper legs. An attack of herpes zoster
usually confers immunity; recurrence is rare. Post herpetic
pain may persist for months or even years, especially in
older people. The whole course usually lasts about two
weeks, and less than one month.
Differential
diagnosis
Diagnosis may
be difficult in the early stage, but is made easily after
the vesicles appear in the characteristic distribution along
sensory nerve pathways. Pain is also an outstanding feature
of herpes zoster, especially post-zoster pain.
If the pain is
in the thoracic and abdominal region, it must be
differentiated from that of gallstones, colitis,
appendicitis and renal colic.
Herpes simplex
lesions may be nearly identical to those of herpes zoster.
Herpes simplex generally recurs, whereas zoster rarely does.
Contact
dermatitis can also present erythematous skin lesions with
vesicles, but it will have a history if skin contact with an
offending substance, and generally there is no associated
pain.
Traditional
Chinese Medicine Etiology
The main cause
of herpes zoster is fire and toxin in the liver meridian.
Spleen deficiency with dysfunction of transportation and
transformation resulting in damp heat is also a common cause
of herpes zoster.
In aged people,
weakness of the body, blood deficiency, liver yang excess or
fatigue, toxic factors invading the body, excessive
damp-heat toxin, and qi and blood stagnation facilitate the
occurrence of the skin lesions.
Treatment
Internal
treatment
1. Fire and
toxin in the liver meridian
Herpes zoster
appears on the head, face and thoracic areas.
Treatment
Principle: Clear liver fire, dry damp and clear heat
Formula:
Modified Long Dan Xie Gan Tang
Long Dan Cao
15g, Zhi Zi 10g, Huang Qin 10g, Sheng Di Huang 10g, Che Qian
Zi 10g, Ze Xie 10g, Fu Ling 10g, Da Qing Ye 15g, Zi Cao 10g,
Yi Yi Ren 15g
Modification:
Lesions on the
face: add Niu Bang Zi 15g, Ye Ju Hua 15g
Lesions around
the eyes: add Ju Hua 12g, Cao Jue Ming 15g,
Herpes zoster
with blood blisters: add Ce Bai Ye 12g, Mu Dan Pi 10g
Acupuncture:
PC6, GB34,
LI11, LI4, LV3
Lesions near
the eyes: Tai Yang, ST8, GB14
Lesions on the
cheeks: ST2, BL1, ST7
Lesions on the
jaw: ST6, ST4, ST5
Treat once
daily with strong, even needle manipulation, and retain the
needles for 20-30 minutes.
Circle the
needles around the skin lesions, and retain the needles 30
minutes, once each day.
Auricular
points: Liver, Shen Men – retain needles for three days
until the pain disappears.
2. Damp-heat in
the spleen meridian
Herpes zoster
on the abdomen and upper legs
Treatment
Principle: Strengthen spleen and dry dampness
Formula:
Modified Chu Shi Wei Lin Tang
Cang Zhu 9g,
Huo Po 9g, Chen Pi 9g, Zhu Ling 12g, Ze Xie 12g, Fu Ling
12g, Xu Chang Qin 12g, Yu Jin 12g, Pu Gong Ying 20g, Sheng
Gan Cao 6g
Modification:
Abdominal
distention: add Mu Xiang 10g, Zhi Shi 10g
Thirst, but
doesn’t want to drink: add Huo Xiang 10g, Pei Lan 10g
Acupuncture:
GB34, ST36,
LI11, SP6, SP9
Lesions above
the umbilicus: LI4
Lesions below
the umbilicus: ST40
Treat once
daily with strong, even needle manipulation, and retain
needles for 20-30 minutes.
Circle needles
around the skin lesions, and retain the needles for 30
minutes, once each day.
Auricular
points: Spleen, Shen Men – retain needles for three days
until the pain disappears.
3. Qi and blood
stasis
In aged people,
the shingles disappear, but still have surface pain.
Treatment
Principle: Soothe liver, move qi, invigorate blood and stop
pain
Formula:
Modified Xiao Yao San
Chai Hu 9g, Bai
Shao 12g, Chi Shao 12g, Fu ling 12g, Dang Gui 10g, Dan Shen
15g, Zhen Zhu Mu 15g, Mu Li 12g, Ci Shi 15g, Yan Hu Suo 15g
Acupuncture:
PC6, SP6, ST36,
SP10, LI11, LI4
If pain lasts a
long time: add SJ6
Treat once
daily with strong, even needle manipulation, and retain the
needles for 20-30 minutes.
Auricular
points: Spleen, Shen Men – retain the needles for three days
until the pain disappears.
External
treatment
1. External
wash with herbal decoction (use once a day): Ce Bai Ye 60g,
Da Huang 60g, Bo He 30g, Ze Lan 30g
2. If the
blister is unbroken, puncture with a three-edged needle, and
drain. This can reduce the distending pain.
Moxibustion
Apply moxa roll moxibustion to the healthy areas between the
lesions. Extreme itching will occur due to the heat.
Continue moxibustion until the itching stops and becomes a
sensation of extreme heat, and cease treatment. Treat once
daily. Lesions will usually show evidence of healing after
3-4 sessions. |
Request an appointment