Shingles, also known as Herpes zoster is caused by the varicella-zoster virus. This is a pathogen that infects the nerves of certain parts of the skin. This condition is marked by a bunch of vesicular eruptions that is painful. These eruptions are known as Che Chuan Chuang (meaning snake cluster sores) in Chinese medicine.
Symptoms and Signs
Poor appetite, malaise, fever and chills are some of the prodromal symptoms of shingles which may last for 3 to 4 days prior to any appearances of the classical shingle skin lesions. Pain and a burning sensation can develop over the area of the still-yet-to-appear lesions. Around the 4th or 5th day, a bunch of vesicles on an erythematous base becomes visible in the skin. These manifestations develop along the route of the affected nerve(s) that is usually accompanied by severe pain. The loin, stomach and thoracic regions are the areas usually affected. The vesicles contain clear fluid, at first that turns cloudy after 4 to 5 days. Around the 5th day, the vesicles start to dry and scab. Shingles may affect certain areas of the body including the medial part of the upper legs, chest, eyes and the face. After undergoing a herpes zoster attack, the person often becomes immune to this disease; it can recur but only in very rare instances. The pain may linger for months or even years, long after the condition has healed and this can be particularly true for old people. Shingles generally lasts around a couple of weeks to less than a month.
Differential diagnosis
Diagnosing shingles may be difficult during its early stage; when the vesicles begin to appear the disease can be easily diagnosed. Herpes zoster is also known for the pain it induces along with the development of the vesicles.
If the stomach and thoracic regions experience pain, it must be distinguished from that of renal colic, appendicitis, colitis and gallstones.
Lesions caused by herpes simplex lesions often look very much like that of herpes zoster. One difference between the two is that herpes simplex often comes back while zoster rarely does.
Vesicles with erythematous skin lesions can also be a sign of contact dermatitis although it usually will be caused by contact of the skin with an offending substance, and no pain usually comes with the contact dermatitis.
Traditional Chinese Medicine’s Perspective on Shingles in Cleveland
Toxin and fire in the liver meridian is the main cause of herpes zoster. Deficiency of Spleen and poor function of conveyance and transformation causing damp heat is likewise a known factor in the rise of herpes zoster.
In older individuals, the factors that make them susceptible for developing skin lesions include blood and qi stagnation, too much damp-heat toxin, toxins affecting the body, fatigue, too much liver yang, blood deficiency and weakness of the body.
Treatment
Internal treatment
1. Blood and qi stasis
Shingles may not be evident in older people although pain may be experienced.
Plan of Treatment: Stop pain, nourish the blood, move qi and soothe the liver
Herbal remedy: Modified Hsiao Yao San
Acupuncture points:
LI 4, LI 11, SP 10, ST 36, SP 6, PC6 and SJ 6 ← this may be used if pain endures for a long time
Once a day treatment using even and strong needle manipulation; needles inserted for around 20 to 30 minutes
Auricular points: Shen Men and Spleen. Needles are inserted and left in the skin for 3 day until pain is alleviated.
External treatment
1. Once a day external wash using herbal decoction (Hse Lan 30g, Bo He 30g, Da Wang 60g, and Hse Bai Ye 60g)
2. Puncture the unbroken blister using a three-edged needle and drain to help relieve the pain.
2 Damp-heat in the spleen meridian
Upper legs and stomach infected with Herpes zoster
Plan of Treatment: Dry dampness and fortify spleen
Herbal Remedy: Modified Tiu Shi Wei Lin Tang
Modification:
For stomach distention: include Zhi Shi 10g and Mu Hsiang 10g
Thirst with no desire to drink: include Pei Lan 10g and Huo Hsiang 10g,
Acupuncture points: SP 9, SP 6, LI 11, ST 36, GB 34
Lesions below the umbilicus: ST40
Lesions above the umbilicus: LI4
Even strong needle manipulation done once a day. Insert needles for 20 to 30 minutes
Once each day, surround needles over the skin lesions. Leave the needles in place for half an hour
Auricular points: Shen Men and Spleen – leave needles for 3 days until pain is alleviated
3. Toxin and Fire in the liver meridian
The thoracic, face and head areas are affected.
Plan of Treatment: Clear heat, dry damp and clear liver fire
Herbal Remedy: Modified Long Dan Hsie Gan Tang
Modification:
For face lesions: include Ye Ju Hwa 15g and Niu Bang Hsi 15g,
Lesions around the eyes: include Cao Chue Ming 15g and Chiu Hua 12g
Herpes zoster accompanied by blood blisters: include Mu Dan Pi 10g and Ce Bai Ye 12g
Acupuncture points: LV 3, LI 4, LI 11, GB 34, and PC 6
Lesions on the jaw: ST5, ST 4, ST6
Lesions on the cheeks: ST 7, BL 1, and ST2
Lesions near the eyes: GB 14, ST 8 and Tai Yang
Once a day treat with even and strong needle manipulation. Insert the needles for 20 to 30 minutes.
Once a day, circle the needles around the skin lesions and leave it there for half an hour, and retain the needles for 30 minutes.
Auricular points: Shen Men and Liver – leave the needles for three days till the pain dissipates
Moxibustion
On the health regions between the skin lesions apply moxibustion using moxa roll. The heat will lead to severe itching. Keep up the moxibustion till the itching ceases and transforms into a feeling of extreme heat; stop treatment. Do this once a day. After 3 to 4 sessions, the lesions will start to heal.