Two cases of herpes zoster are described and their treatment with acupuncture and adjunctive therapies discussed.
The treatment of shingles (herpes zoster) by using the twelve main meridians can be frustratingly slow and often ineffective. Local treatments are often necessary to stimulate the action of qi, and often this needs to be supplemented with herbal or homoeopathic treatment to ensure a good result. The best results are gained if treatment is given promptly at the first sign of an outbreak. Like many other diseases, the longer the infection has to mature and cause tissue damage the harder it is to treat. Then you are fighting a rearguard action, trying desperately to limit the damage.
The herpes zoster virus can lie dormant in the body for years provided the body's immune system is strong enough to keep it in check. At times of slight stress it may present as an ache around the ribs, in the side of the face or in the shoulder. You may well treat it as an invasion of cold damp, little knowing the underlying pathology. It often takes a shock, with severe lowering of the body's defences, to allow the herpes zoster to come to life and cause rampant damage to skin and nerves.
Rowley (1991) states that herpes zoster is a late development of the varicella virus of chickenpox. Having lain dormant for years in the sensory nerve ganglia, it reactivates and produces a painful rash, following the distribution of a dermatome or the sensory part of a cranial nerve. The problem often afflicts people, mainly the elderly, who are immuno-suppressed. Walters (1992) states that the lysogenic virus may lie dormant for years before becoming active. Sometimes an invasion of heat may trigger it off. Occasionally, if I have suspected the virus to be present in an area, I have stimulated it into life with local acupuncture so that it may be dispersed and eliminated safely and quickly.
The most commonly affected areas are the intercostal nerves of the thorax and the trigeminal nerves at the side of the face. The illness starts with pain in the area, with sensitivity of the skin. This is followed by a vesicular rash which crusts and then heals after a week or so. The disease is highly contagious at the stage when the infected crusts of skin are flaking.
A thoracic history Margaret is a small, nervous woman in her early seventies whom I have treated for years. She had a left-sided mastectomy about twelve years ago and had suffered soreness under the scar and around the thorax ever since. There had been a secondary infection with side-effects from drugs after the mastectomy, and Margaret swore that she would have no more surgery. When she developed a lump in her right breast three years after the operation, she asked me to treat her with acupuncture. This was done successfully and she has had no further recurrence of tumours.
Margaret's build-up to herpes zoster occurred over a three-month spell. She first complained of a pain in her thoracic spine at the level of T4-5 and this coincided with pain around the left intercostal area linking with the old mastectomy scar. Tongue and pulse indicated an invasion of damp heat, with liver qi zu. The four-needle technique (Liv 2 and 4, Lu 11, Ht 9) was used to clear the liver and reduce heat. On a later occasion local points were used to ease the inflammation, with GV 13, Bl 13 and 14 and Huatuojiaji points around the vertebrae to reduce spinal inflammation, and ah shi points along the line of pain to draw out the infection (Low, 1983).
After the first two visits, at monthly intervals, this local treatment calmed the pain temporarily. After the third treatment Margaret phoned to say the pain was worse. The shingles rash appeared along the previous inflammatory line three days later. Normally if the shingles has been stimulated by acupuncture it clears quickly without scarring, but it has to be treated promptly.
Margaret was given treatments every two days for a week. Apart from systemic treatment to calm her nerves (LI 4, Liv 3) and remove damp heat (Sp 9, Sp 5) she was always given a star technique around the inflamed area. This involves inserting half-inch needles at one-inch intervals around the skin lesions to disperse perverse energy. When the inflamed patch starts to break up, needles can then be inserted through the middle, on the new healthy skin.
Within ten days the red, inflamed skin had dried and flaked off, leaving a mild scarring, and there was no apparent damage to the intercostal nerves.
An appeal for help Margaret was lucky, unlike another patient, Daphne, who had a similar problem but instead of having acupuncture went to her GP for treatment when the herpes zoster appeared. She was given various (anti-inflammatory) creams and a course of anti-biotics. Within two weeks the shingles had spread over a four-inch wide area right around the chest and was very painful, with obvious nerve damage. Daphne, big and flabby, could not bear her skin to be touched, it was so tender and over the telephone she said she could not stand having acupuncture. She had her 'wound' dressed every day by a visiting nurse, who applied the ointments in gauze. Her doctor told her the pain would last only six months. After seven months she finally appealed for help because there was no reduction in the pain.
Is it not frustrating when patients turn to you when other treatments have failed? While she was being treated by orthodox methods she had periodically phoned me for encouragement. After she had refused acupuncture I had appealed to her to try a homoeopathic remedy and to apply an aromatherapy oil to the wound but to no avail. Now she was willing to try anything.
Her system indicated an invasion of damp heat, with yellow coated tongue, constipation, liver congestion, tight wheezy chest and exhaustion. The skin over the herpes zoster was raised and red and extremely painful to touch. I know from experience that it is of little use treating that condition with the star technique. It is too late, the problem has gone deeper than the wei energy level and the damage has already been done to the skin and nerves. The best you can do is to remove the heat and calm the skin. The pain will largely go away but the damaged area will remain a source of annoyance.
I first of all reduced her liver condition with the four-needle technique mentioned above. This freed the sheng cycle and helped the lungs. On the next treatment I worked more on the lungs and chest with Lu 7, Lu 3, CV 17, and involved the eight extras, du mai and yang qiao mai with Sp 3, Bl 62 to clear the perverse energy.
Herbal remedies Daphne was given a homoeopathic anti-psoric remedy called Calcarea Carbonica. She was later given a herbal mixture to help reduce internal heat, relieve swelling and help the immune system. This was made of Echinacea root, wild indigo root, marigold (calendula) flower, plantain leaf, purslane, usnea thallus, plus two drops of aromatherapy essential oils, one of tea tree and one of lemon rind (Holmes, 1994).
I told her to stop using the chemically-based orthodox ointments and to apply diluted essential lavender oil to the damaged skin. She found that even this diluted oil made the skin burn so I resorted to a more gentle method. I asked her to alternate potato and cabbage poultices, using one on one night and one the next. It took two weeks but finally the heat went out of the scar, which turned white. The pain went, except for occasional spasms and she regained her previous good health.
The poultices are made as follows: Potato - boil the potato in its skin, mash and spread a quarter-inch thick onto a piece of linen. Fold and apply. It also helps healing scar tissue if a little raw potato is eaten after being grated into a liquid. Cabbage - use a pulped raw cabbage leaf, Savoy is best, wrap in lint and apply (Vogal, 1977).
The same star technique that was used on Margaret can be used for shingles in other parts of the body. It works successfully with an attack on the side of the face. Then you often need to use stomach and gall bladder points as well in order to reduce congestion. Bear this in mind when treating a 'frozen' shoulder. I've known a number of cases where a constant dull ache suddenly resolved itself as a painful shingles rash. We must stay alert and must be as much aware of a patient's history as the presenting complaint.
Alan Rouse Alan Rouse gained his acupuncture qualification in 1986 from the British College of Acupuncture and now runs a busy clinic in Hampshire. He is also an osteopath, homoeopath and herbalist and likes to combine treatments.
References Rowley, Nic. (1991). Basic Clinical Science, Hodder & Stoughton Walter, John B. (1992). Principles of Disease, W.B. Saunders Low, Royston. (1983). The Secondary Vessels of Acupuncture, Thorsons Holmes, Peter, (1994). The Energies of Western Herbs, Vol. II, Snow Lotus Press Vogal, Alfred. (1977). The Nature Doctor, Vogal, Switzerland