The Acupuncture Treatment of Herpes Zoster (Shingles)
Chief Complaint: Damp Heat invading Liver and Gall Bladder
Western Diagnosis: Herpes Zoster
Medical History: The patient was a 31 year old male, approximately 5ft 10″ tall and slightly overweight. He had a sallow complexion with swollen eyelids and a weak sounding voice.
His chief complaint was herpes zoster (shingles), the blisters had just started to appear 2 days ago. Plus he had been feeling very tired a lot of the time for the past few months.
The patients GP had diagnosed shingles the day before the first acupuncture treatment and prescribed Aciclovir 800mg 5 times daily for 7 days. The patient had decided not to take them as he feels that he has ‘taken enough medication over the years’ with all the antibiotics he has been prescribed. This is why he decided to seek acupuncture treatment as an alternative to the drugs.
He said that since childhood he had always been prone to catching colds, which usually progressed to a chest infection, therefore he was forever taking antibiotics. He would have approx. 3-4 chest infections per year mainly during the winter and always take antibiotics to clear them. If he didn’t they could last for months. He says his chest seems to have been weak ever since a bout of bronchitis when he was 2yrs old.
The patient is married with two children under 5 years so “doesn’t get much peace at home” which he says can be very stressful especially after a long day at work. Sleeping is fine except he is sometimes interrupted due to the children. He works in sales. He finds constantly meeting targets ‘stressful’. He frequently works long hours including a lot of entertaining clients. This usually happens on a weekly or fortnightly basis, but from October to December, the busiest work period, he will be working long hours and be entertaining until 3am in the morning. During these periods of entertainment he drinks large quantities of alcohol, usually a minimum of 2 bottles of red wine. He doesn’t exercise as has little time. Also a very close friend died in car crash 2 months ago.
Questioning exam: Eyes, Ears, Nose and throat: Regular headaches (approx. 2 per week), starting from the base of head around GB20 radiating to above the left eye around GB14.
Digestion/Appetite: Generally poor appetite, also suffers with borborygmi and feels especially tired after eating.
Diet: Irregular eating habits as misses lunch when busy and always misses breakfast as he starts work very early in the morning, other days he’ll eat rich business lunches or dinners. Eats a lot of pasta and diary products at home. Thirst with no desire to drink, tends to drink black coffee to perk him up through the day.
Bowels: Often loose, foul smelling stools up 5 times a day.
Urination: Copious and pale. Frequent 8-10 times a day.
Sleeps: Gets off easily and sleeps soundly but is frequently woken by two children.
Memory and concentration: Poor. Head feels muzzy sometimes.
Muscle-skeletal: Lower back pain.
Temperament: Irritable and feels ‘pent up’ due to the pressures of work and long hours he is expected to work.
Temperature: Generally feels cold.
Physical Examination: Revealed a rash the size of a medium hand located on the left side of the back lateral to Lumber 2 spreading to GB25. The blisters found on the red rash were in varying stages of development some were weepy and according to the patient the whole area was very painful.
Pulse exam: Slippery and rapid
Tongue exam: Swollen scalloped edges, with a sticky, thick yellow coat.
OM Diagnosis: Internal Damp
Poor concentration & memory
Feeling tired a lot of the time
The blisters on this patient are red and weepy and according to the patient very painful, this is why I think the major pattern involved is damp-heat (Owen et al, 1994). As the blisters/rash is on his lateral costal region on the left side it’s affecting the gall bladder (GB) channel (shao yang) and the Liver (LIV) channel by association with the GB (Owen et al, 1994). Damp is indicated as the rash is located lateral to Lumber 2, thus been located on the lower part of the body. Owen et al (1994) suggests ‘damp is ‘heavy’ and sinks therefore it is more likely to be located on the lower part of the body’.
Thirst with no desire to drink
Loose stools with offensive odour
Sticky thick yellow coat
Damp heat is indicated by the thirst but lack of desire to drink. This is because the heat give rise to the thirst, the Dampness makes one reluctant to drink (Maciocia, 1989). The tongue coating is also indicating damp heat; it is sticky therefore indicating retention of damp. It’s yellow indicating heat. The thickness indicates the presence of a pathogen, damp and heat in this case. The pulse also indicates damp heat, as it’s rapid and slippery, rapid indicates heat and slippery indicates damp.
Damp also results in borborygmi as seen in this patient. Damp also obstructs the raising of pure Qi that is needed to maintain lightness, therefore resulting in a muzzy head feeling, poor concentration and memory. Damp heat is also indicated by his foul smelling stools.
With Heat invading the Liver/Gall Bladder channel
Herpes Zoster manifesting on flank
Spleen Yang Xu
Swollen eye lids
Generally poor appetite
Low energy but especially after eating
Tendency to feel cold
Swollen tongue with tooth-marks
The next important syndrome is Spleen Yang Xu. I think it is Yang Xu as opposed to Qi Xu as he has a tendency to feel the cold which is a sign that the Yang is failing to warm the body. Spleen Yang Xu can form damp as damp can accumulate when the Spleens transporting and transforming of body fluids are impaired. The patient is also showing other signs that his spleen is not transporting and transforming body fluid correctly as he has swollen eyelids and a swollen tongue that has pushed against the teeth, resulting in scalloped edges.
This patients transportation and transformation of food is also impaired as indicated by the poor appetite that he is experiencing. Lack of nourishment from this impairment leads to poor energy levels. Although his appetite is poor he is slightly overweight again this is because of the spleen’s not functioning properly resulting in retention of phlegm which manifests as fat.
Liver Qi Stagnation
Feels pent up
Left sided headaches around GB20 and GB14
The patients Liver energy is stagnant as the headaches that come and go are just on the left side, over his eye, this a result of his Liver not spreading and flowing Qi properly. The symptom of borborygmi is also a result of this. The Liver should harmonises the emotions therefore an impairment can result in irritability and the pent up feeling this patient is feeling.
Lung Qi Xu
Catches colds easily
Tired all the time
The tone and strength of the voice is an expression of the strength of the Gathering Qi which, in turn depends upon Lung Qi, hence his weak voice indicating Lung Qi Xu. Lung Qi Xu results in weak Wei Qi therefore it is less able to perform it’s protective function thus allowing invasion from external pathogenic factors hence the propensity to catch colds easily. Finally the Lungs rule Qi, impairment of this function will result in failure to disperse enough Qi hence the feeling of being tired all the time.
Kidney Yang Xu
Sore lower back
Tendency to feel the cold
Copious, pale, frequent urination
Finally I think the patients Kidney Yang is deficient because the Kidneys don’t have enough Qi to give strength to the bones and the back, hence the soreness of the lower back. Also when Kidney Yang is deficient, the Fire of Ming Men fails to warm the body causing aversion to cold. When Kidney Yang is deficient it fails to transform the fluids, which therefore accumulate, resulting in abundant and clear urination.
I expected to see more signs of heat and was surprised to hear that his urine was copious, pale and frequent and that he felt cold a lot of the time. Perhaps this is because the Spleen and Kid Yang Xu syndrome is well established and the heat hasn’t been around long enough to effect his urine or body temperature yet.
Treatment Principle: Stop pain, clear heat and resolve damp in shao yang
Tonify Spleen Yang
Ease Liver Qi Stagnation
Point Prescription: Treatment 1 – point prescription
Huatuojiaji points at T9, T10, T11, L1, L2, and L3. – reducing (Owen et al, 1994).
Surround needling around area of rash/blisters including GB25-reducing (Ross, 1998).
Treatment 6 – point prescription
Reduce SP9, SJ6, GB34, LI11
Tonify SP6, SP3
Herbal Formula: N/A as not qualified
Lifestyle Prescription: His job is a major challenge and I explained the consequence’s of working so hard and how it can effects the energy balance of his body.
Plus I suggested the follow changes that would help in his recovery:
i. During the treatment period cut out alcohol and coffee completely as both are heat forming (Leggett, 1997). Reduction of alcohol intake when treatment has ceased was also suggested.
ii. Take pre cooked food or soup to work that can be heated up for both breakfast and lunch when not entertaining clients.
iii. Reduce intake of damp and heat forming foods (Leggett, 1997). These include the following:
Trout, Lamb, Cayenne, Chilli, Garlic, Dry Ginger, Horseradish, and Mustard, Pepper
Dairy products, pork and rich meats, roasted peanuts, concentrated juices, especially orange and tomato, wheat, bread yeast, beer, bananas, sugar and sweeteners, saturated fats.
iv. Goat and/or sheep yoghurt is good substitute for cows yoghurt as it is less dampening (Leggett, 1997) and it is readily available in most supermarkets so I would suggest this as an alternative.
v. Reduce working hours
vi. Take a lunch break
vii. Suggested he start to take 10 minutes out of day to meditate, if he cuts down on his working hours he may be able to find the time. Or perhaps he could take up Qi Gong, Tai Chi or Yoga all of which are great at reducing stress. If this is too time consuming going for a 1/2 hour walk 3 or 4 times a week with the children could be also a good way of relaxing.
Results: In China Acupuncture is recognised as the most effective of all therapies for the treatment of herpes zoster. Apparently Dr Zhou Yunxian, lecturer at the Academy of TCM in Beijing commented that ‘acupuncture works miracles in herpes zoster’ (Owen et al, 1994). Having read this before this patient arrived I was very hopeful that the treatment would work well. Especially as the patient was having treatment so soon after being diagnosed by his GP.
Thankfully my expectations were met; the pain he was suffering was substantially reduced by the third treatment and by treatment six was almost gone. The weepy discharge took a bit longer to dry up but was gone by treatment eight.
His feeling of tiredness didn’t improve during the 10 treatments; this is probably because I was specifically treating the damp-heat. The tiredness is probably due to a combination of chronic Lung Qi Xu and Spleen Yang Xu and needs to be address separately over a course of several months.
After 10 treatments he was much improved, the herpes zoster blisters/rash had completely gone and he hadn’t experienced any post-herpetic pain at all.
Fortunately this patients took his GP’s advise and had two weeks off sick from work at the beginning of treatment and completely rested during this time apart from coming for acupuncture treatment. I think this was a major contributing factor to his recovery especially whilst he was at home his wife took the food and drink recommendations I had made to heart and he was put on a strict recovery diet that she controlled for those two weeks.
On his return to work he continued with the improved diet as his wife prepared meals to be taken into work that he could warm up, this included food for breakfast. He now try’s to have a break of least 20 minutes every day. He has also reduced his alcohol and coffee intake substantially.
After the 6 weeks of treatment we agreed that he would come for a further 20 treatments in order to tackle the tiredness and propensity to catch colds.
I have now seen him for 12 weeks; he has had 6 of the 20 further treatments.
I now focus of the treatment on tonifying Lung Qi and Spleen and Kidney Yang.
He says his tiredness has improved by ’30%’ so far.
His Liver Qi stagnation is improving as he is feeling less wound up and irritable and hardly ever suffers from headaches anymore. Also his Spleen Yang Xu is improving as his memory and concentration are ’50% improved’ and his appetite has improved plus his bowel movements have improved as they are firmer, not as smelly and less frequent – approximately 1-2 per day.
He has had two colds in the last 6 weeks but has recovered from them within a week of onset. I am really pleased with this, as before starting acupuncture colds would usually progress into chest infections with antibiotics being the only thing that would clear them up.
Gascoigne, S (1994) Manual of Conventional Medicine for Alternative Practitioners, Jigme Press, Dorking, 59pp
Leggett, D (1997) Helping Ourselves A Guide to Traditional Chinese Food Energetics, Meridian Press, Totnes, 29-32
Owen W & Deadman P (1994) Treatment of Herpes Zoster Journal of Chinese Medicine, Number 45, 28pp
Maciocia G (1989) The Foundation of Chinese Medicine, Churchill Livingstone, Edinburgh. 160pp, 223pp
Maciocia G (1994) The Practice of Chinese Medicine, Churchill Livingstone, Edinburgh 632pp
Ross J (1998) Acupuncture Point Combinations The Key to Clinical Success, Churchill Livingstone, Edinburgh, 51pp
Amanda Farrar DipAc, Cert Acupressure, Tera Mai & Seichem Reiki Master, IHBC (Massage), MBAcC
47 Park Square
Leeds, West Yorkshire
LS1 2NL UK
0113 383 3030