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   Nov 08

Acupuncture and Herbs Stop Shingles Pain, Outperforms Drugs

Acupuncture and herbs prove effective for the treatment of shingles. Researchers from three independent studies conclude that acupuncture and herbal medicine significantly relieve rashes and pain associated with the herpes zoster virus (shingles). Importantly, acupuncture and herbal medicine outperformed antiviral and anti-inflammatory medications, indicating that usual care protocols are suboptimal without inclusion of acupuncture and herbal medicine.

The shingles viral infection is characterized by painful blisters, usually located in a single strip on either side of the trunk, neck, or face. Even once the blisters have subsided, patients can be left with severe neuralgia (nerve pain), which may last for several weeks or months. According to Traditional Chinese medicine (TCM) principles, this condition usually falls into the category of either excess liver fire, liver and gallbladder damp heat, or spleen deficiency with accumulated pathogenic dampness. Rashes associated with shingles are sometimes referred to as “snake string sores” in TCM, reflecting the nature of their physical presentation.

People’s Hospital

The first study we will look at today was conducted by researchers at the People’s Hospital of Shenyang Economic and Technological Development Zone. [i] A total of 88 patients with a clinical diagnosis of a herpes zoster infection were recruited and randomly assigned to an acupuncture and herbal medicine observation group or a drug control group (including anti-inflammatory and antiviral medications).

The acupuncture and herbal medicine group produced significantly greater patient outcomes. This includes a higher cure rate, a higher overall effective rate, and a lower failure rate. The results indicate that standard procedures to alleviate shingles in hospital and outpatient settings absent acupuncture and herbs are definitively not the most effective means to provide relief to patients.

The observation group comprised 20 male and 24 female participants with a mean age of 43.6 years. Their mean duration of disease was 3.4 days. The control group comprised 18 male and 26 female participants, with a mean age of 42.8 years. The mean duration of disease in this group was 3.6 days. There were no statistically significant differences in baseline characteristics between the two groups at the outset of the investigation.

Treatment Procedures

The control group was treated with conventional drug therapy including:

Acyclovir (200mg, three times a day)
Vitamin B1 (10mg, three times a day)
Ibuprofen slow release capsules (300mg daily)
Acyclovir topical ointment

The observation group was treated with a modified version of the herbal formula Long Dan Xie Gan Tang containing the following herbs:

Sheng Di 30g
Che Qian Zi 30g
Ban Lan Gen 30g
Huang Qin 15g
Chi Shao 15g
Zhi Zi 15g
Da Qing Ye 15g
Long Dan Cao 12g
Ze Xie 12g
Chai Hu 10g
Dang Gui 10g

Modifications

For patients suffering from concurrent constipation, Da Huang (10g) was added to the formula.
For patients with symptoms of exuberant heat, Sheng Shi Gao (30g), Zhi Mu (15g), and Mu Dan Pi (15g) were added.
For patients with pus-filled blisters, Pu Gong Ying (30g) was added.
For patients with severe pain, Zhi Ru Xiang (10g) and Zhi Mo Yao (10g) were added.
The herbs were decocted in water and one dose was taken daily, divided into two portions for morning and evening consumption. The patients in the observation group were also treated with acupuncture at the following acupoints:

Huatuojiaji (MBW35)
Zhigou (TB6)
Yanglingquan (GB34)
Yinlingquan (SP9)

Acupuncture was also administered locally in the area of herpetic rashes. Needles were inserted into the spaces between blisters, approximately 1.5 cun apart. The needles were manipulated slightly then withdrawn immediately, and the puncture was not sealed with cotton. The incidental drawing of a small drop of blood was considered a beneficial effect. The affected area was also warmed with a moxa cigar. Treatment was administered once daily. Both groups underwent treatment for a total of ten days, with an initial assessment of rashes after five days.

Clinical Outcomes

Patients with a complete resolution of rashes and clinical symptoms (including pain) were classified as cured. In patients with at least a 30% improvement in rashes and pain reduction, the treatment was classified as effective. In patients showing less than 30% improvement in rashes and no change or worsening of pain, the treatment was classified as ineffective.

In the drug control group, 15 patients were cured, 21 cases were classified as effective, and 8 cases were classified as ineffective, yielding a total effective rate of 81.8%. In the acupuncture and herbal medicine observation group, 25 patients were cured, 18 cases were classified as effective, and one case was classified as ineffective, yielding a total effective rate of 97.7%.

A combination of acupuncture and herbal medicine has been used for the treatment of shingles for over 1,000 years. This modern study confirms the efficaciousness of a common TCM protocol for the treatment of herpes zoster. A rethinking of usual care standards seems appropriate based on the findings. At the Healthcare Medicine Institute (HealthCMi), we examine traditional acupuncture continuing education standards and repeatedly find that an integrative medicine model for the treatment of shingles is superior to drug monotherapy. Let’s take a look at the second study in our review of shingles treatments.

Changjizhou and Jimusa’erxian TCM Hospital
The second study conducted by researchers at the Changjizhou and Jimusa’erxian TCM Hospital (department of acupuncture and moxibustion) determined that acupuncture and herbal medicine are effective for the treatment of shingles. [ii] For this study, a total of 40 patients were recruited and randomly assigned to either an observation or control group.

The observation group was comprised of 12 male and 8 female participants, ages 18–63 years (mean age 35.5 years). Their duration of disease was 1–10 days (mean duration 5.5 days) at the outset. The control group was comprised of 13 male and 7 female participants, ages 18–65 years (mean age 36.5 years). Their duration of disease was 1–8 days (mean duration 4.5 days). There were no statistically significant differences in baseline characteristics between the two groups at the outset of the investigation.

Treatment Procedures

Both groups were treated with herbal decoctions according to their TCM differential diagnoses. Patients diagnosed with excessive heat in the liver channel were prescribed a version of Qing Re Zhi Tong Tang containing the following herbs:

Lian Qiao 15g
Jin Yin Hua 15g
Huang Qin 10g
Zhi Zi 10g
Huang Lian 10g
Long Dan Cao 5g
Gan Cao 5g
Da Qing Ye 25g
Ling Ci Shi 25g

Patients diagnosed with spleen deficiency with accumulation of pathogenic dampness were prescribed a version of Chu Shi Wei Ling Tang containing the following ingredients:

Cang Zhu 10g
Chen Pi 10g
Shao Bai Zhu 10g
Che Qian Zi 15g
Ze Xie 15g
Fu Ling 15g
Jin Yin Hua 15g
Long Dan Cao 5g
Ling Ci Shi 25g

Both decoctions were taken as a daily dose for a total of 21 days. Patients in the observation group also received acupuncture in the area affected by the herpetic rash. Following standard disinfection, 3–6 needles were inserted surrounding the rash at a distance of approximately 0.5–1cm. The needles were inserted transversely to a depth of 20–50mm, angled towards the midpoint of the rash. The needles were manipulated using a balanced reinforcing-reducing method and were retained for 30 minutes. Treatment was administered daily for 14 days.

Clinical Outcomes

For patients whose rash and clinical symptoms fully resolved, treatment was classified as markedly effective. For those whose rash improved by more than 70% and experienced some reduction in pain, treatment was classified as effective. For those whose rash improved by less than 30% and experienced no reduction in pain, treatment was classified as ineffective.

In the control group, there were 10 markedly effective, 6 effective, and 4 ineffective cases, yielding a total effective rate of 80%. In the observation group, there were 15 markedly effective, 4 effective, and one ineffective cases, yielding a total effective rate of 95%.

The patients also rated their pain using a visual analog scale (VAS). VAS scores of 7–10 indicated severe, unbearable pain. Scores of 4–6 indicated severe but tolerable pain, 1–3 indicated mild pain, and scores of 0 indicated a complete absence of pain. At the beginning of the study, mean VAS scores in the control group and observation group were 7.36 and 7.25 respectively. By the end of the study, scores decreased significantly to 4.20 and 2.04 respectively, with significantly greater improvements in the observation group. The results indicate that a combination of acupuncture and herbs is more effective than using only herbal medicine.

Yungang Community Sanitation Service Center
The final study we will examine was conducted by researchers at the Chinese medicine and acupuncture department of the Yungang Community Sanitation Service Center in Beijing. [iii] A total of 36 herpes zoster patients were recruited for the study and were treated with acupuncture, herbs, and cupping therapy. The study group was comprised of 8 male and 28 female patients, ages 25–78 years. Of these participants, 8 had a disease duration of less than 2 days, 11 had a disease duration of 2–14 days, and the remaining 17 participants had a disease duration of over 14 days at the outset of the study.

Treatment Procedure

All patients were treated with a version of Long Dan Xie Tang and Wu Wei Xiao Du Yin. The ingredients were as follows:

Sheng Di 20g
Hei Shan Zhi 15g
Long Dan Cao 10g
Huang Bai 10g
Chai Hu 10g
Huang Qin 10g
Che Qian Zi 10g
Ze Xie 10g
Mu Tong 10g
Sheng Gan Cao 10g
Jin Yin Hua 10g
Lian Qiao 10g
Ye Ju Hua 10g
Zi Hua Di Ding 10g
Pu Gong Ying 10g

Modifications

For patients suffering from concurrent constipation, Da Huang (10g) and Lai Fu Zi (10g) were added to the formula.
For patients with symptoms of excessive heat, Huang Lian (10g) was added.
For patients with severe pain, Chuan Lian Zi (10g) and Yuan Hu (10g) were added.
The herbs were decocted in water on a daily basis and were subsequently divided into three portions to be taken morning, noon, and evening. Acupuncture was administered in the area of the herpetic rashes. Needles were inserted between blisters and were stimulated using a reducing method to elicit a distending pain in the region. Needles were retained for 30 minutes.

Modifications

For patients whose symptoms originated in the area of the limbs, Quchi (LI11), Taichong (LV3), and Chezi (LU5) were added.
For those whose symptoms originated on the back of the torso, Huatuojiaji (MBW35) and Hegu (LI4) were added.
For those with a TCM diagnosis of liver fire blazing, Taichong (LV3), Chize (LU5), and Zhigou (TB6) were added.
For those with a TCM diagnosis of damp-heat in the Stomach and Spleen, Xuehai (SP10) and Sanyinjiao (SP6) were added.
For those with a TCM diagnosis of qi stagnation and blood stasis, Geshu (BL17) was added.
Needles at Huatuojiaji points were inserted perpendicularly to a depth of 0.7–0.8mm. The needles were manipulated using a balanced reinforcing-reducing method, and after the arrival of deqi, were retained for 20 minutes. Needles at the remaining acupoints were inserted and manipulated using a lifting, thrusting, and rotating reducing technique. These needles were also retained for 20 minutes. Treatment was administered daily for a total of ten days.

Cupping therapy was administered on every third day of the treatment period. A three-edged needle was used to puncture the skin surrounding the herpetic blisters. For those with a relatively small area affected by the rash, a single puncture was made. For those with a larger rash, the punctures were made approximately 3–5cm apart. A cup was then placed over the puncture(s) and were retained for 10 minutes.

Clinical Outcomes

Patients with a complete resolution of both rashes and associated pain were classified as recovered. For patients whose symptoms resolved almost completely, the treatment was classified as markedly effective. For patients whose symptoms partially resolved, the treatment was classified as effective. For patients whose symptoms did not improve or worsened, the treatment was classified as ineffective.

For patients whose symptoms had been present for less than two days, all 8 were fully recovered, yielding a 100% effective rate. Among those whose symptoms had been present for 2–14 days, 5 were classified as recovered and 2 were classified as markedly effective, yielding a total effective rate of 63.6%. For those whose symptoms had been present for over 14 days, one was classified as recovered and one was classified as effective, yielding a total effective rate of 11.8%.

Results

The results of three independent studies indicate that acupuncture combined with herbal medicine is a highly effective treatment combination for rashes and pain associated with the herpes zoster virus. Additionally, treatment is significantly more effective the earlier it is administered. For more information, contact a local licensed acupuncturist to learn about treatment options in your area.

References
[i] Cao Bo (2018) “Clinical Study of Longdan Xiegan decoction Combined with Acupuncture and Moxibustion for Herpes Zoster” Guide of China Medicine Vol.16(25) pp. 174-175.
[ii] Zhang Qin, Ding Yujie (2018) “Study on the Effect of Dialectical Treatment with Chinese Medicine and Acupuncture on Clinical Symptoms of Herpes Zoster Neuralgia” Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine Vol.6(25) pp. 134.
[iii] Zhao Yun (2018) “Observation on the Effect of Combined Chinese Medicine and Cupping Method on 36 Patients with Herpes Zoster” Traditional Chinese Medicine Vol.16(16) pp.172-174.

Source: HealthCMI

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