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Deputy Chief Physician Cui Jianjun
General Hospital of Inner Mongolia Forestry, General Department of Traditional Chinese Medicine
Herpes zoster, from the perspective of traditional Chinese medicine, can be classified as waist-wrapped fire pill or snake string sore. Traditional Chinese medicine generally divides it into qi stagnation and blood stasis, phlegm stagnation, qi deficiency and blood stasis, damp-heat accumulation and so on. The treatment of qi stagnation and blood stasis is mainly to promote qi circulation and blood circulation to remove blood stasis, and Dachaihu Decoction, Guizhi Fuling Pill and Shaoyao Gancao Decoction can be selected for treatment. The treatment of phlegm obstruction is mainly to strengthen the spleen and eliminate phlegm, dredge collaterals and relieve pain, and Gualou Honghuagang Decoction and Platycodon grandiflorum Glycyrrhizae Decoction can be used for treatment. The treatment of qi deficiency and blood stasis is mainly to replenish qi and nourish blood, and Huangqi Guizhi Wuwu Decoction and Shaoyao Gancao Decoction can be used for treatment. The treatment of damp-heat accumulation is mainly to clear away damp-heat in liver and gallbladder, and Longdan Xiegan Decoction can be used to adjust it.
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treatment according to syndrome differentiation
1. Damp-heat in liver and gallbladder
Symptoms: red rash, tight swelling of blister wall, burning and stabbing pain, bitter mouth, dry throat, thirst, irritability, loss of appetite, dry stool, yellow urine, red tongue, thin yellow or thick fur, and slippery and thready pulse.
Discrimination:
(1) Syndrome Differentiation: The main points of this disease are red rash, tight swelling of blister wall, burning and tingling, red tongue, yellow fur and number of pulse strings.
(2) Pathogenesis: Damp-heat in the liver and gallbladder, suffocating the skin and seeing red blisters; Damp-heat stagnation is burning and stinging; Heat injury to body fluid leads to bitter mouth, dry throat, dry stool and yellow urine; The liver is just dirty, and the damp-heat in the liver and gallbladder is irritable. Herpes zoster treated by Chinese medicine is characterized by red tongue, yellow fur and slippery pulse.
Treatment: The prescription for clearing liver fire and clearing away heat and toxic materials is Longdan Xiegan Decoction. The commonly used drugs are Gentiana, Gardenia, Scutellaria baicalensis, Lithospermum, Radix Isatidis and Fructus Toosendan.
2. Spleen meridian is full of dampness
Symptom: The color of herpes colliculus is pale, the blister wall is slack, the pain is slightly mild, the mouth is not thirsty or thirsty, and it doesn't want to drink. It doesn't think about diet, and the abdomen is distended after eating, and the stool is loose. Female patients have more leucorrhea, light and fat tongue, thick or greasy white fur, and slow or slippery pulse. Traditional Chinese Medicine Treatment of Herpes Zoster
Discrimination:
(1) Syndrome Differentiation: This syndrome is characterized by light skin color, no thirst in mouth, no appetite, abdominal distension after eating, thick or greasy white fur, and slow or slippery pulse.
(2) Pathogenesis: improper diet, spleen dysfunction, endogenous damp-heat, dampness blocking qi-flowing, stagnation of skin, and skin pimples. Traditional Chinese medicine treatment of herpes zoster results in light skin color and loose blister wall due to dampness exceeding heat; Damp-evil blocking middle energizer leads to thirst, less food and abdominal distension, loose stool. Herpes zoster is treated by Chinese medicine with fat tongue, thick or greasy white fur, and slow or slippery pulse.
Treatment: The prescription is modified with Chushi Weiling Decoction, and the commonly used drugs are Atractylodis Rhizoma, Poria, Coicis Semen, Talcum, Codonopsis pilosula and Alisma orientalis.
3. Qi stagnation and blood stasis
Syndromes: Blister subsides, local pain persists, skin color is dark red, taupe or pigmentation, the pain is aggravated at night or in rainy days, the tongue is dark and coated with white fur, and the pulse is thin.
Discrimination:
(1) Syndrome Differentiation: In this syndrome, the pain is not only the key point of syndrome differentiation after the disappearance of herpes colliculus, and it is more common in the elderly.
(2) Pathogenesis: old and weak, lack of qi and blood, and poor circulation; Damp-heat of liver meridian and excessive dampness of spleen meridian can block qi movement; The circulation of qi and blood is not smooth, which stagnates the skin, and it hurts if it is blocked. Although the evil of damp-heat has subsided, the stagnation of qi and blood has not been solved, so the rash has subsided and the pain continues. The dark tongue with white fur and thin pulse is the image of herpes zoster with qi stagnation and blood stasis.
Treatment: The prescription is Taohong Siwu Decoction, and the commonly used drugs are peach kernel, safflower, Ligusticum chuanxiong, white peony root, Cyperus tuber, corydalis tuber and so on.
Empirical formula
Shedan Decoction: Radix Isatidis and Radix Isatidis each 60g, Radix Arnebiae 1 0g, Radix Scutellariae10g, and Flos Lonicerae 30g, decocted in water, daily1dose. Olibanum and Myrrha10g are added to the patients with severe pain, and Cortex Dictamni Radicis and Fructus Kochiae10g are added to the patients with severe itching. For external use, Qilisan is dissolved in boiling water and applied to the affected area, 2 ~ 3 times a day.
Sanzi Decoction: Radix Arnebiae, Radix Scrophulariae, Herba Violae, Semen Plantaginis, Poria Skin, Caulis Akebiae, Radix Scrophulariae, Folium Isatidis, and Radix Glycyrrhizae.
Decoction with rash: Radix Salviae Miltiorrhizae, Radix Paeoniae Alba, Radix Bupleuri, Radix Isatidis, Herba Scutellariae Barbatae, Radix Gentianae Macrophyllae, Radix Gentianae, Radix Angelicae Sinensis, Fructus Gardeniae, Scutellariae Radix, Rhizoma Corydalis, and Radix Glycyrrhizae.
Zilanbaichi Decoction: Radix Arnebiae, Radix Isatidis, Cortex Dictamni Radicis, Radix Paeoniae Rubra, Cortex Moutan, Periostracum Cicadae, Herba Menthae, Coicis Semen and Radix Sophorae Flavescentis.
Other therapies
1. External treatment method
Liushen Pills: take 5 ~10 capsules three times a day with warm water. Generally, the pain can be relieved that night after taking the medicine, and the color of herpes in the affected area becomes dark the next day, and it can be cured in 3 ~ 5 days.
Qilisan: 3 times a day, each time 1. 2g, taken with warm boiled water or yellow wine. Generally, after taking the medicine1~ 2 days, the pain will be relieved or disappeared, the herpes will begin to subside in 2 ~ 3 days, and it will dry and scab in 4 ~ 6 days.
Ice boron powder: Take a proper amount of ice boron powder, mix it with vaseline and apply it to the affected area, once a day/kloc-0, usually for 2 ~ 3 days to improve the symptoms.
30g of rhubarb, 30g of phellodendron chinense and 30g of coptis chinense, 5g of frankincense and 5g of myrrh. Grind the medicine into fine powder, add a proper amount of strong tea water, make it into paste and apply it externally to the affected area.
The fresh tuber of one flower with seven leaves is mashed and applied to the affected area. Generally, after half an hour, the heat will relieve the pain, and the herpes will subside after1~ 2 times.
Clean fresh purslane12g, mash it into paste and apply it to the affected area, and change the dressing twice a day.
30g of rhubarb, 30g of phellodendron, 2 1 g of fly talc, 60g of indigo naturalis, 5g of borneol and 0g of licorice 10. * * * After grinding into fine powder, mix well, add vaseline and paste for later use, and apply externally to the affected area.
Eucalyptus grandis was decocted in water to make 10% solution, and the affected area was wet-applied with gauze soaked liquid medicine.
Apply persimmon liquid to the rash and surrounding pain, 3 times a day. 64 cases were treated, with an average of 3. 2～4。 The rash subsided in 7 days, and the neuralgia disappeared in 3 ~ 4 days on average.
2. Acupuncture therapy
Acupuncture points Hegu (both sides), Zhigou and Yanglingquan (all on the affected side) were selected, and peripheral needles were used for local lesions. The number of peripheral needles was determined according to the size of the lesion, with a maximum of 15, a minimum of 4, and no herpes. The puncture was made at an angle of 15 degrees at 5 inches, and all of them were treated by diarrhea.
Acupoints Neiguan, Yanglingquan and Zusanli were selected, and needles were placed around some points for flat needling, and the needles were kept for 30 minutes, once a day/kloc-0; If the pain of sequela persists, add a branch groove or Gall to the liver area and bury the needle for 3 days.
3. Moxibustion therapy
Commonly used acupoints: Ashi (affected area).
Operation method: You can choose direct moxibustion with moxa cone, and apply it at both ends and bifurcation of the rash. The amount of moxibustion is the degree that the patient feels burning and can tolerate. This method is suitable for adults and the parts where moxa cone should be placed in the rash. You can also choose hot moxibustion with moxa sticks, that is, depending on the size of the rash (lesion), after lighting with 2 or 3 sticks of clear moxa sticks, you can perform rotary moxibustion locally until the lesion is bloodshot and red, and the pain and itching disappear to a degree, and the time is about 20-30 minutes.
This method is suitable for children or areas where the rash is not suitable for placing moxa cones. 1 time a day, twice a day for patients with neuralgia and rash, or three times for a few patients, 1 time is a course of treatment, and1half a course of treatment is continuous.
Principle: Herpes zoster is caused by intense heat, toxic evil, stagnation of meridians and stagnation of qi and blood. Moxibustion at Ashi point is used to dredge local blood collaterals, induce heat with heat, induce pathogenic factors to disperse, and pull out toxic stagnation. In addition, as a warm stimulus, moxa sticks have the function of promoting blood circulation and eliminating inflammation.
4. Blood pricking therapy
Pricking blood therapy is an effective treatment method under the guidance of the basic theory of traditional Chinese medicine, which can achieve the purpose of regulating qi and blood, balancing yin and yang and restoring healthy qi by bloodletting and eliminating pathogenic factors.
The etiology is mostly caused by wind-heat or damp-heat in the liver and gallbladder, which is caused by the skin.
Symptoms start suddenly, and the affected part first appears cord-like, tingling and burning. The blisters are as big as mung beans or soybeans, and they are as numerous as penetrating beads. They gather in one or several places and are distributed along the nerves, arranged in a band shape, but most of them are confined to one side of the body, the base is red, and the skin between the blisters is normal. The blister fluid is transparent at first, and gradually becomes turbid with occasional bleeding. Most of them are accompanied by mild fever, fatigue, loss of appetite and other systemic symptoms. Clinically, the disease is different from dry and wet, and red and yellow. Dry people are red in color, mostly liver and gallbladder wind-heat; Wet people are yellow in color, mostly due to damp-heat in liver and spleen.
Treat redness and swelling and the skin around the blister group. If accompanied by fever or severe herpes, it should be equipped with Zusanli, Quchi and Xuehai.
Methods: Blood-letting method was used. Puncture around the swelling and the surrounding skin with a triangular needle or a filiform needle every 1-2 cm to see bleeding. You can also use your hands to gently squeeze the puncture site to see bleeding, so as to make the evil blood drain out and relieve the swelling and pain. If accompanied by fever or severe herpes, the needle can be applied to the matching point with a millineedle, and the needle can be kept for 15 minutes by the method of flat reinforcing and purging. If you see herpes ulceration, you can prevent infection by applying gentian violet liquid medicine after the needle and applying sterile gauze externally. Treatment every other day 1 time, to the more severe.
5. Cupping therapy
The technique of treating acute herpes zoster with fire needle plus cupping (fire needle praise needling method) is a combination of the advantages and characteristics of traditional acupuncture methods such as fire needle therapy, pricking blood therapy, cupping therapy and cupping therapy. This method takes fire needle and cupping as the main instruments, and combines the operation methods of fire needle burning, fire needle pricking, pricking needle praise and cupping.
The introduction of ancient Chinese medicine professionals: choose one seven-star needle, one triangular needle, 4~6 glass cupping cups and some sterile gauze. The selected points are around the affected area, Fengxi point in the ear (between the finger area in front of the helix tubercle and the wrist area) and sensitive points in the corresponding parts.
Operation: Acupuncture around the affected area first, and then auricular points. The skin of the affected area is fully exposed. After iodophor disinfection, the operator tightens the skin around the affected area with his left thumb and forefinger. If the local little red dot (blister) is scattered and few, he can pinch the local skin, hold the back end of the seven-star needle with his right hand, press the forefinger on the needle handle, and use the force of his wrist to quickly tap and prick the skin around the affected area to make the skin faint. After operation, the appropriate type of glass cupping cup was selected according to the size of the tapping area, and it was adsorbed on the tapping part with the affected area as the center by flash fire method, so that the bleeding in the cupping ranged from several milliliters to more than ten milliliters.
Wipe the dirty blood with gauze after lifting the can; Then use the pressing method to find out the sensitive points and Fengxi points in the corresponding parts of the ear. After disinfection, fix the ear points with your left hand, prick with a triangular needle with your right hand, squeeze out a little blood and wipe it with a dry cotton ball. Every day 1 time, the ear acupoints are rotated left and right.
Traditional Chinese medicine believes that herpes zoster is caused by stagnation of fire in the liver meridian and damp-heat in the spleen meridian, which is evil when it is hot again, and the damp-heat accumulation invades the skin meridians. The treatment of this disease by pricking blood, cupping and auricular point pricking has a good effect, especially for herpes zoster in the early stage. After the seven-star needle is pricked with strong stimulation, the bleeding point can be seen, and then the blood stasis in the pinhole can be sucked out by cupping, which has the functions of promoting blood circulation, removing blood stasis, and expelling damp-heat and toxic fire, so as to achieve the goal of "general principle is painless".
By burning the needle tip of the fire needle red to white, its high temperature burns the local skin lesions, and by virtue of the thick needle body of the fire needle and the shallow needling with multiple needles, the local herpes skin lesions can be completely opened. In addition, with the strong adsorption of cupping, all local toxic pathogens and evil blood can be carried out, and the damaged parts can be fully nourished with new blood, thus achieving the functions of relieving pain and healing.
6. Diet therapy
Take Folium Isatidis15g. Radix Bupleuri15g. Japonica rice 309. Appropriate amount of sugar. Add 250ml of water to Folium Isatidis and Bupleuri Radix. Fry to 200ml, then add japonica rice and white sugar and cook it into porridge. Take one dose every day for 5 ~ 6 days.
taboo
1, avoid spicy and warm food.
Spicy and warm products such as wine, cigarettes, ginger, pepper, mutton, beef and fried food are easy to help fire and heat after eating. Traditional Chinese medicine believes that the disease is caused by damp-heat and toxic fire accumulated on the skin, so patients with the disease should avoid eating the spicy and hot food mentioned above.
2. Be careful to eat fatty and greasy products
Foods such as fat meat, caramel, milk and sweetness are mostly greasy and fat, which makes it easy for the disease to be full of damp-heat and toxic evil, and the disease is lingering.
3. Be careful to eat sour and astringent products
Sour and astringent products include peas, Euryale ferox, pomegranate, taro, spinach and so on. Traditional Chinese medicine believes that this disease is mostly caused by emotional disorder, stagnation of liver qi, prolonged stagnation of fire, and resumption of toxic pathogens, so the treatment should be based on promoting qi circulation, promoting blood circulation and removing blood stasis. However, the above-mentioned astringent and astringent products are easy to make qi and blood impassable, evil spirits can not go away, and the pain is aggravated.
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How does Yunnan Baiyao treat herpes zoster?
15-04- 13? Shu Ninglan? +Pay attention to the collection of flowers (1)
Herpes zoster is caused by varicella-zoster virus, with a high incidence in summer and autumn. At the initial stage of the disease, it is often accompanied by symptoms such as low fever and fatigue. At the initial stage of herpes, irregular or oval erythema will appear on the skin, and after a few hours, it will develop into a blister. With the development of the disease, it can merge into a large blister, and in severe cases, it will develop into a blood blister. If secondary infection occurs, pustules will appear. The pain is more severe at the onset.
Yunnan Baiyao has the effects of diminishing inflammation, relieving pain, detoxicating, detumescence, removing blood stasis and promoting granulation, and can be used to treat herpes zoster clinically. The specific methods are as follows:
1, Yunnan Baiyao powder directly applied externally:
(1) Treatment method: firstly, wash the affected area with normal saline and medical alcohol, then draw out the bubble liquid from the bottom of the blister wall with a sterile syringe, and then evenly apply Yunnan Baiyao to the affected area, and wrap the easily rubbed part with sterile gauze twice a day for eight days. Acyclovir ointment was used in the control group, and other treatment methods were the same as those in the experimental group.
Results: There were 23 cases in Baiyao group and 23 cases in control group, in which the effective rate was 95.65% in Baiyao group and 73.9 1% in control group.
(2) Song Huifeng and others used normal saline to make Baiyao paste for external application to treat herpes zoster; Yang Zhen used vinegar to mix Baiyao into paste for external application, and even directly mixed Baiyao with cold water, which achieved good therapeutic effects.
2, integrated traditional Chinese and western medicine therapy:
(1) treatment: the Baiyao group was given acyclovir intravenously every day, then Yunnan Baiyao was mixed with sesame oil and applied externally to the affected area, 2 ~ 3 times a day. The control group only received intravenous acyclovir. Seven days is a course of treatment. Herpes, pain and scab were observed on the 3rd, 5th and 7th days after treatment.
Results: The time of stopping blister, relieving pain, scabbing and healing in Baiyao group were shorter than those in control group (P <: 0.0 1）。
Lin Ruifeng and He Xiaoping used this method to treat 30 patients, and achieved good therapeutic effect.
(2) In addition, Miao Wei and Zhang Ruimei used acyclovir ointment with Yunnan Baiyao for external use; Liu Yuefen treated herpes zoster with Yunnan Baiyao external application and intravenous drip of ribavirin, and found that the therapeutic effects were ideal.
3. Physical therapy combined with Yunnan Baiyao to treat herpes zoster;
(1) Treatment method: After routine disinfection of the skin, puncture the central point of herpes with a triangular needle, the number of needles depends on the area of the affected skin lesion, and then pull out the acupuncture point with a large-caliber cupping for about 8 ~12 minutes. Wipe the skin behind the jar and make Yunnan Baiyao paste with vinegar twice a day, while the control group uses acyclovir ointment four times a day. Both groups were used continuously for one week.
Results: The analgesic time, detumescence time, scabbing time, healing time and course of disease in Baiyao group were significantly better than those in control group (P <: 0.0 1)。
(2) Chen Yiwei and others also adopted this method and achieved a therapeutic effect of 100%; Munk treated herpes zoster with semiconductor laser irradiation, then Yunnan Baiyao mixed with rapeseed oil into paste, and then irradiated the affected part with TDP therapeutic device, and the treatment effect was good.
4, Yunnan Baiyao treatment of postherpetic neuralgia.
(1) treatment method: Yunnan Baiyao capsules are taken orally, 2 capsules at a time, twice a day, and the affected area is massaged or irradiated by microwave and TDP.
Results: The analgesic effect was the fastest 1 day, the slowest for 6 days, and the effective rate was 100%.
(2) Chu Jinyu and others used Danshen injection, acyclovir tablets, vitamin B 1, B 12, painkiller tablets, glucocorticoid and Yunnan Baiyao aerosol for external use; Song Qixia and others used Xuefu Zhuyu decoction combined with Yunnan Baiyao external application; Min Yang and others used electroacupuncture and external application of Yunnan Baiyao to treat postherpetic neuralgia, and all of them had good therapeutic effects.
Discussion:
Herpes zoster is mainly characterized by local skin redness, pain and herpes. Traditional Chinese medicine believes that this disease is caused by weak vital energy, infection with damp-heat pathogens, and pathogenic toxins staying in the body, which are confined to meridians and burning the skin. Yunnan Baiyao can resist inflammation, reduce swelling, and promote the proliferation of granulation tissue, thus promoting the rapid healing of wounds. Yunnan Baiyao was used to treat herpes zoster in clinic. Many patients felt cool and the pain was relieved after applying Baiyao externally. At the same time, it can be seen from a large number of documents above that Yunnan Baiyao can also effectively promote the cure of herpes zoster, with low cost and safe use, which is worthy of clinical promotion.
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Liushen Pill can be used for the treatment of herpes zoster in clinic, but it is often a drug for external use. Liushen Pill can be used as an auxiliary drug in the treatment of herpes zoster, and it is generally not recommended that patients simply apply Liushen Pill to treat herpes zoster. Because in clinic, some patients have a large distribution of herpes zoster itself, and there has been obvious herpes ulceration, which is not suitable for the application of Liushen Pill to treat alone. If patients want to treat herpes zoster, they must go to the dermatology department of a regular hospital for treatment. Generally, on the basis of the application of antiviral drugs, adjuvant treatment can be carried out with acyclovir ointment, penciclovir ointment, Liushen pill, etc., and often a good therapeutic effect will be received.
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Liushen pill is useless in treating herpes zoster. Herpes zoster, known as snake-like sores in Chinese medicine, is generally caused by stagnation of heat in the liver and gallbladder, and the traditional Chinese medicine treatment is purging the liver and gallbladder and detoxifying. The main Chinese patent medicines used are Longdan Xiegan Pill or Longdan Xiegan Capsule. In addition to treating herpes zoster with Chinese patent medicine, western medicine, such as valaciclovir or famciclovir tablets, can also be taken orally to prevent viruses, and drugs that nourish nerves, such as vitamin B and mecobalamin tablets, can be taken orally to improve the symptoms of nerve damage.
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What is the difference between acyclovir and penciclovir?
They are nucleoside broad-spectrum antiviral drugs. Clinically, it is mainly used for anti-herpes virus. Comparison: Penciclovir ointment in the treatment of recurrent herpes simplex takes effect faster and has shorter course of treatment than acyclovir for external use. Pharmacological action of penciclovir: penciclovir is phosphorylated by virus thymine deoxynucleoside kinase into penciclovir monophosphate, and then cell kinase converts penciclovir monophosphate into active penciclovir triphosphate, which competes with deoxyguanosine triphosphate to inhibit herpes virus polymerase, thus inhibiting virus DNA synthesis and blocking virus replication.
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Acyclovir ointment+Liushen pill = treatment of herpes zoster.
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Longdan Xiegan Pill+Daiciclovir +VB+ Mecobalamin Tablets to improve nerves.
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What is the difference between acyclovir and penciclovir?