Traditional Chinese medicine believes that herpes zoster is caused by liver and gallbladder fire, spleen dampness for a long time, and exogenous toxic evil. Modern medicine has known that this virus invades the body from respiratory infection and lurks into nerve cells in the posterior root ganglion of spinal nerve or other pathological parts. This kind of virus can not get sick at ordinary times, but it is easy to get sick because of the weak physical resistance of the elderly and people who have been ill for a long time, and then encounter physical fatigue, colds and other incentives. Pathogenesis: People who have no immunity or low immunity after virus infection (mostly children) can have primary infection, namely chickenpox. Or latent infection virus, spread to the sensory nerve endings of skin through blood, spread to the dorsal root of spinal nerve or trigeminal nerve through nerve pathway, and then spread to sensory ganglion neurons of cranial nerve. When the body's immunity declines (such as trauma, cold, cancer, immune system diseases, etc. ), the latent virus will multiply in large numbers, causing inflammation and necrosis of ganglia, bringing pain to patients, and at the same time, the virus will spread down the nerve pathway, causing segmental herpes in this innervated area. Viruses can also infect motor neurons, causing muscle weakness and motor paralysis in patients, but this is rare. At the initial stage of the disease, it mainly manifested as general fatigue, loss of appetite and mild fever, and soon the affected area felt burning and painful. If it happens in the chest or waist, it is often misdiagnosed as heart disease or acute abdomen.
After getting herpes zoster, 1 ~ 3 days later, papules and blisters with great tension and the size of mung beans appeared on the affected skin, which were distributed along the nerves and arranged in clusters in strips. If it occurs in the chest and waist position, it tends to tilt downward from one side of the spine and rarely occurs symmetrically. Folklore: If there is a herpes around the waist, it will be life-threatening and unreliable. In patients with this disease, normal skin can be separated from each cluster, and in severe cases, it can be combined with a large area of banded distribution. After a few days, clear and transparent blisters will become turbid pustules, and some will break out. Old people often have bullae, blood blisters and even necrosis. The lighter person can naturally dry up and scab in about three weeks, leaving no scars after falling off; In severe cases, the course of disease can be extended to more than one month. Elderly patients often have severe pain, which affects their sleep. If the treatment is not timely, the pain will remain after the skin lesions subside and will not completely subside for several months. If herpes zoster appears on the head and face, be alert to headache and facial paralysis caused by nerve invasion on the head and face. If the cornea of the eye is invaded, it may even lead to blindness. Older people, people with weak constitution and people with chronic diseases such as tumors will get worse. It is worth noting that an incomplete herpes zoster is also very common in clinic. In addition to the severe pain in the affected area, blisters do not appear or rarely appear, which is easy to be misdiagnosed. We should attach great importance to it so as not to delay treatment and find serious consequences.
Patients with herpes zoster should seek medical diagnosis and active treatment as soon as possible without local pain.
treat cordially
First, it is mainly general and symptomatic treatment. Principle: anti-virus, relieve pain, prevent secondary infection and shorten the course of disease.
Neuralgia: Analgesics such as aspirin, metamizole, indomethacin, ibuprofen and Xinhuang tablets can be given. Postherpetic neuralgia requires a combination of analgesics and sedatives, such as doxepin 25mg, taken orally three times a day; Cimetidine 0.2g, dexamethasone 1.5mg, cyproheptadine 2mg, taken orally, three times a day, and intramuscular injection of vitamin B 12 100μ g once a day, for a total of 10 days.
② Local skin care and treatment; External use of phthalamide liniment or calamine lotion, 3-5 times a day, 1. Patients with erosion were treated with 2% gentian violet solution or neomycin bran ointment. Or ultraviolet irradiation, audio electrotherapy, laser irradiation (He-Ne or carbon dioxide beam expansion irradiation), TDP spectrum irradiation, etc.
③ Ophthalmic herpes zoster: herpes simplex or acyclovir solution eye drops can be used, and atropine can be used to dilate pupils to prevent corneal adhesion;
Second, antiviral therapy is mainly used for patients with immunodeficiency or immunosuppression, cytarabine or acyclovir. Oral highly effective antiviral drugs: acyclovir, valaciclovir, etc. (Clinical tip: acyclovir is ineffective in the treatment of postherpetic neuralgia) and topical acyclovir eye drops on the affected area. Oral antibiotics or erythromycin ointment can be applied to the affected area. If the blister breaks, you can apply 2.5% gentian violet solution to the affected area. Corticosteroids: Short-term use, be careful!
Three, for patients who are using cytotoxic drugs, immunosuppressants or metabolic antagonists, because the virus is easy to spread, we should try to reduce the dose or stop using it.
Fourth, it can be combined with traditional Chinese medicine and acupuncture therapy for clearing away heat and toxic materials. It is suggested that Chinese patent medicines, such as those with excessive liver fire, take Longdan Xiegan Pill orally; For those with spleen deficiency and dampness, take Ling Wei Pill or Shen Ling Baizhu Pill orally; For patients with blood stasis, take Xuefu Zhuyu Pill orally.
The dosage and usage of the above drugs should be in accordance with the doctor's advice.
During the treatment, you should stay in bed, pay attention to nutrition, wear clean and soft cotton underwear and reduce friction. If the pain affects sleep, you can take some sedatives and painkillers appropriately. Spring is the epidemic season of many infectious diseases, so the elderly and the physically weak should go to public places with unclean air as little as possible to avoid infection. Always keep exercising, keep a happy mood and live a regular life.
Chickenpox-herpes zoster is a DNA virus with a volume of 2 10 ~ 250 nm. It can be transmitted through the respiratory tract, but it is highly contagious.
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Acupuncture treatment of herpes zoster
Dr. Gao Zonggui, the attending physician of the Affiliated Hospital of China Medical College in Taiwan Province Province, was selected from FreeHospital @ 163.net.
Herpes zoster is a virus infection, also known as Yaohuowan, beaded sore, spider sore and so on.
First, the cause of herpes zoster:
(1) Description of modern medicine:
A. Herpes zoster is a viral infection.
B. The virus causing herpes zoster is the same size and antigenicity as varicella virus. Therefore, this disease is also considered to be caused by the reactivation of the first infection with chickenpox virus (Chicken-poxor vaccilla) lurking in sensory ganglia many years ago.
C. It probably won't recur after once (people who are extremely weak occasionally get a second time).
(2) Description of traditional medicine:
A. This disease is mostly caused by emotional exhaustion and eating disorder, which leads to spleen loss of healthy transport, dampness stagnation, heat stagnation and damp heat, and toxic evil.
B From the point of view of acupuncture, herpes zoster is mostly caused by hyperactivity of heart meridian, damp-heat of spleen and lung, and hyperactivity of liver and gallbladder.
Second, the symptoms of herpes zoster:
(1) Description of modern medicine:
A. Often sudden, clustered blisters (red maculopapules, banded arrangement, banded arrangement) appear along the distribution area of one side peripheral ganglion.
B. The pain is severe, and most patients have persistent pain, and the pain often does not disappear after the rash heals.
C the precursor of the disease is pain around the nerve trunk that lasts for about three days, and most of them are complicated with lymph node swelling and pain.
D. The rash is continuous banded or patchy, distributed in one or several nodules along the nerve. At first, it is a raised erythema, which quickly forms a group of blisters the size of the central umbilical fossa, gradually turns into blood blisters or even pustules, and finally covers with necrotic scabs.
E. It often invades the waist, hypochondrium, chest, neck, face and inner thigh, and generally does not exceed the midline (a few patients with serious illness or extremely poor physical strength occasionally cross the midline, forming a bilateral phenomenon).
F the distribution of herpes zoster in the chest and abdomen obviously stops at the midline, and there is no possibility of spreading to the opposite side, which is a diagnostic feature.
G. Invasion of trigeminal nerve, neck or lumbosacral part sometimes brings trouble to diagnosis.
H. The ophthalmic branch of the trigeminal nerve may also be a fragile place. After a typical rash appears, headache will be inevitable.
First, the nasociliary branch is invaded, and blisters can appear on both sides of the nose.
J. Eye changes can range from conjunctivitis, conjunctival keratitis and even iridocyclitis with green cataract, and the clinical symptoms are usually shame and tingling.
K. When the patient's resistance decreases due to leukemia and lymphoma, the rash is not only localized, but also scattered blisters, similar to chicken pox scattered on limbs or trunk. If such clinical symptoms appear, the patient should be carefully examined for potential leukemia.
Skin diseases usually heal in ten days after onset, and severe necrosis will delay herpes zoster on the forehead, with a course of about 4-6 weeks.
M This disease is extremely rare in children under 15 years old, and most patients are over 45 years old.
(2) Description of traditional medicine:
A. According to the record of "waist-wrapped fire pill" in Jin Jian, the disease is commonly known as snake string sore, and Taiwan Province Province is called flying snake.
B. There are differences between dry and wet, red and yellow, all like countless beads. Dry people are red in color and shaped like clouds, and wind millet rises on them, causing pain and fever. Wet people are yellow and white in color, and blisters vary in size, which is more painful than dry people.
C. According to the record of spider sores in the Xuan of Surgery, this sore is born between the skins and looks like a water nest. It's red and painful, and five or seven piles can also provide shade.
Third, the treatment of herpes zoster:
(1) Modern medical care:
1. The following situations need special treatment:
(1) Face: Herpes zoster may leave scars, and the area is not small, so it must be treated as soon as possible. If it is in the eye branch of trigeminal nerve, it may cause corneal ulcer and cause visual impairment.
(2) The elderly: over 60 years old, herpes zoster can cause severe neuralgia lasting for several months. Neuralgia is an intermittent tingling caused by inflammation of nerve fibers themselves.
(3) Immunodeficiency: For example, herpes zoster in cancer patients can spread to all organs of the whole body, including pneumonia and encephalitis.
In the above three cases, acyclovir 800mg can be used, five times a day for five consecutive days, which can inhibit virus reproduction. Prednisolone 60mg/ day can be started on the second day after using acyclovir, which can inhibit neuroinflammation and continue to be used for ten days, but it is not suitable for immunocompromised people.
2. Treatment measures
(1) General patients should pay attention to avoid bacterial infection and relieve pain, and topical ointment containing antibiotics can be used.
(2) Cold compress: Soak the gauze in normal saline or cold boiled water for 30 minutes each time, three times a day, which can quickly dry the affected area and relieve the pain.
(3) Patients who can rest in bed should reduce the friction of clothes, and the pain and discomfort will be alleviated.
(4) If the pain is severe, you can take a tablet of Demerol.
(5) Capsaicin ointment can be used to relieve neuralgia.
(6) Codeine often effectively relieves pain.
(7) Generally, oral corticosteroids can not shorten the course of disease, but can prevent post-treatment neuralgia caused by the elderly.
(8) It is a simple and effective method to spray freeze along the ganglion with chloroethane.
(9) However, painkillers have no good effect on many patients.
(10) Mental function has a great influence on neuralgia, so patients should be encouraged to return to their original jobs.
The recommended prescription is as follows:
(1) dicloxacillin 250 mg, one capsule every 6 hours.
(2) ibuprofen, take one pill every 6 hours after meals.
(3) Panadol, take one pill every 6 hours after meals.
(4) Diazepam, one tablet before going to bed.
(2) Traditional medical care:
According to syndrome differentiation, there are three kinds of treatment methods:
1. Hot filling type:
【 Main symptoms 】 The local lesions are bright red, the blister wall is tense and burning. Consciously bitter mouth, dry throat, thirst, boredom, irritability, loss of appetite. Red urine, dry stool or discomfort. Red tongue, thin yellow or thick yellow fur, and slippery pulse.
Dialectically speaking, excess heat in the liver and gallbladder, qi stagnation and dampness resistance, also have a sense of toxicity and evil.
[Treatment] Clearing away dampness and heat, detoxifying and relieving pain.
[Prescription] Longdan Xiegan Decoction.
2. Wet filling type
Indications: Pale complexion, loose blister wall, mild pain, no thirst or thirst, no appetite, abdominal distension after eating, long defecation, and frequent leucorrhea in female patients. The tongue is light and fat, with thick or greasy coating and slow or slippery pulse.
[Dialectics] Spleen loses health, accumulates dampness, and feels toxic and evil.
[Treatment] Strengthening the spleen and promoting diuresis, supplemented by detoxification.
[Prescription] Jiawei Chu Shi Ling Wei Decoction.
3. Qi stagnation and blood stasis type:
Indications: local pain persists after the rash subsides. The tongue is dark, with white fur and thin pulse.
[Dialectics] Qi stagnation and blood stasis, and the residual poison is not exhausted.
[Treatment] Promote blood circulation to remove blood stasis, promote qi circulation to relieve pain, and clear residual poison.
[Prescription] Huoxue Sanyu Decoction is modified.
(3) Acupuncture treatment:
Length According to the principle of "unblocking and curing diseases", the following meridians are selected:
A hair on the face, involving trigeminal nerve:
A. Invasion of ocular branches: bladder meridian, gallbladder meridian, triple energizer meridian and small intestine meridian are selected.
B. Maxillary branch: choose stomach meridian, small intestine meridian and gallbladder meridian.
C. Mandibular branch: choose stomach meridian, large intestine meridian and gallbladder meridian.
B. Hair on the neck:
A. Stomach Meridian: 65438+ 0.5 inch outside any pulse is the place where the carotid artery beats.
B. Large intestine meridian: on the anterolateral side of the neck, 3.0 inches away from Ren meridian.
C small intestine meridian: neck side, 3.5 inches beside ren mai.
Hair on the chest, waist and back:
A. Renmai: follow the principle of the center of the chest and abdomen, and take the center with the side of the ward.
B: Kidney meridian: abdomen-0.5 inch away from Ren meridian of China Bank.
Chest-2.0 inches from the midriff.
C. stomach meridian: abdomen-2.0 inches away from the ren meridian of the Bank of China.
Chest-4.0 inches from the midriff.
D Spleen Meridian: abdomen-3.5 inches away from any meridian in Zhongjiao.
Chest-6.0 inches from central China.
E. Liver meridian: running through diaphragm and spreading ribs.
F gallbladder meridian: it runs along the flank and is directly threatened by the season.
G bladder meridian: the main surface, distributed in the back of waist, 1.5 inch, 3.0 inch away from Du meridian.
H. Du meridian: The main back is in the middle of the spine, leading a Yang meridian.
D. Hair on legs:
A. stomach meridian: walk in front of your legs.
B. gallbladder meridian: walk in the middle (side) of the leg.
C. Bladder Meridian: Take the leg to the sunny posterior approach.
D Spleen Meridian, Liver Meridian and Kidney Meridian: Walk the front, middle and back of the shady side of the leg.
2. Prescription for acupoint selection (acupoint selection):
A. face
(1) gallbladder meridian:
(a) Distal acupoints: Yanglingquan, Zuliqi and Jueyin.
(2) Local acupoints: Pupil glue, Shangguan, Audition and Fengchi.
(2) Stomach meridian:
(a) Distal acupoints: Zusanli, Shangjuxu, Neiting and Fenglong.
(2) Partial acupoint selection: Chengqi, Sibai, Cang Di and Buche.
(3) Large intestine meridian:
(1) Remote acupoints: Hegu, Quchi, Zusanli and Pianli.
(2) Local acupoints: Hejiao and Xiang Ying.
(4) Triple energizer meridians:
(1) Distal acupoints: Zhigou (ten general acupoints: seeking rib Zhigou), Zhongzhu and Waiguan.
(b) Local acupoints: four-pillar hole, ear point and wind point.
B. Neck:
(1) stomach meridian:
(a) Distal acupoints: Zusanli, Shangjuxu, Neiting and Fenglong.
(2) local acupoint selection: people should be careful not to stab the trachea, nerves or blood vessels. Generally shallow, it is best not to leave a needle).
(2) Large intestine meridian:
(1) Remote acupoints: Hegu, Quchi, Zusanli and Pianli.
(2) Partial acupoint selection: floating map and zenith.
(3) small intestine meridian:
(1) Remote acupoint selection: providing for the aged, nourishing the valley and supporting the right.
(2) Local acupoint selection: skylight, skylight.
C. chest, waist and back:
(1) Ren Mai: Lian Quan, Cheng Jiang, Tan Zhong.
(2) Kidney Meridian:
(1) Far point selection: Taixi and Zhubin.
(2) Partial acupoint selection: Yangzhong and Yufu.
(3) Stomach Meridian:
(a) Distal acupoints: Zusanli, Shangjuxu, Neiting and Fenglong.
(2) Partial points: two doors, Shu Tian, waterway, no entry, warehouse and residence.
(4) Spleen Meridian:
(1) Far point selection: Gongsun, Xue Hai and Sanyinjiao.
(2) Partial acupoints: Zhou Rong, Xiongxiang and Dabao.
(5) Liver meridian:
(1) Remote point selection: Taichong, Zhongfeng and Middle.
(2) Partial acupoint selection: Qimen.
(6) gallbladder meridian:
(a) Distal acupoints: Yanglingquan, Zuliqi, Shi Feng and Jueyin.
(2) Local acupoints: Sun, Moon, Body Fluid and Meridian.
(7) Bladder Meridian:
(1) Remote acupoints: Weizhong, Kunlun, Chengshan and Jinggu.
(2) Local acupoints: Dajue, Ganshu, Danshu, Shu Wei and Shu Fei.
D. legs:
(1) stomach meridian:
(a) Distal acupoints: Zusanli, Shangjuxu, Neiting and Fenglong.
(2) Local acupoint selection: Vertebral Pass and Floating Diagram.
(2) gallbladder meridian:
(1) Far point selection: Yanglingquan and Zulinqi.
(2) Partial acupoint selection: dwelling in the glue, wind and jumping around.
(3) Bladder Meridian:
(1) Remote acupoints: Weizhong, Kunlun, Chengshan and Jinggu.
(2) Local acupoint selection: Yinmen and Rank Edge.
E. local acupoint selection at the lesion site:
A. Yang needling around the blister (i.e. five needles horizontally at the position 0.5- 1.0 inch away from the bulb blister) or local moxibustion (purging method).
B. When the needle is applied, the needle tip will pierce the central area of herpes at an angle of 10-30 degrees, which is also called acupuncture points around the needle.
F. law of acupoint selection:
(1) local subcutaneous (Ashi point) or adjacent points (i.e. points around the needle).
(2) Take the nerve root (Jiaji point) of the lesion from the back.
(3) Long-distance acupoint selection (Quchi, Hegu, Zusanli, Sanyinjiao, Shen Zhu, Neiguan and Yanglingquan).
(4) Add points according to symptoms.
G. Prescription examples:
A. Surround the acupoints locally and add Waiguan, Quchi, Sanyinjiao and Taichong.
B if herpes is on the head, add Hegu point and Neiting point.
C. If herpes is above the waist, extra points should be given to branch groove and Neiguan.
D. If the herpes is below the waist, add Xue Hai and Yinling Spring.
3. Technology:
(1) For solid diseases and acute pain, the needle is kept for 20 to 30 minutes by lifting, inserting and twisting, and by purging, two needles a day, with a millineedle and some flat needles.
(2) Bleeding at acupoints is acceptable for acute diseases, once every other day.
(3) Skin needle or plum blossom needle shallow pricks around herpes.
4. Ear acupuncture therapy:
A. acupoint selection:
A. Corresponding sensitive points, lung, liver, lower screen point and screen room.
B. liver, spleen, adrenal gland, endocrine and Shenmen.
B. Methods: Take 2-3 acupoints, twist and stimulate strongly, and leave the needle for 20-30 minutes.
Four. Conclusion:
There is no specific medicine for herpes zoster in both Chinese and western medicine, which can only relieve pain, so acupuncture can make up for its deficiency, on the one hand, it can eliminate blisters and erythema, on the other hand, it can prevent neuralgia left after herpes zoster disappears, and it can shorten the course of treatment without adverse side effects. The curative effect of acupuncture on herpes zoster may be related to the enhancement of human resistance besides the rapid analgesic mechanism of the second theory.
2. Generally speaking, the prognosis of herpes zoster is good, and acupuncture can be used alone with good effect. After general 1-3 acupuncture treatments, there will be obvious improvement.
3. Because patients with herpes zoster feel very painful, they need to acupuncture both sides at the same time. Acupuncture can be done 1 time for several hours until the condition is relieved.