Pathogenesis.
Chinese medicine
The accumulation of fire and toxins in the liver meridian, with the wind and wind evil running up to the head and face; or with dampness and dampness injected into the yin and lower extremities; the fire and toxins are more frequent in the trunk. In old and frail people, the pain is often severe and prolonged due to blood deficiency, liver exuberance and damp-heat toxicity, resulting in stagnation of qi and blood and obstruction of meridians. The initial stage is dominated by damp-heat and fire toxin, while the later stage is due to deficiency of blood and stagnation of blood, with dampness.
Pathology and pathogenesis.
Western medicine
Caused by varicella-zoster virus. The virus enters the sensory nerve terminals of the skin and moves along the nerve fibers toward the center, latent in the posterior root ganglion of the spinal cord or the trigeminal ganglion. When the immunity of the body is low, the virus can take advantage of the opportunity to produce and multiply, and the invaded nerves produce inflammation or necrosis, which leads to different degrees of pain and pathological reactions, causing the distribution of the virus along the nerves to produce characteristic segmental-like blisters on the skin.
Clinical features.
clusters of blisters
band-like distribution
Pain like a fire
Clinical presentation.
At the beginning of the disease, the lesions are band-like red papules, followed by clusters of corn to soybean-sized blisters, tired as beads, gathered in one or several places, arranged in a band, with normal skin between the clusters of blisters, the blister fluid is initially clear, after a few days the blister fluid is cloudy and purulent, or partially ruptured, and in severe cases there are bleeding spots, blood blisters or necrosis.
In mild cases, there is no skin lesion, only tingling sensation, or slightly flushed, without typical blisters. The lesions are usually found in the lumbar region, chest or head and face, mostly on one side of the body, often unilaterally distributed along the dermal nerve, and generally not exceeding the midline. If the lesions occur on the head and face, especially in the eyes and ears, the pain is severe, accompanied by swelling and pain in the nearby B nucleus, and even affects vision and hearing.
Identification and typing.
Liver meridian heat
Symptoms.
Bright red skin lesions, burning and stinging pain, tense herpes wall; bitter mouth and dry throat, irritability, dry stool or yellow urine; red tongue, thin yellow or yellow thick coating, smooth pulse.
Treatment: Clearing and draining liver fire, detoxifying and relieving pain.
Remedies.
Gentian and liver diarrhea soup with Comfrey, Panax notoginseng, Xuanhuosuo, etc. For head and face, add burdock and wild chrysanthemum; for blood blisters, add buffalo horn powder and peony bark; for obvious pain, add frankincense and myrrh.
Identification and classification.
Spleen deficiency with dampness
Symptoms.
Pale skin lesions, pain is not obvious, herpes wall is loose; mouth is not thirsty, little food and abdominal distension, stools are sometimes loose; tongue is light or normal, coating is white or white greasy, pulse is sluggish or slippery.
Treatment: Strengthening the spleen, relieving dampness, detoxifying and eliminating swelling.
Recipe.
De-Dampness and Stomach Ling Tang with addition and reduction. If the blisters are large and numerous, add Fu Ling, Dioscorea Z and Plantago ovata.
Identification and classification.
Qi stagnation and blood stasis
Symptoms.
Localized pain after rash reduction or fading, radiating to nearby parts, unbearable pain, restlessness, severe cases can last for months or longer; dull tongue, white coating, thin pulse.
Treatment: Promoting blood circulation, promoting blood circulation and relieving pain.
Prescription.
Chai Hu Dredging Liver San combined with Peach Red Four Wonders Tang plus or minus. If the heart is troubled and sleep is poor, add mother-of-pearl, oyster, gardenia, sour date; if the pain is severe, add xuanhuosuo, myrrh, centipede, etc.
Treatment methods.
Western medicine treatment.
1, antiviral drugs: Acyclovir 5mg/kg intravenous drip should be applied early, once every 8 hours, 5-7 days as a course of treatment. In addition, you can also use adenosine 15mg/(kg?d), 1 time/day, slowly sedation, more than 12 hours; also can be oral acyclovir 0.2g/time, 5 times/day; or famciclovir 0.25g each time, 3 times/day; or vancomycin 0?3g each time, 2 times/day. The course of treatment is 7-10 days.
2, glucocorticoids: early use can reduce pain, preferably within 5 to 7 days of the onset of the disease. Generally apply prednisone 20-30mg/d, divided into 2~3 times orally, for 3~7 days.
3.Anti-pain medication: go for pain tablets, cranial pain, ibuprofen, indomethacin, fotarine, difenacin, etc. can be chosen. Aspirin can also be chosen.
Treatment methods.
Chinese medical treatment
1.In the beginning, use two flavors of plucking poison san to mix with strong tea water for external application; or apply Yulu cream externally; or apply Shuangbai san, Sanhuang lotion, Qingliang emulsion (sesame oil plus saturated lime water supernatant fully stirred into emulsion) 3 times a day; or fresh horsetail, wild chrysanthemum leaves, yuzhanhua leaves pounded for external application.
2.After the blisters are broken, apply Huanglian paste, Sihuang paste or Qingda paste externally; if there is necrosis, change the medicine with Jiuyi Dan or Hai Fushan.
3.If the blister does not break or if the blister is large, use a trigeminal needle or sterilized empty needle to pierce it and suck out the herpes or make the herpes flow out to reduce the discomfort of swelling and pain.
Chinese medicine special treatment.
Body acupuncture: acupuncture points: upper limbs: Neiguan, Quchi, Hand Sanli, Shoulder k. Lower limbs: Foot Sanli, Sanyinjiao, Fenglong, Neiting, etc. Back: take Yu points with the corresponding viscera. Technique after needling in: rapid lifting and inserting, twisting and turning, retaining needles for 10-20min.
Chinese medicine special treatment.
Local root-cutting treatment
The herpes can be dried and contracted by using a trigeminal needle to release blood and cupping along the starting point and end point of the herpes, so that the internal toxicity can be released and the pain can be relieved and healed quickly. The cupping time should not be too long, usually 5-10 min is appropriate.
Chinese medicine specialties.
Puncture method.
After disinfection, the trigeminal needle first punctures the normal skin on the periphery of the affected area at 1cm for one week, with a needle distance of about 0.5~1cm and a needle depth of 0.5cm, and then punctures the affected area in the same way from outside to inside in a spiral shape to the center. The affected area was rubbed with iodophor. If the blister ruptures, keep the area dry. Effects: Removing blood stasis and relieving pain. Puncturing the periphery of the affected area increases local blood flow, mobilizes local resistance to disease, and prevents herpes from spreading. After puncturing, iodine volts are applied to make the herpes contents and inflammatory tissues subside and absorb.
Chinese medicine special treatment
Plum Blossom Acupuncture.
After disinfection, the herpes and the surrounding skin are punctured with plum blossom needles, to the extent that the herpes is punctured, the fluid inside the herpes flows out, and the skin at the edge of the lesion is congested and red or slightly bleeding. Effects: The strength of the outward penetration of the evil heat and poisonous evil can avoid blisters after cupping, thus avoiding local skin infection or even pus, suitable for diabetic patients and patients with heavy dampness.
Traditional Chinese Medicine
Surrounding moxibustion method.
The moxibustion method should be applied to the area of herpes and its surrounding area, until the local flushing, to the extent that the patient feels no pain, 20~30min. The efficacy of moxibustion should be significant only when it is applied thoroughly, otherwise it is poor. According to the theory of Chinese medicine, “the lung is the master of the skin”, “all painful and itchy sores belong to the heart”, moxibustion lung Yu, heart Yu, etc., once a day, 2 times a day in severe cases, about 1 to 4 days herpes can be crusted. Effects: Dispersing the poisonous evil, dispersing depression and diarrhea of heat, so that the evil heat stagnating in the skin can reach the surface of the body and be dispersed.
Chinese medicine special treatment
Post-herpetic neuralgia
Danshen injection 2 mL is injected into the three li of the hand (foot), and the rash area is sterilized with alcohol and percussion by plum blossom needle, to the extent of slight bleeding, once a day, once a week. Mechanism of action: Salvia miltiorrhiza has the function of activating blood circulation and removing blood stasis, it is said that “one taste of Salvia miltiorrhiza drink is as effective as winning four things soup”.
Chinese medicine special treatment
Post-herpetic neuralgia
Acupuncture: Acupuncture points are mainly taken from the foot sympathetic liver meridian and foot shaoyang bile meridian. For trigeminal neuralgia, use Zhangmen, Zhimen, Lactation, and A-Ye points. Operation: milli-needle stabbing, localized to the affected side and distal to both sides; trigeminal acupuncture is used to release blood from the long-eye point; damp-heat stasis is used to lift and insert the diarrhea method; qi-blood weakness is used to twist and tonic.
Chinese medicine special treatment
Postherpetic neuralgia
Acupuncture of dorsal points: according to the location of herpes zoster, select the corresponding dorsal points (e.g., if herpes zoster is located between the 3rd and 4th ribs, use Lung Yu and Turbulent Yin Yu. The acupuncture point is routinely sterilized, and the needle is stabbed obliquely with a 1.5-inch milli-needle 1.2-1.5 inches in the direction of the spine. The needle was left for 30 min, with intermittent acupuncture 1~2 times. 7 d is a course of treatment.
Chinese medicine special treatment
Acupuncture point: 1.5 milli-inch needles are stabbed obliquely in the direction of the spine, and the bilateral foot Sanli, Neiguan and Hegu points are taken, and the “Tuotianliang” technique is used, and the needles are left in place after obtaining qi (the “Tuotianliang” technique is used once every 5 min), for 30 min, Once a day, one week is a course of treatment.
External medicine
Take 20g of fresh cactus, remove the hard skin and add 1~2g of ice chips, pound it into a paste.
Make a paste and apply thinly to the lesion area, 1 time/day.
Pound fresh lychee grass and boil the dried product into soup, and apply cold and wet compresses on skin lesions 3~4 times a day.
Topical application
Fresh cactus plus fresh amaranth, green daid and live heart pills mixed with pounded juice to apply on the sore surface, 2 times/day.
Qing Dai San combined with alum and ice chips or Qing Dai combined with Angelica dahurica to make a paste for external application.
Externally applied medicine
12g of Xiong Huang, 3 centipedes (roasted and dried), 15g of gardenia, 30g of ice chips, finely grinded and mixed with fragrant oil are applied externally to the affected area for 3~7d.
For Xiong Huang alone, add herbal tea, chrysanthemum and dandelion in decoction.
External medicine
Infusion therapy: take 30g of Ban Cai, 10g each of Qing Dai, Bitter Ginseng, Phellodendron, Bing Pian and Xiong Huang, soak them in 95% ethanol 300ml for 2 weeks, then filter and remove the residue. Dip a cotton swab into the solution and apply it on the herpes or around it. Stop applying the medicine after foaming 3 times a day. After the blisters are initiated for 1 day, they can be punctured with a sterile needle and a scalding ointment can be applied externally. Apply topical scalding ointment at 1 day intervals, 2 to 3 consecutive foaming treatments.
Selected points on the back
Jijiao point (five minutes from the side)
Governor’s vein
Special reaction points
A-Yi point