Research progress of herpes zoster
A. Etiology and treatment: Recent medical practitioners have gradually agreed on the etiology and basic treatment of the disease, and believe that the internal cause is due to liver and spleen lesions and damp-heat accumulation, while the external cause is due to external toxicity, and the treatment is to clear the liver, strengthen the spleen, remove dampness, clear heat and toxicity, and activate blood circulation to remove blood stasis.
However, there are many different views. Wei Wenhao believes that poison, fire, dampness, stasis and deficiency are the basic features of herpes zoster and advocates the “Five Causes Identification Method”, which considers poisonous evil as an important factor causing the disease. The treatment is to remove the fire and detoxify the liver, to clear the heart and cool the liver, and to remove the toxin with the addition of Rhizoma Rhizoma Dihuang Tang; dampness is a yin evil, heavy and sticky, lingering and difficult to be cured, and it is easy to turn heat into dampness and heat, so the treatment is to remove dampness and toxin, and the formula is to remove dampness and toxin with self-prepared Dampness and Detoxification Tang; blood stasis is easy to turn toxin from heat and enter the blood, so the treatment is to activate the blood to remove toxin, regulate qi and relieve pain, and the formula is to activate the blood to remove toxin; individuals with insufficient endowment, weak qi and blood, or those who are old and exhausted in essence, cannot penetrate the toxin and go out, so the treatment is to replenish qi and nourish blood The formula is based on the eight treasures of detoxification and pain relief. Yue Dongshan and others believe that this disease is difficult to be summarized by the word “fire”, and if the medicine is confined to the bitter cold and diarrhea of fire, it will be incomplete, and five common treatment methods are summarized by combining the causes of the disease: 1.
1, the method of dispelling wind and clearing heat, the formula selected from the large agent Puji Disinfectant Drink plus antelope horn, raw gypsum decoction for internal use;
2, diarrhea and detoxification method, the formula is selected from San Huang Diarrhea Heart Soup, Gentian Diarrhea Liver Soup, Cheng Qi Tang;
3.Strengthen the spleen and dispel dampness by removing cinnamon from Dampness and Stomach Ling Tang and adding Coix Seed, Tiger Balm and Huang Lian;
4.Toris to eliminate toxins, select Toris Disinfection Drink plus reduction; 5.Benefit Qi and nourish Blood, select Ginseng Nourishing Glory Tang and Paeonia Glycyrrhizae Tang. In the early stage of herpes zoster, Cheng Tong Shen believed that the evidence was due to dampness and heat in the liver meridian, which turned into fire and developed on the skin, and in the later stage, the toxic evil in the affected area was not cleared, resulting in stagnation of qi and blood stasis, and pain if it did not pass. Meng Ning [5] believed that poor blood flow and stagnation of the meridians are the pathological basis of the disease, so the method of activating blood and removing blood stasis should be used throughout the treatment process.
Based on the clinical symptoms of this disease, such as pain like fire, Ma Lili proposed that the treatment could be based on the theory of burns, and the clinical results were satisfactory. Liu Jiayi et al. took a different approach and suggested that the cause of the disease is not internal damp-heat but external heat and toxicity in the skin and veins, according to which they formulated their own treatment of clearing heat and cooling the blood (45-60g each of Da Qing Ye and Ban Lan Gen, 10g of Zi Cao, 15g each of Huang Qin and Lian Qiao, 30g of Yin Hua, and add and subtract according to the symptoms, combined with external treatment), which is more effective than Gentian Diarrhea Liver Soup.
Second, identification and treatment.
1.Typing: Clinical treatment is mostly divided into four types and three types. For those who are divided into four types, such as Yang Shengfu [8 ]: for the treatment of mild symptoms, it is advisable to clear heat and remove dampness, and the formula is Gentian Diarrhea Liver Tang with addition and subtraction; for the treatment of severe symptoms, it is advisable to clear heat and remove dampness and detoxify, and the formula is Gentian Diarrhea Liver Tang with addition and subtraction of Five Flavors Sterilizing Drink; for the treatment of very severe symptoms, it is advisable to clear heat and remove fire and detoxify, and the formula is Five Flavors Sterilizing Drink with addition and subtraction of Ma Zhi Zhan Tang; for the treatment of posterior symptoms, it is advisable to activate blood circulation, remove stasis, search the veins, and nourish blood and soften tendons, and the formula is Si Wu Tang with addition. Liu Fuxing: for the type of fire in the liver meridian, the treatment should be to clear the liver and drain heat, with the formula of Gentian and Liver Diarrhea Tang plus or minus; for the type of dampness and heat in the spleen meridian, the treatment should be to strengthen the spleen and clear dampness and heat, with the formula of San Ren Tang plus or minus; for the type of liver depression and qi stagnation, the treatment should be to dredge the liver and regulate qi to relieve pain, with the formula of Consistent Decoction plus or minus; for the type of qi deficiency and blood stasis, the treatment should be to benefit qi and invigorate blood, with the formula of Tonic Yang Returning Five Tang plus or minus.
Feng Chonglian [10]: For liver and gallbladder damp-heat type, the treatment is to clear the liver and bile, and the formula is Gentian and Liver Dissolution Tang with addition and subtraction; for liver depression and qi stagnation type, the treatment is to clear the liver and resolve the depression, pass the ligaments and relieve pain, and the formula is Sibei San with addition and subtraction; for heat and toxin incandescence type, the treatment is to clear the heat and detoxify the toxin, and the formula is to clear the plague and defeat the toxin drink with addition and subtraction; for residual toxin and blockage of blood and ligaments type, the treatment is to activate blood and resolve silt, pass the ligaments and relieve pain, and the formula is to combine Jinling Zi San with Lost Smile San with addition and subtraction. The treatment is to clear heat and dampness, detoxify and eliminate the rash, and the formula is self-prescribed Clear Heat and Diarrhea and Fire Detoxification Tang; the treatment is to clear heat and dampness, diarrhea and fire detoxification, pass the ligaments and relieve pain, and the formula is self-prescribed De-Dampness and Detoxification Tang with addition and subtraction; the treatment is to benefit the Qi and hold the toxin, cool the blood and eliminate the rash, and the formula is supplemented with Tonic Zhong Yi Qi Tang with addition and subtraction.
Jiang Yan: Damp-heat in liver and gallbladder, treatment is to clear liver fire, remove dampness in gallbladder, detoxify and relieve pain, formula is Gentian Diarrhea Liver Soup with addition and subtraction; Spleen deficiency and dampness, treatment is to strengthen the spleen, relieve dampness, detoxify and relieve pain, formula is to remove dampness and stomach Ling Tang with addition and subtraction; Qi stagnation and blood stasis, treatment is to move Qi and blood, promote blood circulation and relieve pain, formula is to select Tao Hong Si Wu Tang with addition and subtraction. Zhang Xiaohong: for the evidence of external infection of evil toxins, the treatment is to clear heat and detoxify; for the evidence of dampness and fire stagnation, the treatment is to remove dampness and diarrhea of fire; for the evidence of damp-heat infusion, the treatment is to clear heat and relieve dampness. Chen Weimei [14]: for heat stagnation in the liver meridian, the treatment is to clear the fire in the liver, detoxify and relieve pain, with the formula of gentian diarrhea liver soup plus or minus; for spleen deficiency and dampness, the treatment is to strengthen the spleen, relieve dampness, detoxify and relieve pain, with the formula of removing dampness and stomach ling Tang plus or minus; for qi stagnation and blood stasis, the treatment is to regulate qi and activate blood circulation, pass through the channels and relieve pain, with the formula of Chai Hu sparing the liver and combining with Tao Hong Si Wu Tang plus or minus. For example, Meng Ning [5] chose Gentian Diarrhea Liver Soup for liver and gallbladder solid fire or liver and gallbladder damp-heat, Xieyao San and Lingzi San for qi stagnation and blood stasis, Peach Kernel Cheng Qi Tang for heat stagnation in Yangming and stasis in the meridians, Yang Yang Returning Five Soup for deficiency of positive energy, loss of nourishment in the meridians and stasis in the blood, and Consistent Decoction for liver and kidney yin deficiency and qi stagnation and blood stasis.
2. Treatment by site: Huang Youbin [15] considered that the head, face and upper limbs are mostly affected by wind-heat of the liver meridian, and the treatment is to remove wind and heat and detoxify the toxin, using Yin Qiao San, Sang Ju Drink and Sheng Ma Ge Gen Tang with addition and subtraction; the chest and back are mostly poisonous by fire of the liver meridian, and the treatment is to clear liver fire, detoxify and relieve pain, using Gentian and Liver Pill and Xiao Chai Hu Tang with addition and subtraction; the waist, abdomen and lower limbs are mostly damp-heat of the liver meridian, and the treatment is to clear damp-heat, detoxify and relieve pain, using Er Miao San, Si Miao Yong An Tang with Dioscorea and Dioscorea. The formula is based on Ermiao San, Si Miao Yong An Tang and Dioscorea Tang with addition and subtraction.
3. Staged treatment: Mao Jialin et al [16] summarized different treatment methods according to the new and long course of the disease combined with clinical symptoms, the initial treatment is to dredge the liver and resolve dampness, and the formula is selected from Gentian Diarrhea Liver Soup.
Third, specific prescriptions and medicines: Gentian-Diarrhea Liver Tang is the most commonly used effective formula for clinical treatment of this disease, Wang Chaoxia [17], Zhong Guangshe [18], Yin Jianping [19], Wang Yinhua [20], Luo Kaisheng [21], Fan Shenghua [22], etc. all obtained significant effects mainly with this formula. Wang Dongmei et al [23] treated 98 cases with self-designed four worms soup (15g of each of Dilong, Stachybotrys, Boswellia and Myrrh, 10g of Tu-Yuan, and 2 centipedes), with a cure rate of 77.4% and a total effective rate of 89.8%. Liu Qingchun et al [24] treated 61 cases of this disease with a decoction of fire and detoxification soup (30g each of Panax quinquefolium, Amaranthus, Red vine and Radix et Rhizoma, 20g each of Dandelion and Zingiber officinale, 10g each of Gentiana, Xia Gu Cao, Scorpion, Sclerotium, Zedoary and Plantago, and 10-15g of Rhizoma Rheum) together with the dregs of the medicine, with a cure rate of 80.32%. Jiang Wei et al [25] treated 67 cases with Huang Lian Detoxification Tang plus flavor, with a cure rate of 92.5% and an effective rate of 100%.
Ouyang Xiaoyong [26] treated 29 cases with Guai Herb Tang, and all of them were cured. Wang Bu-Li [27] treated 97 cases with homemade anti-toxic and knotting oral solution (20g each of Astragalus membranaceus, Panax quinquefolium, Radix et Rhizoma Dioscorea, Xia Ku Cao, Rhizoma Rhei, 5g of Safflower, 30g each of Mugwort, Dandelion and Salvia, 15g of Red Peony, 40g of Da Qing Ye, 10g of Guan Zong, 30g of Serpentine, and 40g of Amaranthus), with a cure rate of 90.75% and an effective rate of 97.95%. Qu Qiang [28] treated 96 cases with the formula for herpes (15g of Artemisia inchi, 10g of Qing Pi, 10g of Chen Pi, 20g of Bai Xian Pi, 20g of Rutaceae, 15g of Dandelion, 15g of Zihua Di Ding, 10g of Gentiana, 10g of Xia Ku Cao, 10g of Bitter Ginseng, 12g of June Snow, 15g of Honeysuckle, 15g of Xin Yi Hua, 20g of Dragon Bone) prepared by Mr. Shi Feng, a famous herbalist in Tianjin, with a total effective rate of 97.92%. Ai Zhenghai [29] treated 32 cases with self-prepared Tongluo Blood-vitalizing soup with added flavor (6g of whole scorpion, 2 centipedes, 15g of dilong, 20g of wei lingxian, 15g of gui zhi, 10g of roasted frankincense, 10g of roasted myrrh, 15g of safflower, and 30g of chicken blood vine), with a cure rate of 65.63% and an effective rate of 93.75%. Zou Shenglan [30] treated 17 cases of ocular herpes zoster with Puji Disinfectant Drink plus or minus, and all of them were cured. Peng Lanju et al [31] treated 78 cases with the folk formula Longfeng San, using 5g of dragon’s clothing, 10g of dragon’s beard grass, and 3g of phoenix clothing (grinded), burning the dragon’s clothing and dragon’s beard grass into ash, mixing it with the powder of phoenix clothing, and mixing it with sesame oil to make a paste and applying it to the affected area 2-3 times a day, curing 56 cases, improving 20 cases, and invalidating 2 cases.
IV. Proprietary Chinese medicine.
1, traditional preparations: Huang Houde et al [32] used Ji Desheng snake medicine tablets to observe the efficacy of some patients with herpes zoster and compared it with acyclovir. The results showed that the snake medicine group was significantly better than the acyclovir group in terms of anti-blistering, crusting, pain relief, healing time, and overall efficacy, and no adverse effects were observed in any of the snake medicine groups. Hu Meng et al [33] treated 43 patients with herpes zoster with an oral lotion of opium bile oil and compared it with conventional treatment. The results showed that all of the treated group were cured within 7 days, and the mean number of days to heal was 4 days, which was significantly different from the control group (P<0.01). Mu Hua [34] conducted a clinical observation of the treatment of herpes zoster with compound Tianxian capsule (smallpox powder, snake tongue herb, niuhuang, lobelia, frankincense, myrrh, musk, ice chips, wei lingxian, ginseng, astragalus, poria, etc.), and the results showed that the healing rate and total effective rate of the treatment group were significantly higher than those of the control group with intramuscular injection of polymyxin (P<0.05).
2.Chinese medicine injection
Su Xiaojie et al [35] treated 30 patients with herpes zoster using Astragalus injection and made controlled observations, and found that the time to stop herpes and pain was significantly shortened. Zhou Xiancheng [36] observed 45 cases of herpes zoster treated with Shuanghuanglian powder injection, and the clinical efficacy was significant, similar to and significantly better than that of intraosseous injection of polycystin. Li Lianhua et al [37] reported that thornysunate in the treatment of herpes zoster could significantly shorten the time of stopping blistering, pain relief, crusting and duration of disease, with rapid effect, and the efficacy was significantly superior compared with that of intravenous virazole (P<0.01).
Fifth, acupuncture therapy: Liu Tingzhi [38] selected acupoints according to the distribution of the rash and according to the meridians to which they belonged, such as liver and gallbladder damp-heat, acupoints such as liver Yu, gallbladder Yu, Yanglingquan, and Taichong, and spleen Yu for spleen deficiency and dampness, mixed with 0.5-1.0 ml of prednisolone acetate and 4-6 ml of 2% procaine, stabbed vertically into the selected acupoints, and after obtaining gas, the liquid was slowly injected into the acupoints in equal amounts once a day, lighter cases 2 to 3 times, 4 to 5 times in severe cases. A total of 42 cases were treated, with 40 cases cured and 2 cases with significant effect. Zhang Hongxia et al [39] took the affected side of Shaoshang, Shang Yang, Shaochong, Shaozhe, Guanchong, Li Tui, Yinbai, Zhiyang, Zhiyin, Dadun, and after routine disinfection, stabbed the acupuncture points quickly with a trigeminal needle, bleeding at least 5 drops per point, and punctured several times around the lesion with the trigeminal needle to make it bleed naturally, together with cupping and acupuncture, once a day, 4 times a course, treated 45 cases, cured 36 cases, showed efficacy 5 cases, effective 2 The treatment was effective in 2 cases and ineffective in 2 cases.
Lu Xiling et al [40] used No. 30 115-210 inch milli-needle, depending on the size of the painful area, and stabbed horizontally from the edge of the lesion along the subcutaneous from the periphery to the center line at an angle of 15 degrees, and after obtaining the qi, performed a flat tonic and flat diarrhea technique, and kept the needle for 30 minutes, and at the same time, moxibustion was applied to the snake eye and snake tail points in the order of eye first and then tail, using 0.2 cm thick garlic skin with a moxa pillar of soybean size for 3 strokes each, and the cure rate reached 100%. Fu Xiuqin [41] used plum blossom needle to tap the local area to break the herpes and bleed slightly, then cupped the fire pot and treated 30 cases, all of which were cured. Wang Yan [42] treated 130 cases with puncture cupping method by taking points at the edge of the herpes lesion site prevailing, heat-rich type with bilateral Yanglingquan, yin-rich type with bilateral Yinlingquan, qi-stagnant type with local A-yi point, or surrounding the lesion with puncture, resulting in 107 cases cured, 21 cases with significant effect, and 2 cases with effective effect.
VI. Moxibustion method
Feng Qiao [43] treated 160 cases of this disease with Zhuang medicine line moxibustion, acupuncture points: rash grains at the edge of the lesion, snake eye point (2-3 rash grains at the beginning) with 2 threads (day lily thread soaked with medicine), perform plum blossom type point moxibustion, so that the head of the thread round fire on the point, avoid flat press, point 1 time fire moxibustion 1 strong, once a day; and set up Chinese medicine group (gentian grass, Che Qian Zi, Chai Hu, Scutellaria, Gardenia, Mouton, Da Qing Ye, Ban Lan Gen, licorice, 1 day Results: 76 cases and 47 cases were cured (P<0.05), 72 cases and 60 cases were improved, and 12 cases and 23 cases were ineffective in both groups, with total effective rates of 92.5% and 82.3%, respectively. Wang Meng [44] used moxibustion to treat 189 cases of this disease, taking acupuncture points: A-Yi point, covered with gauze about 0.2 cm thick, the left hand fixed the surface of the cloth, the right hand holding a lit moxa stick, the fire head touching the surface of the cloth, around the herpes to the center of the clockwise diarrhea moxibustion treatment, moxa ash on the herpes, to the degree of local skin burning, comfortable pain relief, 40 min each time.
Combined with the meridian acupuncture points: hair on the head to take the Hegu, Fengchi, Dazhi, the back of the chest to take the period, the sun and moon, the commission, foot Sanli, waist, hip, femoral lower extremities to take the foot Sanli, Yanglingquan, Yongquan and other acupuncture. And there were 106 cases in the control group (with acyclovir sedation and oral administration of gentian diarrhea liver pill). Results: 187 cases and 81 cases were cured, 2 cases and 16 cases were improved, and 0 cases and 9 cases were ineffective in the two groups, respectively. Efficacy:Pain relief and rash disappearance time, and the number of posterior neuralgia cases were significantly different between the two groups (P<0.01). Gao Runhua [45] treated 32 cases of this disease with paste cotton moxibustion, usage: a thin and uniform layer of sterilized cotton balls, applied to the beginning to the end of herpes zoster, ignited the beginning with fire, quickly burned out and then lightly tapped with plum blossom needle to bleed, and then cupped to pull out the stasis of blood, once a day, 5 times for a course of treatment. Results: 1 to 2 courses of treatment, the efficiency of 93.75%.
VII. Other treatments
Li Zhijun sprayed the affected area with UV negative ions for 20-30 minutes each time. For large and dense blisters, the blisters were punctured with a trigeminal needle to make the herpes flow out to reduce distension and pain before treatment. After the irradiation and spraying, topical application of Comfrey elm oil was applied once every 1 to 2 days. The results showed that 49 cases were cured, 29 cases were improved, and 2 cases were invalid, and the efficacy was significantly better than that of the Chinese medicine and western medicine control groups (P<0.01, a very significant difference).