Diagnosis of shingles
The diagnostic criteria for herpes zoster in The Complete Book of Practical Dermatology are as follows.
I. Medical history
1. There may be a history of low resistance.
2. The disease develops mostly in spring and autumn, and usually does not recur after healing.
3, rapid onset, rapid course, usually lasting 1 to 2 weeks.
4. Before the onset of the disease, there is often fever and other mild and severe general discomfort.
Neuralgia is one of its characteristics, which may appear before or during the onset of the rash, and the pain radiates along the innervated nerves.
2. Physical signs
1. Initial local burning, sensory allergy or neuralgia, followed by flushing of the skin, on which appear clusters of corn to green bean-sized papules, which quickly develop into blisters, the walls of the blisters are tense and shiny, the center is sunken, umbilical fossa-shaped, the contents are clear and transparent, the base is red, they do not fuse with each other, and are mostly distributed in bands.
2. The nearby lymph nodes are often enlarged.
3. Temporary pigmentation may remain after healing, and there are also cases of co-infection due to ulceration and erosion of the lesions.
Laboratory tests
1.Blood picture The white blood cells are normal or low, but the blood picture is more elevated in secondary infection.
2. Herpes smear Scrape the tissue smear from the bottom of the early blisters, Tzanck stain, microscopically visible multinucleated balloon cells.
3.Herpes fluid rabbit corneal inoculation Does not produce keratitis.
4.Pathological organization The blisters were multicompartmental and located deep within the spiny layer of the epidermis. There are balloon-like cells in and around the blisters, and eosinophilic inclusion bodies can be found in the nuclei of the degenerated epithelial cells. The dermis has a perivascular infiltrate of lymphocytes and polymorphonuclear leukocytes.
Differential diagnosis of herpes zoster
1. Herpes simplex: it occurs at the junction of skin and mucous membrane, not along the nerve distribution, is less painful, and often has a tendency to recur, mostly in febrile diseases, gastrointestinal disorders and menstrual disorders.
2, contact dermatitis: there is a history of contact, the rash is itchy, the rash is not related to the distribution of nerves, and there are no symptoms of neuralgia.
3. Impetigo: It occurs on exposed parts of the limbs, and the distribution of lesions is not related to the nerve paths. Self-perceived itching, pain is not obvious.
4, small herpetic eczema: self-conscious severe itching, rash polymorphic, no certain site, mostly symmetrical distribution.
5, intercostal neuralgia: no certain seasonality, episodes of severe pain in one or several intercostal nerve distribution areas, consistent with the direction of intercostal nerve travel, and pressure pain at the junction of the chest and rib cartilage. In contrast, herpes zoster occurs in the spring and fall, and is usually preceded by prodromal symptoms and a burning sensation in the affected skin, without pressure pain at the junction of the chest and the cartilage of the ribs.
Chinese medicine treatment of herpes zoster
I. Fire in the liver and gallbladder.
1, clinical manifestations: soon after the initial onset, the skin appears erythematous, red papules or papules are visible on the spot, the rash is flushed and dense, the herpes is like corn, the wall of the herpes is tense, often in one or several places, mostly on one side of the chest and back, occasionally seen in other parts. The rash is often burning, painful, generalized discomfort, or itching, dry mouth, thirst, irritability, loss of appetite, red urine and dry stool. The tongue is red, with thin yellow, dry yellow or thick yellow coating, and a slippery pulse. The rash is mainly erythematous and dense papules, also visible as papules and a few blisters.
2. Treatment: Clearing away heat and dampness, diarrhea and detoxification.
3.Formula: Gentian diarrhea of the liver soup with addition and subtraction (“Secret Collection of the Orchid Room”).
4. Drugs: Gentiana 10g Radix Bupleurum 15g Radix Zedoaria 10g Plantago 10g (packet) Tongcao 3g Radix et Rhizoma 15g Radix Angelicae Sinensis 10g Gardenia 6g Radix Scutellariae 10g Rhizoma Equisetum 30g Rhizoma Polygala 15g Radix Fenugreek 15g Glycyrrhiza 6g
5. Addition and subtraction: add Yujin, Yuanhu, Boswellia, Myrrh, Salvia; add Burdock, Wild Chrysanthemum if it occurs on the face; add Eucommia, Mulberry if it occurs on the waist; add Danpi, Red Peony if the herpes is bloody; add Yinhua, Lianxiao if the blisters are eroded and ulcerated.
Second, the spleen meridian damp heat.
1, clinical manifestations: lesions mainly blisters, dense clusters, herpes light-colored, herpes wall relaxed, surrounded by red and purple, but there is partial ulceration, erosion and oozing, and even local necrotic ulcers, self-conscious pain and itching, mouth not thirsty or thirsty to drink, loss of appetite, less food and dull, abdominal distension after eating, loose stools, increased leucorrhea in women. The tongue is fat, light in texture, with white greasy or white thick coating, and a moist, sunken or slippery pulse.
2. Treatment: Strengthening the spleen, relieving dampness, detoxifying and relieving pain.
3.Formula: De-Dampness and Stomach Ling Tang (“Jinjian of Medicine”).
4.Drugs: Atractylodes macrocephala 15-30g Houpa 10-15g Poria 15-30g Atractylodes macrocephala 15-30g Chenpi 10g Poria 15g Zedoary 10g Red peony 10g Slippery stone 15-30g Fangfeng 6g Gardenia 6g Tongcao 3g Licorice 6g
5. Addition and subtraction: add hedgehog, fried wheat germ, calamus, sand; add bitter ginseng, cypress, astragalus, amaranth; add Chai Hu, aromatic herb, yujin if there is liver depression.
Third, dampness gathering poisonous heavy.
1, clinical manifestations: mostly on one side of the chest and back, occasionally seen in other parts. The lesions are mainly blisters, dense clusters, blisters crystal, full wall, cloudy contents, red base, or purple-red, several groups of blisters in a band arrangement, varying in length and width, local burning pain, swelling around more than 20-30cm, or even multiple occurrences, mostly seen after the onset of three or four days, or even up to 1 week or more can not dissipate, the formation of pus crust, or see blood blisters, necrosis, often accompanied by moderate fever. It is often accompanied by moderate fever, dry mouth, bitterness, lack of food and dullness, distension and fullness in the chest, irritability, irregular bowel movements, and yellow and red urine. Sometimes the lymph nodes near the skin lesions are swollen and painful. The tongue is red, the coating is yellow and thick or greasy, and the pulse is smooth and counted. This evidence is mostly seen in the peak of herpes zoster rash.
2. Treatment: Clearing heat and removing dampness, removing fire and detoxifying.
3.Formula: Gentian diarrhea of the liver soup (“Secret Collection of the Orchid Room”) combined with Wu Wei Disinfection Drink (“Jin Jian of Medicine”) plus or minus.
4. Drugs: Gentiana 10g Radix Bupleurum 15g Radix Zedoaria 10g Radix Plantago 20g Radix Tongcao 3g Radix Rehmanniae 15g Radix Gardeniae 6g Radix Scutellariae 10g Radix Chrysanthemum 30g Radix Zedoariae 30g Radix Chrysanthemum 20g Radix Dandelion 30g Rhizoma Equisetum 30g Radix Fleabane 15g Radix Glycyrrhiza 6g.
5. Addition and subtraction: add Yujin, Yuanhu and Neem for severe pain; add bitter ginseng and Dioscorea for dampness and extravasation of herpes; add Banlangen and Da Qing Ye for fever.
Qi stagnation and blood stasis.
1. Clinical manifestations: Herpes with dark red base, blood and water-like herpes, severe pain, or the rash has subsided, but the local pain is still not removed, sometimes light and sometimes heavy, the duration varies, especially at night, it is difficult to sleep, bitter mouth and dry throat, chest distension, irritable heart, bowel movement. The tongue is purple and dark or with petechiae, the tongue coating is thin and white, and the pulse is string. This evidence is mostly seen in post-herpetic neuralgia.
2.Treatment: Promote blood circulation, resolve blood stasis, move Qi and relieve pain.
3.Formulation: Chai Hu Dredging Liver San with Addition and Reduction (Jing Yue Quan Shu).
4. Drug: Chai Hu 15g, Citrus Aurantium 15-30g, White Peony 15-30g, Chen Pi 10g, Chuanxiong 15g, Rhizoma Ligusticum 15g, Gardenia 6g, Scutellaria 10g, Forsythia 30g, Licorice 6g.
5. Addition and subtraction: for severe pain, add frankincense, myrrh, yuan hu, salvia, chicken blood vine; for old age and weakness, liver and spleen disharmony, liver strength and spleen weakness, adjust with prolotherapy.
V. Qi deficiency and blood stasis.
1. Clinical manifestations: localized pain after rash reduction or fading, insomnia, little food, weakness, pale tongue and thin string veins.
2. Treatment: Benefit Qi and nourish Blood, activate Blood to relieve pain, and clear residual heat.
3.Formula: Tonic Yang Returning Five Soup (“Medical Forest Correction”) plus and minus.
4. Drug: Astragalus membranaceus 30g Radix Angelicae Sinensis 6g Rhizoma Ligustici Chuanxiong 6g Radix Paeoniae Alba 6g Peach kernel 6g Safflower 6g Dilong 15g Yujin 30g Baicalin 10g Radix Scutellariae Sinensis 30g Licorice 6g
5. Addition and subtraction: for obvious Qi deficiency, Huang Qi can be gradually increased to a maximum of 120g, and add Dang Shen and Atractylodes; for ulcers formed in the skin lesions, which do not heal easily, accompanied by a light and fat tongue and a sunken and weak pulse, add Tonic Zhong Yi Qi Tang.
Other treatments of herpes zoster in Chinese medicine
I. Acupuncture
1, general acupuncture method: take the corresponding part of the pinch point, and according to the site of the lesion and the distribution of points.
(1) Upper eyelid and forehead: take Sun, Head Wei, Yang Bai, Zanzhu, with Gu and Quchi.
(2) Cheek area: take Sun, Sibai, Miming, and Shimonoguan, with Gu and Cataract.
(3) Mandible: take Cheek Chee, Di Cang, Cataract, Da Ying, with Gu.
(4) Torso: take the corresponding Yu points, above the umbilicus with Quchi and Hegu, below the umbilicus with Foot Sanli and Sanyinjiao.
(5) Upper extremities: take Quchi, Waiguan, and Hegu, with A-Yi points.
(6) Axillary: take Shoulderzhen and Jiquan, with Diwuhui and Waiguan.
(7) Lower extremities: take Blood Sea, Foot San Li, Sanyinjiao, Yanglingquan, with A-Yi points.
The technique is appropriate for medium-intensity stimulation, all using the diarrhea method, retaining the needles for 20-30 minutes, performing acupuncture every 5-10 minutes, twice a day, and changing to once a day after the symptoms are controlled.
2, plum blossom acupuncture.
(1) plum blossom needle therapy: in addition to using plum blossom needle percussion local lesions, and according to the different parts of the rash and the choice of acupuncture points, the upper limbs and thoracic abdomen to take Dazhi, Quchi, Neiguan, Hegu, Lung Yu, Liver Yu, the lower limbs to take the foot Sanli, Yanglingquan, Dazhi, Lung Yu. During the operation, the skin is routinely disinfected first, and the percussion technique should be even, until the skin appears red and moist (if the blister breaks, just use gentian violet to apply), once a day.
(2) plum blossom needle percussion plus moxibustion: with plum blossom needle heavy technique percussion after sterilization of the local lesions, in order to blister all broken and slightly bleeding for the degree, followed by clear moxa to the broken bleeding local moxibustion pecking, to the patient feel warm and tolerable burning pain is appropriate, need to smoke until the local skin redness and heat for the degree, generally need to moxibustion 5 ~ 10 minutes per place, once a day. Note that the treatment first check the tip of the needle must be flush, no hook, the tip of the needle must be vertical and down when percussion; around moxibustion to prevent burning moxa fall burns skin and burn clothing.
3, along the skin needling method: in the junction of skin lesions and healthy skin with 75% alcohol disinfection, according to the size of the lesion, choose different lengths of milli-needle, along the skin for cross-shaped flat stab. If the lesion area is larger, can be in the lesion around the heart parallel stabbing, do not leave the needle, once a day.
4, peri-needle stabbing method: around the herpes about 2-3cm into the needle, the tip of the needle to the center of the herpes area at an angle of 250 oblique stabbing, depending on the size of the lesion selected 4 to 8 needles, with the diarrhea method, stay for 30-40 minutes, 1-2 times a day. In addition, it can also be combined with the method of taking acupuncture points by following the meridians.
5, spider point moxibustion method: point, the patient is sitting, with a thin line around the head for a week, cut off the remaining line, to its front to back around the neck a circle, and then align the two ends of the line, along the thoracic vertebrae are slightly tightened to the back under the line, where the head of the line is reached is the spider point. Only 1 strong moxibustion is needed for each patient, and the pain is relieved within a few hours after moxibustion, and the redness, swelling and stinging disappears after 1 to 2 days, and heals after 3 days of decabbing.
6, ear acupuncture points.
(1) Ear acupuncture: take points in the liver area, biliary area, lung area, Shen Men and points corresponding to the skin lesion area, which have certain pain-relieving effect.
(2) Gallium arsenide semiconductor laser irradiation ear Shen Men acupuncture point: wavelength 0.29mu, output power 1.5mw, spot diameter 5mm. easy treatment, no pain, no side effects.
Second, closed therapy.
1, head and tail closure therapy: the patient lies flat on the bed, exposing the affected area, with 5ml empty needle aspirate vitamin B1100mg, vitamin B12500ug, in the root of the focal nerve and the tail of the end cluster of blisters are injected subcutaneously, the injection point can be depending on the size of the lesion, can be 2 points or multi-point injection. In mild cases, 1 time is healed, in severe cases, the injection point can be replaced every 2 days and then closed 1 time, individual need 3 times. Vitamin B1 is a component of the coenzyme required for pyruvate oxidative decarboxylase, involved in sugar metabolism, to promote further oxidation and decomposition of lactic acid and pyruvate, supply energy to tissues and organs, reduce the accumulation of metabolic products, reduce the stimulation of acidic substances on nerve endings, which can significantly reduce pain; vitamin B12 is also involved in sugar metabolism, can maintain the integrity of nerve fiber function.
2, acupoint closure therapy: vitamin B1, vitamin B12 or angelica injection line A is point (upper limb plus Quchi, Hegu, lower limb plus the foot Sanli, Sanyinjiao) closed, each point injection 0.2 ~ 0.5ml, each time the total amount of no more than 4ml, every 1 ~ 2 days once.
Third, single prescription, experimental prescription
1, internal method
(1) Paeonia lactiflora and licorice soup with flavor: 30g of peony, 10g of licorice, 15g of yuan hu, 10-15g of poppy husk, decocted in water with thick juice, divided into two doses, 1 dose per day.
(2) Whole Scorpion Powder: Wash the whole scorpion, roast and powder, 0.3g each time, 2-3 times a day. Or 8-10g of whole scorpion (cleaned), taken with the decoction of soup.
2.External treatment method.
(1)Xiong Huang, Wang Bu Liuxing each equal parts, respectively, with vinegar and sesame oil dressing, also can be used Wang Bu Liuxing research fine for the powder, sprinkle with the broken wound, generally 10 ~ 20 minutes, the patient feels pain relief, 2 ~ 5 days can be cured, the more serious cases can be cured in 7 days.
(2) Xiong Huang San: 150g of Xiong Huang, 60g of snake clothing, 100g of cinnabar, and 30g of plum slices, finely ground together and mixed with chicken seeds to make a paste, applied to the lesion, covered with sterilized dressing, and changed once every other day until it is cured.
(3) Yunnan Baiyao: mix Yunnan Baiyao and sesame oil into a paste and apply to the affected area 1 to 3 times a day, and take Yunnan Baiyao 0.3g orally 3 times a day for 3 to 5 days.
(4) Qing Dai 20-30g, ice chips 2g, sesame oil appropriate amount, mix into a paste, apply to the affected area, suitable for light evidence at the beginning, has the function of clearing heat and relieving pain.
(5) Dai Qing Paste: 9g each of Huang Lian, Huang Bai and Ginger Huang, 15g of Gui Wei, 30g of Sheng Di, 360g of sesame oil to boil the above medicine and remove the residue, 120g of yellow wax (reduced to 80g in winter), melted and filtered, put into a dry container and set aside. When using, take 20g of paste, add 1g of Qing Dai powder, stir well, and apply to the affected area. Generally, the pain is relieved after 1 to 3 days of medication, and the blisters disappear in 3 to 5 days.
(6) 50g each of Qing Dai and Huang Bai, 6 each of Fei Yu Shi and Calcined Gypsum, 20g of Rhubarb, grind together very fine, mix with sesame oil and apply externally 1 to 2 times a day, suitable for those whose blisters are not broken, with the function of clearing heat and removing dampness and detoxification. If the blister is broken or with infection, use Huanglian ointment to apply externally.
(7) Centipede: 8 centipedes, 15g rhubarb, 15g Huanglian, 20g Phellodendron, 10g frankincense, 10g myrrh, finely ground, mixed with strong tea water into a paste and applied to the affected area without showing the sore rash, 3 times a day, until healed.
(8) Cactus: appropriate amount (depending on the extent of the lesion), remove the surface of the small thorns, mash as mud, add glutinous rice flour or flour stirred into a paste, applied to the affected area, about 1cm thick, covered with linen paper, bandage wrapped, once a day.
(9) Snake, however (carry the board to return): take 100g of fresh grass, add 300g of water, decoction to about 100ml, remove the slag and cool the reserve. Apply directly to the affected area 3 to 4 times a day. Generally, the pain is relieved in 2 to 4 hours, the erythema subsides in 23 to 36 hours, the blisters stop developing, and the vesicular surface dries and crusts off in 2 to 4 days.
(10) Liushenwan: According to the size of the affected area, Liushenwan with the appropriate amount of sesame oil paste coated with the affected area, with internal consumption is better, adults 3 times a day, each time 10 capsules can be, generally 1 to 3 days of medication.
(11) Double yellow ice centipede: Huanglian 20g, rhubarb 20g, centipede 5, ice chips 3g, grinded and mixed with sesame oil into a paste, applied externally to the affected area, once a day.
(12) Fig leaf: several pieces of chopped and pounded, add a little vinegar to make a paste and apply to the affected area. 30 minutes each time, 2 times a day. This method is not suitable for those with broken skin.
(13) Fresh Tian Ming Jing: Wash the appropriate amount, pound the juice and rub it on the affected area, 3-5 times a day. If there is no fresh product, the dried product can also be finely ground, add sesame oil to make a paste and apply to the affected area, change the medicine 1 to 2 times a day. If there is still neuralgia after the rash disappears, add a little ice chips to the solution or paste and continue to apply until the pain disappears completely.
(14) Cuscuta: Take 100g, roast it, grind it finely, add sesame oil and mix it into a thin paste. Wash the skin lesion, dry it and apply the cream with cuscuta, 2 times a day. Stop using other therapies during the medication period.
(15) Cuscuta sinensis: put an appropriate amount of it in a high-temperature electric stove and bake it, then grind it after cooling, add 50% alcohol to make a paste and apply it on the affected area. Can be repeatedly applied, dry and reapplied until the pain disappears and the blisters crust off. Wash the sore surface with 75% alcohol before applying the medicine.
(16) Amaranth: Wash, chop, mash into a paste and apply to the affected area, change the medicine 2 times a day.
(17) Medical cotton: according to the size of the lesion, make a thin sheet and cover the surface of the lesion, and use an open fire to burn.
(18) fresh lily: appropriate amount of pounded juice, applied to the rash, 3 times a day, until the blisters crusted.
(19) Fresh snake berry: 100-200g, add 15-20g of glutinous rice, pound together to extract juice and apply to the affected area. If the disease is on the face and other exposed parts, use a soft cotton swab to apply the liquid to the affected area, if the lesion is on the trunk and other parts, can be soaked with sterilized gauze and applied externally to the affected area, and covered with plastic film, adhesive tape fixed, 12 hours to change the medicine once.
(20) appropriate amount of washed and pounded to take the juice for external application, 4 times a day, or direct external application (wrapping), change the medicine once a day.
(21) 12g of Bacopa monniera cream, grinded and applied to the affected area with vegetable oil or tea oil, 2 times a day for 1 week.
Four, bloodletting therapy: take the dragon’s eye point, located at the end of the transverse stripe between the second and third bone joints of the ulnar side of the little finger, clench your fist, routine local sterilization, use a trigeminal needle to puncture and release blood, squeeze out two or three drops of blood, once a day or every other day.
V. Audioelectric therapy: it can reduce inflammation, relieve pain and shorten the course of the disease.
Sixth, negative pressure attraction therapy: in the herpes zoster lesion range of routine disinfection, with sterile needle circular puncture, take the corresponding negative pressure suction tank to the affected area, pump out the air, so that the negative pressure up to 60 ~ 80kPa, body fluid forced outflow, for 10 minutes can be, once a day treatment. After the first treatment, the skin at the herpes becomes purple, 10-20 minutes to start crusting, 2-4 times more consecutive treatment can be cured.
Seven, cupping therapy: along the distribution line of the lesions in the painful points every other section of the puncture bleeding, cupping, once every other day, until healed.
Western medical treatment of herpes zoster
I. Systemic treatment
1, pay attention to appropriate rest, bed rest in severe cases, avoid clothing and skin friction, if necessary, sedatives, analgesics, severe cases can be given with supportive therapy.
2, antiviral drugs.
(1) Acyclovir (acyclovir): 0.2-0.4g, orally, 4-5 times/day for 7 days, or intravenously at a dose of 5mg/kg, once every 8 hours, for a total of 5 times;
(2) Vanamycin: 0.3g, orally, 2 times a day for 7 days;
(3) Adenosine: 10-20mg intravenous dose, once a day for 5 days;
(4) Polymyxin: 2mg/time, intramuscular injection, 2-3 times a week.
(5) Morpholine guanidine (virus spirit): 0.1 ~ 0.3g, oral, 3 times / day for 7 days;
(6) Virazole (Ribavirin): 10~15mg/kg per day, divided into two times intramuscularly or intravenously, 7 days as a course of treatment;
3.Anti-pain agents.
(1) oral aspirin, Somigel, indomethacin (anti-inflammatory pain), pain relief tablets, etc. to reduce nerve pain;
(2) Vitamin B1: 10mg orally, 3 times daily, or 100mg intramuscularly daily;
(3) Vitamin B12: 100-500mg daily, intramuscular injection, once a day, 5-10 times for a course of treatment;
(4) 0.25-1% procaine hydrochloride solution for subcutaneous closure around the lesion or ganglion blocking closure;
(5)Mecamidine (cimetidine): 0.4g, orally, 3 times a day, or add 5% glucose solution 250ml-500ml intravenously, once a day, 10 times a course of treatment;
(6) Carbamazepine: 0.1g, orally, 3 times a day.
4.Immunomodulators.
(1) normal human leukocyte transfer factor, interferon, thymidine, cytarabine, placental globulin or gammaglobulin can be used as appropriate to improve symptoms and shorten the course of the disease;
(2) Herpes zoster immunoglobulin is a specific high-value immunoglobulin, containing a high concentration of neutralizing antibodies, with significant efficacy, but the source of drugs is small and expensive.
(3) live attenuated measles vaccine 0.3 to lml subcutaneous injection once, the herpes mostly crusted within 48 hours.
(5) Glucocorticoids: For patients with generalized, severe, elderly and ocular involvement, early application is beneficial to shorten the course of the disease, reduce inflammation, relieve the sequelae of neuralgia, and stop the toxic and destructive effects of the virus on the affected ganglia and nerve fibers. Use with caution in patients with secondary infections.
(1) Prednisone: 20-40mg orally once a day for 7-10 days, then stop in decreasing doses.
(2) Dexamethasone: 4-10mg, add to 5% glucose solution 250 ml intravenously, once a day, for 5-7 days.
6. Apply antibiotics systemically when there is secondary infection.
Local treatment
1, external application of 1% dacronin dai mato oil (mud) cream, blisters dry coated with 1 to 2% methyl violet solution, a small area coated with new hydrogen pine ointment, severe lesions coated with 1% cytarabine, 3% aciclovir cream, 0.1% peptide butylamine dimethyl sulfoxide solution, 0.25% herpes net ointment, etc., can also be used methyl violet paste or zinc oxide paste wrapped dressing. If the combined infection, you can add 0.5-1% Levanox or 1-2% furacilin.
2, the affected area to prevent abrasion, local clean and dry. Topical powder or lotion can be used, such as sprinkling powder, topical zinc lotion or furnace glycerin lotion, several times a day. If herpes ulcerated skin erosion can be used potassium permanganate solution and boric acid solution wet compress, 1 to 2% gentian violet potion rubbing or with mucosal ulcer cream, neomycin ointment and other external coating, 1 day 2 to 3 times.
3. For the rash occurring in the eyes, treatment and care should be strengthened, and tetracycline, chlortetracycline or herpes net eye ointment can be applied.
Physical therapy
1, infrared: WS-spectrum multifunctional therapy instrument, voltage 220V, frequency 50-60Hz, power 150-250W, spectrum generator directly to the affected area, 25-35cm from the skin lesions, treatment power 250W, once a day, each time 30min.
2, ultraviolet light: take the floor type German 500wu high-pressure mercury lamp irradiation focal area and the corresponding nerve root area next to the spine, lamp distance 50cm, Ⅰ ~ Ⅲ ED, irradiation every other day, individual high sensitivity in 48 hours after the erythema reaction is still significant, can stop shining 1 time.
3, low-frequency electromagnetic therapy: magnetic therapy machine magnetic head open surface across the sterile gauze, directly against the surface of the lesion, each treatment for 20 minutes, once a day.
Herpes zoster clinical treatment experience
1, herpes zoster is commonly known in Chinese medicine as waist wrapping fire, the disease is caused by emotional disorders, liver depression and gas stagnation, depression for a long time into fire, or poor diet, dampness and heat, and poisonous evil. Among the five viscera and six internal organs, the most significant is the invasion of the liver and gallbladder meridians, and the most common sites are the hypochondriac region (intercostal nerve innervation area) where the liver meridians pass and the temporal cheek region (trigeminal nerve innervation area) where the gallbladder meridians pass, so Chinese medicine treatment mostly starts from the liver and gallbladder meridians.
2. Accurate clinical identification and typing is the key to achieve curative effect. Although the disease is manifested in different clinical patterns, its onset must be triggered by the feeling of poisonous evil (virus), therefore, in the identification and treatment, it should also be combined with the identification of the disease treatment, appropriate selection and addition of Dazhengye, Banlangen, Guanzhong and other heat-clearing and detoxifying products, and the use of topical application of Liushenwan to improve the efficacy.
According to the theoretical viewpoint of Ye Tianshi, it is a long-standing pain into the ligaments, so it can be treated by activating blood circulation and relieving pain.
4.According to the different parts of the lesions, different meridian inducing drugs should be used, such as burdock and orris for head, face and neck, Chai Hu, Yu Jin and Gua Pou for chest, waist and back, and Niubizi for vulva and lower limbs, so that the medicinal power can reach the disease directly.
5. The severity of the disease and the prognosis are related to the patient’s age and physique. Older and frailer patients have severe skin lesions and pain, and the pain lasts for a long time after the rash disappears.
6.When the clinical effect of treating this disease with one method alone is not good, consider combining Chinese and Western medicine, internal and external treatment, together with acupuncture, physical therapy, etc. to improve the efficacy.
7. The method of moving qi and blood to relieve pain should be used throughout the treatment process.
Care of herpes zoster
1, skin care: after cleaning the affected area, to the larger blisters to 3% boric acid water or plate blue root, dandelion, honeysuckle and other Chinese medicine decoction wet compresses, several times a day. For dried and deflated blisters, use Zijinzuo and Yunnan Baiyao to apply to the affected area with cold water, about 3 to 4 times a day. For itchy skin, it is advisable to try to distract the attention, or use warm water bath, local application of 0.25% glacial glycopyrite lotion or 5% sodium bicarbonate solution, or oral antihistamines. If there are no comorbidities, no special treatment is usually needed, only symptomatic treatment. When the herpes breaks down, apply 1% methyl violet, and for secondary infections, use local antibiotic ointment or oral antibiotics to control the infection. Irradiation of the rash with a therapeutic apparatus has the effect of relieving itching, preventing secondary infection, and accelerating the drying and crusting of herpes. In addition, avoid local scratching to avoid blister rupture and infection, urge the patient to change clothes and cut nails regularly, keep the skin clean, keep the room temperature appropriate, clothes wide and soft, bedding neat and should not be too thick and should be changed regularly to avoid discomfort and increase itchiness. Keep your hands clean, cut your nails short, and wear gloves for infants and children to avoid scratching the skin and secondary infection or scarring.
2, dietary care: herpes zoster is considered by Chinese medicine to be caused by dampness or heat toxicity, so do not spicy and fried hot products, so as not to help the fire heat, but also avoid too greasy fatty products, to prevent greasy moisture. Diet should be light, drink more soup, eat more fruits, vegetables, lean meat, eggs, milk, tofu and other nutritious and easy to digest food.
3, symptomatic care: according to the different symptoms of the patient to give the appropriate care, skin severe pain, in addition to giving anti-inflammatory pain, Valium and other drugs taken orally, as much as possible to talk with the patient, encourage patients to go out for a walk. If conditions allow, you can also participate in small recreational activities, such as chess, poker, listening to music, watching TV, etc. to distract yourself and reduce pain. For those with spleen deficiency and dullness, the diet should be diversified, with small and frequent meals that are easy to digest and avoid affecting the transport function of the spleen and stomach. For those who are anxious and worried, patient persuasion should be made to encourage them to build up confidence, while trying to improve the room environment and keep it quiet to make the patient calm and comfortable. For constipation, encourage the patient to develop the habit of regular bowel movements, gently massage the abdomen frequently to promote intestinal peristalsis, add appropriate amount of coarse fiber food to the diet, drink more soup and water, and drink honey water for the elderly, and if necessary, use drugs such as constipation pass and Cistanche laxative to help defecate.
Prevention of shingles
Do not overeat, do not overeat, do not overeat cold products, to prevent damage to the spleen and stomach, breeding dampness. Avoid eating spicy and fishy products, and stop smoking and drinking to prevent dampness and heat. Maintain a relaxed mood, actively participate in sports and exercise to improve the immunity of the body. If the spleen and stomach function is low, timely treatment should be carried out to prevent dampness from gathering and turning into heat. Those who have not had chickenpox and those with low immune function should avoid contact with patients with chickenpox and herpes zoster. For those at high risk, gammaglobulin or herpes zoster immunoglobulin can be injected intramuscularly. In recent years, live attenuated varicella-zoster virus vaccine has been tried abroad to immunize susceptible individuals.