Shingles Part II: TCM Differentiation and Treatment

[Caution for my readers: The information in this post is intended for healthcare practitioners. Do not attempt to administer any of the suggested medicinals or supplements to yourself at the doses suggested here. Not all of the substances mentioned here are safe for every patient and they should only be prescribed by licensed practitioners.]

I have treated many cases of shingles since I started treating patients in 1998.  Recently I actually broke out in shingles myself and my experience as a patient suffering from this condition taught me more about it than I ever wanted to know.  Here is what I have been taught (and what I have learned) over the last 14 years about the treatment of shingles with Traditional Chinese Medicine.

The Three Most Important Things To Keep In Mind About Treating Shingles (Herpes Zoster):

  1. ACUPUNCTURE IS AMAZING AT RELIEVING THE ACUTE PAIN FROM SHINGLES.  Everyone who is unfortunate enough to develop shingles should get acupuncture treatment as soon as possible.  Not only does it alleviate the horrible pain, but acupuncture treatment during an acute shingles outbreak can significantly reduce the risk of post-herpetic neuralgia.
  2. Practitioners, YOU MUST NOT BE WUSSY when treating shingles.  You must be aggressive and you must treat quickly and frequently.  Acupuncturists, please forget about that “once per week for 10 weeks” crap.  You start herbs and acupuncture IMMEDIATELY upon diagnosis.  If the patient can get to you within the first couple days of the rash, you treat every day for the first 5 – 7 days.  Don’t make these patients wait, not even a day if you can help it.  Treat even if they are also taking a pharmaceutical antiviral.  Some patients may choose to let this self-limiting disease just burn itself out.  That is fine, but realize there is increased risk of post-herpetic neuralgia and scarring.  I always choose to treat in the elderly and for cranial nerve cases (affecting face and eye region).
  3. Acute attack of herpes zoster is always an excess (shi) condition.  There may be deficient conditions underlying the development of this illness (especially in the elderly and those with suppressed immune systems), but the acute attack is always excess and must be treated aggressively to spare the patient post-herpetic neuralgia and scarring of the skin (which is rare but is especially a concern when shingles appear on the face).

Acute pain from this condition is easy to treat and responds exceptionally well to acupuncture treatment, but post-herpetic neuralgia can be stubborn and sometimes does not respond to acupuncture treatment.  So it is vital that you educate your patients about how to recognize shingles immediately so they can seek treatment as soon as possible.  Patients should start antiviral therapy (western pharmaceutical or herbal) within 72 hours of the first signs of the rash erupting (FYI, Famvir is the best choice for pharmaceutical antiviral therapy against Herpes Zoster – it is more effective than Acyclovir or Valcyclovir/Valtrex). For many people, shingles will resolve with no problems even if they do not treat it.  But I would not leave it up to such chance.  And I would never let a case of shingles go untreated in a person over age 50 or in the case of ophthalmic zoster, regardless of patient age.

TCM Differentiation and Herbal Treatment of Acute Herpes Zoster

Acute herpes zoster typically is either Fire (and Wind) in the Liver & Gallbladder Channels(the most common pattern), or Damp Heat in the Spleen.  Either of these patterns can lead to Stagnation of Qi & Blood which is seen in post-herpetic neuralgia.

From this photo alone, I would guess this was Fire in Liv/GB Channels but Damp Heat in the Spleen is possible, too, since those are rather large vesicles with much fluid. More info is needed for proper differentiation.

Fire (and Wind) in the Liver & Gallbladder Channels usually arises from emotional stress that caused Stagnant Liver Qi that then was constrained for a long period.  This stagnant Qi develops into Heat that then “blazes” out from the channel to the skin. In all practicality, the differentiation of Fire and Wind in the Liver & Gallbladder Channels is not an indication that the symptoms are strictly confined to those channels alone.  The patches of blisters most often will appear on the torso in the hypochondriac region (the flanks) or the lumbar region.  They typically will show up first on the back just lateral to the spine or on lateral aspect of the torso and can progress along the dermatome to the anterior midline.  Lumbar region vesicles can spread into the groin or even down the thigh (any aspect – anterior, lateral or posterior thigh). Sometimes the eruptions will begin on the shoulder blade or just lateral to the spine of the upper back.  In cases of shingles involving the 5th cranial nerve, pain and vesicles will erupt right along the Gallbladder channel on the scalp and forehead.  Know your dermatomes – this will help you predict the progression of the eruptions and “head them off at the pass” (via acupuncture, which will be discussed momentarily). In this syndrome, the vesicles usually are small and clumped close together (appearing very similar to poison ivy) in patches that form relatively linear trails and the pain from the shingles often has a burning quality to it.

In Fire in the Liver & Gallbladder Channels, accompanying symptoms may include bitter taste in the mouth, constipation, darker or scanty urine, dizziness, restlessness, red eyes, red facial complexion, irritability or outright anger.  But let’s be realistic…when the patient is experiencing this much pain (shingles is disproportionately painful to what you will see on the surface of the skin) and itching (the lesions can get crazy itchy!), it is near impossible to be anything but restless and irritable.  So that is not really very helpful diagnostic criteria.  The patient’s tongue will likely be red with a yellow sticky coating, but this may not be the case if there is much underlying deficiency.  The pulse will likely be wiry and rapid, even if there is underlying deficiency, as this is an indication of the acute pain and inflammation.

Compare this to the photo below. This looks more like Fire in Liv/GB Channels.  The vesicles are small and tightly clumped with little fluid.

The Treatment Principal for Fire in the Liver & Gallbladder Channels is to Clear Heat, Drain Liver Fire, and Resolve Toxins (and Stop Pain).  The chief formula to accomplish this is Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver).  In simple cases (younger patients, small area of skin affected), patent formulations can be effective enough if you also prescribe a concurrent antiviral formula (Chuan Xin Lian formula from Mayway  is my patent of choice for shingles).  Have the patient take both formulas at full dose of each (which obviously depends on which brand of pills you choose).  I advise using a custom formulation in the form of decoction or granules if the pain is severe, if there is significant inflammation, if a large area of skin is involved, if the patient is over age 50, if the patient has much underlying deficiency, or if the face (cranial nerve) is involved (this is a dangerous condition).  If you are making a custom formula, add Ban Lan Gen (15 – 18g) and Ma Chi Xian (15 – 18g) for their antiviral properties (they have specific antiviral effect against herpes zoster). You can also add herbs that Move Blood to Stop Pain such as Dan Shen, Ru Xiang, Mo Yao and/or Yan Hu Suo.   If the skin rash is severe, add Zi Cao, Lian Qiao, Ye Ju Hua, and/or Jin Yin Hua.  You may also consider modifying your formulation for other symptoms such as fever or constipation.  Give the patient the maximum dose of the formula appropriate for their age/size/constitution and warn the patient how bitter this formula will be.  If the patient is elderly and/or has much deficiency, adjust your formula accordingly.  Long Dan Cao (the chief herb in Long Dan Xie Gan Wan) is very bitter.  If you feel it may be too bitter for your patient, substitute Ban Lan Gen.  Keep the main treatment principal to Clear Heat and Drain Liver Fire, but add a small amount of herbs to support their constitution (such as herbs to Nourish Liv Blood /Yin, like Dang Gui).  As the vesicles begin to scab over, the itching can become intense.  At this stage, add herbs such as Bai Xian Pi, Fang Feng, and/or Ku Shen to further reduce itching.

Compare to photo above. I would diagnose this as Damp Heat in the Spleen. Note the larger vesicles and the facial edema around both eyes.

Damp Heat in the Spleen develops from underlying Spleen Qi Deficiency and is more difficult to treat than Fire in the Liver & Gallbladder Channels. When shingles erupts on the chest, upper trunk in/near armpit, or on the face, consider this syndrome for your differentiation.  To generalize (which is not always a good thing to do), the individual vesicles from Damp Heat in the Spleen are typically larger than those seen in Fire in the Liver & Gallbladder Channels, have thinner walls and more fluid in them.  These vesicles tend to ooze more and in serious cases (like on the face), necrosis and erosion can occur, leading to scars. Vesicles of this type form a soft crust that looks like cottage cheese or cauliflower (see photo to the left) that eventually forms a black scab and can leave an erosion when the scab finally falls off (scroll down to next photo).  With Damp Heat in the Spleen, accompanying symptoms can include loose stools, bloating, fatigue (though most patients will be fatigued during the viral outbreak), and poor appetite.  The patient’s tongue will be puffy or flabby (or really big) with greasy coating and possibly scalloped sides.  The pulse will likely be soft or slippery, but can be wiry and rapid if there is much pain and inflammation.

The Treatment Principal for Damp Heat in the Spleen is to Clear Heat and Drain Damp (and Stop Pain).  The chief formula to accomplish this is Chu Shi Wei Ling Tang(Eliminate Dampness Decoction by Combining Calm the Stomach and Five-Ingredient Powder with Poria, original formula found on p. 182 Benskey):

Erosion (into dermis) remained after black scab fell off on day 16 of the shingles.

Cang Zhu  10g
Hou Po  10g
Chen Pi  6g
Zhu Ling  10g
Ze Xie  10g
Fu Ling  10g
Bai Zhu  10g
Fang Feng  6g
Zhi Zi  6g
Mu Tong  10g
Gan Cao  3g
Deng Xin Cao  6g
 

Add Ban Lan Gen (15g) and Ma Chi Xian (15g) for their specific antiviral properties, and Zi Cao (10g) to address the Heat Toxins in the skin.  If there is a lot of oozing, I add Yi Yi Ren (15g).  For itching, Di Fu Zi (9 – 15g) is my herb of choice here.

When the internal nerve pain caused by the herpes zoster infection becomes severe and intense, we have to consider that there is obviously Qi & Blood Stagnation.  In my practice I have never seen a case of acute shingles that was purely Qi & Blood Stagnation, so I just add to the above formulas to address the Qi & Blood Stagnation accordingly.  If you don’t want to make custom formulas, Evergreen Herbs makes a granule formula (available in capsules) specifically for herpes zoster.  It is called Dermatrol HZ and I think it is a good formula regardless of TCM differentiation.  For patients with very weak constitutions, amend your formulas with a small amount of tonics (Dang Shen or Huang Qi for general Qi Xu, Dang Gui for Blood Xu, Gou Qi Zi for Yin Xu).  A decent patent formula for viral infections in a patient with a weak immune system is Astra Isatis by Health Concerns.  Keep this on hand if you tend to treat many elderly or immune-compromised patients. This is also a good patent formula choice for chronic herpes zoster.

Having difficulty differentiating?  You are not alone.  In my case, I originally diagnosed my shingles as Fire in the Liver and Gallbladder channels because the eruptions and pain were right along the GB channel on my head, I had sudden constipation (when typically my stools tend toward loose), I was incredibly irritable and I was dealing with high stress levels  (I have underlying Liv Qi Stagnation).  In hindsight, I think I misdiagnosed myself. I think it was actually Damp Heat in the Spleen (underlying Spleen Qi Xu with Dampness that turned to Heat with the help of stagnation).  I did not treat the Dampness enough once the scabs started to form since there was not much fluid in the vesicles…but then there was necrosis and erosion and now I have a pitted scar above my eyebrow – son of a bitch!  (I’ll address how to treat that kind of scar in an upcoming post).  So if your patient’s lesions begin forming that cauliflower-looking yellow crust, treat that as Damp Heat even if there hadn’t been much fluid in the original vesicle.

Acupuncture Treatment of Acute Herpes Zoster

Acupuncture is possibly the most effective method of reducing the acute nerve pain associated with shingles.  You must start acupuncture treatment as soon as possible when treating shingles if you hope to reduce the likelihood of post-herpetic neuralgia. Patients should receive treatment EVERY day for the first 7 to 10 days.  For patients with severe pain, twice daily acupuncture may be necessary.  Wear gloves when performing acupuncture on shingles patients with acute eruptions (the vesicles may contain active virus). Patients will be far more needle-sensitive than they typically are.  Do not underestimate the sensitivity of their skin and do not underestimate the severity of the internal nerve pain – it is so grossly disproportional to what you will see on the surface.

To properly choose where to needle, you must be clear which dermatomes are involved.  If eruptions are on the trunk, needle the Jia Ji points associated with the affected dermatome as well as the adjacent dermatomes.  I also recommend needling the points along the Kidney channel at the anterior aspect of the affected dermatome(s).  Do circle needling (“surrounding the dragon”) around the patches of the vesicles.  If there are many clumps of vesicles, choose the largest clumps and/or the ones that look “angriest”.  Imagine that you are using your needles to corral the vesicles, to prevent them from spreading further along the nerve dermatome.  Also needle LIV 14, GB 24, and SP 21.  Needle points that help clear the affected channels (Shu-Stream points) and if your differentiation is Fire in the Liv & GB Channels, be sure to also needle GB 34, LIV 5, LIV 2, GB 43 and GB 44.  You also can needle the Jing-Well points of affected channels or bleed them if the patient will tolerate it to help Clear Heat.  General acupoints to choose from include LI 11 and LI 4 to Clear Heat; Sp 6 and Sp 10 to Move Blood; LIV 3 for pain; TW 5 to Dispel Wind from the skin if there is itching; or TW 5 + GB 41 to Move Qi along the sides of the body.  For the nerve pain, needle directly into Ah Shi points.  It will be quite painful to the patient, but the pain relief it can achieve will be worth it.

For shingles on the face, your main goal is to protect the health of the eye.  Needle Bl 1 and GB1 as well as BL 2 and Yu Yao.  This will hurt if the nerve is inflamed in this area – warn your patient.  But don’t skip these points – they are invaluable.  Other important points for ophthalmic zoster include Tai Yang, GB 14, GB 13, GB 15, TW 23, BL 7, ST 8 and any Ah Shi points on the scalp.  Be sure to also choose points that clear the Gallbladder channel (even if your differentiation is Damp Heat in the Spleen), Triple Warmer (esp. TW 2) and the Bladder channel as these channels are along the dermatome of the 5th cranial nerve. Distal points I would needle to Clear Heat from the eye area are BL 62, LIV 2, KID 6, BL 67, GB 44 (BL and GB channels start at corners of eye).  Don’t leave out the Ruler of the Face and Mouth, LI 4.  Include other systemic points listed above for pain, Heat and Wind as necessary.

I highly recommend doing Plum Blossom (7 star) for shingles on the scalp as they can get really itchy and the Plum Blossom works great to reduce the itch – just don’t be too aggressive.  You can also do it for smaller vesicles on the body but I do not recommend it for the big, deep vesicles seen in Damp Heat in the Spleen or for vesicles on the face.  Use the disposable Plum Blossom needles so you can send one home with the patient to use daily.

The treatment of shingles may be the only time we use moxibustion to treat a hot condition.  But indirect moxa can be very helpful to speed the healing of the lesions (it makes them come out faster and accelerates the course of the rash so it finishes sooner).  And even though there is inflammation, the heat from the moxibustion actually feels good to the patient.  I find smoky moxa poles work better than smokeless moxa, but choose your tools according to your preferences.  Colleagues of mine have recommended tiger warmers for use on the face.  Moxibustion can be done for 20 minutes daily.  I do not allow patients to do moxibustion on themselves near their face (if you have shingles near your eye, you have to close that eye when the moxa is near and that impairs your depth perception and burns can occur easily.  It would suck to have shingles and singe off your eyebrow or eyelashes).

Topical Treatment of Acute Herpes Zoster

As much as I love using herbs topically, I don’t think topical treatment is necessary for shingles.  But it can be quite helpful to reduce the discomfort (especially the itching) from the rash and may help the rash heal faster.  For large vesicles with much fluid in them, do not use oil-based ointments as you want air to get to the lesions.  Herbal compresses, soaks or pastes are a better choice.  A simple paste can be made from equal parts Shi Gao, Hua Shi and oatmeal (which helps with the itching).  Grind rolled oats in a coffee grinder (or buy oat flour) and add it to the Shi Gao and Hua Shi in a jar (shake it up to mix well).  Put a scoop of the dry mixture in a small bowl and add a small amount of water to form a paste.  Apply this to the lesions and cover with loose gauze to avoid a mess.  Alternatively, you could add 2 to 4 cups of this mixture to a bath and soak in it.  I prefer to make a paste from oatmeal, Shi Gao, Hua Shi, Ma Chi Xian, Ban Lan Gen and Huang Bai, but the simpler formula will work well enough.  You can also apply fresh aloe vera gel (directly from the plant).  Put the cut leaf in the refrigerator to cool and then squeeze the gel from it and apply to the lesions – the cold gel is such a relief.

Any of the internal herbal formulas above can be decocted and used as a wash/soak/compress by dipping gauze into them and then applying to the skin of the affected area. Cover lightly with a dry piece of gauze to contain the mess.  Do not wring out and reuse the gauze if the vesicles are fluid-filled.

Once the vesicles have dried out and are forming crusts, ointments can be applied.  But I am not a fan of applying ointment to the entire rash area.  You want those scabs to stay on there as long as possible so the skin beneath it has enough time to heal properly.  Ointments tend to soften the scab so it may fall off too soon.  I find it is better to apply ointments just around the edges of scabs to keep the skin there supple and to prevent it from being pulled too much as the scab shrinks.

Additional Treatment Considerations for Acute Herpes Zoster:

  • Vitamin C: to bowel tolerance (about 2000 mg BID).  Helps immune system fight virus and helps with wound healing. I enjoyed the Emergen-C drink because it was refreshing when I felt like total shit with the shingles.  I drank 2 packets per day and that also helped with the constipation.
  • Vitamin B12: 100 mg TID of a B Complex supplement or I.M. injection of hydroxycobalamin (if you do that sort of thing…I do not). Helps with nerve pain.
  • Lysine: 2000 to 4000 mg/day.  Inhibits the herpes virus.  (If you think that seems like a lot, consider that the vet has my 6.2 lb cat on 1000mg/day for her herpes eye infection.)
  • Vitamin E: internally 400 to 800 I.U. daily. Can also apply topically to the edges of scabs or to the entire lesion once scab falls off to prevent or reduce scarring.
  • If ophthalmic zoster affects the eye (lesions on the eyeball, vision problems, pain in eyeball) or the ears (pain in ear or hearing loss), the patient should see an ophthalmologist (or ENT, respectively) immediately.
  • Standard Process (nutritional supplements) protocol for acute viral infections:
      • St. John’s Wort (from MediHerb) 6 – 8/day – weakens the protein shell of the virus (all herpes viruses are enveloped viruses that have protein shells) and alerts the immune system
      • Cataplex C 12- 15/day
      • Cataplex F 12 – 15/day
      • Calcium Lactate 1 tblsp/day
      • Immunplex 6 – 12/day
      • Thymex  12/day
      • Andrographis Complex 6 – 8/day (or can take Chuan Xin Lian pian from Plum Flower instead)

Length of Treatment:

If you can start treating a patient when symptoms first arise, treat them daily for the first week.  The rash should stop progressing after 7 days and should be fully scabbed over and healing by day 14.  The rash should be fully healed (with the exception of any fresh scars) within 21 days.  Scarring may require further treatment.  The nerve pain should respond to acupuncture immediately, though it will return after each treatment during the progressive phase (first 7 days).  Do your best to resolve all nerve pain by day 10.  If nerve pain lingers beyond one month, post-herpetic neuralgia is likely.  Keep patients on the appropriate base herbal formula (based on your original differentiation) but adjust individual herbs according to the evolution of symptoms.  As the condition resolves, you can transition to formulas that treat underlying constitutional imbalances, but modify to continue treating any lingering pain or skin sensitivities due to lingering Toxins (I like Zi Cao, Ye Ju Hua, Lian Qiao and Jin Yin Hua for this).  The skin may remain sensitive, itchy, or tender for 2 months or so, but this is not the same as the nerve pain and is not likely to result in long-term discomfort. Patients should keep the affected skin out of the sun to avoid hyper-pigmentation of the newly healed lesions.  During the entire course of treatment, patients should avoid all alcohol and spicy/greasy/fried foods until the illness is completely resolved.

TCM Differentiation of Chronic Herpes Zoster:

Shingles can become a chronic condition in some individuals.  It may manifest as small patch of slightly red skin that is very tender or painful.  Or it may manifest as post-herpetic neuralgia that lasts months or even years.  This nerve pain can be quite disabling.  If you start acupuncture or herbal treatment during this phase of the illness, do not make any promises on how much you can help because this pain does not always respond to TCM treatment.  But do treat it because if you can make even minor improvement of this pain it can make a huge improvement in the patient’s quality of life.

The two most common TCM patterns seen in chronic shingles are Kidney Yin Xu and Qi & Blood Xu, both of which are often complicated by some degree of Qi & Blood Stagnation.  Lesions that exist in this chronic phase should not be exposed to cold or damp as any accumulation of Damp will make the condition more difficult to treat.

If you are a health care practitioner and have additional treatment options for herpes zoster , please share in the comments section below.  We’d love to hear what has worked for you and your patients.

[All photos in this post are Copyright © 2012 Elsevier Inc. and used with permission]

Tags: Chinese herbal medicine, Chinese medicine, dermatology, herpes zoster, shingles

Topics: Chinese Medicine, Herbs for Skin Care, Herpes & Shingles, Rashes

Publish Date: March 29, 2012     *Articles may include updates since original publishing.

About the Author ()

Diana Hermann is a licensed acupuncturist and board certified in Chinese Herbal Medicine. She received her Master Degree in Acupuncture and Oriental Medicine from the Oregon College of Oriental Medicine in Portland, OR and trained in China at the Nanjing University of Traditional Chinese Medicine. Diana treats patients in her Fort Collins, Colorado clinic and hand crafts herbal skin care products for her company Zi Zai Dermatology. In 2015, she completed the Diploma In Chinese Medicine Dermatology program from Avicenna in London, UK.

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  1. What Are the Treatments for Shingles With Acupuncture? | Health & Food - Popular Question & Answer | January 13, 2014
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  1. Diana Moll says:

    Truly great post, such an intense condition, in school direct moxa was recommended…what about laser?

    • I don’t have any experience with using lasers. Have you? Can anyone else comment on the use of laser treatment for shingles? A dermatology nurse I work with said the cryogun that sprays liquid nitrogen (usually used to freeze off warts) can be used to treat the more superficial skin pain from shingles (the gun is held much further away from the skin in this case). I should ask her about the use of lasers.

      • Diana Moll says:

        I use laser for areas and points, it can be quite effective. The manual has a Shingles protocol, though I’ve not had the opportunity to try it.

  2. amy says:

    What causes the stagnation? I have been dealing with this for years? having shingles several times a year, having gall stones just started however I think that trying the tcm instead of surgery, since this is the one that made scene and could explain nearly every other symptom, i have been having on a monthly cyclical basis, for about six months, I have seen a chiropractor since childhood, and also had Juandice, did I just start out messed up?

  3. Michele says:

    Do you have a recommendation for a Doctor in New York?

  4. Elsie says:

    How about in australia? Do you know anyone that you can recommend?

    • The only practitioner I know is Greg Bantick, in Brisbane, Queensland, Australia. But I have no idea you are near him or not. But I bet if you email him and tell him where you live, he may be able to recommend a colleague. If you find someone who is good at treating dermatological conditions, be sure to let me know so I can add them to my referral list. Good luck.

    • Karen Murdick says:

      Do you have any recommendations for someone in Saratoga Springs, New York?

  5. Elsie says:

    Is there a way of preventing recurrent shingles? It has been 5 weeks since I had my outbreak. I was given antiviral but after the 7 days so I probably already have phn. The nerve pain that I’m still suffering is not too bad. But I’m still not feeling myself–still feeling tired everyday (heavy around my eyes). Last week again, I had another flu-like symptom and tingling sensation from time to time, sometimes on my back, sometimes on my leg or arm. Is there any herbs that I can take to help me feel normal again? I’m desperate. I have family to take care of and work. I cant seem to function my daily activities well. I went to a retired chinese accupuncturist. He said exactly what you have said, he cant promise that he is able to help as it has been weeks. Help 🙁

  6. My recommendation would be to go to a TCM practitioner who is currently practicing and can can prescribe herbs for you. You will not find what you need over the counter. There is never any guarantee when it comes to health care – but you still need to be proactive. You cannot prevent a recurrence of the shingles in your case, but you can reduce the risk. If you work with a practitioner, they will be able to improve the function of your immune system (i.e. reduce the risk of another outbreak) and if you do get it again, they will have the ability to treat it quickly. Also, now that you know what shingles looks and feels like, if you get another outbreak you can get pharmaceutical antivirals immediately. Good luck to you.
    To find a current practitioner near you, visit:
    http://www.nccaom.org/find-a-nccaom-certified-practitioner

  7. marcie stout l.ac, mtcm says:

    I find yu nan bai yao powder as a topical, takes pain away and heals lesions faster. It also prevents infection.

  8. Nice – and the powder form is good for topical use as it forms a dry paste, as opposed to an ointment which is oil-based and not appropriate for use in the early stages of the rash.

  9. col says:

    hello,
    I have an outbreak of shingles and I live in London. Do you know of any acupunterists here that
    can treat this condition.
    kind regards
    Col

  10. col says:

    the shooting pains have only been for around 4 days and i am now on Acyclovir for one day. Do you think I got it too late?. Its all around my left shoulder blade and under my armpit. Lesions arn’t too bad..maybe about three around the edge of my singlet rim near my underarm and one on my left breast..size of a 10 pence. shooting pain has stopped since taking the antiviral medication..i was thinking of changing to Famvir, as I read it is better? what do you think..want to start acupuncture tomorrow..
    kind regards
    col

  11. Paul DeMott says:

    Thank you very much I,just got shingles and you have put my mind at easy!!thanks Paul.

  12. Gerard says:

    When using a tiger warmer, is it OK to use smokeless moxa sticks? Thanks!

  13. Thank you for the post! I’m an acupuncture student right now, and a professor of mine told me to treat shingles by gently, gently tapping about 1-2″ radius away from the shingle and go out from there to where it is no longer painful at all, then apply seven star needling and bleed. Note this is not bleeding the shingle itself, but about 2″ or more inch radius away from the shingle. Have you ever tried this and have you noticed any success?

  14. Gerard says:

    Another technique is bleeding of Ear Apex (Erjian M-HN-10) or visible capillary near that point for a more dramatic result, with a three-edged needle (7-8 drops of blood). Then auriculotherapy using pressure with vaccaria seeds (wang bu liu xing) at points LV, GB, Neck, HT and Ear Shenmen. Use this last treatment for a full 7 days.

  15. Liz says:

    Do you have any suggestion for a practitioner in Espanola or Santa Fe, NM? I have shingles all over my body and now on my face, and conventional medicine isn’t helping. Thanks.

    • I do not know of anyone in particular in that area, but most acupuncturists are trained to treat shingles. And if they are not certain how to treat it, they can call me and I will tell them exactly what to do!

    • Hi, Liz ~
      I practice in Espanola and Santa Fe, and dermatology is one of my special interests. If you are still having trouble with lesions, or with chronic pain following the outbreak, please contact me. I’m at Full Well Acupuncture in Santa Fe http://www.fullwellacupuncture.com, or Espanola Advanced Center for Healing, off Riverside Drive near the Fairview Pharmacy.
      best, Pamela

      • Wonderful! Thank you for letting us know about you.

        • pgflax says:

          Diana,

          I was so grateful to find your blog – it’s wonderful! I really appreciate your detail and explanations. Thank you so much for sharing your knowledge with our field. It’s such an important gift.

          Do you have info on postherpetic neuralgia treatments? I’m researching that as part of a pain PhD in Austin. Of course, most of your patients may not suffer from this because you have such good protocols to get them early and frequent treatments. If you do have ideas, I would appreciate them.

          Best regards, Pamela

          • PHN can be tough to treat and becomes more challenging the longer the pain is left untreated. I don’t really have good numbers for you to say what percentage of cases get good results because I don’t get too many of these cases – I think this is because many people do not consider acupuncture treatment for this (which is too bad). To best treat PHN, combine acupuncture plus herbs. Acupuncture is useful to Move Stagnation to reduce pain, but the herbs address the underlying deficiencies that prevent the affected nerves from healing completely. Starting with acupuncture, I would choose ah shi points for certain (needling these may hurt like hell but when the therapeutic effects of the acupuncture overcome the initial pain, it will be worth it) and definitely do Jia-Ji points along the spine at the level of the affected dermatome, as well as the adjacent dermatomes (the one above the affected dermatome and the one below it). Then choose from the following distal points: GB34 (+ TW6 if there is hypochondriac region pain), GB41 (to move Qi in the GB channel; and add TW5 for pain along sides of body), GB43 (clear Heat from GB channel), GB44 (clear Heat from GB channel), LIV2 (clear Heat from LIV channel and for pain along LIV channel and in pelvic region), LIV3 (for general pain as well as LIV channel pain), SP6 and SP10 (Move Blood – sharp pain in PHN is from Blood Stasis), and any Shu-Stream points along affected meridians to move Qi in the channels that have pain. So basically you want to Move Qi & Blood in the affected channels and along the affected dermatome(s), Stop Pain, and Clear Heat (from the inflamed nerves). It is important to consider what we know about the physical anatomy and how the virus affects nerves in this disease. Treat the dermatomes; do not just consider the TCM theory and energetic layers of the body.

            For herbal treatment of chronic PHN (or recurrent shingles outbreak), you have to diagnose the individual. Most commonly I see Kid/Liv Yin Xu with Blood Stasis or Qi & Blood Xu with Blood Stasis. If there is also Dampness (or Liv/GB Damp Heat), it will more complicated to treat this chronic phase. Either the weakness of the immune system or the presence of Dampness (esp. DH in Liv/GB) will predispose these individuals to possible recurrent shingles rash outbreaks, whether or not they have chronic PHN. Anyway, treat the constitutional imbalances with the appropriate herbal formulas for these patterns and you can add Ban Lan Gen and/or Ma Chi Xian to further treat the virus (don’t use too high a dose as high doses or long-term use of these cold and bitter herbs can be further damaging to Yin or cause digestive upset). I highly recommend adding St. John’s Wort (Guan Ye Lian Qiao) or, if using patent herbs, giving the patient a St. John’s Wort tablet in conjunction to the herbal formula. St. John’s Wort is an important addition to the treatment because it has the unique ability to break down the protein shell of the Varicella Zoster virus. This not only helps reveal the “cloaked” virus to the patient’s immune system, but it also creates a weakness so the antiviral herbs can penetrate and kill the virus more easily. You can’t kill all of the shingles-causing viruses in the patient’s body but you can reduce the viral load and improve the immune system to keep the disease in check. In addition to acupuncture and herbs, consider a maintenance dosage of the nutritional supplements suggested in the above post (typically 1/3 or 1/4 of the dosage recommend for the acute phase).

          • FYI, I recommend the addition of St. John’s Wort for treatment of ANY herpes virus.

  16. I practice Medical Qigong Therapy (Chinese energy medicine), this is what I do:
    1. Directly address the shingles vesicles by pulling out the heat using raking techniques. Visualize the qi heat/stagnation/dampness like a string of molasses being pulled out of the area. This is great for people in a lot of pain since there is no touch.
    2. Use the PC meridian to drain heat from PC2 to PC8 by stretching the meridian (one hand on each point) roll the thumb away from the body, opening the Yin meridians. Make sure the Laogong (PC8) point remains open.
    3. Then, clear dampness by first opening SP6 moving qi up the meridian. Once you get movement here, then you can drain down the ST meridian by using simple raking technique.
    4. Look for any remaining areas of stagnation and break those up using Tiger Kneading technique.
    5. Tonify Kidneys using Yin Sword fingers from Kd1 to Kd27.
    6. Finish by tonifying Righteous Qi by energizing the Taiji Pole at BaiHui.

    Modify diet accordingly.

  17. Mardi Herron says:

    Hello, my father, 94, is in his 4th month of shingles! The post heretic neuralgia remains even after initial treatment with acyclovir, neurontin and pred. It worked great at first as we started treatment on day one of his symptoms. Then he had a flare up of his congestive heart failure and the docs stopped his shingles meds. He was ok for a few weeks, then the herpes came back, neuralgia set in and has not quit. His is located mid back radiating around to the front of his torso. They have tried lidocaine patches, sarna, and now 2 steroid epidurals 2 weeks apart, no help. He needs help, in Portland Or. We are willing to try acupunture, at 94 he is still going! A great spirit!

    • You could not be in a better city to get him the care he needs. There are many fine acupuncturists in Portland, OR. If you are not certain where to start looking for a practitioner, contact the graduate school I graduated from: The Oregon College of Oriental Medicine (503) 253-3443. They will find a practitioner near you or your father can get treatment at their teaching clinic.

  18. M Cheong says:

    Quick question.. Have you ever seen shingles in a 3 year old? What would you guess to be the underlying condition and any suggestions on what treatnent might be most helpful?

    • I have never seen a case of shingles in someone that young – you have to have had chicken pox before you can get shingles, so if the toddler had chicken pox already so early in life, it is possible to then develop shingles. Poor kid! Herbs would probably be most helpful for this little one. Are you a practitioner yourself? The youngest case of shingles that I have personally seen was in a 19-year-old (he developed shingles after having the flu).

  19. Amy says:

    Glad to find your site. We are in small town southwest central NH, between Keene and Peterborough. I will check the acupuncturist here and forward your site. My husband got shingles in July and still has PHN. He did not make it to a doctor soon as he has only catastrophic insurance. We are followers, generally, of natural therapies, although he is hesitant to do anything that is not a guarantee as our income is very limited (thus the stress- inducing cause?), at the current time. I wonder if we should buckle up and go for these treatments, with the closest acupuncturist we can find? He is so irritable and down-hearted, right now. Are you familiar at all with cantharis- the homeopathic remedy? It is listed as being used for for shingles and neuralgia,

  20. Lance says:

    I got shingles a week ago, which was a surprise since I had the vaccine 1.5 years ago, and it attacked my hip & pelvis muscles, then the rash, and my bladder (which stopped working) – I’m told it happens occasionally. So I have to wear a catheter for 2 weeks. My wife discovered your great site and I’ve had acupuncture in the past, but I’m hesitant to go now because of the catheter since it would be embarrassing. Any thoughts about my predicament? Also, any recommendations for acupuncturists in Minneapolis? Thanks.

    • Don’t let modesty prevent you from seeking acupuncture (or any other form of treatment). Licensed acupuncturists/herbalists are trained professionals, and a catheter is a non-issue on our end. You have many excellent acupuncturists in your city. I will ask around if any of my colleagues can recommend someone specific. But don’t wait to hear back from me. Seek treatment as soon as possible to get the best results.

  21. Lance says:

    I took your advice and made an appointment with my regular TCM clinic, however my Shingles has been so bad that it wasn’t until this week that I felt like I could go. I’ve been disappointed by my health care providers, who told me tests showed I didn’t have shingles, and by the dermatologist they sent me to – yesterday she told me that my leg is filled with infection and acupuncture would spread the disease and cause harm by the needles which would expose the infection to air. Is this true? Her tests showed I had Shingles.

    • I’m surprised it was such a challenge for you to get a diagnosis – shingles is generally diagnosed on appearance and symptoms and rarely requires additional testing. That being said, acupuncture will NOT make anything worse, even if there is infection. First, licensed acupuncturists are trained in Clean Needle Technique and should use the proper procedures to ensure no infection is introduced or existing infections are spread. Secondly, we do not needle into infected skin, we needle elsewhere to illicit our therapeutic effect. Under the care of a licensed acupuncturist, you should be perfectly safe. Do make your practitioner aware that you were diagnosed with an infection though. And be cautious – shingles is infectious of you have fluid-filled blisters. You can spread it elsewhere on your own body and it can be spread to others if they come into direct contact with the fluid in those blisters (it contains active virus). Best of luck to you in your recovery.

  22. Shellie R says:

    I have shingles with a small rash under my left breast. The pain starts at mid-back and wraps all the way around my torso. My acupuncturist did several treatments, including bleeding some points on my back. Now, two days later, those points he bleed are red, angry, and itchy. I also have some stabbing pain, but that could be from the nerve pain. Is this normal? I have confidence that he follows universal precautions, although I did not see him put a new needle in the lance, I just assume that he did. FYI – he showed me the resulting blood and he commented that it looked good – not dark – suggesting that I still had good oxygenation in that area. Thanks!

    • Since I did not observe the treatment performed by your acupuncturist, I cannot say for sure what he did. I can only tell you that I do not bleed local points when treating shingles (I might bleed points on fingers or toes, though). I would let your practitioner know exactly what you are currently experiencing so he can help you determine if it is the typical progression of the shingles or if it is a negative reaction to the treatment. Sorry I cannot assist you further here. And so sorry you are suffering from shingles in the first place!

  23. Thank you for being such a generous resource of information. I agree that when we “inhabit” an illness we understand it so much better!

    Blessings,

    Raven

  24. Jane says:

    For post-herpetic neuralgia in the hip that responds to absolutely nothing…compression shorts work fairly well. Bear in mind that the patient has been in pain for nearly four years and there is no scarring, but lots of ongoing pain. Any other suggestions? Thanks

    • Well, without knowing what other treatments have been attempted, it is tough to advise. Have you tried herbal treatment? If so, what formula and what dose and for how long did the patient take it? Have you tried acupuncture at the Jia-Ji points of the lumbar spine and/or BL32 with electro-stim? Is the patient heavy-set with lots of fat at the outer hip? Weight loss can help to reduce the pull of gravity on that tissue which can aggravate the area. Is the pain in the skin still or is it deeper in the muscle?

  25. Judith Leong says:

    I am a TCM trained Zen Shiatsu practitioner. My husband began with back pain on August 2 and now, August 13 is in the full throws of shingles. It extends from his mid spine to the front of his left torso. He is in extreme pain. No prescriptions have helped – even pain pills are ineffective.
    Should I try Shiatsu? Do you believe it will be helpful in his case? I could treat his right side (GB) and easily treat KID/BL. In the beginning, Reiki was most effective, but in the past 5 days, he has had a difficult time relaxing and laying down.
    Your advice please. Mahalo.

  26. Lin says:

    I having shingles on my head, it have been a week and I having medovir oral medicine and acyclovir cream to apply for 5 days. Currently, still having a few like lymph node on the head which cause pain and my neck will strain. Any solutions for me?

  27. Diana,

    So happy to see your up-front admonition for “early & often” intervention. I am actually finding that twice daily treatment (we started at about Day 3 of the first little patch of redness, as soon as the diagnosis was unmistakable). We are using both distal and “surround the dragon” approaches, and they are working remarkably well. Patient also taking lysine (1g 2-3 times daily, as stomach can handle), valacyclovir (1g daily, to minimize risk of PHN) and Long Dan Xie Gan Tang (3g encapsulated granules (Evergreen, Gentiana Complex), aiming for 6g total daily dose). Results after just 2 days surprised even me and were a great boon to the patient’s emotional state, as at first it appeared the rash was growing/extending endlessly.

    Since someone inquired about moxibustion, I feel I should add that we also did pole moxa over the rash twice daily, until about half the stick was burnt down each time. I cannot say how much– or if at all– this is contributing to our results in this one case, but it does not seem to be hurting! (I know that many MDs caution against heat and advocate ice & cooling generally, but then they also recommend ice for sprains & contusions where we would also choose heat, I believe.)

    Just wanted to share and thank you again for this comprehensive and thoughtful post!

    • Heat in other forms (such as a warming ointment or hot pack or heat lamp) are inappropriate for shingles. But pole moxa works well to hasten the blisters to resolve and to alleviate the pain. It truly is the only case where I will use moxa in a condition that is already very hot. Great job on the case you shared and thank you for posting about it here!

  28. David Tobey says:

    Hi thank you for your website is information on Shingles.

    I am finished with the rash and inflammation, it was over my R forehead and R eye.

    My eye Dr has had me applying drops,steroid 12x’s daily/dilate 2×24, and apply eurthromyacin oint 3 x’s daily, this has removed inflammation to inner eye, all OK now.

    Currently I have the Neuralgia, and prior to shingles I have acid reflux, which if I don’t breath correctly, have wind in upper region, It increases Neuralgia.

    I am taking Long Ding Zhi, and a digestive combination that relieves esophagus and stomach discomfort.

    + Astragalus and Cordyceps sinensis.

    Can you help me understand how this is triggered by acid reflux?

    Thanks, I am in Portland Oregon

    • I do not see any way that the shingles are triggered by acid reflux. It is possible that (from the perspective of Chinese Medicine) the underlying energetic imbalance that has led to your acid reflux developing also has contributed to the environment that makes shingles a likely possibility, but acid reflux does not cause shingles and reflux alone should not cause the post-herpetic neuralgia to worsen. Of course, we should also realize that pain/discomfort anywhere in the body may make a person less able to be distracted by pain elsewhere (i.e. if your acid reflux causes discomfort, maybe your mind cannot hold the neuralgia pain at bay). I am sorry you are in pain. Acupuncture can be very helpful. You have MANY MANY great practitioners in your fine city who can help you.

  29. Laura says:

    Thank you so much for this post – it was incredibly helpful to me in terms of conceptualizing shingles and formulating possible treatments.

    However… I’ve got a particularly weird case and I wonder if I’m missing something key.

    The patient is a 76-year-old male who has had shingles for about a month and seems to be experiencing PHN at this point. The rash is on his left cheek and the pain started around ST-4 and is now shooting out to his ear and up along the BL and GB channels in the scalp. His pulses were excess, wiry, choppy, and rapid, with excess particularly in the LI and ST (which surprised me) when he came to see me the first time. I stayed away from the head and face at the time, not wanting to aggravate the area. Instead, I did some guasha along the back of the neck and shoulders, bled ST-44, and did an acupuncture treatment which ended up consisting of a lot of the points you recommend for releasing heat, moving qi and blood, and a bit of tonification for underlying deficiency.

    The next time he came in (yesterday), an attack started minutes before walking in my door. I had read your post between these two treatments and was emboldened to go to the head and face to try to stop the attack at its source. In addition to a few distal needles, I plum-blossomed the scalp, bled a few jing wells, put four needles in the face (BL-2, Yu Yao, GB-1, and SI-19), and used pole moxa gently over the cheek and scalp, as well as up and down along the channels of the legs because…

    While he was lying on the table, he suddenly got the sensation of his legs swelling, “filling up with air,” and they were painful. He’s diabetic and has neuropathy, but he said he had never experienced this sensation before.

    I just got off the phone with him, and he says he still has this sensation (as well as cranial nerve pain) since the treatment yesterday. The only thing that relieves the pain in the face is splashing hot water on his face (and I know you said heat is generally not recommended for shingles, but cold seems to make it worse and I’m loathe to forbid him to do something that helps).

    So…I’m stymied. After he reported the swelling sensation, I added ba feng on both sides, and it seemed to have no effect. I assume there’s a piece I’m missing since all of these venting, qi-moving techniques seemed to have the opposite effect (or perhaps no effect, but either way, I’m missing something). In all of the excess, might I have missed a key deficiency that allowed room for another EPI to slip in? Or something?

    He’s going to come back later this week for another try because I’m his only hope, and at this point all I can think to do is distal points again. I would appreciate any thoughts or insights you (or anyone) have.

    Thanks!

    • 76 y.o. and diabetes – maybe your treatment was simply too much. It is important to point out that your patient experienced a SENSATION AS IF his legs were swelling…there was no concrete physical swelling of tissue following your protocol (just want to make sure no one misreads that). If it were my patient I would avoid gua sha anywhere close to the affected nerves right now. I probably wouldn’t bleed Jing Well points at this time…he has had the outbreak for over a month now. But I still recommend local points and indirect pole moxa if it feels good to the patient. This patient has a mixture of Excess and Deficiency, so you must use caution with how forcefully you treat his shingles. I might suggest GB34 as well as more Tonifying points such as SP6 and KID3 for distal points. More tonifying now to help his body finish this fight against the virus. Is he taking any herbs? Pharmaceuticals?

      • Laura says:

        Thanks for your response!

        He is not taking herbs at this point except for a topical salve (of which he doesn’t know the ingredients – he got it at a local apothecary and it was mixed up for him specifically for shingles). He is on several pharmaceuticals (mostly for heart-related problems), though, so he was very hesitant when I suggested an herbal prescription as well. This being his first foray into non-Western medicine, he’s mistrusting about possible interactions (which I completely understand). I still recommended that he take echinacea, at least, since it’s relatively safe. I don’t think he followed up on that suggestion.

        The indirect pole moxa seemed to help a bit, and I was using tonifying points like GB34, SP6, SP9, LR3, ST 36, etc. because of his diabetes, but looking back on my notes I agree that I probably didn’t do enough tonifying that second treatment.

        Unfortunately, this patient had to cancel his last appointment with me because he ended up going to the hospital (his wife didn’t say why, although she did say that she would call to reschedule when he got out). So practically, this thread might be moot now, although this experience has been both educational and humbling for me.

        One more question. You say you wouldn’t do gua sha so close to the area of nerve pain: is that because of the pain itself or a is there a more TCM theory-related reason? The nerve pain stopped at the top of his scalp and the gua sha I did was farther down around C7, T1-2 area. Do you consider that too close?

  30. El Kell says:

    Very Interesting and informative. I live in the Seattle area. Shingles attacked me October 2015. It is not March 8, 2017. I have been suffering from PHN. The pain is in the V1 area of the trigéminas nerve. I have had 2 ablations.
    2 sets of several week accupuncture. Have been on gabapentin since the beginning. In addition since last two months I am now taking venlafaxine. Since my left eye was also affected. I have been seeing an opthomologist
    and using eye drops and valacyclobir. Also topical lidocaine. I experience pain and intense itching.
    Anything that you can add that will help me?
    sincerely
    El

  31. Jane wilson says:

    Essential oils for use in bath or in an oil carrier.

    Tea tree to combat infection

    Lavender to support healthy skin

    Geranium to suppress the virus

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