Treat herpes zoster.

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Deputy Chief Physician Cui Jianjun

Inner Mongolia forestry general hospital traditional Chinese medicine

Herpes zoster, from the perspective of traditional Chinese medicine, can be classified as waist-wrapped fire pills or snake sores. Traditional Chinese medicine generally divides it into qi stagnation and blood stasis, phlegm and blood stasis, qi deficiency and blood stasis, damp-heat accumulation and so on. The treatment of qi stagnation and blood stasis is mainly to promote qi circulation and remove blood stasis, and Dachaihu Decoction, Guizhi Fuling Pill and Shaoyao Gancao Decoction can be used for treatment. The treatment of phlegm obstruction is mainly to strengthen the spleen and eliminate phlegm, dredge collaterals and relieve pain, which can be treated with Gualou Honghuagang Decoction and Platycodon grandiflorum and Glycyrrhiza uralensis Decoction. The treatment of qi deficiency and blood stasis is mainly to replenish qi and nourish blood, which can be treated with Huangqi Guizhi Wuwu Decoction and Shaoyao Gancao Decoction. The treatment of damp-heat accumulation is mainly to clear away damp-heat in liver and gallbladder, which can be regulated by Longdan Xiegan Decoction.

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treatment according to syndrome differentiation

1. Damp-heat in liver and gallbladder

Symptoms: red rash, tight swelling of blister wall, burning and stinging pain, bitter taste, dry throat, thirst, irritability, loss of appetite, dry stool, yellow urine, red tongue, thin yellow or thick fur, and slippery and thin pulse.

Discrimination:

(1) Syndrome Differentiation: The main points of this disease are rash, swelling of blister wall, burning pain, red tongue, yellow fur and rapid pulse.

(2) Pathogenesis: damp-heat in liver and gallbladder, suffocating skin and red blisters; Damp heat stagnation, burning pain; Heat injury to body fluid leads to bitter taste, dry throat, dry stool and yellow urine; The liver is just dirty, and the liver and gallbladder are hot and irritable. Traditional Chinese medicine treatment of herpes zoster is characterized by red tongue, yellow fur and slippery pulse.

Treatment: The prescription for clearing liver and purging fire and clearing away heat and toxic materials is Longdan Xiegan Decoction. Commonly used drugs are Gentiana macrophylla, Gardenia, Scutellaria baicalensis, Lithospermum, Radix Isatidis and Fructus Toosendan.

2. Spleen meridian is full of moisture.

Symptoms: the color of herpes colliculus is pale, the blister wall is slack, the pain is slightly mild, the mouth is not thirsty, and I don't want to drink water. It doesn't think about diet, and after eating, it flattens and has loose stools. Female patients have more leucorrhea, light and fat tongue, thick or greasy fur, and slow or slippery pulse. Treatment of herpes zoster with traditional Chinese medicine

Discrimination:

(1) Syndrome Differentiation: The symptoms of this syndrome are light complexion, no thirst, no appetite, abdominal distension after eating, thick or greasy white fur, and slow or slippery pulse.

(2) Pathogenesis: improper diet, spleen losing health, endogenous damp-heat, dampness blocking qi, skin stasis and skin papules. Traditional Chinese medicine treatment of herpes zoster, due to dampness and heat, leads to light skin color and loose blister wall; Damp pathogen blocking middle energizer leads to thirst, anorexia and abdominal distension, loose stool. Herpes zoster is treated by Chinese medicine with fat, thick or greasy tongue coating and slow or slippery pulse.

Treatment: The prescription is modified by Chu Shi Ling Wei Decoction, and the commonly used drugs are Atractylodis Rhizoma, Poria, Coicis Semen, Talcum, Codonopsis pilosula and Alisma orientalis.

3. Qi stagnation and blood stasis

Syndromes: Blister subsides, local pain persists, skin color is dark red, taupe or pigmentation, pain gets worse at night or in rainy days, tongue is dark, fur is white, and pulse is thin.

Discrimination:

(1) Syndrome Differentiation: The key point of this syndrome is that pain is not only the key point of syndrome differentiation, but also common in the elderly.

(2) Pathogenesis: old and weak, lack of qi and blood, poor circulation; Dampness of liver meridian and excess of spleen meridian can block qi-flowing; Poor circulation of qi and blood makes the skin stagnate, and it hurts if it is blocked. Although the evil of damp-heat has subsided, the stagnation of qi and blood has not been solved, so the rash has subsided and the pain continues. White tongue coating and thin and dark pulse are signs of qi stagnation and blood stasis in herpes zoster.

Treatment: The prescription is Taohong Siwu Decoction, and the commonly used drugs are peach kernel, safflower, Ligusticum chuanxiong, white peony root, Cyperus tuber, corydalis tuber and so on.

empirical formula

Snake gall decoction: Folium Isatidis, Radix Isatidis 60g, Radix Arnebiae 10g, Radix Scutellariae 10g, Flos Lonicerae 30g, decocted in water, daily 1 dose. Frankincense and myrrh are added to patients with severe pain, and Cortex Dictamni Radicis and Kochiae Fructus are added to patients with severe itching. For external use, Qili powder is dissolved in boiling water and applied to the affected area 2-3 times a day.

Sanzi Decoction: Radix Arnebiae, Radix Scrophulariae, Herba Violae, Semen Plantaginis, Poria Skin, Caulis Akebiae, Radix Scrophulariae, Folium Isatidis and Glycyrrhrizae Radix.

Rash soup: Radix Salviae Miltiorrhizae, Radix Paeoniae Alba, Radix Bupleuri, Radix Isatidis, Herba Scutellariae Barbatae, Radix Gentianae Macrophyllae, Radix Gentianae, Radix Angelicae Sinensis, Fructus Gardeniae, Scutellariae Radix, Rhizoma Corydalis and Glycyrrhrizae Radix.

Zilan Bletilla Decoction: Radix Arnebiae, Radix Isatidis, Cortex Dictamni Radicis, Radix Paeoniae Rubra, Cortex Moutan, Periostracum Cicadae, Herba Menthae, Coicis Semen and Radix Sophorae Flavescentis.

Other therapies

1. Off-site treatment

Liushen pills: take 5 ~ 10 pills three times a day with warm water. Generally, the pain can be relieved the night after taking the medicine, and the color of herpes in the affected area becomes dark the next day, and it can be cured in 3 ~ 5 days.

Qilisan: 1 three times a day. 2g, served with warm boiled water or yellow wine. Generally taking 1 ~ 2 days, the pain is relieved or disappeared, herpes begins to subside in 2 ~ 3 days, and it is dry and crusted in 4 ~ 6 days.

Boron ice powder: take a proper amount of boron ice powder, mix it with vaseline and apply it to the affected area, once a day/kloc-0, usually for 2 ~ 3 days to improve the symptoms.

30g of rhubarb, 30g of phellodendron bark and 30g of coptis root, 5g of frankincense and 5g of myrrh. Grind the medicine into fine powder, add a proper amount of strong tea water, make it into paste, and apply it externally to the affected area.

Mash the fresh tuber with seven leaves and one flower and apply it to the affected area. Generally, after half an hour, the heat can relieve the pain, and herpes 1 ~ 2 times can subside.

12g fresh purslane is washed, mashed and applied to the affected area, and the dressing is changed twice a day.

Radix et Rhizoma Rhei 30g, Cortex Phellodendri 30g, Talcum 2 1g, Indigo Naturalis 60g, Borneolum Syntheticum 5g, Glycyrrhrizae Radix 10g. * * * After grinding into fine powder, mix well, add vaseline and ointment for later use, and apply externally to the affected area.

Decoct Eucalyptus grandis with water to make 10% solution, and wet compress the affected area with gauze soaked liquid medicine.

Apply persimmon liquid to the rash and surrounding pain, 3 times a day. 64 cases were treated, with an average of 3 cases. 2~4。 The rash subsided in 7 days, and the neuralgia disappeared in 3 ~ 4 days on average.

2. Acupuncture therapy

Acupoints Hegu (both sides), Zhigou and Yanglingquan (both sides are used), and the number of acupoints depends on the size of the lesion, with a maximum of 15 and a minimum of 4, without herpes. 5-inch puncture angle 15 degrees, all of them were treated with diarrhea.

Take three acupoints, Neiguan, Yanglingquan and Zusanli, and place needles around the local area for 30 minutes, once a day/kloc-0; If the sequela pain persists, add a branch groove or gall in the liver area and bury the needle for 3 days.

3. Moxibustion therapy

Commonly used acupoints: Ashi (affected area).

Operation method: You can choose moxa cone moxibustion directly and apply it on both ends and bifurcation of the rash. The amount of moxibustion is the degree to which patients feel burning and can tolerate it. This method is suitable for adults and places where moxa sticks should be placed in rashes. You can also choose hot moxibustion with moxa sticks, that is, depending on the size of the rash (focus), after lighting with 2 or 3 moxa sticks, local rotary moxibustion is carried out until the focus is congested and red, and the pain and itching disappear to a certain extent, and the time is about 20-30 minutes.

This method is suitable for children or areas where rashes are not suitable for placing moxa cones. 65438+ 0 times a day, twice a day for patients with neuralgia and rash, and three times for a few patients. 10 is a course of treatment, and 1 half course of treatment is continuous.

Principle: Herpes zoster is caused by the stagnation of pathogenic fire in the skin, the obstruction of meridians and the stagnation of qi and blood. Moxibustion at Ashi point can dredge local blood collaterals, induce heat with heat, guide evil to disperse stagnation, and draw poison to stagnate. In addition, as a warm stimulus, moxa sticks have the function of promoting blood circulation and diminishing inflammation.

4. Blood pricking therapy

Under the guidance of the basic theory of Chinese medicine, pricking blood therapy is an effective treatment method to regulate qi and blood, balance yin and yang and restore healthy qi by bloodletting and eliminating evil spirits.

The etiology is mostly wind-heat or damp-heat in the liver and gallbladder, which is caused by the skin.

Symptoms start suddenly, and the affected parts first appear rope-like, tingling and burning. Bubbles are as big as mung beans or soybeans, and more like beads. They gather in one or several places and are distributed along the nerves, and they are arranged in bands, but most of them are confined to one side of the body, the base is red and the skin between blisters is normal. Blister fluid is transparent at first, gradually becomes turbid and occasionally bleeds. Most of them are accompanied by mild fever, fatigue, loss of appetite and other systemic symptoms. Clinically, there are dry and wet diseases and red Huang Zhi diseases. Dry people are red in color, mostly due to wind and heat in the liver and gallbladder; Wet people are yellow, mostly caused by damp-heat in liver and spleen.

Treat redness and blisters around the skin. If accompanied by fever or severe herpes, it should be matched with Zusanli, Quchi and Xue Hai.

Methods: bloodletting method. Puncture the swollen and surrounding skin with triangular needle or filiform needle every 1-2 cm to see the bleeding. You can also gently squeeze the puncture site with your hands to see the bleeding, so that the evil blood can be discharged, and the swelling and pain can be reduced. If you are accompanied by fever or severe herpes, you can apply a millineedle to the matching points and keep the needle for 15 minutes by the method of flat reinforcing and purging. If you see herpes ulceration, you can apply gentian violet liquid medicine behind the needle and use sterile gauze externally to prevent infection. Treatment every other day 1 time, the more serious.

5. Cupping therapy

The technique of treating acute herpes zoster with fire needle plus cupping (fire needle praise method) combines the advantages and characteristics of traditional acupuncture methods such as fire needle therapy, pricking blood therapy, cupping therapy and cupping therapy. This method takes fire needle and cupping as the main instruments, combined with fire needle burning, fire needle selection, needle selection and cupping.

Introduction of ancient Chinese medicine professionals: choose seven-star needle 1 root, three-edged needle 1 root, 4~6 glass cupping cups and some sterile gauze. The selected acupoints are the sensitive points around the affected part, Fengxi point in the middle of the ear (between the anterior finger area of the helix tubercle and the wrist area) and the corresponding parts.

Operation: first acupuncture around the affected area, and then acupuncture ear points. The skin in the affected area is completely exposed. After iodophor disinfection, the operator tightens the skin around the affected area with his left thumb and forefinger. If the local little red dot (blister) is scattered or few, you can hold the local skin, hold the back end of the seven-star needle with your right hand, press your index finger on the needle handle, and quickly tap and puncture the skin around the affected area with the strength of your wrist to make the skin dizzy. After operation, a suitable type of glass cupping cup was selected according to the tapping area, and it was adsorbed on the tapping part centered on the affected part by flash fire method, so that the bleeding in the cupping cup ranged from several milliliters to more than ten milliliters.

Wipe the dirty blood with gauze after lifting the can; Then find out the sensitive points and Fengxi points in the corresponding parts of the ear by pressing. After disinfection, fix the auricular point with the left hand, insert the needle with a triangular needle with the right hand, squeeze out a little blood and wipe it with a dry cotton ball. 65438+ Rotate the auricular points about 0 times a day.

Traditional Chinese medicine believes that herpes zoster is caused by stagnation of fire in the liver meridian and damp-heat in the spleen meridian, and reheating is evil, and damp-heat accumulation invades the skin meridians. Pricking blood, cupping and auricular point sticking have a good effect on this disease, especially for early herpes zoster. After the seven-star needle is pricked with strong stimulation, the bleeding point can be seen, and then cupping can suck out the blood stasis in the pinhole, which has the functions of promoting blood circulation, removing blood stasis, and eliminating damp-heat and toxic fire, thus achieving the goal of "general principle is painless".

By burning the tip of the fire needle red and white, its high temperature burns local skin lesions, and by virtue of the thick needle body of the fire needle and shallow needling with multiple needles, the local herpes skin lesions can be completely opened. In addition, with the strong adsorption of cupping, all local toxic and pathogenic blood can be brought out, so that the damaged parts can be fully nourished by new blood, thus achieving the effects of pain relief and healing.

6. Diet therapy

Take Folium Isatidis 15g, Radix Bupleuri 15g, japonica rice 309, and appropriate amount of sugar. Folium Isatidis and Bupleuri Radix are added with 250 ml of water. Stir-fry until 200ml, then add japonica rice and white sugar to cook porridge. One dose a day for 5-6 days.

taboo

1, avoid spicy and warm food.

Spicy and warm products such as wine, cigarettes, ginger, pepper, mutton, beef and fried food are easy to help fire and heat after eating. Traditional Chinese medicine believes that the disease is caused by the accumulation of damp-heat and toxic fire on the skin, so patients with the disease should avoid eating the spicy food mentioned above.

2. Be careful to eat fat and greasy products.

Fat meat, maltose, milk, sweet taste and other foods are mostly greasy and fatty, which is easy to make the disease full of damp heat, toxic evil and lingering.

3. Be careful to eat sour and astringent products

Sour products include peas, Euryale ferox, pomegranate, taro, spinach and so on. Traditional Chinese medicine believes that this disease is mostly caused by emotional disorder, stagnation of liver qi, stagnation of fire for a long time, and resurgence of toxic pathogens, so the treatment should be mainly based on promoting qi circulation, promoting blood circulation and removing blood stasis. However, the above-mentioned astringent products are easy to make qi and blood impassable, evil spirits persist, and the pain is aggravated.

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How does Yunnan Baiyao treat herpes zoster?

15-04- 13? Shu Ninglan? +Pay attention to flower collection (1)

Herpes zoster is caused by varicella-zoster virus, and the incidence rate is high in summer and autumn. Early onset is often accompanied by symptoms such as low fever and fatigue. At the initial stage of herpes, irregular or oval erythema will appear on the skin, which will develop into blisters after a few hours. With the development of the disease, it can merge into a large blister, and in severe cases it will develop into a blood blister. If there is a secondary infection, pustules will appear. The pain was worse at first.

Yunnan Baiyao has anti-inflammatory, analgesic, detoxicating, detumescence, blood stasis and granulation promoting effects, and can be used to treat herpes zoster clinically. The specific method is as follows:

1, Yunnan Baiyao powder directly applied externally:

(1) Treatment method: firstly, wash the affected area with normal saline and medical alcohol, then pump out the bubble liquid at the bottom of the blister wall with a sterile syringe, and then evenly apply Yunnan Baiyao to the affected area, and wrap the easy-to-wipe part with sterile gauze twice a day for eight days. The control group used acyclovir ointment, and other treatments were the same as the experimental group.

Results: There were 23 cases in Baiyao group and 23 cases in control group, in which the effective rate was 95.65% in Baiyao group and 73.9 1% in control group.

(2) Song Huifeng and others made Baiyao paste with physiological saline for external application to treat herpes zoster; Yang Zhen used vinegar to make Baiyao paste for external application, and even directly mixed Baiyao with cold water, which achieved good therapeutic effect.

2, integrated traditional Chinese and western medicine therapy:

(1) Treatment: The Baiyao group was given acyclovir intravenously every day, and then Yunnan Baiyao was mixed with sesame oil and applied externally to the affected area, 2-3 times a day. The control group only received intravenous acyclovir. Seven days is a course of treatment. Herpes, pain and scab were observed on the 3rd, 5th and 7th day after treatment.

Results: The time of stopping blister, relieving pain, scabbing and healing in Baiyao group were shorter than those in control group (P

Lin Ruifeng and He Xiaoping used this method to treat 30 patients and achieved good therapeutic effect.

(2) In addition, Miao Wei and Zhang Ruimei used acyclovir ointment with Yunnan Baiyao for external use; Liu Yuefen used Yunnan Baiyao external application combined with ribavirin intravenous drip to treat herpes zoster, and the effect was ideal.

3. Physical therapy combined with Yunnan Baiyao to treat herpes zoster;

(1) treatment method: after routine skin disinfection, puncture the central point of herpes with a triangular needle, the number of needles depends on the area of the affected skin lesion, and then pull out the acupoint with large-caliber cupping for about 8 ~ 12 minutes. After cleaning the skin, Yunnan Baiyao paste was mixed with vinegar twice a day, while the control group was treated with acyclovir ointment four times a day. Both groups were used continuously for one week.

Results: The analgesic time, detumescence time, scabbing time, healing time and course of disease in Baiyao group were significantly better than those in control group (P

(2) Chen Yiwei and others also adopted this method, and achieved a therapeutic effect of 100%; Munk used semiconductor laser irradiation to treat herpes zoster, then mixed Yunnan Baiyao and rapeseed oil into paste, and then irradiated the affected area with TDP therapeutic instrument, and the treatment effect was good.

4, Yunnan Baiyao treatment of postherpetic neuralgia.

(1) treatment method: Yunnan Baiyao capsules are taken orally, 2 capsules each time, twice a day, with massage of the affected area or microwave and TDP irradiation.

Treatment results: The analgesic effect is the fastest 1 day, the slowest for 6 days, and the effective rate is 100%.

(2) Chu Jinyu and others used salvia miltiorrhiza injection, acyclovir tablets, vitamin B 1, B 12, analgesic tablets, glucocorticoids and Yunnan Baiyao aerosol for external use; Song Qixia and others used Xuefu Zhuyu decoction with Yunnan Baiyao for external application; Min Yang et al. used electroacupuncture and Yunnan Baiyao external application to treat postherpetic neuralgia, and both achieved good results.

Discussion:

Herpes zoster mainly manifests as local skin redness, pain and herpes. Traditional Chinese medicine believes that the disease is caused by the weakness of vital qi, infection with damp-heat evil, and the retention of evil poison in the body, which is limited to meridians and burns the skin. Yunnan Baiyao can resist inflammation, reduce swelling and promote granulation tissue proliferation, thus promoting rapid wound healing. Clinical treatment of herpes zoster with Yunnan Baiyao. Many patients feel cool and relieve pain after external use of Baiyao. At the same time, it can be seen from a large number of documents that Yunnan Baiyao can also effectively promote the cure of herpes zoster, with low cost and safe use, which is worthy of clinical promotion.

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Liushen pill can be used to treat herpes zoster in clinic, but it is often used externally. Liushen Pill can be used as an auxiliary drug to treat herpes zoster, and it is generally not recommended for patients to simply use Liushen Pill to treat herpes zoster. Because in clinic, some patients have a large distribution of herpes zoster, and obvious herpes ulceration has occurred, which is not suitable for the treatment of Liushen Pill alone. If patients want to treat herpes zoster, they must go to the dermatology department of a regular hospital for treatment. Generally, based on the application of antiviral drugs, acyclovir ointment, penciclovir ointment and Liushen pill can be used for adjuvant treatment. , often will receive good therapeutic effect.

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Liushen pill is useless in treating herpes zoster. Herpes zoster, known as snake-shaped sore in Chinese medicine, is generally caused by stagnation of heat in the liver and gallbladder. The traditional Chinese medicine treatment is to purge the liver and gallbladder and detoxify. The main Chinese patent medicines used are Longdan Xiegan Pills or Longdan Xiegan Capsules. In addition to treating herpes zoster with Chinese patent medicine, you can also take western medicine orally, such as valaciclovir or famciclovir tablets, to prevent viruses, and take drugs that nourish nerves, such as vitamin B and mecobalamin tablets, to improve the symptoms of nerve damage.

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What is the difference between acyclovir and penciclovir?

They are nucleoside broad-spectrum antiviral drugs. Clinically, it is mainly used to fight herpes virus. Comparison: Penciclovir ointment in the treatment of recurrent herpes simplex takes effect faster and has a shorter course of treatment than acyclovir for external use. Pharmacological effects of penciclovir: penciclovir is phosphorylated by virus thymine deoxynucleoside kinase to penciclovir monophosphate, and then cell kinase converts penciclovir monophosphate into active penciclovir triphosphate, which competes with deoxyguanosine triphosphate to inhibit herpes virus polymerase, thus inhibiting virus DNA synthesis and blocking virus replication.

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Acyclovir ointment+Liushen pill = treatment of herpes zoster.

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Longdan Xiegan Pill+Ganciclovir +VB+ Mecobalamin Tablets to improve nerves.

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What is the difference between acyclovir and penciclovir?