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HERPES ZOSTER (SHINGLES)

GENERAL

Clinical Manifestations	Prior to onset there may be: Slight fever Lymph node enlargement Local skin sensitivity and pain This is an acute infectious skin disease Usually along one side of the body Papular eruptions Lymph node enlargement Nerve pain which may be very severe and may continue after disappearance of the papules Occurs along the nerve routes, usually of the neck, intercostals, abdomen, lower back or extremities Ramsey-Hunt Syndrome: Facial paralysis Ear pain External ear papular eruption Several days later they become scabs Then they become light red There may be pain without eruption There may only be erythema The virus may distribute through the blood system (systemic) If Damp predominates: the lesions are primarily located on the lower part of the body with more fluid discharge If Heat predominates: there is more pain, heat and redness If Wind predominates: the lesions appear more often in the upper body with more itching If Dampness and Heat combine: there will be painful, red blisters with discharge If Wind and Heat combine: there will be painful, red blisters in the upper body Channels: Liver/Gall Bladder: lesions and pain in the flanks and intercostal regions Yang Ming and Shao Yang: lesions and pain on the head and face
Treatment Principle
Herb Formulas	Herpes Zoster #2 Acute: Da Yan Tang With Yin Deficiency: + Liu Wei Di Huang Wan With Yin Deficiency and Fire Rising: + Zhi Bai Di Huang Wan With Yin and Yang Deficiency: + Er Xian Tang After emotional stress causing Toxic-Heat: Jie Du Zhi Tong Tang Topical: Jin Huang San (Gao) Before the lesions have ruptured: 1. Mash together 1 fresh Aloe Leaf Lu Hui about 1 gram in length, 0.3-1g Borneolum Bing Pian and a pinch or Margarita Zhen Zhu and apply as a paste. 2. Use Fol. Hibisci Fu Rong Ye in an ointment base. After the lesions have ruptured: Apply equal parts Realgar Xiong Huang and Alumen Ming Fan mixed with water directly to the open sore, 1-2 times per day. Do not apply to the surrounding tissue and do not use if there are no wet, open, glistening sores. For erosive lesions: Decoct 30g each of Rx. Sanguisorbae Di Yu and Hb. Portulacae Ma Chi Xian and apply as a wet compress. After the erosive lesions have dried and scabs have formed: Apply Jin Huang Gao
Points	LI-11, ST-36, Sedate: SI-5, ST-44, LIV-2, HT-8 LI-4, LI-11, SJ-6, LIV-3, GB-34, Huatuojiaji, SP-10, SP-6 Forehead: Taiyang, ST-8, GB-14, UB-2, LI-4, LI-11 Head and face: 1. LI-4, LI-11, SI-5 2. GB-1, UB-2, Yuyao For ophthalmic herpes zoster: GB-13, GB-14, GB-15, SJ-2, SJ-23, ST-8, Taiyang, UB-7 and any Ahshi points on the scalp Distal points: GB-44, KI-6, LIV-2, UB-62, UB-67 Zygomatic area: Taiyang, ST-2, UB-1, ST-7, LI-4, SJ-17 Mandible area: ST-6, ST-4, ST-5, SJ-17, LI-4 Trunk: 1. Follow the nerve root + LI-4, LI-11 2. GB-24, LIV-14, SP-21 + the Huatuojiaji points associated with the affected dermatome as well as the adjacent dermatomes Below the umbilicus: ST-36, SP-6 Upper extremities: LI-4, LI-11, SJ-5 Lower extremities: SP-10, SP-6, ST-36, GB-34 Axillary area: HT-1, GB-42, SJ-5 Flanks and intercostal area: GB-34, GB-41, SJ-6 Lower Jiao: SP-9, UB-40 Wind: GB-31, LI-4, LI-11 Damp: SP-6, SP-9, ST-36, ST-40 To clear Heat: 1. LI-11, SP-10 2. LI-4, LI-11 To move the Blood: SP-6, SP-10 For pain: LIV-3 For nerve pain: needle directly into Ahshi points To Dispel Wind from the skin if there is itching: SJ-5 To move Qi along the flanks: GB-41, SJ-5 Ear: 1. Liver, Lung, Shenmen 2. Lung, Diaphragm, Shenmen, Subcortex Puncture papular eruptions with a triangular needle Plum-needle + cupping of the papular eruptions Apply moxa to the eruptions

WEN BING - WEI STAGE HEAT - EARLY STAGE

Clinical Manifestations	Early-stage measles or rashes that do not surface evenly Fever and chills Headache Generalized body aches Sneezing Cough Red eyes Tearing Thirst Intolerance of Wind T: Red and dry P: Floating and rapid.
Treatment Principle	Expel Exterior Wind-Heat Release muscle layer Vent rashes
Herb Formulas	Sheng Ma Ge Gen Tang modified Jing Fang Bai Du San modified Jing Jie Lian Qiao Tang With Phlegm: Pu Ji Xiao Du Yin For toxic Wind-Heat with hot sores and pimples: Shi Wei Bai Du San
Points	General points

WEN BING WEI STAGE WITH UNDERLYING SPLEEN AND STOMACH HEAT

Clinical Manifestations	Severe sore and swollen throat High fever with convulsions in infants Difficulty swallowing Carbuncles Acute localized infection Lymphangitis Furuncles Boils Abscesses T: Red C: Greasy and yellow P: Rapid
Treatment Principle	Relieve Toxic Heat Reduce swelling Alleviate pain
Herb Formulas	Liu Shen Wan (can be used as a gargle)
Points	DU-14, DU-16, GB-20, LI-4 + LU-7 or LI-4 + SJ-5, LU-5, LU-10, LU-11, ST-44, UB-12, UB-13

WEN-BING: QI STAGE: LUNG AND STOMACH HEAT INJURING THE QI AND FLUIDS

Clinical Manifestations	Lingering fever from a febrile disease Vomiting Irritability Thirst with a desire to drink Parched mouth, lips and throat Choking cough Restlessness Insomnia Nausea Anorexia Profuse perspiration A dry mouth Indigestion Listlessness Chest oppression Ulcerations of the mouth Coarse skin Cough Night sweats Stifling sensation in the chest or epigastrium T: Red C: Little or None P: Rapid and Deficient or Thready and rapid
Treatment Principle	Clear Heat Generate fluids Tonify Qi Harmonize the Stomach
Herb Formulas	Zhu Ye Shi Gao Tang
Points

WEI QI DEFICIENCY

Clinical Manifestations	Soft, weak cough with clear thin sputum Physical and mental exhaustion Soft, weak voice Reluctance to speak Shortness of breath Pale face Spontaneous perspiration (daytime) Low resistance to THE common cold Tendency to blocked nose T: Pale C: Thin and white P: Weak
Treatment Principle	Reinforce the Lungs Strengthen Qi.
Herb Formulas	Yu Ping Feng San
Points	UB-13, UB-43, ST-36, REN-17, LU-9

DAMP-HEAT INJURES THE SPLEEN

Clinical Manifestations	Anorexia Abdominal distention and discomfort Suffocating sensation in the chest Epigastric mass Maybe abdominal pain on palpation Yang jaundice (sclera and skin are bright yellow) Dislike of oily foods Nausea Vomiting Lassitude Scanty, dark urine Maybe thirst or thirst with no desire to drink Diarrhea with foul smell or Constipation Fever Sweet sticky taste or bitter taste in mouth T: Pink C: Thick, yellow and greasy (maybe sticky) P: Soft and rapid
Treatment Principle	Clear Heat Benefit Dampness
Herb Formulas	Yin Chen Wu Ling San
Points	LI-11, REN-12, SP-9, ST-36, ST-44, UB-20 For Damp-Heat Diarrhea: LI-4, SP-9, ST-25, ST-36, ST-44, UB-25 For Damp-Heat Dysentery: LI-4, LI-11, SP-9, ST-25, ST-37, ST-44

SPLEEN QI DEFICIENCY WITH DAMPNESS

Clinical Manifestations	Headache Loose stools Urinary difficulty Scanty urination T: Normal C: Slippery and white P: Floating and rapid
Treatment Principle	Regulate water circulation Drain Dampness Strengthen the Spleen
Herb Formulas	Si Ling San Wu Ling San Tuo Li Xiao Du Yin
Points	REN-6, REN-9, SP-6, SP-9, ST-28, ST-36, UB-20, UB-22, UB-23

SPLEEN CHANNEL DAMP HEAT

Clinical Manifestations	Shingles on the chest, upper trunk in or near armpit or on the face Large yellowish, white skin vesicles filled with turbid fluid which easily break and seep and form a soft crust that looks like cottage cheese or cauliflower that eventually forms a black scab and can leave an erosion when the scab finally falls off Severe aching and pain after the lesions rupture Torpid intake Abdominal distention Loose stools Fatigue T: Fat and enlarged C: Slippery and white or yellow P: Soggy and rapid or Slippery and rapid
Treatment Principle	Clear and disinhibit Dampness and Heat Invigorate the Blood Transform toxins
Herb Formulas	Si Miao San Jia Wei Chu Shi Wei Ling Tang
Points	LI-4, LI-11, SP-6, SP-9, ST-36 For lesions near the eyes: + SJ-23, Taiyang, UB-2 For lesions on the cheek: + ST-4, ST-6 For lesions near temple: + Taiyang For lesions on the lower body: + GB-34 For Blood Heat: + bleed UB-40, needle UB-17 For severe pain and a burning sensation: + LIV-1, SP-1, then needle the head and tail of the eruption For irritability, a bitter taste in the mouth and a quick temper: + GB-34 For restlessness and insomnia due to pain: + DU-20, DU-24, HT-7 For itching: + LI-11, SP-10 For severe Internal Heat: + ST-44 Moxa SP-6, ST-44, 0.5 cun outside of the first lesion to appear, in a clear area between the lesions, 0.5 cun outside the last lesion to appear

HEART FIRE

Clinical Manifestations	Ulceration, erosion, and pain of mouth and tongue Thirst with a desire for cold drinks Irritability, irascibility Feeling of Heat and disturbance in Heart Insomnia Flushed face Bitter taste in mouth T: Red tip, ulcers especially on tip P: Shi and rapid
Treatment Principle	Clear Heart Cool Fire
Herb Formulas	Dao Chi (Re) San
Points	HT-7, HT-9, REN-3 PC-8, PC-7, UB-15, HT-7, HT-8 PC-5, SP-6, Qiying (Do not retain) With Excess sweat: HT-6, KI-7 With palpitations and insomnia: HT-7, Anmian With sexual irritability and flushed face: LIV-3, GB-20 With protruding eyes: UB-20, ST-2, Shangtianzhu With tachycardia: PC-6 Alternate between: a. GB-20, DU-4, DU-14, UB-11, REN-22, ST-10, SJ-3 b. UB-10, UB-12, DU-3, DU-12, REN-23, ST-9, GB-22 DU-14, UB-13, UB-15, UB-23, GB-21, LI-11, ST-36, SP-6, REN-22, SI-14, HT-7 + indirect moxa for 5 min. PC-4, Qiying, SP-6 Ear: Shenmen, Subcortex, Endocrine, Stop wheezing, Heart, Lung Moxa: 50 cones @ LIV-3 and Ahshi points around goiter Cutaneous: tap from T-5-T-10, UB-18, LIV-3, SP-3, REN-22, ST-36, LI-11, LI-4, SJ-17, LI-18, LI-4, REN-17, REN-22, SI-16, ST-12, KI-27, LU-1, LU-7, bleed Shixuan

LIVER QI STAGNATION WITH DAMP-HEAT AND PHLEGM

Clinical Manifestations	Feeling of a lump in the throat The lump is soft and becomes larger or smaller according to the emotional situation The lump is small or medium sized, relatively soft and slippery The edges are indistinct Oppressive feeling in the chest and hypochondrium Difficulty swallowing Loose stools Irregular menstruation Premenstrual tension Suppurative sores Ulcerations, abscesses and swellings that remain hard after discharge of pus Restlessness Insomnia Thirst Feeling of Heat Irritability Frequent sighing Bitter taste in the mouth Red eyes Red face Tremor of the hands T: Pale or dusky or Red with red tip and edges C: White or Thin and greasy or Dry and yellow P: Wiry
Treatment Principle	Disperse Qi Stagnation Dispel Heat and Dampness Resolve Phlegm Dissipate nodules Reduce swelling Drain pus
Herb Formulas	San Zhong Kui Jian Tang
Points

LIVER FIRE

Clinical Manifestations	Taut, red-colored skin vesicles which are like spots and dots of millet, gathered into patches Burning Heat Lancinating, pricking pain Thirst with a preference for cold drinks Vexation Agitation Severe, splitting headaches with dizziness Sudden tinnitus or deafness Flushed face Red, swollen, painful eyes Irascibility with violent angry outbursts Dry mouth Bitter taste in mouth Vomiting sour or bitter liquid Insomnia Restlessness Constipation or dry stools Maybe rib pain T: Red tip and edges C: Thick, yellow, dry and rough P: Wiry, excess and rapid
Treatment Principle	Clear the Liver Purge Fire Invigorate the Blood Transform toxins
Herb Formulas	Long Dan Xie Gan Tang modified Xi Gan Ming Mu Tang Niu Huang Jie Du Pian Xie Qing Wan Yin Chen Hao Tang
Points	GB-12, GB-34, GB-37, LIV-2, UB-18, UB-19 GB- 20, KI-1, LIV-2, bleed Taiyang, UB-2 DU-10, GB-41, LIV-2, SJ-5 For lesions near the eyes: + SJ-23, Taiyang, UB-2 For lesions on the face: + LI-4 For lesions on the cheek: + ST-4, ST-6 For lesions near temple: + Taiyang For lesions on the upper body: + LI-11 For lesions on the lower body: + GB-34 For Blood Heat: + bleed UB-40, needle, SP-6, UB-17 For severe pain and a burning sensation: + LIV-1, SP-1, then needle the head and tail of the eruption For irritability, a bitter taste in the mouth and a quick temper: + GB-34 For restlessness and insomnia due to pain: + DU-20, DU-24, HT-7 For itching: + LI-11, SP-10 For severe Internal Heat: + ST-44 For damp sores: + SP-9 For lesions on the trunk: GB-24, GB-34, GB-43, GB- 44, LIV-2, LIV-5, LIV-14, SP-21 + the Huatuojiaji points associated with the affected dermatome as well as the adjacent dermatomes Moxa GB-34, LIV-2, 0.5 cun outside of the first lesion to appear, in a clear area between the lesions, 0.5 cun outside the last lesion to appear

QI AND BLOOD STAGNATION

Clinical Manifestations	This describes post-herpetic neuralgia. There may not be any remaining skin lesions or There may be dark purplish scars but no vesicles Severe, lancinating pain may be the main or only symptom If there are vesicles, the bases are dark and purple The fluid contains bloody water The aching and pain are severe and difficult to bear T: Purple and dark or with static Maculae or spots C: Thin and white P: Wiry and/or choppy
Treatment Principle	Invigorate the Blood Transform toxins Move Qi Stop pain
Herb Formulas	She Chuan Fang Qi Li San Chai Hu Shu Gan Tang
Points	LI-4, PC-5, SJ-6, SP-6 + one local treatment For lesions on the cheek: + ST-4, ST-6 For lesions near temple: + Taiyang For lesions on the upper body: + LI-11 For lesions on the lower body: + GB-34 For Blood Heat: + bleed UB-40, needle, UB-17 For severe pain and a burning sensation: + LIV-1, SP-1, then needle the head and tail of the eruption For irritability, a bitter taste in the mouth and a quick temper: + GB-34 For restlessness and insomnia due to pain: + DU-20, DU-24, HT-7 For itching: + LI-11, SP-10 For severe Internal Heat: + ST-44 For damp sores: + SP-9 Moxa UB-17, 0.5 cun outside of the first lesion to appear, in a clear area between the lesions, 0.5 cun outside the last lesion to appear

QI AND BLOOD STAGNATION WITH HEAT

Clinical Manifestations	Nerve pain which may be very severe and may continue after disappearance of the papules Occurs along the nerve routes, usually of the neck, intercostals, abdomen, lower back or extremities Facial color dark and dull Emaciation Sides and ribs distended on both sides (maybe with sharp pain) Enlargement of Liver and Spleen Suffocating sensation in chest Tendency to sigh Melancholy Depression Irritability Vexation Agitation Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Dark purple (maybe purple spots on edge of tongue) C: Normal P: Wiry, choppy and slow
Treatment Principle	Invigorate the Blood Relieve Stasis Regulate Qi Alleviate pain Clear Heat Detoxify
Herb Formulas	Herpes Zoster #1
Points	General points

DAMP-HEAT - HEAT PREDOMINANT

Clinical Manifestations	Hypochondriac pain Headache Dizziness Red sore eyes Hearing loss Swelling in the ears Bitter taste in the mouth Irritability Short temper Difficult and painful urination with a heat sensation in the urethra Swollen and itchy genitalia Yellow, foul smelling leukorrhea Short menstrual cycle with reddish-purple blood Ear discharge Yellow urine Chest pain Constipation Turbid urine Dry throat Hematuria Pain in the armpits Sweating in the groin T: Red or Red edges C: Yellow or Yellow and greasy P: Wiry, Excess and rapid
Treatment Principle	Clear Heat Relieve Dampness
Herb Formulas	Long Dan Xie Gan Tang
Points	General points

DAMP-HEAT - DAMP PREDOMINANT

Clinical Manifestations	Hypochondriac pain Headache Dizziness Red sore eyes Hearing loss Swelling in the ears Bitter taste in the mouth Irritability Short temper Difficult and painful urination with a heat sensation in the urethra Swollen and itchy genitalia Yellow, foul smelling leukorrhea Short menstrual cycle with reddish-purple blood Ear discharge Yellow urine Chest pain Constipation Turbid urine Dry throat Hematuria Pain in the armpits Sweating in the groin T: Red or Red edges C: Yellow or Yellow and greasy P: Wiry, Excess and rapid
Treatment Principle	Clears Damp-Heat from the San Jiao
Herb Formulas	Chu Shi Wei Ling Tang
Points	General points

BLOOD STASIS - LATE STAGE

Clinical Manifestations	Copious bleeding of dark purple blood The blood is sticky during menstruation May or may not have clots Menstrual cycle is shortened (early menstruation) Palpitations Dizziness Blurred vision Pale, lusterless complexion Pale nails Abdominal pain Irregular menstruation with little flow Fixed lower abdominal pain Vertigo Tinnitus Pale lips May be amenorrhea Insomnia Menstruation may also be accompanied by distention and pain T: Pale C: Normal P: Thin and weak or Thin and choppy
Treatment Principle	Tonify and Invigorate the Blood Regulate Blood Circulation Break up Stagnation Eliminate Blood Stagnation Regulate menstruation Alleviate pain
Herb Formulas	Tao Hong Si Wu Tang
Points	General points

PHLEGM-HEAT

Clinical Manifestations	Dizziness Vertigo Nausea and vomiting Insomnia Dream-disturbed sleep with unusual dreams Palpitations Anxiety Profuse white foamy sputum Restlessness Timidity Indecisiveness Indeterminate gnawing hunger Seizures accompanied by copious sputum Chest distention Expectoration of yellow Phlegm Bitter taste in the mouth Chills and fever Abdominal distention Frequent dark, scanty urine Irritability Depression Slight thirst Anorexia after serious illness T: Pink or Red tip C: Yellow and greasy P: Slippery and rapid or Wiry and rapid
Treatment Principle	Cool the Liver Extinguish Wind Increase Fluids
Herb Formulas	Ling (Yang) Jiao Gou Teng Tang
Points	General points

TOXIC HEAT

Clinical Manifestations	High fever Irritability Fidgeting Dry mouth Dry throat Incoherent speech Insomnia Dark urine Deep-rooted boils Maculae Carbuncles Hematemesis Hemoptysis Palpitations Furuncles Tinnitus Purpura Red face Rashes Deep-rooted boils Red eyes Itchy skin Fidgeting Dry lips Delirium Dysentery with fever Jaundice Epistaxis Hematuria Cloudy mind Diarrhea T: Red C: Yellow P: Rapid and forceful
Treatment Principle	Clear Heat Drain Fire Relieve toxicity from all three Jiaos Relieve inflammation Stop bleeding Purge Damp-Heat
Herb Formulas	Huang Lian Jie Du Tang San Huang Xie Xin Tang Zi Gen Mu Li Tang
Points

TOXIC HEAT DUE TO EXTERNAL HEAT LODGED IN THE CHANNELS

Clinical Manifestations	Local inflammation with pus Deep-rooted, hard and painful boils Erythema Swelling Heat Carbuncles Furuncles Fever and chills Pain T: Red C: Yellow and greasy P: Rapid
Treatment Principle	Clear Heat Purge Fire Relieve toxicity Cool the Blood Reduce swelling
Herb Formulas	Wu Wei Xiao Du Yin Huang Lian Jie Du Tang + Xi Jiao Di Huang Tang For Toxic Heat in the Blood: Zi Gen Mu Li Tang Topical: Yu Lu San
Points	General points