Definition and Cause
Shingles, also known as zoster or herpes zoster, is a viral disease characterized by a painful skin rash. It is caused by the varicella zoster virus (VZV), the same virus that causes chickenpox. Once an episode of chickenpox has passed, the virus is not eliminated from the body; rather it remains latent in the nerve cell bodies without causing any symptoms. Years or even decades after the initial infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the nerve region. Herpes zoster used to rarely occur in the young, generally developing elderly people over the age of 60 with weaker immune system. However, herpes zoster is now much more prevalent in younger patients, especially patients with HIV or weaker immune systems as a result of organ transplants or cancer treatments. In most cases, the pain and rash usually involve a narrow area in the skin, but the rash may be more widespread, leading to death in patients with highly weakened immune systems. In Western medicine, the zoster is contributed to the varicella zoster virus as mentioned above. However, in Oriental medicine, zoster is understood as the result of low resistance to infection due to an imbalance between zang-fu (six viscera and six entrails). This is the same in the case of children who get chickenpox.
In most cases, after one or two days (but sometimes as long as three weeks) the initial phase is followed by an infection of the corresponding dermatome (an area of skin supplied by one spinal nerve) causing the characteristic skin rash and pain. Later the rash becomes vesicular, forming small blisters filled with a serous exudate. Within 3 days after they appear, the blisters will turn yellow, then dry and crust over. Over the next 2 weeks the crusts will drop off, sometimes leaving small, pitted scars. Because they tend to follow nerve paths, the blisters are usually found in a line often extending from the back or flank to the abdomen on one side. The pain may still remain in the area around the blisters even after they heal, though this mostly occurs in the elderly at about a 30% rate. In these cases, treatment may require the use of narcotic analgesics.
Generally, shingles heal well and there are few problems with an early treatment. However, on occasion, the blisters can become infected with bacteria and cause cellulitis, a bacterial infection of the skin. The most common complication of shingles is a condition called post-herpetic neuralgia (PHN). People with PHN have severe pain in the areas where they the rash occurred even after the rash clears up. Elderly people or those with weakened immune systems are at greater risk for PHN, and the severity of the pain is likely to be greater as well. Shingles can cause more serious problems when they affect the face, as the spread of shingles to the eye can lead to loss of vision. Other complications as a result of shingles include pneumonia, hearing problems, blindness, brain inflammation, or death.
In Western medicine, doctors generally will start treatment with antiviral medication to reduce the pain and duration of shingles, but it takes time to heal and PHN can cause pain for months or even years.
Evidence from a systematic review of studies assessing the use of acupuncture to treat herpes zoster sugests that acupuncture therapy is effective for the condition. It is effective in facilitating crust formation, mitigating pain, and reducing the incidence of residual neuralgia. The use of acupuncture to treat herpes zoster will speed up the total healing process by strengthening the body’s natural healing abilities, enhancing natural killer cell activities and modulating the number and ratio of immune cell types. This key point is what distinguishes Oriental medicine from Western medicine in the treatment of herpes zoster.
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