Acupuncture can have positive benefits for the treatment of shingles, or herpes zoster, and the pain associated with it. If a patient had chicken pox in their childhood, they can acquire shingles later in life. An estimated 1 million people get shingles every year in the United States according to the Centers for Disease Control and Prevention (CDC), and although children can also get it, a patient’s risk increases as they get older. That is essentially 1 out of every 3 people in the United States that will develop shingles in their lifetime. Although it is difficult to treat in eastern medicine, the use of acupuncture in addition to herbal medicine can render successful results for shingles patients, especially with the pain in the thick of the condition, and long after.
What is Shingles?
Shingles, also known as herpes zoster, is a reactivation of the varicella zoster virus that has been dormant (and can remain dormant for many years) after having chicken pox. Most often, shingles is more expected from elderly patients and/or those with suppressed immune systems, and is very rare in children. There are 2-3 cases per 1,000 people in early adult life, and up to 10 per 1,000 in those 80 years and over. The severity of shingles symptoms will increase with age.
Shingles Symptoms:
- Pain, burning, tingling, or numbness
- Red rash
- Clustered vesicles (fluid-filled blisters) that break open and crust over
- Itching
Some people may also experience:
- Fever & chills
- General achiness
- Headache
- Fatigue
The pain associated with shingles may occur days before the rash shows, or no rash may appear which makes diagnosis sometimes difficult. It usually only affects a small section of one side of the body such as the head, face, eye, scalp, along the ribs, abdomen, shoulder, groin, or thigh, but most commonly across the chest, ribs or abdomen.
Shingles are very contagious and last about two to four weeks. For most people, the pain from shingles lessens as the rash heals, however, it can also lead to other more severe health complications. There is a condition known as postherpetic neuralgia (PHN) which can develop after shingles, persist for many months or longer due to nerve damage.
Possible Complications of Shingles:
- Bacterial skin infections
- Scarring
- Decrease or loss of hearing (if shingles is
near the ear)
- Decrease or loss of sight (if shingles is near
the eye)
- Muscle weakness
- Paralysis on one side of the face
- Allodynia (feeling pain from non-painful
stimuli such as a light touch or brushing hair)
- Postherpetic neuralgia (long term nerve pain from shingles)
The condition known as postherpetic neuralgia (PHN) can develop after shingles, and persist for many months or longer due to nerve damage. Typical treatment in western medicine for this condition would be intercostal nerve blocks, thoracic epidural injections, tricyclic antidepressants, membrane stabilizers, or capsaicin cream.
Western Treatment for Shingles:
- Antiviral drug such as Acyclovir at the first sign of outbreak to lessen the severity of the attack
- Corticosteroids to reduce inflammation
- Topical lidocaine or analgesics for pain
- Shingles vaccine once your patient has reached the age of 50 and is in good health. Zostavax which has been around since 2006 according to the CDC, and Shingrix which has been in use since 2017 and is recommended as the preferred shingles vaccine. Those who have compromised immune systems should not get the shingles vaccine.
If your patient has already had shingles, unfortunately unlike chicken pox, they can get shingles again. If they are healthy, they can get the shingles vaccine 6 to 12 months after they have had shingles to help prevent it from occurring in the future. However, eastern medicine involving acupuncture and herbal medicines incorporated into daily treatment may help heal and aid in pain relief from shingles.
Acupuncture & TCM for Shingles
Acupuncture works for the treatment of shingles because it speeds up the resolution of the rash, and reduces pain & itching. In Chinese medicine we know that shingles involves toxic heat, internal wind, and dampness lodged inside the body, and acupuncture resolves these imbalances and helps restore the body to health. Although it is successful in treating shingles at any stage, it is most successful in the early stages of shingles when the symptoms first appear.
Shingles can cause many TCM diagnoses:
- Liver-qi stagnation – qi can’t flow freely which causes pain & other symptoms like headaches.
- Lung-qi deficiency – the Lungs are weak and unable to fight off the virus.
- Heart heat – the virus penetrates to a deeper level causing different symptoms like insomnia & restlessness.
The exact diagnosis is dependent on the progression of the illness, symptoms, and specific cause.
Three Common Patterns of Shingles in TCM:
- Damp-heat in the Spleen & Stomach – general weakness and fatigue with a possible underlying deficiency of the Spleen due to excessive worrying & poor diet. It also presents with poor appetite, abdominal distention, and pale tongue body with a sticky yellow or white coating. The vesicles are widespread & oozy with thick yellowish fluid easily broken.
- Liver & Gallbladder damp-heat with fire toxin – this type is often triggered by stress severely affecting the Liver & Gallbladder. There will be signs of heat such as fever, thirst, red complexion, red lesions, and skin with burning pain or heat. There is also dry mouth, constipation, yellow urine, irritability, red tongue with a yellow coating.
- Qi & Blood stagnation – this pattern usually manifests with postherpetic neuralgia with purple tongue, dark color where the lesions once were, and poor sleep.
The main concept to remember is that shingles in TCM is considered to be caused by pathogenic damp, wind, and heat in the body. If heat predominates, the lesions are likely on the lower body with more discharge from the blisters. If damp is predominant, the blisters show more redness & heat with more severe pain. Lastly, if wind predominates, the lesions are more likely on the upper body with itchier skin. It is important no matter the diagnosis to seek acupuncture and TCM treatment earlier in the stages of shingles for the quickest results.
Acupuncture works in the 3 stages of shingles:
- Acute stage – treatment at this stage controls the progression of the illness, resolves the rash, reduces pain, prevents new lesions from forming, and boosts the immune system (defensive qi). It is best at this stage to have a treatment plan that enables the patient to come in more frequently in order to reduce the duration and intensity of the symptoms.
- Healing stage – treatment needs to focus on taking care of any underlying conditions or constitutional imbalances at this stage. This will help stop the disease from progressing and turning into postherpetic neuralgia (PHN) all the while promoting circulation and preventing residual pain.
- Chronic stage – at this stage in shingles, halting and reversing postherpetic neuralgia pain is a slower process. However, even at this late stage, acupuncture helps to calm the nerves and promote nerve regeneration as well as help with sleep.
It’s important to note when assessing a shingles patient in their consultation, especially if a patient comes to you with symptoms already progressing, that the location of the lesions indicates the meridians affected. This can provide you with better direction in a treatment plan as a provider. Lesions may involve multiple meridians, and it is vital to select acupuncture points that address both the pathogenic factors and the meridian involved once determining the patient’s specific causes.
Acupuncture Points for Shingles
There are certain diagnostic patterns that are common with shingles, and in turn, there are specific acupuncture points that are obviously not universal for everyone, but are great treatment protocols to use as a guideline when taking on a shingles patient.
Wind-Heat Acupuncture Points for Shingles:
- UB40 – Bend Middle – Wei Zhong – located at the midpoint of the transverse crease of the popliteal fossa between the tendons of biceps femoris and semitendinosus. It is used to clear blood heat, and in the way of shingles aids in itching, oozing, inflammation, and good for heat conditions.
- SP10 – Sea of Blood – Xuehai – located 2 cun above the superior medial border of the patella on the bulge of the medial portion of the quadriceps femoris (with the knee flexed). It is also used to clear blood heat, and in the way of shingles aids in pain, swelling, itching, and skin problems from damp-heat or hot blood.
- LI11 – Pool at the Bend – Qu Chi – located at the lateral end of the transverse cubital crease midway between LU5 and the lateral epicondyle of the humerus. It clears heat, and in the way of shingles aids in damp heat skin diseases that are red, itchy, oozing, or inflamed.
Meridian Related Acupuncture Points for Shingles:
- TH6 – Branch Ditch – Zhigou – located 3 cun above TH4 between the radus and ulna on the radial side of the extensor digitorum muscle on the TH4 and tip of the olecranon line. This point is used if the shingles manifests on the sides of the body, and in the way of shingles is used for chest and rib pain.
- GB34 – Yang Mound Spring – Yang Ling Quan – located in a depression anterior and inferior to the head of the fibula. Also used when the shingles manifests on the sides of the body, and in the way of shingles aids in pain, weakness, numbness, and bitter taste in the mouth.
- GB41 – Foot Overlooking Tears – Zu Lin Qi – located posterior to the 4th metatarsophalangeal joint in a depression lateral to the tendon of extensor digiti minimi. Used when the shingles manifests on the sides of the body as well, and used for shingles by helping with pain, eye problems.
- LI4 – Union Valley – He Gu – located in the middle of the 2nd metacarpal bone on the radial side. In the case of shingles this point is used to treat the area of the head and/or face affected with shingles.
- TH5 – Outer Pass – Waiguan – located 2 cun above TH4 between the radius and the ulna on the TH4 – TH10 line. Also used for treating shingles of the head and/or face.
- SP9 – Yin Mound Spring – Yin Ling Quan – located on the lower border of the medial condyle of the tibia in the depression posterior and inferior to the medial condyle of the tibia or on the lower border of the medial condyle of the tibia level with the tuberosity of the tibia or between the posterior border of the tibia and gastrocnemius muscle. Used to treat shingles on the abdomen.
Acupuncture for Shingles Pain
Acupuncture is known to be extremely effective in treating pain. In the case of shingles, it affects about 1 million people in the United States each year, and 1 in 10 people develop postherpetic neuralgia (nerve pain from damaged nerves due to shingles) that lasts months or years after the rash goes away. Acupuncture has been shown to reduce pain intensity, relieve anxiety, and improve the quality of life in patients with postherpetic neuralgia according to a meta-analysis in 2018. Always advise patients that seeking out acupuncture at the earliest signs is vital to the speed up recovery when seeking treatment and pain relief from shingles.
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