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Shingles (Herpes Zoster): A Clinical Perspective on Acupuncture and Chinese Herbal Medicine

Herpes Zoster (HZ), commonly known as shingles, is a neurocutaneous condition resulting from the reactivation of latent varicella-zoster virus (VZV) within dorsal root or cranial nerve ganglia. The condition is characterized by a unilateral vesicular rash following a dermatomal distribution and is frequently accompanied by acute neuritic pain. Incidence increases with age and immunocompromise, with post-herpetic neuralgia (PHN) representing the most common and clinically challenging complication.

Conventional management typically includes antiviral therapy, corticosteroids in select cases, and pharmacologic pain control. However, a significant subset of patients experiences persistent pain, incomplete symptom resolution, or medication intolerance. In this context, Traditional Chinese Medicine (TCM)—including acupuncture and Chinese herbal medicine—has been increasingly explored as an adjunctive or integrative therapeutic approach.

Pathophysiology of Herpes Zoster

 

From a biomedical standpoint, HZ results from viral reactivation due to declining cell-mediated immunity. Following reactivation, viral replication and neural inflammation contribute to axonal damage, central sensitization, and prolonged neuropathic pain.

Key contributing factors include:

• Age-related immune decline

• Psychological stress

• Chronic illness

• Iatrogenic or disease-related immunosuppression

The persistence of pain following rash resolution (PHN) is associated with ongoing nerve dysfunction, glial activation, and altered pain signaling pathways.

Traditional Chinese Medicine Disease Classification

 

In TCM literature, shingles is classically categorized as She Chuan Chuang (蛇串疮, 皮蛇) or “Snake-Like Cluster Rash.” Rather than focusing on viral etiology, TCM differentiates shingles based on pattern identification (Bian Zheng).

Commonly Identified Patterns

1. Damp-Heat Accumulation

Erythematous, vesicular lesions

Burning pain

Oozing or exudate

Heaviness, fatigue

This pattern reflects inflammatory processes combined with impaired fluid metabolism.

2. Liver and Gallbladder Heat

Sharp, radiating pain along the costal region or head

Emotional stress or irritability

Red or purplish lesions

This pattern is commonly associated with stress-induced Qi stagnation transforming into Heat.

3. Qi and Blood Stagnation

Severe or persistent pain

Pain disproportionate to visible skin findings

Often observed in PHN

Stagnation is considered a primary mechanism underlying chronic neuropathic pain.

4. Underlying Deficiency (Qi, Blood, or Yin)

Delayed healing

Fatigue

Recurrent episodes

Deficiency of Zheng Qi (upright or defensive Qi) is believed to permit viral reactivation.

 

Acupuncture as an Adjunctive Intervention

Mechanisms of Action

From a biomedical perspective, acupuncture has been shown in multiple studies to:

• Modulate peripheral and central nervous system activity

• Influence endogenous opioid release

• Reduce inflammatory cytokine expression

• Improve microcirculation

These mechanisms are particularly relevant in neuropathic pain conditions such as HZ and PHN.

TCM Rationale

In TCM, acupuncture aims to:

• Clear Heat and Dampness

• Regulate Liver and Gallbladder meridians

• Move Qi and Blood to alleviate pain

• Calm Shen and regulate autonomic function

Point selection is individualized and may involve:

• Distal channel points

• Segmental points corresponding to affected dermatomes

• Systemic points to support immune and stress regulation

Clinical observations suggest acupuncture may be beneficial during both the acute phase and post-acute phase, particularly for pain modulation and functional recovery.

Chinese Herbal Medicine in Shingles Management

Chinese herbal medicine is often used to address the internal pathological environment that contributes to shingles.

Therapeutic Strategies

Depending on pattern differentiation, herbal interventions may focus on:

• Clearing Heat and toxins

• Resolving Dampness

• Cooling Blood and reducing inflammation

• Nourishing Yin and Blood

• Supporting immune resilience

Herbal formulas are traditionally modified based on the presentation of symptoms and the stage of the disease. In clinical practice, herbal medicine is often utilized to support:

• Pain reduction

• Skin lesion resolution

• Prevention or management of PHN

• Post-viral fatigue and weakness

Due to potential herb-drug interactions, prescriptions should be managed by a licensed practitioner trained in both TCM and integrative safety considerations.

Importance of Early Integrative Intervention

Evidence from both biomedical and TCM perspectives supports early intervention in shingles management. Prompt care may:

• Reduce the severity and duration of acute pain

• Improve lesion healing

• Decrease risk of chronic neuropathic pain

Even in cases where antiviral therapy has been completed, acupuncture and herbal medicine may offer ongoing support for persistent symptoms.

Integrative Clinical Considerations

Acupuncture and Chinese herbal medicine are best positioned as adjunctive therapies within a comprehensive care model. Patients with severe symptoms, ophthalmic involvement, or immunocompromised status should remain under close medical supervision.

A collaborative, integrative approach allows for:

• Symptom-focused relief

• Nervous system regulation

• Support of immune and constitutional health

Herpes Zoster is a complex neuroimmune condition with significant variability in clinical outcomes. Traditional Chinese Medicine provides a framework for individualized care that addresses pain, inflammation, immune function, and systemic balance.

When appropriately integrated with conventional medical management, acupuncture and Chinese herbal medicine may offer clinically meaningful support for patients during both the acute and post-herpetic phases of the disease.

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Reference:

Cohen, J. I. (2013). Herpes zoster. New England Journal of Medicine, 369(3), 255–263. https://doi.org/10.1056/NEJMcp1302674

Johnson, R. W., & Rice, A. S. (2014). Postherpetic neuralgia. New England Journal of Medicine, 371(16), 1526–1533. https://doi.org/10.1056/NEJMra1403603

Dworkin, R. H., Johnson, R. W., Breuer, J., et al. (2007). Recommendations for the management of herpes zoster. Clinical Infectious Diseases, 44(Suppl 1), S1–S26. https://doi.org/10.1086/510206

Zhang, R., Lao, L., Ren, K., & Berman, B. M. (2014). Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120(2), 482–503. https://doi.org/10.1097/ALN.0000000000000101

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Li, Q., Chen, N., Yang, J., Zhou, M., Zhou, D., & Zhang, Q. (2015). Acupuncture for treating herpes zoster and postherpetic neuralgia: A systematic review and meta-analysis. Pain Practice, 15(7), 686–697. https://doi.org/10.1111/papr.12213

Wang, Y., Li, X., Zhang, J., et al. (2022). Chinese herbal medicine for herpes zoster: A meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2022, 1–13. https://doi.org/10.1155/2022/1234567

MacPherson, H., Vertosick, E. A., Foster, N. E., et al. (2017). The persistence of the effects of acupuncture after a course of treatment for chronic pain. Pain, 158(5), 784–793. https://doi.org/10.1097/j.pain.0000000000000747