The Chinese Medicinal Treatment of Herpetic Neuralgia

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

In standard professional Chinese medicine, the basic prescriptive methodology is to base treatment on each patient’s personal Chinese medical pattern discrimination as opposed to their disease diagnosis. This means that different patients with the same disease may get different treatments if their Chinese patterns are different. Likewise, the same patient at different stages of their disease will or at least should be treated differently if their pattern has undergone transmutation. Due to the pervasive influence and great prestige of modern Western medicine, this principle of basing treatment on each individual pattern instead of their disease diagnosis is a very difficult one to stick to for both contemporary Chinese and Western practitioners of Chinese medicine. It is so much easier and, therefore, very seductive to treat all patients with the same disease diagnosis with the same treatment. However, as the following clinical audit and case history of the Chinese medical treatment of post-herpetic neuralgia from "The Treatment of 39 Cases of Herpetic Neuralgia with the Methods of Quickening the Blood & Resolving Toxins" by Zheng Jian-ting^[1] show, this does not always get satisfactory clinical results.

Introduction:

Based on his many years of clinical experience, the author has treated 39 cases of post-herpetic neuralgia with the methods of quickening the blood and resolving toxins with very good results in this difficult to treat disease as summarized below.

Cohort description:

Among these 39 cases, 25 were male and 14 were female. They ranged in age from 45-81 years old. Their course of disease had lasted from 1.5 months to two years with a median duration of six months. All had had herpetic blisters which resolved but had been followed by difficult to bear aching and pain. A number of these patients had been previously treated with various other prescriptions with no marked effect.

Treatment method:

The formula consisted of: Radix Salviae Miltiorrhizae (Dan Shen), Herba Taraxaci Mongolici Cum Radice (Pu Gong Ying), and Radix Isatidis Seu Baphicacanthi (Ban Lan Gen), 30g each, and Radix Angelicae Sinensis (Dang Gui), Flos Carthami Tinctorii (Hong Hua), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Scutellariae Baicalensis (Huang Qin), Rhizoma Corydalis Yanhusuo (Yuan Hu), Rhizoma Smilacis Glabrae (Tu Yuan), and Radix Glycyrrhizae (Gan Cao), 10g each. These medicinals were decocted in water and administered internally, one packet per day.

If there was old age and/or bodily weakness, 20g of Radix Astragali Membranacei (Huang Qi) and 15g Radix Codonopsitis Pilosulae (Dang Shen) were added. If there was oral dryness and/or bitterness and constipation, 6g of stir-fried Radix Et Rhizoma Rhei (Da Huang) was added. If there were loose stools, 20g of Semen Dolichoris Lablab (Bai Bian Dou) and 10g of Rhizoma Atractylodis Macrocephalae (Bai Zhu) were added. If there was insomnia and/or profuse dreams, 15g of Semen Zizyphi Spinosae (Suan Zao Ren) were added.

Treatment outcomes:

Marked effect meant that all the symptoms completely disappeared. Some effect was defined as marked improvement in the symptoms, and no effect meant that there was no obvious improvement in the symptoms. Based on these criteria, 25 cases or 64.1% got a marked effect, 10 cases or 25.64% got some ffect, and four cases or 10.26% got no effect from this protocol. Thus the total amelioration rate was 89.74%.

Representative case history:

The patient was a 72 year old male. In December 1997, the patient had caught a cold. Afterwards he developed herpes zoster lesions on his right rib-side. These turned into water blisters that were accompanied by severe burning pain. After one month of treatment with Western medicinals, the herpes lesions went away. However, the burning pain did not diminish. This was particularly severe at night and it kept the patient from sleeping. The man tried a number of other treatments for this pain, all to no avail.

When the patient visited the author, there was no redness or swelling of the skin in the affected area. His pulse was bowstring and his tongue was red with thin, yellow fur. In addition, his stools were particularly dry. Therefore, the author discriminated this patient’s pattern as evil toxins internally bound with static blood obstructing the network vessels. Based on this, the treatment principles were to quicken the blood and dispel stasis, clear heat and resolve toxins. The formula thus consisted of: Radix Angelicae Sinensis (Dang Gui), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Flos Carthami Tinctorii (Hong Hua), Radix Scutellariae Baicalensis (Huang Qin), Rhizoma Smilacis Glabrae (Tu Yuan), and Radix Glycyrrhizae (Gan Cao), 10g each, Radix Salviae Miltiorrhizae (Dan Shen), Herba Taraxaci Mongolici (Pu Gong Ying), and Radix Isatidis Seu Baphicacanthi (Ban Lan Gen), 30g each, and stir-fried Radix Et Rhizoma Rhei (Da Huang), 6g. These were decocted in water and administered.

After six packets, the pain had decreased. After 12 packets, the piercing pain was gone and there was only a feeling of insidious pain. After 18 packets, all the pain had disappeared. Another five packets were given in order to secure the treatment effect. On follow-up, there had been no recurrence of the aching or pain.

Author’s discussion:

Herpes zoster typically heals in 15-20 days. However, in a percentage of patients, after the skin lesions disappear there may be aching and pain or burning pain which does not heal even after enduring treatment. According to the author, this disease is due to external evils entering and assailing and thus damaging the skin. The qi becomes stagnant and the blood becomes static, therefore resulting in this condition. When treated by the common principles of clearing heat and resolving toxins, dispelling wind and disinhibiting dampness, the treatment effects are not so good. This is because the external evils have damaged the skin and caused blood stasis which obstructs the network vessels. Therefore, one should add blood-quickening, stasis-transforming ingredients to heat-clearing, toxin-resolving formulas. When stasis is eliminated, pain is dispersed. Thus the treatment effect is more satisfactory.

Translator’s discussion:

As the Chinese author states, acute attacks of herpes zoster accompanied by water blisters are usually treated by the principles of clearing heat and resolving toxins, dispelling wind and disinhibiting dampness. However, in the case of post-herpetic neuralgia, the water blisters have disappeared and the over-lying skin may no longer be red or swollen. The main clinical manifestation in that case is simply the subjective sensation of burning or piercing aching and pain. Therefore, these symptoms no longer suggest the presence of wind evils or water dampness. Instead, they add up to qi stagnation and blood stasis. However, taking into account the disease history and other such signs as a red tongue with yellow fur, it is the author’s opinion that hidden heat toxins remain. Hence, the treatment principles he advises are to quicken the blood (and transform or dispel stasis) and (clear heat and) resolve toxins. This is based on the fundamental dictum of Chinese medicine, "If there is pain, there is no free flow; if there is free flow, there is no pain."

This is not so much a new way of treating post-herpetic neuralgia but rather a fine adherence to the principle of basing treatment of the patient’s personal pattern discrimination. Although the author is too polite to say so, he is implicitly criticizing other practitioners for treating an idea about the patient’s disease rather than the actual pattern of signs and symptoms they present. This is the single most important principle in all of standard professional Chinese medicine. As Prof. Chen Wei, my formulas and prescriptions teacher at the Shanghai College of Chinese medicine liked to say: "If one discriminates the patient’s pattern correctly, logically derives the treatment principles from that pattern, and then bases their treatment upon those principles, the treatment will be effective."

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