Course: - CatsTCMNotes

Course: Acupuncture Treatment of Disease 2 Date: February 9, 2009
Class #: 6 – Herpes Zoster and Trigeminal Neuralgia
Both of these conditions are pain. Pain in TCM is due to blockage or malnutrition. Blockage is excess
while malnutrition is more deficiency.
Herpes Zoster
She chuan chuang
Aka: “Snake Cluster Sores” or Belt Meridian Sores
Widely seen in the clinic. Incidence in the US is about 0.2% of the population or 1 in 544 people. This is
a very painful disease caused by the same virus that causes chicken pox. So basically, if you’d had
chicken pox, Varicella Zoster virus, you might well get this monster. It goes dormant, residing in the
nervous system, specifically in the spinal nerves. As a result when it activates it follows the pathways of
the spinal nerves. This is why it often wraps around the rib cage. It can also express on the head, face,
shoulders…anywhere those little spinal nerves flow. Where the virus expresses shows you which spinal
nerves are affected.
Please note: the Fuyiu Yip book says that once you get shingles you’re done and you never get it again.
Actually 1-5% of patients have recurring episodes, though anything beyond 2-3 episodes is even more
rare. If you have a patient that suffers from recurring episodes they might have the cousin of shingles,
herpes simplex (HSV1).
Symptoms:
Note: can have pain before, middle stage, or after the vesicles are gone! Middle is more common,
however.
Flu-like symptoms
Day 1-4: Early stage – looks like common cold or flu. May or may not have pain in the
area.
Digestive symptoms
Day 1-4: Early stage – looks like
common cold or flu. May or may
not have pain in the area.
Rash and/or Pain
Day 7 + of the flare up. Often a
burning pain comes along with this
stage but not always.
Blisters
2 nd stage. Clustered vesicles
around the ribs, following the
spinal enervation pattern on the
body. There’s a lot of fluid inside
the vesicles which contain the
virus! Don’t break the blisters!!!
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 1 of 12

Will infect other parts of the skin that it touches.
Post-herpetic neuralgia
The rashes and blisters dry up after a while – how long depends on patient. This is when
the pain sets in usually. Pain along the ribs, following the spinal nerves as they wrap
around the body. See the dermatome map to the right on the previous page. This pain can
last for years – neuralgia. Very little will make it feel better.
Disease is characterized by painful skin lesions, trunk, face, mouth. Complications include headache,
vomiting, fever, meningitis. Recovery can take 5 weeks+. Click here for a fun website about this
disease.
The Yip/Wu book chart the symptoms this way:
Day Eruption phase Symptoms
Day 1-4 Prior to eruption ☯ Flu-like symptoms:
chills, fever, headaches, fatigue
☯ Digestive symptoms:
nausea, vomiting, decreased appetite,
loose stools or diarrhea, abdominal
cramps. Remember that dampness
attacks digestive organs first.
☯ Pain:
May or may not have pain
Day 5-9 Eruption ☯ Crops of clustered vesicles
o Vesicles containing serous fluid
distributed in bands and
erythema along the dermatome
nerve pathways.
o Clusters usually on the lower
back, hypochondriac region,
forehead, outer canthus, but can
be anywhere the spinal nerves
go.
o Usually unilateral
☯ Pain:
Probably will have pain, but may not.
Day 10-21 + Post-eruption ☯ Fluid in the vesicles becomes cloudy,
vesicles dry out and scab. Coloration
may be dark red/purple in the area.
☯ Pain
Following
months/years
Post-eruption and
skin clearing
☯ 15% of patients get pain only, no skin
manifestations.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 2 of 12

TCM Etiology
This is a latent virus. How to explain this in TCM?
Heat is an external Yang pathogen while Dampness is an internal Yin pathogen. The heat
normally wants to exit the body but dampness, being a sticky pathogen, holds it inside. This
results in a half-exterior/half-interior problem.
If there is more dampness, the latency is more internal while if there is more heat, it is more
external. The ramification of this in TCM is that it tends to affect 1) the diaphragm, the border
between upper and lower jiao, 2) the dai or girdling vessel, the border between upper and lower
halves of the body, and 3) the Shaoyang channel which is the ½ in- ½ out channel anyhow.
You’ll see in the following information that indeed, the Gallbladder and Liver are often involved
in shingles.
☯ Invasion of External pathogens
These are yang pathogens with triggers bringing out the latent pathogen.
o Wind
o Heat
o Summer Heat
☯ Retention of latent pathogens
See discussion of latency above.
o Damp heat
Reflected in the red color (heat) and the vesicles (damp)
o Toxic damp heat
☯ Emotional disorder
Liver heat and fire brings the dampness out to the superficial areas.
☯ Irregular diet
Can aggravate dampness and heat internally. This refers predominantly to the over-consumption
of spicy foods, alcohol, and other substances that disturb the balance of yin and yang.
☯ Aging
Yin, Essence, and Blood deficiencies (as well as Kidney and Liver Yin Xu) result in floating
Yang which allow the Yang pathogens to move from latent to active stages. And of course, with
more age you have suffered more from bad diet if you live here. Ain’t America great?
TCM Mechanism
Retention of latent pathogens stimulated by inducing factors or Yang
pathogens to move the latency to the surface/superficial areas of the
body.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 3 of 12

Differential Diagnosis and Treatment
There are both excess and deficient reasons for Shingles. Excess reasons include Liver and Gallbladder
wind fire, Dai channel or Spleen damp heat/toxic heat and qi and blood stagnation. Distribution is often
along the Gallbladder channel.
Basic Points
☯ SJ 5 + GB 41. SJ 5 dampness/heat. GB 41 is the exit point – helps the pathogen leave
☯ LI 11 – heat
☯ ST 40 – damp/phlegm
☯ SP 10 – Clears heat in the blood, removes dampness, addresses blood/heat skin problems. Also
good for stasis.
☯ UB 40 – damp heat and toxic heat
☯ Hua Tuo Jiaji – addresses CNS, nervous system which is infected by the herpes zoster, also Du
channel.
Invasion of Wind-Fire in Liver and Gallbladder
(First Stage)
Wind fire includes infectious, contagious, febrile and epidemic diseases.
Patient will have chills and fever, more fever and less chills. Could also have emotional
problems – liver/gallbladder affectation: irritable, restless, bitter taste in mouth. Superficial pulse
because is wind related. Could also be wiry/fast.
☯ UB 12 – wind gate
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 4 of 12

☯ Du 14 – good with bleeding/cupping but only on the first stage. Will suck out the heat.
Bleed and cup unless have the rash around this area!
☯ LV 2 – clears out the heat
Damp Heat or Toxic Heat in the Dai Mai or in the Spleen
(Second Stage)
Sharp pain, damp symptoms such as nausea, vomiting, heaviness. Tongue will be red with
yellow greasy coating. Should see rash on half of the trunk. Sometimes encircles the body, but
really rare for those unlucky few. These folks have most meridians involved and the whole Dai
channel is thus involved.
☯ Sj5 + GB 41 is first choice
☯ SP 9 – damp retention
☯ Dai channel points
o GB 26 (“dai mai” point). Good for both shingles and gynecological diseases
o Use reducing methods on these points.
Qi and Blood Stagnation
(Third Stage)
This stage arises from the previous 2.
Blisters are shrinking or gone. Might have scars and darkens, showing stasis. The marker
symptoms for this stage and the manifestations of Blood Stasis in Herpes Zoster:
☯ Needling pain which is very sharp, is fixed, is worse at night.
☯ Skin might also be very dry and dark purple/red - also stasis
☯ Tongue could be scarlet - stasis.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 5 of 12

☯ UB 17 – blood. SP 10 is also helpful for blood stasis. UB 17 is more for the upper part of
the body and is also a local point to the problem. Can also combine with Jiaji. Spleen 10
is more general.
☯ SI 3 + UB 62. You can open the Du channel, but not if the heat is strong.
Other treatments for Shingles:
Deng xin cao is very widely used as a form of moxa on the vesicles – lets the heat out. This herb
is cold in nature and also bland (drains damp). Now in chinese hospitals use a very small syringe
at the bottom of the vesicles to drain the fluid – drains the damp heat. Then you let the patient’s
blisters dry out without a dressing. Feels less pain. May have to do this repeatedly over the
course of several days.
Herbs: Long dan xie gan tang – best at the 2 nd /acute stage. Enters the Liver and Gallbladder
channels and clears the heat. Yi Guan Jian could also be used to nourish the Yin and thus the
chronic neuralgia – late stage.
Folk therapies
Initial stage, Peripheral Treatment:
With a ½ - 1 cun needle, obliquely insert on the perimeter of the affected area. Surround
and needle under/into the area. Use a 15 ° angle 0.5-0.8 cun deep all around the
perimeter/border. You can also insert the tip under the rash, but use a more oblique angle
of 20-30 °.
2 nd Stage with vesicles, Deng Xin Cao Therapy:
This is when you use the Deng Xin Cao therapy for moxibustion to clear the heat. Soak
the reed in vegetable oil for 20-30 minutes. Squeeze the oil out and light one end. Touch
it to the blister quickly. You’ll hear a cracking sound and the fluid will flow out,
removing the Evil Qi in a way that just draining it won’t. Use gloves if you do this!!!
That fluid contains the virus and you can indeed get it if you aren’t already a carrier of
this little bugger. Following treatment, keep the area clean and dry, avoid sweating, don’t
cover it with gauze! Let it dry out. You may have to do this a couple of times. Treating
heat with heat is ok for suppressed heat. This is an exception to moxa on excess heat
conditions.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 6 of 12

3 rd Stage, Row Insertion Technique:
There are no vesicles now, but there is dark red, dry skin in the local area. The skin may
be of normal color. Use 20-30 needles in the affected area with all points parallel and
oblique in the same direction in rows. This changes the stasis and significantly release the
pain. After treatment the area will be erythematous again. Explain this to the patient. Pain
should decrease significantly.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 7 of 12

Trigeminal Neuralgia
Main Tong
Incidence is 0.006%. By definition this is a painful condition affecting the Trigeminal Nerve (CN V).
This is the largest of the cranial nerves. CN V is a sensory nerve for the head and a motor nerve for the
masseter muscle. CN V has 3 branches:
1) Ophthalmic.
Sensory information to the brain for the forehead, scalp, upper eyelid, eyeball and nose.
2) Maxillary.
Sensory information from the mouth, upper lip, cheek, palate, uvula, etc.
3) Mandibular.
a. Sensory information from the lower lips/teeth/gums, chin and jaw, parts of the external
ear. This portion of the branch is most often affected.
b. Motor enervation of the masseter and other muscles.
Can be idiopathic or symptomatic. Trigger zones are on the face, most often on the lips, mouth, and
tongue. These vary from patient to patient. Symptoms can be triggered by:
☯ Heat
☯ Wind
☯ Eating
☯ Swallowing
☯ Chewing
☯ Talking
☯ Drinking
☯ Sneezing
☯ Shaving
☯ Touching
It is thought that vascular compression on the nerve causes the
problem. This affects the area shown in green on the dude to the
right. Could also be due to demyelination of the nerve sheaths.
Symptoms include momentary episodes of fleeting lacerating or electrical type pain lasting a few
seconds to a few minutes. The pain returns and may recur 50-100 times in a 24 hour period.
TCM Etiology
Sensation versus movement (or sensation disturbance versus paralysis)
Ying Qi (nutritive Qi)
Controls sensation
Wind heat often attacks Ying Qi
Wei Qi (defensive qi)
Controls movement
Wind cold often attacks Wei Qi
Anything bothering the Ying Qi will affect sensation. Anything bothering the Wei Qi can disturb
movement – paralysis for instance. This is why Bell’s palsy causes paralysis, but not so much sensation
disturbance.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 8 of 12

☯ External Yang pathogen
Wind heat, plus phlegm
☯ Emotional disorder
Liver fire or heat rising, plus phlegm
☯ Irregular diet
o Dampness
o Phlegm
o Heat/fire in the Stomach
☯ Age
Incidence increases with age and women get it more often than men. Another yippee for being a
chick. Lucky us.
TCM Mechanism
☯ Invasion of Yang pathogen with retention of phlegm
Yang can move the phlegm around and block channels/collaterals. Phlegm retention here is more
constitutional and in the channels. You may not see organ phlegm signs.
o Heat from Yang pathogens moves the blood faster but the phlegm blockage is
exacerbated this way. This just leads to more heat, worse blockage and on and on in a
vicious cycle. (Or a viscous cycle if you prefer, since we are talking ‘bout phlegm!)
☯ Blockage of channels.
Liver/Kidney yin xu can cause the yang to float upward. Liver fire can cause the tornado which carries
the fire/yang upward.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 9 of 12

Differential Diagnoses and Treatment
All six Yang channels are affected in this excess Yang disease.
☯ 1 st Branch (ophthalmic):
Mostly GB channel, but also UB, SJ, ST
☯ 2 nd Branch (maxillary):
Mostly ST, but also SI, LI, SJ
☯ 3 rd Branch (mandibular):
Mostly ST and GB, but also LI
Per the Wu/Yip book, ST 7 is a key point to all 3 branches. ST 7, SJ 17, and GB 20 are 3 very important
points.
Basic points
Lots of wind problems – pain moves, comes/goes. This is a manifestation of wind. Know the
branches and what points are for each! Bear in mind that you don’t want to use a point if it’s a
trigger point! The patient will probably know where those points are. Note that the 3 branches
area local to the areas.
☯ LI 4 + LU 7 = host/guest combination
☯ GB 20 and SJ 17 – wind
☯ 1 st – opthalmic branch (this one got a “please exactly make sure” several times in a row.)
o UB 2
o GB 14
o Taiyang
o Yintang
☯ 2 nd branch – maxillary branch
o LI 20
o ST 3
o SI 18
o SI 19
o SJ 21
☯ 3 rd branch – mandibular branch
o ST 4
o ST 6
o ST 7
When you treat trigeminal neuralgia, can choose the contralateral side or you can just avoid the
trigger points and treat on the affected side.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 10 of 12

Invasion of Wind-Heat with Phlegm Retention/Blockage
Strong “tornado” in the body. Fever is more in this version. 3 rd branch is more frequently
affected. Thin yellow tongue coat, superficial fast pulse. Moving pain. These are key points.
☯ UB 12 and Du 14 are the most important. Wind gate and bleed Du 14 to clear heat.
Liver Fire Flaring with Phlegm Retention
Possibly induced by emotional disorder. Bitter taste, wiry fast pulse.
☯ LV 2 and GB 41 are key points. First choice.
☯ Sometimes GB 41 + SJ 5 to balance upper lower disorder/disharmony.
☯ Sometimes bleed on UB 18/19 plus cupping. Can relieve the pain.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 11 of 12

Qi and Blood Stagnation with Phlegm Retention
Patient may look anxious, tongue dusky/purple indicating stasis. Arises from the 1 st two types or
from trauma. If there’s too much heat, don’t open the Du! Move the blood and clear the heat.
Acupuncture Treatment of Disease 2 – Winter 2009
www.CatsTCMNotes.com
Page 12 of 12