Appreciating Professor Li Zizhi's Case of Shingles Treated by Clearing Heat and Resolving Toxins

Professor Li Zizhi, a disciple of Shi Jinmo and one of the founders of Gansu University of Chinese Medicine, once used a heat-clearing and toxin-resolving method to treat a case of shingles. The case is as follows:

Cui, a 65-year-old man, first visited on February 10, 1992. His chief complaint was that a week earlier blisters had suddenly appeared on his left chest and gradually spread to the rib-side and back, with burning, stabbing pain unbearable; medication he had taken was ineffective. Examination found clustered, red, mung-bean-sized blisters in a band across his left chest, rib-side, and back; the blister fluid was turbid and mixed with blood crusts. His tongue was red, and his pulse was wiry and forceful.

Professor Li differentiated: the herpes appeared in spring, and the pattern was exuberant liver fire with internal accumulation of damp-heat causing snake belt (she dan—the TCM name for shingles, also called "snake coiling the waist"). He planned treatment by clearing heat, draining fire, cooling blood, and resolving toxins, devising his own Jinniu Jiedu Tang (Golden-Cow Detoxification Decoction).

Initial prescription: Jinqiancao (spreading glochidion/lysimachia) 60g, schizonepeta (jingjie) 10g, Coptis rhizome (huanglian) 30g, red peony root (chishao) 10g, burdock fruit (niubangzi) 10g, scutellaria root (huangqin) 6g, moutan bark (danpi) 10g, honeysuckle flower (jinyinhua) 15g, dandelion herb (pugongying) 15g, forsythia fruit (lianqiao) 12g, Paris rhizome (zaoxiu) 10g, licorice (gancao) 6g. Four doses; decoct twice, combine the decoctions, split into two portions, and take one in the morning and one in the evening. At the same time, the patient was told to take 30g of lygodium spores (haijinsha), mix with vegetable oil, and apply to the affected area.

On February 14, after four doses as instructed, the patient returned: the blisters had begun to dry and shrink, the skin color was normalizing, and the pain was greatly reduced, though he still had a bitter mouth. His tongue was red and his pulse wiry. Since the formula was working, the approach should not change; he combined the previous formula with Siwu Tang (Four-Substance Decoction) to nourish blood and cool blood and consolidate the effect.

Second-visit prescription: Jinqiancao 30g, schizonepeta 10g, Coptis 3g, red peony 10g, burdock fruit 10g, scutellaria 5g, forsythia 10g, rehmannia root (shengdi) 12g, Chinese angelica (danggui) 10g, Sichuan lovage (chuanxiong) 10g, coix seed (yiyiren) 15g, Phellodendron (huangbai) 5g, bupleurum (chaihu) 10g, gardenia (zhizi) 10g, licorice 6g. Three doses, decocted in water; the external treatment was unchanged. After these three doses the patient was completely cured; the whole course took only seven days.

Shingles is a common disease caused mainly by the varicella-zoster virus; because the lesions form a band across the skin, it is called shingles, and the ancients vividly named it "snake coiling the waist." Shingles causes severe pain; patients who miss the best treatment window may be left with post-herpetic neuralgia. Western medicine generally uses antivirals such as acyclovir, adding painkillers when pain is severe, but this sometimes works and sometimes does not.

Before seeing Professor Li, this patient had already taken other medication without effect. TCM holds that such acute-onset skin surgical diseases are basically caused by heat-toxin, so treatment should center on heat-clearing, toxin-resolving herbs. Because there is fluid in the blisters, TCM further holds that the disease involves not only heat-toxin but also damp-toxin, so treatment should clear heat and resolve toxins while also draining dampness.

In Professor Li's prescription, the largest dose was Jinqiancao—a distinctive choice. Jinqiancao clears heat and drains dampness, combining both heat-clearing/detoxifying and damp-draining actions; it is the key herb for shingles due to damp-heat. Jinqiancao has diuretic, anti-inflammatory, liver- and gallbladder-protective, and gallstone-promoting effects; modern pharmacology shows it has broad-spectrum antiviral, anti-inflammatory, analgesic, and bilirubin-lowering actions.

In addition, zaoxiu (Paris rhizome, also called chonglou) is a specific herb for shingles. A modern patent medicine called Chonglou Jiedu Ding is a commonly used external treatment for shingles; it rapidly relieves shingles pain and can replace the hai jinsha Professor Li used externally.

Red peony, Coptis, burdock fruit, scutellaria, moutan, honeysuckle, and dandelion are all commonly used heat-clearing, toxin-resolving, blood-cooling, and pain-relieving herbs; building a formula from such herbs makes the heat-clearing and blood-cooling pain relief all the more marked. No wonder this patient improved so quickly.