TCM Treatment Protocol for Herpes Zoster, a Common Complication in Cancer Patients
Herpes zoster, known in TCM as "snake-coiling sores" (Shechuanchuang), is also called by folk names such as "spider sore" and "waist-coiling snake cinnabar." Immunocompromised patients are highly prone to herpes zoster, and many cancer patients have suffered from it. Once it appears, the patient experiences excruciating pain, so many cancer patients turn pale at the very mention of shingles.
A netizen on Zhihu described the pain this way: if the pain of childbirth in a woman is rated level 10, the pain of shingles is also level 10. The difference is that labor pains in childbirth are temporary, whereas the pain of shingles can last a very long time; and if not treated in time, shingles leaves sequelae—the patient continues to suffer from neuralgia.
Shingles and chickenpox are caused by the same varicella-zoster virus (VZV). This virus is widespread in the population and generally spreads among people with low or no immunity (mostly children). On initial infection, the patient clinically manifests only chickenpox or has an inapparent infection. Thereafter the VZV enters the sensory nerve endings of the skin and travels centripetally along the nerve fibers of the posterior spinal roots or trigeminal ganglia, remaining persistently latent in the neurons of the posterior root ganglia. Under various triggering stimuli, the latent virus can be reactivated, grow and reproduce, causing the affected ganglia to become inflamed and necrotic, producing neuralgia. Papulovesicles then appear on the skin. During active viral replication, the nervous system is heavily affected.
It is reported that the most common factor predisposing to shingles is malignant tumor, among which lymphoma is most common. Among cancer patients receiving cytotoxic chemotherapy or immunosuppressive therapy, the incidence of shingles within one year is about 30%. Second, patients receiving high-dose glucocorticoid therapy also have an increased risk of VZV infection; the incidence of shingles in HIV-positive individuals is ten times that of normal people. In the general population, trauma, overfatigue and various infections can also trigger shingles.
Therefore, cancer patients who have undergone chemotherapy or immunosuppressive therapy must prevent shingles and should learn about the condition so that, should it appear, they can detect it early. The earlier shingles is treated, the better the outcome and the lower the chance of sequelae. If one waits until the "band" has formed before treating, the difficulty is far greater, and most patients are left with sequelae that are hard to cure. Many cancer patients still shudder when talking about shingles, because the suffering is so unforgettable; the severity of cancer pain in most patients does not match that of shingles.
This disease tends to occur in spring and autumn, but for cancer patients it may arise at any time of year. There is usually first a mild fever, accompanied by fatigue, malaise, poor appetite, and a burning sensation or neuralgia of the skin.
After 1–3 days, irregular erythema appears in a certain nerve distribution area, followed by numerous or clustered millet-to-mung-bean-sized papules that quickly coalesce into vesicles filled with clear, transparent fluid. Thereafter new rashes and vesicles continuously appear. The vesicles are dense, grouped in clusters, with several clusters arranged in a band; the skin between clusters may be normal. Only the affected area feels burning, as if on fire. The vesicles may suppurate or rupture, leaving ulcerated surfaces on the skin. In patients with malignant tumors, within days of shingles onset, chickenpox-like rashes may appear all over the body, accompanied by persistent high fever; in severe cases this can lead to pulmonary and cerebral damage and even death.
The key to prevention is dietary moderation, avoiding spicy and irritating foods, ensuring sleep, not staying up late, and at the same time maintaining emotional ease so as to enhance one's own immunity. When immunity is low, the VZV already present in the body takes the opportunity to attack and triggers shingles.
The nerves most commonly affected by shingles are the intercostal nerves, trigeminal nerve and lumbosacral nerves, so some patients initially present with what they feel is trigeminal neuralgia, costal pain or low-back pain. The author recently saw a cancer patient whose first symptom was low-back pain. At the time the patient thought it was a drug side effect, but on careful recall she realized the symptom had been faintly present before medication. The author therefore suspected shingles and advised her to see a dermatologist nearby. After examination, the local doctor confirmed it was shingles. Fortunately it was detected in time; after medication the pain began to ease.
TCM holds that shingles is mostly caused by exuberant liver-gallbladder fire combined with damp-heat. In severe cases it may manifest the critical signs of clouded spirit and convulsion, with the pathogen entering the pericardium. Treatment mainly centers on clearing heat, resolving toxin, coursing the liver and draining the gallbladder.
The author found 16 shingles cases in the medical records of veteran TCM physician Zhu Yongxian. The treatment rationale was essentially the same, with minor variations in medicinals across patients, and the outcomes were remarkable. Dr. Zhu's approach to shingles is thus reproducible. The author has organized these cases for readers' reference.
Dr. Zhu commonly used Machixian (Portulacae Herba), Daqingye (Isatidis Folium), Banlangen (Isatidis Radix), Chishao (Paeoniae Rubra Radix), Shengdi (Rehmanniae Radix), Jinyinhua (Lonicerae Flos), Lianqiao (Forsythiae Fructus), Yejuhua (Chrysanthemi Indici Flos), Yujin (Curcumae Radix), Yanhusuo (Corydalidis Rhizoma), Ruxiang (Olibanum), Moyao (Myrrha), Wulingzhi (Trogopterori Faeces), Wuseshe (Zaocys), Quanxie (Scorpio), Wugong (Scolopendra), Taizishen (Pseudostellariae Radix), and others. Among these are heat-clearing, toxin-resolving medicinals as well as swelling-reducing and pain-relieving medicinals. Dr. Zhu used the heat-clearing, toxin-resolving herbs in relatively large doses; because the dose was large and the action strong, recovery was also rapid.
For example, when treating a colleague at his own hospital, Dr. Zhu prescribed: Machixian 50 g, Daqingye 30 g, Banlangen 30 g, Jinyinhua 30 g, Lianqiao 30 g, Yejuhua 30 g, Chishao 15 g, Shengdi 15 g. The patient felt improvement the very day the medicine was taken; after five more days the condition was halved, and after another five doses he was cured.
As another example, in a case of a certain Gong who had already been treated for many days by other Western and Chinese doctors and was referred to Dr. Zhu only when critically ill, Dr. Zhu urgently administered large doses of heat-clearing, toxin-resolving and blood-cooling pain-relieving medicinals: Daqingye 30 g, Banlangen 30 g, Huhanlian (Picrorhizae Rhizoma) 6 g, Shengdi 15 g, Chishao 15 g, Yejuhua 30 g, Pugongying (Taraxaci Herba) 30 g, Machixian 60 g, Jinyinhua 15 g. It was to be taken every 8 hours. On the follow-up visit, the swelling had subsided and the pain had stopped.
For patients with trigeminal neuralgia, Dr. Zhu added wind-settling and spasm-stopping medicinals such as Wuseshe, Quanxie and Wugong; for those with severe swelling and pain he added Ruxiang, Moyao and the like. For severe pain, Dr. Zhu used Yanhusuo 30 g to strengthen the analgesic effect.
The 16 shingles cases recorded in Dr. Zhu's medical records were all treated basically along this line. Dr. Zhu excels in treating dermatological and external conditions, and his experience is well worth learning from. The author likewise advises patients to follow Dr. Zhu's line of treatment.
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