1. Compound Formulas for Treatment

1. Compound Formulas for Treatment Traditional Chinese Medicine views varicella as an external infection caused by harmful external factors affecting the lungs and spleen, leading to dampness and heat accumulation, which then manifest on the skin. Treatment should focus on clearing heat, cooling the blood, and detoxifying. Since patients are often children—whose bodies are still developing and whose constitutions are still weak—there is a high risk of yin and liquid depletion during the course of the disease; therefore, it is crucial to strengthen the body’s vital energy and consolidate its foundation. Compound herbal formulas follow the principles of TCM diagnosis based on syndrome differentiation and individualized medication adjustments, ensuring that each prescription is tailored to the specific condition of the patient. Yang Longsheng treated 20 cases of varicella based on Yin-Qiao San, all of whom experienced fever resolution, rash regression, skin lesion recovery, and elimination of complications such as infections, with overall good clinical conditions. Zhang Hua and others used a self-prepared disinfectant decoction for internal administration and a topical decoction for external washing, treating 57 adult cases of varicella, achieving a cure rate of 1% within 10 days. Zhao Ping et al. used a modified Dabai Mei Jie Du Tang combined with intramuscular or intravenous administration of Virozol as a control group, finding that the treatment group showed significantly better therapeutic effects than the control group. Yang Jingbo et al. administered Yinhuang Jie Du Tong Xie He Ji, while Ma Yinglong applied Longzhu Soft Paste to apply directly to the skin lesions, treating 21 cases of varicella, with 18 cases cured, resulting in a cure rate of 95.24%. Yang Xia et al. prepared a silver-stone mixture for treating varicella in children, averaging a treatment duration of 4 days, with no significant adverse reactions observed. Zheng Dunfa compared a Qingre Jie Du Tang formula with intravenous acyclovir treatment; the treatment group achieved 35 cures, with a total effective rate of 100%, outperforming the control group (94.67%).

Patent medicines offer stable quality and convenient use, and the emergence of new dosage forms has expanded the options for administration. Zhao Heying used Shuanghuanglian powder injections diluted to 0.8% solution for intravenous infusion; she also applied a 3% concentration solution topically to treat varicella, with 18 cases showing marked improvement and 4 cases showing effectiveness. He Guodong treated 46 cases of varicella using Banlan Gen decoction, all of whom were cured, with an average treatment duration of 2–5 days, sometimes up to 8 days. Cao Ning et al. used Fishyingsha injection for treating varicella in children, comparing intramuscular or intravenous injections of Fishyingsha injection with intramuscular injections of Vitamin B₂ and intramuscular or intravenous injections of Virozol, finding that both groups showed highly significant differences in average fever reduction time, time to stop new rashes, and time for complete rash crusting (p<0.01). None of the treatment group experienced secondary rash development, and no adverse reactions occurred. Xiao Zhaowei soaked the compound Gua Zi Jin Ke Granules (Jin Hong Sheng) in warm water for oral administration, treating 43 cases of varicella, with 22 cases cured, 17 cases showing marked improvement, and a total effective rate of 97.7%, surpassing the oral formulation of Lìbā.

Part Two: Infectious Diseases

Wei Lin’s group reported a cure rate of 89.3%.

3. Integrated Chinese and Western Medicine Treatments Deng Hua employed Qingkai Ling injection, Fishyingsha injection, and Astragalus injection, combined with Western medicine like Ribavirin for intravenous infusion, while simultaneously administering the traditional Chinese medicine formula Wu Wei Xiao Du Yin together with anti-inflammatory and anti-itch medications. After treatment with these combinations of Chinese and Western medicines, along with Ribavirin intravenous infusion, 46 patients experienced the following outcomes:

• 2 cases took 2–3 days to see their rash subside;
• 25 cases took 4–5 days;
• 9 cases took 6–7 days. The shortest treatment period was 3 hours, while the longest was 6 hours.

The children generally remained in good spirits and did not experience any particular discomfort. Tang Yu used intravenous acyclovir injections combined with Fishyingsha injections into muscles, and the treatment duration was shorter compared to the control group, with more pronounced improvements in fever reduction time, time to stop new rashes, time to relieve itching, and overall skin crust formation—all of which were statistically significant (p<0.01).

The treatment group had no cases of secondary rash development, and no adverse reactions were observed. Xiao Zhaowei soaked the compound Gua Zi Jin Ke Granules (Jin Hong Sheng) in warm water for oral administration, treating 43 cases of varicella, with 22 cases cured, 17 cases showing marked improvement, and a total effective rate of 97.7%, surpassing the oral formulation of Lìbā.

Second Part: Practical Internal Medicine

(1) General Care

This disease is highly contagious; once a child is identified as infected, they should be immediately isolated until all the rashes have formed scabs. During the fever phase, the child should rest in bed and consume easily digestible foods along with adequate hydration. The child’s skin should be kept clean, with nails trimmed short to prevent scratching and subsequent infections. In collective settings such as daycare centers, it is important to maintain cleanliness, disinfection, and proper ventilation in the living spaces, including UV irradiation, sun exposure, and boiling bedding and other items. Poor care can lead to secondary skin infections that may result in pus formation and even joint inflammation.

(2) Medicinal Treatment

1. For symptoms involving skin lesions, apply 10% Gentian Violet externally; for skin itching, use 2% Carbonic Acid Solution or Calamine Lotion, among others. If the vesicles rupture, apply Neomycin ointment. If the skin becomes infected or if there is concurrent pneumonia or sepsis, use sulfonamides or antibiotics accordingly. If encephalitis is present, treat it according to the standard protocols for encephalitis caused by type B.

2. Adrenal corticosteroids are generally contraindicated in cases of varicella. However, if varicella is complicated by severe complications, and effective antibiotics are being used, a 3–5 day course may be appropriate. If the patient already has a history of hormone use but subsequently develops varicella, and the hormone usage is relatively short, it may be discontinued, or the dosage can be gradually reduced back to physiological levels—approximately 1/10 to 1/5 of the original therapeutic dose.

3. Local External Treatments: When the rashes break open and ooze fluid, sprinkle pine pollen over the affected areas. If the rashes become ulcerated, apply Blue Indigo Oil Paste (60g of Indigo, 120g each of Calcined Gypsum and Talc, 30g of Phellodendron Amurense, 15g each of Camphor and Coptis Chinensis, ground into fine powders and mixed thoroughly, then applied with sesame oil).

Integrated Chinese and Western Medicine Practical Internal Medicine – Appendix: Herpes Zoster – I. Overview

Herpes Zoster is an acute inflammatory disease characterized by clustered vesicles appearing on the skin, accompanied by neuralgia. The rash typically follows the distribution of peripheral nerves on one side of the body, forming bands.

The general population is susceptible to infection; after contracting chickenpox [------]{.underline}, individuals develop lasting immunity against the herpes zoster virus. However, the high-titer antibodies produced in the body cannot eliminate the latent virus residing in the spinal cord nerve ganglia. Years—or even decades—later, under certain triggers such as trauma, cold exposure, fatigue, various infectious diseases, leukemia, or after immunosuppressive therapy, or due to physical weakness, immune function may decline, allowing the latent virus to proliferate and cause illness. Often, before the onset of symptoms, local lymph node swelling may occur; initially, the skin along the nerve segments may feel a sharp, dull, or burning pain, accompanied by mild systemic symptoms. The skin presents with inflammation, with vesicles located deep within the epidermis, containing transparent serous fluid. Within the vesicles and their margins, enlarged balloon-like cells are often observed, indicating degeneration of the cells. Free epithelial cells within the vesicles may contain eosinophilic nuclear inclusions. The most common form is intercostal herpes zoster, followed by the distribution area of the first branch of the trigeminal nerve in the head and face, as well as the neck, waist, abdomen, and limbs.

Some patients may only exhibit papules without the appearance of vesicles, which then resolve on their own; this is known as a sluggish herpetic zoster. Some vesicles may appear as bullous or hemorrhagic, or even show central necrosis, forming dark brown scabs—these are referred to as gangrenous herpetic zoster. Elderly patients with lymphoma or other conditions may experience widespread rashes covering the entire body, resembling extensive chickenpox lesions, known as generalized herpetic zoster, often accompanied by high fever and other systemic symptoms.

II. Diagnosis

(1) Diagnostic Criteria

On one side of the body, clusters of chickenpox-like rashes appear, arranged in bands along the nerves, asymmetrically, and generally do not extend beyond the midline of the body, accompanied by distinct neuralgia.

Before the vesicles appear, it is easy to confuse them with angina pectoris, chest muscle pain, duodenal ulcers, biliary colic, and other conditions. However, once the vesicles appear, they should be differentiated from the following diseases.

(2) Differential Diagnosis

1. Simple Herpes Most commonly occurs at the junctions of skin and mucous membranes, such as the corners of the mouth, the edges of the lips, around the nostrils, and on the external genitalia. Although there are clustered vesicles, they are small and tend to rupture easily, with mild inflammation, itching, and a burning sensation—but usually without pain. These lesions often accompany febrile illnesses such as meningitis, malaria, or lobar pneumonia.

2. Chickenpox presents with mild systemic symptoms and sporadic, batch-like rashes on the trunk and head, gradually spreading to the face and eventually reaching the limbs. The rashes are itchy, without significant pain.

3. Impetigo begins as a few scattered erythematous patches or vesicles, which gradually evolve into vesicles, surrounded by redness and inflammation. The vesicle fluid is cloudy, causing burning and itching, leading to scratching and contamination, with erosion and exudation, recurring and spreading over time. The disease tends to affect exposed areas such as the head and face, as well as the limbs, though it can also spread throughout the body.

III. Traditional Chinese Medicine Understanding and Treatment of Herpes Zoster

(1) Historical Medical Perspectives on Herpes Zoster

Although the term “herpes zoster” did not exist in ancient medical texts, there were records of similar causes, pathogenic mechanisms, and symptoms. For example, the Suwen’s “Zhi Zhen Yao Da Lun” states: “All pains, itching, and sores belong to the heart.” The Suwen’s “Yin Yang Ying Xiang Da Lun” notes: “The dampness of the earth, when sensed, harms the skin, flesh, tendons, and veins.” The Yizong Jinjian says: “When dry, the skin turns red and crimson, resembling cloud-like flakes, with a tingling itch and fever—this belongs to the liver. The wind and fire of the heart meridian… When damp, the skin turns yellowish-white, with vesicles of varying sizes, oozing fluid, and more painful when dry—this belongs to the spleen and lung meridians, where dampness and heat prevail…” The Surgical Qixuan states: “Spider-like sores appear between the skin layers, resembling water pits, pale red and painful, with five or seven sores forming ulcers, five or seven sores clustering together, and sometimes spreading outward.” All of these descriptions share similarities with the current disease.

(2) Traditional Chinese Medicine Understanding of Herpes Zoster’s Pathogenesis In Traditional Chinese Medicine, this disease is known as “Snake String Rash,” “Band-Aid Fire Dan,” “Banded Dragon,” “Spider Sores,” etc., often arising from emotional distress leading to excessive liver and gallbladder fire; or from drinking too much…

Part Two: Infectious Diseases To regulate the body’s qi, dampness and turbidity accumulate internally, becoming stagnant and obstructing the flow of qi. When the qi becomes blocked, stagnation arises, leading to the accumulation of dampness and heat, and external pathogens are introduced. The body’s natural defenses are weakened, allowing latent viruses to multiply and cause illness. Before the onset of symptoms, local lymph node swelling often occurs; initially, the skin along the nerve segments may feel a sharp, dull, or burning pain, accompanied by mild systemic symptoms. The skin shows inflammation, with vesicles located deep within the epidermis, containing transparent serous fluid. Within the vesicles and their margins, enlarged balloon-like cells are often observed, indicating cell degeneration. Frequent eosinophilic nuclear inclusions can be found within the free epithelial cells of the vesicles. The most common form is intercostal herpes zoster, followed by the distribution area of the first branch of the trigeminal nerve in the head and face, as well as the neck, waist, abdomen, and limbs.

Patients may only exhibit papules without the appearance of vesicles, which then resolve on their own; this is known as a sluggish herpetic zoster. Some vesicles may appear as bullous or hemorrhagic, or even show central necrosis, forming dark brown scabs—these are referred to as gangrenous herpetic zoster. Elderly patients with lymphoma or other conditions may experience widespread rashes covering the entire body, resembling extensive chickenpox lesions, known as generalized herpetic zoster, often accompanied by high fever and other systemic symptoms.

III. Traditional Chinese Medicine Diagnosis and Treatment of Herpes Zoster