2 Traditional Chinese Medicine Understanding of the Pathogenesis of Herpes Zoster

Although the term "herpes zoster" did not exist in ancient medical texts, there were records regarding the causes, pathogenic mechanisms, and symptoms associated with this disease. For example, the Su Wen · Zhi Zhen Yao Da Lun stated: "All pains, itching, and sores belong to the Heart." The Su Wen · Yin Yang Ying Xiang Da Lun noted: "The dampness of the Earth, when sensed, harms the skin, muscles, tendons, and vessels." The Yi Zong Jin Jian wrote: "When dryness appears, the skin turns red and red like cloud fragments, with a tingling sensation and heat, indicating Liver Qi. The Wind and Fire of the Heart Meridian... When dampness appears, the skin turns yellowish-white, with vesicles of varying sizes, oozing fluid, and more painful when dry, indicating the Spleen and Lung Meridians—dampness and heat..." The Surgical Qi Xuan stated: "Spider-like sores appear between the skin layers, similar to water pits, pale red and painful, with five or seven sores forming ulcers, five or seven sores clustering together, and even spreading outward." All of these descriptions share similarities with this disease.

(2) Traditional Chinese Medicine Understanding of the Pathogenesis of Herpes Zoster In Traditional Chinese Medicine, this disease is known as "Snake String Rash," "Lumbago Fire Dan," "Lumbago Dragon," "Spider Sores," among others. It is often attributed to emotional distress, leading to excess Liver and Gallbladder Fire; or due to excessive drinking, eating, and other dietary habits.

Part Two: Infectious Diseases II. Diagnosis (1) Diagnostic Criteria

On one side of the body, clusters of chickenpox-like rashes appear, arranged in bands along the nerves, asymmetrically, generally not extending beyond the midline of the body, with distinct neuralgia.

Before the appearance of rashes, it is easy to confuse them with angina pectoris, chest muscle pain, duodenal ulcers, biliary colic, etc.; however, once the rashes appear, they should be differentiated from the following conditions.

(2) Differential Diagnosis

1. Simple Herpes Most commonly occurs at the junctions of skin and mucous membranes, such as the corners of the mouth, lip edges, around the nostrils, and on the external genitalia. Although there are clustered vesicles, they are small and prone to rupture, with mild inflammation, itching, and a burning sensation—but usually without pain. These rashes 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 finally reaching the extremities. The rashes are itchy but without significant pain.

3. Impetigo begins as a few scattered erythematous patches or vesicles, gradually progressing to vesicles, with surrounding redness and swelling, cloudy vesicle fluid, burning and itching, causing scratching and contamination, leading to erosion and exudation, recurring and spreading over time. The disease often affects exposed areas such as the head and face, as well as the limbs, but can also spread throughout the body.

III. Traditional Chinese Medicine Understanding and Treatment of Herpes Zoster

(1) Historical Medical Views on Similar Conditions

Although the term "herpes zoster" did not exist in ancient medical texts, there were records regarding the causes, pathogenic mechanisms, and symptoms associated with this disease. For example, the Su Wen · Zhi Zhen Yao Da Lun stated: "All pains, itching, and sores belong to the Heart." The Su Wen · Yin Yang Ying Xiang Da Lun noted: "The dampness of the Earth, when sensed, harms the skin, muscles, tendons, and vessels." The Yi Zong Jin Jian wrote: "When dryness appears, the skin turns red and red like cloud fragments, with a tingling sensation and heat, indicating Liver Qi. The Wind and Fire of the Heart Meridian... When dampness appears, the skin turns yellowish-white, with vesicles of varying sizes, oozing fluid, and more painful when dry, indicating the Spleen and Lung Meridians—dampness and heat..." The Surgical Qi Xuan stated: "Spider-like sores appear between the skin layers, similar to water pits, pale red and painful, with five or seven sores forming ulcers, five or seven sores clustering together, and even spreading outward." All of these descriptions share similarities with this disease.

(2) Traditional Chinese Medicine Understanding of the Pathogenesis of Herpes Zoster In Traditional Chinese Medicine, this disease is known as "Snake String Rash," "Lumbago Fire Dan," "Lumbago Dragon," "Spider Sores," among others. It is often attributed to emotional distress, leading to excess Liver and Gallbladder Fire; or due to excessive drinking, eating, and other dietary habits.

Part Two: Infectious Diseases II. Diagnosis (1) Diagnostic Criteria

On one side of the body, clusters of chickenpox-like rashes appear, arranged in bands along the nerves, asymmetrically, generally not extending beyond the midline of the body, with distinct neuralgia.

Before the appearance of rashes, it is easy to confuse them with angina pectoris, chest muscle pain, duodenal ulcers, biliary colic, etc.; however, once the rashes appear, they should be differentiated from the following conditions.

(2) Differential Diagnosis

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

2. Chickenpox presents with mild systemic symptoms and sporadic

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Input: Scattered rivers use evil needles to puncture water and pustules, and after cleaning the wound surface, lightly sprinkle Qinghuang Powder onto the affected area, then cover with gauze for fixation—continue until the blisters heal. Pool of pain disappears. Treatment outcomes: 6 cases were cured after a single treatment, 15 cases were cured after two treatments, 42 cases were cured after three treatments, 42 cases were cured after four treatments, 12 cases were cured after five treatments, 8 cases were cured after six treatments, 8 cases were cured after seven treatments, 8 cases were cured after eight treatments, 3 cases each received nine and ten treatments, 2 cases each received eleven and twelve treatments, 1 case received thirteen treatments, 2 cases received fourteen and fifteen treatments, and 1 case each received twenty, twenty-one, and twenty-five treatments. The average treatment duration was 5.1 times. Among the 190 cases treated as described above, the herpes lesions dried up and formed scabs, and the pain disappeared. Follow-up examinations showed no cases developed postherpetic neuralgia, indicating excellent long-term efficacy. (Practical Medical Technology Journal, 2003.11) Ning Tianyuan et al. treated 48 cases of herpes zoster using an integrated approach of traditional Chinese medicine and Western medicine. The method involved taking 40 tablets of 25 mg of diphenhydramine, 10 tablets of 0.75 mg of dexamethasone acetate, 50 g of rhubarb, 50 g of phellodendron, 20 g of whole scorpion, 20 g of centipede, and 10 g of camphor, grinding them into powder, finely grinding and sieving the mixture, then storing it in a clean, sealed bottle for later use. Before medication, wash the herpes lesions with saline solution, then disinfect with 2% iodine alcohol. Based on the size of the herpes lesions, take an appropriate amount of the powdered medication and mix it with ginseng pearl powder to form a paste, applying it to the affected area twice or three times daily, exposing it to air until dry, then gently scraping off the excess before reapplying. A course of treatment consisted of 7 days, typically 1–2 courses. In this group, all 48 cases achieved complete recovery within a single course; among the 46 cases followed up, 42 were cured, resulting in a cure rate of 96%. Two cases showed improvement (4%). (Nursing Research, 2004.7) Liu Ping treated 86 cases of herpes zoster with traditional Chinese medicine. The treatment regimen included: ① local treatment with external application of traditional Chinese medicine: prepare a formula consisting of realgar, raw rhubarb, centipede, toad venom, camphor, 70% ethanol, and other ingredients, storing the preparation as a tincture for use twice daily, applying it to unbroken herpes lesions. For areas with extensive acute inflammatory rashes, cover the lesions with a layer of sterile gauze to protect the skin and prevent vesicles from breaking and causing infection. Avoid applying oily ointments; ② systemic treatment: according to traditional Chinese medicine theory, herpes zoster is attributed to liver fire overactivity and internal damp-heat accumulation; therefore, the principle of treatment is to clear damp-heat from the liver and gallbladder. Use 3 g of gentian root, 5 g of bupleurum, 12 g of skullcap, 30 g of honeysuckle, 12 g of forsythia, 10 g of gardenia, 15 g of rehmannia root, 3 g of licorice, 30 g of indigo woad, 6 g of xiangxiong, 6 g of coptis, 12 g of polygonum cuspidatum, 15 g of plantain seeds, 12 g of polygonum cuspidatum, 12 g of polygonum cuspidatum, 10 g of alisma, and other herbal formulas, taken once daily, with one week constituting a course of treatment, using rash regression as the therapeutic criterion. Results: All 86 patients were cured, with the shortest disease course lasting 9 days and the longest reaching 46 days. (Chinese Practical Medicine, 2009.1) IV. Western Medical Treatment (1) Symptomatic and supportive therapy The skin around the affected area can be washed with soda water, and applied with camphor powder or peppermint powder, or by mixing realgar powder with alcohol or water. Apply 5% sulfur-copper oxide water-based powder or 3–5% gentian violet solution externally for protective, anti-inflammatory, and drying effects. Alternatively, apply olive oil, sulfonamides, or gold-mycin ointment to moisturize the skin and promote scab formation. For severe pain, consider local nerve blocks with alcohol or procaine, or administer vitamin B1 and B2 intramuscularly. If conjunctivitis or iridocyclitis occurs concurrently, use atropine eye drops to dilate the pupils and apply corticosteroid ointment. For elderly patients, it is advisable to increase the use of sedatives such as bromide, diazepam, or lorazepam, or add analgesics like aspirin, analgesic, or diclofenac. For long-term and severe postherpetic neuralgia, while pain medications may have limited effectiveness, combining analgesics, sedatives, and hypnotics can be beneficial. For elderly patients, early administration of prednisone for several weeks, gradually reducing the dosage and discontinuing the medication, can help reduce the occurrence of postherpetic neuralgia without causing side effects. (2) Antiviral drugs

1. Ara-A can inhibit the synthesis of varicella-zoster virus. For foreign patients, administering Ara-A at 10 mg/kg·day via intravenous infusion for 5 days per course can halt viral release, accelerate skin healing, reduce lesion spread, and shorten the duration of neuralgia—but it cannot prevent the onset of postherpetic neuralgia.
2. Acyclovir inhibits varicella-zoster virus and has low toxicity. Administering it at 15 mg/kg·day via intravenous infusion for 7 days per course can control the spread of skin lesions and the release of the virus, effectively promoting local healing and alleviating pain.
3. Acyclovir has been reported in recent years to be administered as 500 mg intravenously once daily, along with 400 mg cimetidine and 5 mg dexamethasone, given intravenously once daily for 5–7 days, which demonstrates significant effects in relieving pain, promoting herpes healing, and preventing postherpetic neuralgia. 3. Other treatments include dermal acupuncture: after disinfecting the lesion with 75% alcohol and marking the boundary between the lesion and healthy skin, based on the size of the lesion, first use a needle of appropriate depth, making cross-shaped, subcutaneous punctures.

Second Chapter: Infectious Diseases

Qu’s cream, Guiguo Wei…

2% procaine applied externally proved highly effective, especially for patients experiencing severe pain. Qu, realgar 5:1 mixed with egg white or petroleum jelly…

Add… (Cai Xiaoping, Qiao Fuguo, Wu Shi) Chapter Seven: Epidemic Parotitis I. Overview

Epidemic parotitis (Mumps), often referred to as “flow腮” in Chinese, is an acute respiratory infectious disease caused by the mumps virus. Its most prominent clinical feature is non-suppurative swelling and pain in the parotid glands. The virus can infect almost every organ, leading some cases to present with meningitis, orchitis, oophoritis, dermatitis, mastitis, myocarditis, and other complications. This disease is prevalent across China, occurring throughout the year, with peak seasons in spring and winter, commonly affecting children and adolescents, though adults are also frequently impacted. According to previous medical surveys, the incidence has shown a rising trend since 1978. The mumps virus belongs to the paramyxovirus family and is RNA-based, first isolated in 1934 from the saliva of infected patients. It is extremely sensitive to physical factors (sunlight, ultraviolet rays, etc.) and chemical agents (1% phenol, ethanol, etc.). The virus rarely mutates; it enters through the oral and nasal mucosa, multiplies in epithelial tissues, then enters the bloodstream, where it further proliferates in the parotid tissue before entering the bloodstream again, causing viremia and triggering symptoms such as fever, loss of appetite, and bilateral parotid swelling and pain. Due to obstruction of the parotid ducts, salivary amylase can flow back into the blood and be excreted in urine. It can also easily lead to conditions such as testicular and ovarian inflammation, as well as pancreatitis—though the former is more common. White blood cell counts are usually normal, with lymphocytes being slightly elevated. Serum amylase levels are mildly or moderately elevated in 90% of cases. In traditional Chinese medicine, this disease is often referred to as “itchy parotitis.” After contracting this disease, lifelong immunity can develop.

II. Diagnosis (1) Diagnostic Criteria

1. Epidemiology: Local outbreaks and contact with infected individuals are common, particularly during winter and spring.
2. Clinical Manifestations: Swelling, hardness, and tenderness centering around the lower part of the earlobes, often bilaterally, without pus formation. Some cases may be complicated by orchitis, myocarditis, pancreatitis, meningitis, and other conditions.
3. Laboratory tests show mostly normal white blood cell counts, with relative increases in lymphocytes, elevated serum and urinary amylase levels, and mild to moderate elevation of cerebrospinal fluid cells in over 50% of cases. If necessary, serological tests (neutralizing antibodies, complement fixation, hemagglutination inhibition), inactivated virus skin tests, and virus isolation can be performed to confirm the diagnosis. (2) Differential Diagnosis
4. Suppurative parotitis typically presents on one side, with significant redness, swelling, and pain, accompanied by fluctuating pressure, and markedly elevated white blood cell counts and neutrophils, often requiring antibiotic treatment. 117HMo
5. Lymphadenitis in the neck and preauricular regions: not centered on the earlobes, but characterized by well-defined, hard nodules with significant tenderness, often accompanied by inflammation in nearby areas such as teeth, pharyngitis, or ulcerative lesions.
6. Secondary parotid enlargement may occur in patients with diabetes, malnutrition, chronic liver disease, or drug-induced conditions (iodine preparations, hydrocortisone, isoprenaline, etc.), often presenting symmetrically, soft, and painless.
7. Other rare cases may involve allergic parotitis (e.g., those associated with other symptoms). With a history of recurrent episodes, the swelling resolves quickly. In adolescent males, there are also cases of simple parotid swelling, though these are less common. To differentiate from ductal obstruction, these cases should be carefully evaluated. Integrated Traditional Chinese and Western Medicine Practical Internal Medicine III. Traditional Chinese Medicine’s Understanding and Treatment of Epidemic Parotitis