What is Shingles?
Shingles, also called Herpes Zoster, is viral skin condition treatable using Chinese Medicine. For a person who has had chicken pox, the varicella-zoster virus that caused it may have lain dormant in the peripheral nerves exiting his/her spinal cord.
The varicella virus sits latent in the nervous system. At some point in adulthood, during a time of reduced immune function, this inactive virus is activated and causes excruciating pain in affected areas. It usually starts with an area of pain, which is then accompanied by purulent blisters. This is an outbreak of Shingles (Herpes Zoster).
Is Shingles contagious?
During a Herpes Zoster outbreak, first a rash appears, and then the rash enters the blister phase. It is the shingles blisters that are contagious. It is not contagious before the blisters appear, nor is it once the blisters erupt and are crusted.
Q: Do I need to have had chickenpox to get Shingles?
A: The only way you can get shingles is if you have had chickenpox before. If you do not already have the chickenpox (varicella) virus in your system, it is very unlikely for you to get the shingles disease.
Differentiating between the two Herpes diseases
It is actually quite simple, so focus your attention as you read on.
They are not the same virus! Oral/Genital Herpes and Herpes Zoster (Shingles) are two different conditions! The confusion often happens because when the word “HERPES” is mentioned. “Herpes” is often associated with genital herpes. The fact is this: “not all herpes is genital herpes.”
Here’s one way to differentiate between them both.
- Herpes Simplex happens either as cold sores around the mouth (oral herpes), or as blisters and open sores in the genital area (genital herpes).
- Herpes Zoster happens around the side of the face or the ribs. This is Shingles.
They are both viral conditions and an outbreak often coincides with a weakened immune system. In both conditions, there is usually a burning sensation associated with the skin outbreak.
But Shingles has nothing to do with genital infection or STDs. If you have Genital Herpes, read on here.
Shingles in Chinese: 生蛇, 蛇串疮 and 带状疱疹
Shingles has three names in Chinese, and each one tells you something different about the disease.
- 带状疱疹 (dài zhuàng pào zhěn) — the medical term. It means belt-shaped blister rash, after the way the rash wraps around one side of the trunk like a sash.
- 蛇串疮 (shé chuàn chuāng) — the classical Chinese medicine name. Snake-string sores: sores strung out along a line, in the shape of a snake.
- 生蛇 (shēng shé) — what people actually say in Singapore, Malaysia and Hong Kong. Growing a snake. If someone tells you their mother is 生蛇, this is what they mean.
Is It True That If The Snake Encircles Your Waist, You Die?
No. This is the most persistent piece of folklore about shingles, and it frightens people badly. Shingles follows a single nerve root, and a nerve root serves one side of the body, so the rash almost never crosses the midline in the first place. The two ends do not meet — and nothing would happen if they did.
What the old name gets right is the shape. The rash runs in a band along the path of one nerve, which is exactly what a reactivated virus travelling back down that nerve would produce. In Chinese medicine that band usually falls along the Liver and Gall Bladder channels, which is why the treatment is built around clearing damp heat from those two.
The Shingles Outbreak
Shingles is an acute skin infection associated with chicken pox virus. During the chicken pox infection (often in childhood), the virus enters the cutaneous nerves, making its way to the dorsal root ganglia where it lies dormant. In a adulthood, this virus becomes active again, usually due to the following which causes the immune system to become compromised.:
- Stress and mental overwhelm (usually a big event in life)
- Emotional stress (usually a big event in life)
- Debilitating medical condition which overwhelms the physical body (usually a big event in life)
- Usage of immunosuppressant drugs or vaccination
Turning points in our life somehow causes the virus to travel back from the dorsal root ganglia to the cutaneous nerve, which causes nerve pain, red rashes and blisters along the line of the cutaneous nerve.
What is the Acute Phase of Shingles?
Of all the symptoms that come with a herpes zoster infection, the most outstanding one is pain. Pain is experienced as a sensitive, tingling sensation or burning pain, usually on the ribs on one side of the body, but sometimes also on the face. Thereafter, red rashes appear, the rashes spread and groups of blisters start to appear.
Note that the lesions are one-sided (asymmetrical). Shingles occur in the form of a one-sided eruption of a red rash, accompanied by blisters and severe pain.
In the beginning, when the red rash occurs, it is difficult to give a precise diagnosis, as the body may also experience symptoms such as fever, headache, loss of appetite and tiredness. These symptoms are common in the initial stages of many early-stage viral infections. It is only when the painful blisters appear that it becomes obvious it is an outbreak of shingles.
The ribs are most commonly affected area, and pain may be experienced even a few weeks before skin changes are seen. In the situation where no skin lesions are visible, it is called zoster sine herpete.
The Best Medical Treatment for Shingles?
Antivirals are the first line of treatment in this day and age. You need not visit the National Skin Centre to get access to antivirals medication. Even a GP clinic is able to offer this prescription. While oral antiviral drugs are effective, corticosteroids (even topical creams) are considered ineffective or even harmful treatment for shingles.
TCM is the next line of treatment. In the long past, patients may have done well with TCM alone, but at our TCM Clinic, we may still advise for you to get antiviral drugs while seeing us. We just want you to get the best recovery possible. You do not need to go to the National Skin Centre to get antiviral, any GP clinic will be able to prescribe for you.
This is not to downplay the effectiveness of Traditional Chinese medicine TCM. Rather, it is to recognize the effectiveness of combined treatment for shingles. Treat with both pharmaceutical drugs and TCM; it does not have to be one or the other! You will only benefit from receiving TCM session in tandem with early use of antivirals.
TCM Diagnosis and Treatment for Acute Shingles Infection
Because the shingles lesions often coincide with the parts of the body traversed by the Liver and Gall Bladder meridians, the TCM strategy in the treatment for shingles revolves around clearing Damp Heat in the Liver and Gall Bladder. One way of clearing out damp heat is through acupuncture. Those who have received acupuncture for shingles will be quick to affirm a significant change in the way they feel after treatment. Acupuncture can reduce painful sensations very effectively and most of the patients at our TCM clinic attest to its efficacy.
TCM Herbs for Shingles infection
Herbal medicine is the other way to treat shingles using TCM. The herbal aspect of traditional Chinese medicine is often overlooked in the treatment for shingles. We thoroughly recommend it, because it is crucial in the prevention of postherpetic neuralgia (PHN).
In the acute phase of shingles, herbal medicine will always include herbs like Gardenia and Skullcap to drain out pathogenic damp, as well as a slew of herbs like Bupleurum and Lonicera that have anti-inflammatory and anti-viral action.
How the shingles blisters present also affects how we choose herbs for our patients. The size of the blisters, how much they ooze, as well as possible accompanying symptoms like fatigue and poor appetite, help the TCM physician determine the optimal mix of herbs. For some patients, the TCM herbs may focus more on clearing Liver fire; for others, the focus may be more on draining Spleen damp.
In some patients with a weak constitution, tonic herbs are added in with care to support the immune system in a gentle manner. As the intensity of the acute phase begins to peter out, the TCM herbal formula is modified to take into account the need for enhanced circulation, with the intent to prevent postherpetic neuralgia.
As certain foods are not optimal for the body, the patient is advised to stay away from both raw and spicy foods, and to not indulge in rich foods for the time being.
What is the Recovery Phase of Shingles?
There is no NEW varicella zoster rash erupting in the recovery phase. The initial rash has started to fade, and the skin starts to heal. You feel like you are on the mends and can continue life as normal.
BUT READ ON!
For some people, even though the rash has resolved, there may continue to be abnormal or even painful sensations at the site of the lesion. This is because the nerve damage may cause exaggerated sensory response. This is post herpetic neuralgia (PHN), and you would want to consider using TCM to prevent this.
TCM for Post Herpetic Neuralgia
While shingles blisters are very painful, it is post herpetic neuralgia (PHN) that has longer-term consequences! Post herpetic neuralgia is where the pain persists even after the outbreak is over. Some patients experience severe nerve pain if the nerves are damaged. The pain can last for a very long time, up to years after the rash has disappeared. Sometimes, it is not so much pain but unfamiliar and uncomfortable sensations that remain after the outbreak. This is why Herpes Zoster should be treated once it is diagnosed, even if you are already on antiviral medication in the acute phase of the outbreak.
Two Cases of Post-Herpetic Neuralgia
Two cases I saw show that we really do not know who will get post-herpetic neuralgia. In both, the patients were men of Asian descent in their forties. Both had started antiviral medication on diagnosis.
Case 1: no problem
The first presented with lesions around the right sacrum, with pain radiating all the way to the posterior anus. He was in pain. We confirmed it was not genital herpes, which can also affect the area around the anus.
Electroacupuncture was administered once. He felt better after that first and only treatment and decided not to proceed with further sessions. He also declined herbs. One week later he reported feeling fine and was no longer perturbed by the condition.
Case 2: big problem
The second had lesions on the right side of his face which had already subsided. No more blisters — he was coming for nerve pain in the areas mapped by the trigeminal nerve: around the eye, the cheek, and the mouth and chin.
By the time he decided to come in for acupuncture he had already finished his course of antivirals. Despite being past the active blister phase, the nerve pain remained. I told him it would have been better had he come in at the beginning, but hindsight is 20/20.
In the end he had to come in every day or every other day to keep the pain manageable. Acupuncture definitely helps, whether during the active blister phase or afterwards for the nerve pain. I also gave him Chinese herbs, which were instrumental in bringing about full recovery.
What are the odds?
These two show the risk of not getting acupuncture and herbal treatment early. That is especially true for shingles on the face or affecting the eyes. The first man did fine on a single session. The second would have done better had he come sooner.
References:
Y. Hua, Y. Li, Q. Guo, Ll Ji, J.B. Wang. Observation on clinical effect of electroacupuncture plus pricking-cupping bloodletting therapy for herpes zoster. J Acupunct Tuina Sci, 13 (2015), pp. 54-57.
X. Fang. Clinical observation of acupuncture therapy for postherpetic neuralgia. J Acupunct Tuina Sci, 9 (2011), pp. 113-115.
S. Yuan-Zheng, M. Jin-Yun. Treatment of 28 cases of post-herpetic neuralgia by local encircled needling method. J Acupunct Tuina Sci, 4 (2006), pp. 250-251.
Shingles on the Face and Around the Eyes
Most shingles turns up on the ribs. A minority appears on the face, and that minority carries most of the risk.
At our TCM clinic we do not just treat shingles lesions at the ribs. We are especially good at treating face shingles and shingles around the eyes.
When to stop reading and see a doctor today
Facial shingles follows the trigeminal nerve, and one of its branches supplies the eye. If that branch is involved the cornea can be affected and sight is genuinely at stake. Do not wait for a convenient appointment if any of these apply:
- Blisters on the tip or the side of your nose. That branch of the nerve also supplies the eye, so a rash there is a warning that the eye may be next.
- Pain in the eye, redness, blurring, or light hurting more than usual.
- Blisters in or around the ear with one side of the face drooping, sometimes with hearing loss or vertigo.
Any of those needs same-day medical review, alongside whatever else you do.
Why we push harder on herbs for facial cases
For outbreaks on the face, in addition to acupuncture treatment, we highly recommend you be treated with TCM herbs. The herbs are crucial in preventing post herpetic neuralgia as well as restoring normal nerve sensation.
The reason is what facial nerve pain is like afterwards. It maps to the trigeminal nerve — around the eye, the cheek, and the mouth and chin — and it is on your face, where you cannot ignore it and cannot cover it. The second case further down is exactly that.
Why Treat Shingles with Chinese Medicine?
We are also proponents of using Chinese herbs in addition to acupuncture treatment, because we have seen how this speeds up the disease process, allowing the patient’s body to recover much faster.
Usage of Chinese herbs by our TCM physicians also prevents the occurrence of post herpetic neuralgia (PHN), where the shingles pain continues even when the shingles outbreak has already come and gone. Too little consideration is given to PHN, and the best approach is to undergo TCM treatment as soon as possible; your body will thank you for making this decision.
For the reasons outlined above, you have to get treated with Chinese Medicine if you are suffering from Shingles!
Who Would Be Treating You
Shingles is a nerve problem that shows up on the skin. The rash is the visible part. The pain is the nerve, and the pain is what can outlast everything else by months or years — especially on the face. That is the part worth treating early.
I’m Dr Mark Chern, PhD, registered with the TCM Practitioners Board of Singapore. Inflammatory conditions are what I treat, at 545 Orchard Road.
Shingles Is Time-Sensitive. Come In Early.
Tell us when the rash started and whether you are already on antivirals. If it is on your face or near your eye, say so.
FAQs
1. Can TCM be used to treat shingles?
Yes, and it is best used alongside antivirals rather than instead of them. Acupuncture reduces the pain of the acute phase, often noticeably within the first session or two. Chinese herbs are the part most people skip, and they are the part that matters most for preventing the nerve pain afterwards.
2. Can TCM cure shingles?
Shingles clears on its own in most people — the rash runs its course in two to four weeks whatever you do, so “cure” is the wrong word for anything, TCM included.
What treatment changes is the two things that actually cost you. It shortens and softens the acute phase, which is the painful part. And it lowers the odds of post-herpetic neuralgia, the nerve pain that can persist for months or years after the rash has gone. That second one is the real reason to treat, and it is why waiting until the blisters have settled is a mistake.
3. What is the root cause of shingles?
The varicella zoster virus — the same one that caused your chickenpox, usually in childhood. It never left. It has been sitting dormant in the nerve roots beside your spine ever since, and it reactivates when your immune system dips: major stress, a big life event, a debilitating illness, or immunosuppressant medication.
4. How long is shingles contagious?
Only while there are open blisters. It is not contagious before the blisters appear, and it stops being contagious once they have crusted over. And you do not catch shingles from someone — you catch chickenpox, and only if you have never had it.
5. Can I get shingles from a person with shingles?
If you have never had chickenpox and come in contact with someone with active shingles, you could contract the virus and get chicken pox if the person is contagious. The person is contagious if the rash has turned to blisters and you are exposed to the shingles blisters.
6. Can a vaccinated person be infected by a person with shingles?
If you have received vaccination for chicken pox, you’re also protected from shingles as an adult.
7. What foods should I avoid with shingles?
During the acute phase we ask patients to stay off raw food and spicy food, and to go easy on rich food for the time being. The reasoning is the same as the treatment: you are trying to clear damp heat, not add to it.
8. How soon should I start TCM treatment for shingles?
As soon as you are diagnosed, even if you have already started antivirals. Waiting until the blisters have settled is the common mistake. By then the window in which treatment prevents post-herpetic neuralgia has largely closed, and you are treating established nerve pain instead — which takes far longer.
9. Can herpes simplex be mistaken for shingles?
Yes, and the mix-up runs both ways. They are different viruses in the same family — herpes simplex (HSV) and varicella zoster (VZV) — and both produce painful fluid-filled blisters.
Four things separate them:
- Where. Herpes simplex sits on or around the lips (HSV-1) or the genitals and anus (HSV-2). Shingles runs in a band along one nerve, usually on the chest or back, on one side only — and sometimes on the face.
- The pattern. Shingles is unilateral and follows a dermatome. Herpes simplex clusters in one small area and is not tied to a nerve band.
- How you got it. HSV-1 passes by oral contact, HSV-2 by sexual contact. Shingles is not caught from anyone — it is your own chickenpox virus reactivating after years of lying dormant beside your spine.
- Whether it comes back. Herpes simplex recurs, often triggered by stress, illness or hormonal change. Shingles is usually once in a lifetime.
10. Is shingles the same as genital herpes?
No. The confusion comes from the word herpes, which most people associate with genital herpes — but not all herpes is genital herpes. There are more than a hundred herpes viruses, eight of which routinely infect humans; Epstein-Barr is one of them.
Shingles is herpes zoster, from the chickenpox virus. It has nothing to do with sexual transmission. If genital herpes is what you are dealing with, that is treated at our sister clinic — Soma Clinic.
11. Can I prevent shingles?
Vaccination with the varicella-zoster vaccine is the one established way to prevent it, and it is recommended from age 50. Antivirals shorten and soften an outbreak once it has started, but they do not prevent one.
Herpes simplex is a different matter — barrier methods and avoiding contact with active lesions are what reduce transmission there.
