Herpes Simplex / Herpes Zoster

WESTERN MEDICINE:

Herpes simplex (also called fever blister, or cold sore) is a recurrent viral infection characterized by the appearance on the skin or mucous membranes of single or multiple clusters of small vesicles, filled with clear fluid, on slightly raised inflammatory bases. Its etiology is the herpes simplex virus (herpes virus hominis, HVH). 

Herpes zoster (also called Shingles, Zona, Acute Posterior Ganglionitis) is an acute infection of the CNS involving primarily the dorsal root ganglia, and characterized by a vesicular eruption and neuralgic pain in the cutaneous areas supplied by peripheral sensory nerves arising in the affected root ganglia. Herpes zoster is caused by the same virus that causes varicella. It may be activated by local lesions involving the posterior root ganglia or by systemic disease, and may occur at any age but is most common after fifty. Inflammatory changes occur in the sensory root ganglia, the posterior horn of the gray matter, the meninges, and the dorsal and ventral roots. The cutaneous eruptions are caused by an inflammatory infiltration of the epidermis and dermis, with vesicle formation resulting from serous exudate beneath the stratum corneum. 

SYMPTOMS AND SIGNS: 

In the herpes simplex, the lesions may appear anywhere on the skin or on mucous membranes but are most frequent on the face, especially around the mouth or on the lips, conjunctiva and cornea, or the genitals. The appearance of small tense vesicles on an erythematous base follows a short prodromal period of tingling discomfort or itching. 

In the herpes zoster, prodromal symptoms of chills and fever, malaise, and GI disturbances may be present for 3 or 4 days before distinctive features of the disease develop, with or without pain along the site of the future eruption. On about the 4th or 5th day, characteristic lesions appear as crops of vesicles on an erythematous base in the cutaneous distribution of one or more posterior root ganglia. The eruptions occur most often in the thoracic region, and spread unilaterally. About the 5th day after their appearance the vesicles begin to dry and scab. Zoster may sometimes become generalized. 

ETIOLOGY AND PATHOLOGY: In Chinese medicine, herpes is called Chuang (meaning of sore). The etiology and pathology of herpes simplex are due to the following factors: 

  1. Wind - Heat factors attack the skin through the channels of lung and stomach, then accumulated at skin causing the Chuang. 
  2. The damp - heat flows down to attack the lower parts of the body through the channels of liver and gallbladder. 
  3. In the chronic stages, the interior heat due to the recurrent infection consumes the Yin part of the body creating interior deficient heat.

The etiology and pathology of herpes zoster are as follows: 

  1. The interior fire due to liver stagnation combined with damp - heat from the spleen and stomach accumulated at the skin, and causes skin problems.
  2. People with damp - heat body type affected by external toxic factors may easily accumulate toxins at the skin causing the herpes. 
  3. Elderly with blood deficiency and liver deficient fire can cause the body to easily catch external damp - heat or toxic factors, and cause abnormal circulation of Qi and blood.

DIFFERENTIATIONS: 

1. Herpes due to the Wind - Heat:

Indications: Beginning of herpes simplex: fever, aversion to wind, headache, sweating, skin or mucous membranes of single or multiple clusters of small vesicles on face, especially around the mouth or on the lips, itching or pain, normal or red tongue, thin and yellow coating, floating and rapid pulse. 

Treatment & Formulas: Dispel the wind factor and clear the heat of lung and stomach. 

Products:

    • Shi Wei Bai Du San (Bupleurum and Schizonepeta Formula, Item No. 2017): This is a very good formula for skin diseases due to wind heat factors with interior dampness. 
    • Xin Yi Qin Fei Yin (Magnolia Flower and Gypsum Combination, Item No. 2099): This is a very effective formula to treat herpes of wind -heat type. It clears the heat and dispels the wind factor. 
    • Sang Ju Yin (Morus and Chrysanthemum Combination, Item No. 2146): It is a mild formula for skin or lung diseases caused by wind - heat factor.
    • Yin Qiao San (Lonicera and Forsythia Formula, Item No. 2246): This is good to use when there is a fever with strong aversion to wind. 
    • Zhu Ye Shi Gao Tang (Bamboo Leaves and Gypsum Combination, Item No. 2091 ): This is good for wind - heat type in late stages when there is Yin consuming sign. 
    • Jing Jie Lian Qiao Tang (Schizonepeta and Forsythia Combination, Item No. 2167): This is a strong formula to dispel the wind factor and clear both external and interior heat. 

2. Herpes due to the Damp- Heat of liver and Gallbladder:

Indications: Skin lesions mostly appear on the genitals or other lower parts of body, lesions appear as crops of vesicles, strong pain and burning sensation, fever, constipation, restlessness, scanty and yellowish urine, or with burning sensation, red tongue with thick yellow coating, wiry and rapid pulse. 

Treatment & Formulas: Clear the interior heat and eliminate the dampness. 

Products:

    • Long Dan Xie Gan Tang (Gentian Combination, Item No. 2267): It is very strong and effective formula for the damp - heat of liver and gallbladder. 
    • Yin Chen Hao Tang (Capillaris Combination, Item No. 2142): This formula is used for damp - heat of liver and gall bladder when there is more heat than dampness. 
    • Yin Chen Wu Lin San (Capillaris and Hoelen Five Formula, Item No. 2143): This formula is used for the damp - heat of liver and gallbladder when there is more dampness than heat factor. 

3. Herpes due to the Interior Heat Toxin:

Indications: Skin lesions appear as crops of vesicles on an erythematous base in the cutaneous distribution of one or more posterior root ganglia, local areas are red, swollen or with yellowish fluids from vesicles, burning pain, fever, restlessness, headache, constipation, burning sensation of urination, red tongue, yellow thin or yellow thick coating, wiry and rapid pulse. 

Treatment & Formulas: Clear the interior heat and eliminate the interior toxin. 

Products:

    • Huang Lian Jie Du Tang (Coptis and Scute Formula, Item No. 2212)
    • Shan Huang Xie Xin Tang (Coptis and Rhubarb Combination, Item No. 2026)
    • Both formulas are very effective to clear the interior heat or toxicant factors by their cooling functions. 
    • San Zhong Kwei Jien Tang (Forsythia and Laminaria Combination, Item No. 2221): This is a strong formula for herpes due to the strong interior heat and toxic factors. 

4. Herpes due to the Deficiency:

Indications: Late stage of skin lesions, vesicles begin to dry and scab, slight red or pain, or burning sensation, thirsty, dry mouth and throat, constipation, scanty yellow urine, red and dry tongue, scanty or no coating; skin lesions are hard to cure, fatigue, shortness of breath, poor appetite, pale tongue, white and thin coating, weak pulse. 

Treatment & Formulas: Tonify the Yin or Qi, clear the interior heat at same time.

Products:
  • Dang Gui Liu Huang Tang (Tang- kuei and Six Yellow Combination, Item No. 2231): This is very good to use when a person has Yin deficiency and interior heat at the same time. 
  • Zhu Ye Shi Gao Tang (Bamboo Leaves and Gypsum Combination, Item No. 2091): This is very good to use at late stages of herpes when there is Yin and Qi deficiency, and some interior heat. 
  • Tuo Li Xiao Du San (Gleditsia Formula, Item No. 2088): This is used for late stages of herpes when there is Qi deficiency and when other formulas have difficulty expelling the interior heat. 
  • Sha Sheng Mai Dong Tang (Adenophorea and Ophiopogon Combination, Item No. 2107): This is used for late stage of herpes with Yin deficiency. 

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