Liu Yin-ni, Zhang Hong-xing, Huang Guo-fu, Zou Ran, Wei Wei

Acupuncture-moxibustion Department, Wuhan Hospital of Integrated Traditional Chinese and Western Medicine, Hubei 430022, China

Treatment of Herpes Zoster with Electroacupuncture plus Collateral-pricking and Cupping Therapy

Liu Yin-ni, Zhang Hong-xing, Huang Guo-fu, Zou Ran, Wei Wei

Acupuncture-moxibustion Department, Wuhan Hospital of Integrated Traditional Chinese and Western Medicine, Hubei 430022, China

Objective: To observe the clinical effect of electroacupuncture (EA)plus collateral-pricking and cupping therapy for herpes zoster.

Methods: Fifty-three cases with herpes zoster were randomly divided into two groups. Thirty-one cases in the treatment group were treated with EA at Jiaji (EX-B 2) points plus local collateral-pricking and cupping therapy. Twenty-two cases in the control group were treated with oral administration of Valaciclovir Hydrochloride and Indomethacin.

Results: The curative and remarkable effective rate was 93.5% in the treatment group and 72.7% in the control group. The difference between the two groups was statistically significant (P＜0.01), indicating that EA plus collateral-pricking and cupping therapy is better than Western medications in the clinical effects for herpes zoster.

Conclusion: The EA plus collateral-pricking and cupping method is an effective therapy for herpes zoster.

Herpes Zoster; Acupuncture Therapy; Electroacupuncture; Cupping Therapy; Pricking Blood Therapy; Points, Jiaji (EX-B 2); Plum-blossom Needle Therapy

Herpes zoster is a herpetic dermal disease caused by attack of virus to the nerve root and is similar to ‘snake-like sores’ in traditional Chinese medicine (TCM). This disease would involve the skin and nerves at the same time, manifested by regular flaky erythema, quickly forming clusters of papules and shiny blisters arranged in a stripe. The areas along the distribution of skin lesions are often accompanied by neuralgia to different extent, seriously influencing the patients’ quality of life. We treated 31 cases with electroacupuncture (EA) at Jiaji (EX-B 2) points plus collateral-pricking and cupping method by a plum-blossom needle in recent years, together with 22 cases treated with medications for control study. Now, the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria were stipulated for this disease in reference to the diagnostic criteria of ‘snake-like sores’ in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. The skin lesions are mostly blisters in size of mung beans, in clusters, with comparatively fight walls and red bases, often distributed on one side and arranged in stripes; the severe skin lesions can be manifested bybleeding or gangrenous damage; skin lesions on the head and face are usually very serious conditions; before appearance of skin rash, pricking pain or burning sensation is often present on the skin, accompanied by general discomfort and fever; obvious subjective pain, and there can be intolerable severe pain or post-herpetic neuralgia after skin rash subsides.

1.2 Inclusion criteria

Those in conformity with the above diagnostic criteria; aged 18-70 years old; with herpes within 1-7 d; without treatment of anti-viral and analgesic agents.

1.3 Exclusion criteria

Those in pregnancy and lactation; allergic constitution and allergic to many medications; scar constitution; complicated with severe primary diseases in the cardiocerebrovascular, hepatic, renal and hematopeitic system or general failure; those with diabetes, malignant tumors or mental disorders; those with connective tissue disease and/or hemophilia; patients with bleeding tendency; and those in critical condition and are difficult to make precise assessment on the efficacy and safety of the treatment.

1.4 General data

Totally 53 cases of patients were recruited, including outpatients and inpatients from the Acupuncturemoxibustion Department, Wuhan Hospital of Integrated Traditional Chinese and Western Medicine, and were randomly divided into a treatment group (31 cases) and a medication group (22 cases). In the treatment group, there were 13 males and 18 females, with the age ranging from 19 to 67 years old, and the duration ranging from 1 d to 7 d, including 5 cases with herpes on the neck and shoulder, 12 cases on the lumbar and hypochondriac region, 9 cases on the chest and back, 3 cases on the lower limb and 2 cases on the upper limb. In the control group, there were 10 males and 12 females, with the age ranging from 18 to 66 years old, and the duration ranging from 2 d to 6 d, including 3 cases with herpes on the neck and shoulder, 10 cases on the lumbar and hypochondriac region, 5 cases on the chest and back, 1 case on the lower limb and 3 cases on the upper limb. By statistical management of general materials of the age, duration and pathologic locations, the differences were not statistically significant (P＞0.05), indicating that the two groups were comparable.

2 Therapeutic Methods

2.1 Treatment group

2.1.1 EA

Acupoints: Jiaji (EX-B 2) points on the sick side (respectively one segment above and below the corresponding nerve segment of the pathologic locations).

Operation: The patient took a recumbent position to expose the sick area. After routine disinfection of the acupoints, the filiform needles of 0.35 mm in diameter and 40 mm in length were selected and inserted into Jiaji (EX-B 2) points by an angle of 70°-80° with the spine till 1-1.5 cun. After the arrival of the needling sensation by the twisting technique, LH202H HANS acupuncture apparatus was connected, with sparsedense wave, and frequency at 2/100 Hz, and current intensity at 2-5 mA. The stimulation intensity was within the tolerance of the patients. The needles were retained for 30 min. The treatment was given once every day and ten sessions made one course.

2.1.2 Collateral-pricking and cupping method

After routine disinfection of herpes area and the surrounding skin, the plum-blossom needle was used to tap herpes area till slight blood oozing, and then the cup was quickly applied by fire-flashing method. The cup was retained for 10 min to draw about 5 mL of local tissue fluid and stagnant blood. After the cup was taken off, the local area was disinfected for prevention of infection. The treatment was given once every other day and five sessions made one course. The observation was given for one course.

2.2 Control group

Oral administration of Valaciclovir Hydrochloride 300 mg, twice a day; Indomethacin 25 mg, three times a day; Vitamin B110 mg, Vitamin B120.25 mg, three times a day. The local skin of herpes was kept clean to protect the skin. Ten days made one course. The therapeutic effect was assessed after one course.

3 Observation of Therapeutic Effects

3.1 Scores of clinical symptoms

Pain, itching and serious burning sensation, accompanied by general symptoms, restlessness, unable to fall into asleep, and need of sedatives were calculated as 4 points. Intolerable pain, intermittent sleep, proper administration of sedatives at night, and influence on job were calculated as 3 points. Tolerable pain, able to sleep and normal working ability were calculated as 2 points. Slight pain or slight itching, not influencing the work or rest was calculated as 1 point. No subjective pain and itching was calculated as 0 point.

3.2 Statistical methods

The SPSS 13.0 software was used for statistical analysis of the obtained data. The Chi-square test was used for the enumeration data, and thet-test was used for the measurement data. The significance level isα=0.01.

3.3 Criteria of therapeutic effects

The therapeutic effects were assessed in accordance with the efficacy indexes.

Efficacy index = (Integral before treatment – Integral after treatment) ÷ Integral before treatment × 100%.

Cured: Efficacy index was 100%.

Remarkable effect: Efficacy index was 60%-99%.

Effect: Efficacy index was 30%-59%.

Failure: Efficacy index was less than 30%.

3.4 Therapeutic results

3.4.1 Comparison of clinical symptom scores before and after treatment between the two groups

Before treatment, the differences in the scores of the clinical symptoms between the two groups were not statistically significant (P＞0.01). After treatment, the scores of the clinical symptoms in the two groups were all improved. But, the improvement better in the treatment group and it was statistically significant (P＜0.01) in comparison with the control group, indicating that the therapeutic effect was better in the treatment group than that in the control group (table 1).

3.4.2 Comparison of the curative and remarkable effective rate between the two groups

Curative and remarkable effective rate = (Number of cured cases + Number of remarkable effect cases) ÷ Group number of cases × 100%.

The curative and remarkable effective rate was 93.5% in the treatment group and 72.7% in the control group. By Chi-square test, the differences between the two groups were statistically significant (P＜0.01), and the curative and remarkable effective rate was better than the control group (table 2).

Table 1. Comparison of clinical symptom scores before and after treatment between the two groups (, point)

Table 1. Comparison of clinical symptom scores before and after treatment between the two groups (, point)

Note: Compared with the control group, 1)P＜0.01

GroupsnTime Pain Itching Burning sensation Sleep Treatment 31 Before treatment After treatment Control 22 Before treatment After treatment 3.9±0.1 0.3±0.11)3.8±0.2 1.8±0.3 3.6±0.4 0.2±0.11)3.7±0.3 1.2±0.4 3.5±0.4 0.4±0.11)3.5±0.5 1.9±0.4 3.7±0.3 0 3.7±0.3 1.0±0.5

Table 2. Comparison of therapeutic effects between the two groups (case)

4 Discussion

It is believed in modern medicine that herpes zoster is a skin condition caused by varicella-zoster virus (VZV). After the primary infection of this virus in the human body, chicken pox or latent infection was present. After the virus enters the sensory nerve endings of the skin, it can hide for long time, and when the cellular immune functions of the human body subside, the virus can be excited and activated, to cause inflammation or necrosis of the involved nerve segments, leading to neuralgia. At the same time, the virus reaches the skin along the sensory nerve pathways to induce the specific segmental herpes. Therapeutically, the anti-virus and anti-infectious treatment is often given to prevent infection and shorten the duration and relieve the symptoms. But, the defects of high medical cost and certain adverse reaction exist.

It is believed in TCM that this disease is mostly caused by accumulation of fire in the Liver Meridian or accumulation of damp and heat in the Spleen Meridian, and additional infection of pathogenic fire and heat and seasonal pathogenic dampness, and then the liver fire is induced to steam and infiltrate the muscle, skin and meridians by warm and heating pathogens, resulting in herpes. When the meridians are blocked by pathogenic dampness and heat, pain would appear due to obstruction, gradually leading to severe pain. Jiaji (EX-B 2) points are situated between the Governor Vessel, and can be used to regulate yang qi of the Governor Vessel and Meridian of Foot Taiyang and even the whole body, so as to get rid of obstruction and assist the anti-pathogenic ability for realizing the goals to dredge and regulate Zang-fu organs and meridians. It has been proved by modern anatomy[1]that there is distribution of the posterior branch of spinal nerve, sympathetic trunk in the deep layer, and paravertebralganglia of the sympathetic nerve and distribution of gray and white communicating branch in association with the spinal nerve. To puncture Jiaji (EX-B 2) points situated in the corresponding nerve segments of herpes can stimulate the above structures and surrounding tissues. Perhaps on one hand, the conduction of pain fibers in the nerves is blocked and at the same time acupuncture can enhance the pain threshold of the organism and intensify the tolerance to pain. On another hand, the propagation of the needling sensation caused by stimulating Jiaji (EX-B 2) points can influence by the regulatory effects of the nerves and humour the endings of the sympathetic nerve to release chemical medium, so as to realize the analgesic effect[2-4]. It has been indicated by large number of clinical studies that electroacupuncture has better analgesic effect. Also, it is reported in the literature that electroacupuncture can regulate and intensify the immune functions of the body, inhibit inflammatory exudation, enhance pain threshold, reduce pain reaction and produce better analgesic effect[5-6].

The bleeding tapping technique on the local area by plum-blossom needle can dredge the meridians and dissipate the pathogens, in combination of electroacupuncture at Jiaji (EX-B 2) points, and can dredge the meridians, regulate and harmonize qi and blood. And once the meridians are not obstructed, pain would be gone[7]. At the same time, collateral-pricking technique plus cupping method can promote the excretion of stagnant blood, which is able to dredge the collaterals and stop pain and also able to expel the blood stasis for production of new blood, beneficial to healing of the skin. This is the important key to shorten the duration. Judging from the modern medical theory, the collateral-pricking and cupping method can quickly reduce and remove pressure of herpes to the surrounding nerves, so as to realize the analgesic effect[8-10].

It has been indicated by the findings of this study that electroacupuncture plus collateral-pricking and cupping method for herpes zoster is fast in stopping pain, precise in the therapeutic effect, free of adverse reaction and is worthy of clinical application.

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[3] Liu RF, Jiang YM. Exploration on acupuncture analgesic mechanism of Huatuo Jiaji points. Zhongguo Zhongyi Jichu Yixue Zazhi, 2008, 14(12): 943-944.

[4] Fang XJ. Clinical observation of acupuncture therapy for postherpetic neuralgia. J Acupunct Tuina Sci, 2011, 9(2): 113-115.

[5] Fu JL, Dong WY. Treatment of 36 cases of herpes zoster by electroacupuncture plus moxibustion. Zhongguo Zhenjiu, 2002, 22(5): 314.

[6] Qi DB, Li WM. Effect of electroacupuncture on expression of NMDA-R1 receptor in the rostral ventromedial medulla of rats with chronic visceral hyperalgesia. Shanghai Zhenjiu Zazhi, 2011, 30(7): 491-494.

[7] Song YG, Zhao JC, Yuan H. Clinical observations on the treatment of Ramsay Hunt syndrome by blood-letting puncture and cupping as main therapy. J Acupunct Tuina Sci, 2005, 3(2): 42-45.

[8] Jiao XL. Observations on the efficacy of pricking-cupping bloodletting method in treating herpes zoster. Shanghai Zhenjiu Zazhi, 2009, 28(10): 587-588.

[9] Zhou Y. Observation on therapeutic effects of combined surrounding needling, bloodletting with cupping therapy for localized scleroderma. J Acupunct Tuina Sci, 2011, 9(3): 154-155.

[10] Zhao T, Wang YH. Systematic assessment of randomized controlled trials of acupuncture-moxibustion treatment of herpes zoster. Shanghai Zhenjiu Zazhi, 2007, 26(6): 30-33.

Translator: Huang Guo-qi

R246.7

A

Date: May 18, 2013

Author: Liu yin-ni, M.M., physician.

E-mail: zjtnyx@126.com