Chinese Medicine Differential Diagnosis of Herpes and Zoster

This is a page for Chinese medicine professionals who are interested in the traditional disease diagnosis and differentiation of herpes simplex and herpes zoster (shingles). If you are a patient, and would like to know more about the way I use acupuncture and herbal medicine to treat herpes and shingles, please visit the Zoster and Herpes Simplex page.

Herpes Simplex, or Re Chuang

Herpes simplex is a viral infection caused by HSV type I or II. Herpes is further classified by location, being oral or ano-genital herpes. Herpes presents as single or multiple fluid-blisters, known as vesicles, appearing on the mucous membranes. Preceding the appearance of sores, a herpes outbreak presents with tingling or itching, which is known as the prodromal phase. Blisters may be in clusters, and clusters may join together to form one large blister. After a few days, vesicles will dry out and form a crust. If lesions recur in the same place repeatedly, scarring is likely. Outbreaks may be triggered by emotional upset, diet, fever, overexposure to sunlight or even certain drugs.Acupuncture and Chinese medicine has identified 4 main patterns for herpes:

  1. Wind-Heat attacking the Upper Jiao – In this presentation, lesions will appear on the head and face, concentrating around the orifices. Other symptoms will include dry mouth, restlessness, and constipation/dry stool. The guiding herb formula is Xin Yi Qing Fei Yin. Acupuncture will focus on chasing Wind and clearing Heat and Toxicity.
  2. Damp-Heat lodged in the Lower Jiao – This pattern presents with lesions on the genitals. Other symptoms may include bloody urine and constipation/dry stool. The guiding herbal formula is Long Dan Xie Gan Tang. Acupuncture treatment will focusing on removing Dampness and clearing Heat and Toxicity.
  3. Heat smoldering in the Spleen and Stomach – This pattern describes a recurrent type of herpes on the face, especially the around the mouth and on the cheeks. Other symptoms will include loss of appetite, constipation/dry stool, and red lips. The guiding herbal formula is Zhu Ye Shi Gao Tang or Fang Feng Tong Sheng San. Acupuncture treatment will focus on clearing Heat from Spleen and Stomach and resolving toxicity.
  4. Deficiency Heat – In this pattern, there are recurrent lesions accompanied by dry mouth, throat and lips, and thirst with desire to drink cold beverages. The guiding herb formula is Zhi Bai Di Huang Wan. Acupuncture treatments will focus on nourishing Yin and clearing deficiency Heat. When Qi is deficient concurrently, look to Ren Shen Gu Ben Wan.

External herbal washes are also useful, as are sitz bathes. Ma Chi Xian Shui Xi Ji is an appropriate wash.

Herpes Zoster / Shingles, or She Chuan Chuang

Herpes zoster, or shingles, is a painful viral infection affecting the nerves responsible for sensation in the skin. Outbreaks occur along strips from the spine to the front of the body known as dermatomes. The eruptions are vesicular and often appear in a reddened area and have a reddened border. The fluid inside the vesicle is commonly clear turning to cloudy after a few days. Prior to outbreak (prodromal period) it is common to feel fatigued with fever and chills. Digestive disturbances are also common. After vesicles crust over and heal, it is common to continue to have pain, called post-herpetic neuralgia or post-zoster pain.

Chinese medicine and acupuncture can help to reduce the severity of outbreaks of shingles and stop pain. Acupuncture effectively treats post-herpetic neuralgia, too.1

There are 3 patterns of shingles in acupuncture and Chinese medical theory:

  1. Blazing Fire in the Liver Channel – This pattern presents with bright red, tight-skinned vesicles. The pain has a burning quality that feels like pin prickles. Other symptoms include bitter taste in the mouth, dry mouth/throat, thirst for cold drinks, restlessness, irritability/anger, and constipation/dry stool. The guiding herb formulas are Long Dan Xie Gan Tang and Da Qing Lian Qiao Tang. Acupuncture treatments will focus on clearing Heat toxicity and draining Fire.
  2. Damp-Heat in the Spleen Channel – In this pattern, vesicles will be large and filled with a clear yellow-ish fluid. Vesicles are thin-walled and are easy to break open. There may be pus formation. Other symptoms include poor appetite, loose stools, and bloating. The guiding herbal formula is Chu Shi Wei Ling Tang and Yi Ren Chi Dou Tang. Acupuncture treatments will focus on venting heat from the spleen and resolving toxicity and Dampness.
  3. Qi and Blood stagnation- This is a pattern of post-herpetic neuralgia, when the Qi and Blood are weakened by illness or old age and so cannot move easily. Lesions will be partially erupted and pain will be severe pin-point pricks. Movement will make the pain worse. Other symptoms may include loss of appetite, disturbed sleep, and restlessness. The guiding herbal formulas are Jin Ling Zi San and Xiao Yao San. Acupuncture treatments will move and harmonize Qi and Blood, course Jueyin and stop pain.

Topical herb applications may include Huang Lian Gao and tincture of licorice, a common Western herbalism treatment.

To read about the follow-up treatment of herpes and zoster, please visit the Post-herpetic Neuralgia page.