How do I treat recurring pain from shingles?

Q: I am 75 years old. Early last year, I developed shingles. This appeared as blisters around the left side of my waist from the navel to the spinal cord.

The burning, pinching and scratching sensation was extremely painful.

Within three months, the blisters disappeared, leaving black and white spots around the waist, but with most of the skin around the area now back to normal.

Of late, I have been experiencing a terrible burning and pinching sensation, resulting in a lot of pain again.

I have been applying home-made ayurvedic (traditional Indian medicine) lotion, which gave me some relief for about two months.

But the pain has since returned. It comes in bouts at regular frequency.

This has constrained my normal day-to-day activities.

Please advise me on how to reduce the pain.

A: In traditional Chinese medicine (TCM), shingles and the subsequent pain, called post-herpetic neuralgia, are probably due to a deficiency in the functions of the stomach, spleen and liver.

The liver is responsible for the flow of qi (energy) in the body. Good circulation of qi and blood are required for good health.

When the liver is weak - due to ageing, mood swings, excessive alcohol, depression and anxiety - qi in the liver will stagnate.

When it has stagnated for a prolonged period, it will create "heat", "fire" and toxins.

These will circulate to the liver meridian (channel for qi) and gall bladder meridian, and trigger shingles with red blisters along both meridians, which pass through the face, eyes, chest and side of the waist and ribs.

They will be accompanied by a burning sensation, heat and pain, together with bitterness in the mouth, dryness in the throat, yellowish urine and dry stool.

The stomach receives and digests food. The spleen absorbs the nutrients and converts them into qi and blood.

When the stomach and spleen are weak - due to ageing, poor diet, weak constitution, overexertion and chronic illnesses - the nutrients will be converted into phlegm and "dampness" instead.

When accumulated in the body for a prolonged period, phlegm and "dampness" will create "heat" and "fire".

All four pathogenic (disease-causing) factors will follow the stomach meridian and spleen meridian and trigger shingles in the abdominal area and legs.

The blisters are watery and easily broken. They are less painful than those caused by liver "fire".

Other symptoms include thirst with an inability to drink much water, poor appetite, and a bloated stomach with loose stool.

When the blisters begin to dry and scab, if the patient is weak - due to ageing, weak constitution and chronic illnesses - it will create blood stasis. This will trigger persistent and stabbing pain in the affected area with irritability, fatigue and sleep disorders.

Chinese herbal medicine, acupuncture, moxibustion and cupping therapy can help to improve your condition by strengthening your organs and dispelling the pathogenic factors.

Moxibustion involves burning a small herb above acupuncture points to help healing.

Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.

Chinese medicine, such as Chinese gentian, Chinese thorowax root, baical skullcap root, cape jasmine fruit, weeping forsythia capsule, dyers woad leaf and purslane herb strengthen the liver and dispel "heat", "fire" and toxins in the organ.

Atractylodes rhizome, largehead atractylodes rhizome, oriental waterplantain rhizome, officinal magnolia bark, dried tangerine peel, Indian bread, polyporus umbellatus and coix seed strengthen the stomach and spleen to dispel the "dampness".

Rhizoma corydalis, turmeric root-tuber, white peony root, liquorice root, paniculate swallowwort root, panax notoginseng, safflower and Sichuan chinaberry fruit strengthen the liver and spleen, and enhance qi and blood circulation.

In the elderly, heterophylly falsestarwort root and milkvetch root increase qi, while Chinese angelica and suberect spatholobus stem enhance blood circulation.

You should take easily digestible food, such as porridge, and more vegetables and fruits.

Abstain from spicy and oily food, prawns, crabs, alcohol and smoking. Avoid intense emotions such as anger, anxiety and sadness.

Sleep early and do light exercise regularly, such as taiji and brisk walking, to enhance your qi and blood circulation and reduce the pain.

Ms Lim Lay Beng,
traditional Chinese medicine practitioner at YS Healthcare TCM Clinic

Doctor says: No cure for shingles

A: You appear to be suffering from pain after an attack of herpes zoster (commonly known as shingles), which is known medically as post-herpetic neuralgia.

A person needs to have had chickenpox before, to have herpes zoster later in life.

Both conditions are caused by a virus called varicella zoster, which belongs to the herpes family of viruses.

Generally, once people have contracted the virus, they are infected for life.

After causing chickenpox, the virus hides deep in the nerves of the person where it is shielded from the immune system.

During old age or when the immunity towards the virus wanes, the virus can reactivate and infect the skin from the nerves, causing the skin rashes that typify herpes zoster.

Some people naturally have less immunity towards the virus than others.

A new zoster vaccine known as Zostavax, which has been introduced in Singapore, can prevent one from getting herpes zoster, but it is not cheap. It is recommended only for people older than 50 years of age.

Nonetheless, even with the vaccine, it is not definite that a person would not get an attack of herpes zoster in his lifetime.

There is no cure for herpes zoster, but it can be treated to ease the symptoms.

Antiviral therapy, such as acyclovir, should be taken. The sooner the medication is taken, the better the results are.

Nerve damage can occur during an attack of herpes zoster. This can result in pain, itch and/or tingling sensations and these persist after the skin has healed.

This is probably what happened in your case.

In view of the significant amount of pain interfering with your daily activities, I would suggest that you take oral medication to alleviate the pain.

I would usually start with the drugs gabapentin or pregabalin. They calm the nerves and thereby reduce pain and itch gradually after the attack. They are to be taken continually to achieve this effect, unlike painkillers, such as paracetamol, which are taken as and when they are required to relieve pain.

In addition, you can apply topical medication to the painful area, such as topical lidocaine gel, which will temporarily numb the pain.

If these measures fail, you may need to take other types of painkillers.

Please see your family doctor for further advice.

Dr Tey Hong Liang,
consultant at the National Skin Centre


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