Herpes zoster, commonly known as "snake around the waist", "dragon around the waist", "snakebite", etc., is a infectious diseases that affects nerves and skin. Viral infections are more common in older, immunocompromised, or immunocompromised populations, and often progress to neuropathic pain. Continuous pain can seriously affect the patient's quality of life. Even after the skin symptoms have healed, some patients may still experience pain for several months to years. What is herpes zoster? Our human body is at risk of multiple microbial invasions, and shingles is induced by the varicella zoster virus. Chickenpox shingles virus does not immediately appear as a "coiled waisted dragon" when it enters the body. When infected with the virus for the first time, it will manifest as the well-known chickenpox. After recovering from chickenpox, the virus is not cleared, but instead lurks in the dorsal root ganglia of our spinal cord. When our resistance decreases and our immune system is weakened, the virus will be reactivated, which manifests as shingles. Why do we get herpes zoster from the perspective of traditional Chinese medicine syndrome differentiation? The herpes zoster recorded in traditional Chinese medicine can be traced back to the Yuan Dynasty, when it was recorded based on some clinical symptoms. Due to its bead like blisters that are prone to occur in the lower back, it is called "Entangled Waist Dragon", "Snake Disk Ulcer", "Entangled Waist Fire Pill", etc. From the perspective of traditional Chinese medicine, herpes zoster is caused by long-term emotional suppression, internal heat generation and fire burning in the organs, as well as the influence of external factors. The combination of internal and external factors leads to the occurrence of the disease, which belongs to the seven emotions of traditional Chinese medicine. The relationship between chickenpox and shingles. Both chickenpox and shingles originate from the same virus, which is the varicella zoster virus. When the human body first comes into contact with it, it manifests as chickenpox. However, some patients who did not get chickenpox as children still suffer from shingles because they were infected with the varicella zoster virus as a latent infection without symptoms, mistakenly thinking that they were not infected with this virus. Clinical data shows that approximately 99.5% of adults aged 50 and above exhibit serological evidence of varicella zoster virus infection. Therefore, as long as infected with this virus, regardless of whether chickenpox is present or not, it is possible to be activated and develop shingles. How to distinguish herpes zoster from other skin diseases? Although eczema, contact dermatitis, and herpes zoster rash have similar symptoms, experienced dermatologists can distinguish them by diagnosis. Of course, some examinations can also be used to assist in identification, such as breaking blisters and compressing them to observe cell morphology. But now this method is rarely used, mainly relying on clinical experience for diagnosis. If there is a rash on one side accompanied by pain, the possibility of herpes zoster is extremely high. There is a type of herpes zoster called disseminated herpes zoster, which has a scattered distribution similar to chickenpox. Disseminated shingles requires a full body examination to identify any rash with a distribution pattern similar to that of shingles, in order to distinguish it from chickenpox. So, if blisters appear, seek timely medical attention and receive targeted treatment at the clinic. From the perspective of traditional Chinese medicine, why do the symptoms of herpes zoster vary? Herpes zoster is a manifestation of liver qi stagnation and stagnation that occurs after prolonged emotional suppression, and there are individual differences as well. Some people have severe internal heat, and the main symptoms of infection are damp heat in the liver and gallbladder, such as bitter mouth, irritable temperament, tendency to get angry, dry stool, etc. The pain is severe, and the herpes is bright red. There is also a type of patient who has a relatively weak constitution. After being infected with herpes zoster, they are prone to symptoms of spleen deficiency, which is oriented towards qi deficiency. This type of patient shows symptoms such as fatigue, fatigue, and poor appetite, and the color of the herpes tends to be light white. In traditional Chinese medicine, herpes zoster is a disease closely related to emotions. In the process of regulation and diagnosis, individualized treatment will be carried out based on the individual's condition. What are the types of herpes zoster? The best place to wrap the "waist wrapped dragon" is around the waist, usually half a circle around the waist. But shingles can spread throughout the body, and some people may develop it in the chest, back, or even in the limbs, such as hands and feet. Herpes zoster that grows on the head and face, such as ocular herpes zoster, can easily involve the ocular branch of the trigeminal nerve. Therefore, some herpes zoster can induce trigeminal neuralgia, affecting the cornea, and in severe cases, corneal herpes may even lead to blindness. Ear herpes zoster can cause blisters in the ear canal, causing pain and even hearing loss and tinnitus. In addition, there are also some patients who only show pain without rash. This type of diagnosis is very difficult and requires clinical experts to differentiate and diagnose. How to treat herpes zoster? Early detection, early treatment! The best time for treating herpes zoster is within 72 hours of discovering the rash, during which the use of antiviral drugs also has a good preventive effect on possible postoperative neuralgia. Antiviral drugs are generally metabolized through the kidneys, so patients with renal insufficiency or abnormal creatinine clearance should use them according to the instructions. The recommended dosage is 7-10 days, and it is not recommended to exceed 2 weeks. Secondly, there are nutritional and neurological drugs commonly used in clinical practice, such as vitamin B1 and methylcobalamin. In addition, it is the use of analgesic drugs. If you are unwilling to take Western medicine, or if there are contraindications to taking Western medicine, choosing oral Chinese medicine can also have good antiviral effects. How does traditional Chinese medicine treat herpes zoster? Acupuncture and moxibustion and moxibustion in traditional Chinese medicine is a characteristic treatment for herpes zoster, and acupuncture and moxibustion and moxibustion have a good effect on painful diseases. The treatment is staged, and the treatment methods are not the same in the acute phase, recovery phase, and sequelae phase. During the acute phase, using the method of bloodletting to release local blood can quickly alleviate local inflammatory reactions. But treatment requires a process, and after two or three days of basic bloodletting, the color of the skin lesions darkens, and then turns black and scabs. During the recovery period, if neuralgia occurs, electroacupuncture will be used to relieve pain. In the sequelae period, the mechanism of neuropathic pain is not the same as in the early stage. Patients generally suffer from deficiency of positive qi, so they need to drink herbal medicine and use the method of warming and promoting circulation with fire needles to relieve pain. It should be noted that during early blood letting, diabetes patients must control their blood sugar. Never try blood letting at home. It is easy to cause infection. They should go to a regular medical institution for treatment. Who is prone to postherpetic neuralgia? Herpes zoster has two main manifestations, the first being skin herpes and the second being neuralgia. The manifestation of the skin is various internal inflammatory reactions and inflammatory edema, including infiltration of lymphocytes and plasma cells. Pathological sections of clinical nerves show that after suffering from herpes zoster, the nerves are damaged by the virus, with infiltration of lymphocytes and plasma cells, as well as demyelination of the nerves, which can cause pain. But not everyone has pain, it has a certain proportion, and age is a particularly important independent risk factor. The older one gets, the higher the probability of developing postherpetic neuralgia. What are the manifestations of postherpetic neuralgia? There are various forms of pain in herpes zoster, including burning, electric shock, knife cutting, needle piercing, or tearing, and multiple types of pain may coexist. Mainly characterized by paroxysmal pain, some people also experience significant persistent pain. Pain grading is expressed on a scale of 0 to 10, with 0 indicating no pain, affecting the patient's sleep classified as moderate or above pain, and 10 indicating extremely severe pain. There are individual differences in herpes zoster neuralgia, ranging from mild to severe, mostly moderate and severe, with a few mild cases. However, severe pain can also occur up to level 10, which is more severe than the intense pain caused by childbirth in women. The severity of the pain is evident. How does anesthesia and pain management treat postherpetic neuralgia? The anesthesia and pain department has full process management for herpes zoster. Patients need to take oral medication (anti-inflammatory drugs, analgesics), undergo nerve block and pulsed radiofrequency, and complete it within three months to achieve the best treatment effect. Pulse radiofrequency mostly involves puncturing the dorsal root ganglion with a radiofrequency needle, while other areas such as the trigeminal nerve require puncturing the semilunar ganglion. After the puncture is in place, the local temperature is heated to 42-44 degrees Celsius. In this case, the C-fibers responsible for pain sensation in the damaged nerves will become inactive, leading to a decrease in the ability to transmit pain sensation. Neural block is also a common method in outpatient clinics. Patients with severe pain receive paraspinal block injections, which are locally administered to clear inflammatory substances and reduce pain levels. And the earlier the treatment, the better the effect, reducing nerve damage and decreasing the probability of residual neuropathic pain. Who needs to receive nerve block injections to treat neuralgia? Generally, it is the elderly who need injections. Young people around 40 years old who have blisters can take oral medication to solve the skin lesions. Young people with blisters are usually caused by fatigue, staying up late, and working overtime. They usually recover in about three weeks and 99.99% will not have residual neuralgia, so there is no need to receive nerve block injections for treatment. However, patients with poor immunity, old age, combined with some chronic diseases such as coronary heart disease, hypertension, diabetes, combined with immune system diseases such as lupus erythematosus, immune nephropathy, and oral immunosuppressants, who have undergone liver and kidney transplantation, need to intervene in a timely manner, and use nerve block to reduce the ability of disease toxin to damage the nerves, so as to avoid the generation of sequela neuralgia. Can I get shingles without taking painkillers? The treatment of herpes zoster cannot resist analgesics. Proper analgesia during the early stages of treatment has a protective effect on the body. Meanwhile, a dual approach of anti-inflammatory and anti infective measures can prevent further damage to the nerves. So analgesic drugs are very important. Currently, the addiction of analgesics used in clinical practice is very low, so there is no need to worry about the problem of analgesic drug addiction. Will shingles recur after getting it? The consensus of Chinese experts in the diagnosis and treatment of herpes zoster (2022 edition) points out that the recurrence rate of herpes zoster in the global general population is 1% -10%, and the recurrence rate gradually increases with age after the age of 50. Because the virus cannot be eliminated, herpes zoster will occur as long as the immune system drops below the threshold. It is recommended that patients with a history of shingles receive timely shingles vaccine according to their own situation to prevent recurrence. Can I still get shingles after getting vaccinated against chickenpox? How to prevent shingles? There is no necessary relationship between having received the varicella vaccine and having shingles. Even if vaccinated against chickenpox, one may still develop shingles. The pathogenesis of chickenpox and shingles is different. The manifestation of childhood infection with varicella zoster virus is chickenpox. The varicella vaccine we use for prevention is a live attenuated vaccine that, when injected into the body, triggers the production of antibodies in the body, forming humoral immunity to prevent virus invasion. The pathogenesis of herpes zoster is that the varicella zoster virus has already latent in the ganglia, leading to immune decline and reactivation. Therefore, in addition to enhancing autoimmunity, the most cost-effective way is to receive recombinant herpes zoster vaccine, which can stimulate specific cellular immunity and prevent the onset of herpes zoster. It is recommended that elderly people aged 50 and above receive timely vaccination against shingles to prevent its occurrence. Who is suitable for receiving the herpes zoster vaccine? The recombinant herpes zoster vaccine can be used for individuals aged 50 years or older, regardless of whether they have previously received the varicella vaccine, and there is no need to screen for a history of varicella. The herpes zoster vaccine has no effect on patients with common underlying diseases (including coronary artery disease, diabetes, asthma, chronic obstructive pulmonary disease, depression or chronic kidney disease), and the protective effect is consistent with that of the general population. The following groups of people need attention: those with a history of severe allergic reactions to any component of the vaccine or those who have received the vaccine in the past