I am currently recovering from an outbreak of shingles. As you learned in my previous post, shingles is the common name for the condition that results from a reactivation of the varicella-zoster virus. Ten days ago, the virus that had been lying dormant in my left 5th cranial nerve since I contracted chicken pox at age 8, became active again. Have I really been that stressed? I didn’t think so, but apparently my immune system was taxed enough to let its guard down against the herpes zoster army that subsequently attacked my ophthalmic nerve.
For about a week prior to the rash developing, I had been feeling some tenderness on the left side of the top of my scalp (along the Bladder channel, for those of you who are acupuncturists or are familiar with the pathways of Qi flow). But I often get some tenderness there so I really didn’t pay much attention to it. Then one morning a tiny bump appeared just above the inner corner of my left eyebrow. It looked like a zit that wasn’t quite ready to pop. I gave it a little squeeze (why, oh why, did I think that was a good idea??) and it really hurt. I thought perhaps it was a spider bite. Then a few hours later I felt a mild prickly sensation in the middle of my eyebrow. Crap. This is shingles, isn’t it? Well, perhaps not. But within the next few hours, the prickly sensation had increased in intensity and I began experiencing other neuralgias: disproportionate tenderness of my left eyebrow, sharp pains deep to the little bump (which was also growing in size), the sensation of snowflakes softly landing on my upper eyelid (that would have seemed pretty cool if it wasn’t a sign of nerve problems). Son of a bitch, I have shingles! I started taking internal antiviral herbs immediately. I started myself on Plum Flower brand Yin Chiao Chieh Tu Pien (6 tabs every hour) and Zhong Gan Ling (also 6 tabs every hour) for the rest of that first day because it was the weekend and that is what I had on hand at home.
More eruptions began to appear on Day 2 and the original lesion grew larger in size and began to fill with purulent fluid. My eyebrow and the skin on my scalp and forehead became increasingly more tender to the slightest touch and the pains coming from in my head grew more intense, more frequent and affected a larger area. I continued taking the Zhong Gan Ling (8 tabs every 2 hours) plus Yin Chiao (6 tabs every 2 hours) and I applied an herbal compress to the lesions on my forehead twice that day. I soaked gauze in a decoction of Ban Lan Gen, Ma Chi Xian, Huang Qin, and Pu Gong Ying, wrung it out just a bit and stuck it to the lesions on my forehead (it just stayed there as it dried). I occasionally added more herbal liquid to the gauze with a dropper.
By Day 3, the pain had gotten pretty damn intense from my upper eyelid throughout the rest of the dermatome. It was not constant, though. I also developed lymphadenopathy of the lymph nodes on the left side of my neck – it hurt like hell to turn my head because it stretched the tender and swollen nodes. I switched my herbal prescription to Zhong Gan Ling (still 8 tabs every 2 hours) plus Plum Flower brand Long Dan Xie Gan Wan (8 pills every 2 hours) since more of the Gallbladder Channel was becoming affected. I feared for the health of my eyes, though no eruptions were yet appearing on my nose (thank goodness!). But it was only Day 3; I was aware that new lesions could continue to erupt for the first week plus the sharp shooting pains through my skull were getting worse which meant the condition was not slowing down despite my herbal efforts. Time to do acupuncture. I had needled myself plenty of times in the past. Though it was never comfortable to needle my own face or eyes, I could tolerate it. But this time, when I placed the needle into tender Yu Yao (center of my eyebrow) I almost passed out from the pain. My nerves were so raw and inflamed. I cried in response to placing 3 of the needles. But within about 30 seconds, 90% of the intense sharp shooting pains were gone. THIRTY SECONDS! I was absolutely amazed and it was absolutely worth the discomfort of performing acupuncture on myself.
Although the acupuncture treatment took so much pain away, it returned overnight, though not as intense as the day before. The condition was still progressing despite my best efforts. I have seen enough cases of shingles to speculate that my case would have progressed just the same even if I had opted to take pharmaceutical antivirals. But I needed to be more aggressive in my treatment. I had my boyfriend do indirect moxa (using a smokeless moxa pole) in addition to my own acupuncture treatment (surrounding the dragon on the lesions with needles pointing inward; ah shi points on my scalp and forehead for pain; and then LIV2, St44, GB44 or 43, LI 11, LI4, and TW2 to Clear Heat and Move Qi in the affected channels). I think perhaps smokey moxa would have been more effective, but I didn’t think of it at the time. I was very tired and my thinking was becoming a bit foggy. I cancelled the rest of my work week. I needed to heal and I couldn’t see patients in this condition.
On Day 5 I encountered a complication – I developed an acute allergic reaction to a heavy-duty cleanser I had used the day before at the office without gloves (stupid stupid stupid!). I woke with symmetrical dermatitis on my hands that spread to my neck, groin and feet – bright red papules on an erythematous base that were intensely itchy. Insane itching coupled with the now debilitating paroxysmal shooting pains through my skull and the painfully tender eruptions on my forehead made me miserable. I took Benadryl to get the allergic reaction under control (it stopped it in its tracks but I think it consequently retarded my body’s ability to heal the shingles). At this time I also developed facial edema around both eyes (this is common for ophthalmic zoster). I had a colleague treat me with acupuncture and I also saw a specialist who did lymphatic drainage therapy to help with the lymphedema. I switched to granule herbs:Ban Lan Gen 15g (Clear Heat, Resolve toxins, antiviral against Herpes zoster) Da Qing Ye 9 (Clear Heat, Resolve Toxins, antiviral) Huang Qin 9 (for the eruptions) Jin Yin Hua 12 (for the eruptions and dermatitis) Lian Qiao 12 (for the eruptions and dermatitis) Ma Chi Xian 12 (Clear Heat, Resolve Toxins, antiviral) Chi Shao 9 (to Move Blood and help with the lymphadenopathy) Yi Yi Ren 18 (for the facial edema) Di Fu Zi 12 (for the facial edema and itching)
I have been taking 18 grams per day (6 g TID) of this formula and still am because it is helping significantly. By Day 6, the eruptions began crusting over and getting quite itchy. I did Plum Blossom (seven star needling) on my scalp to improve blood flow to reduce itching. I kept the ones on my forehead covered with gauze to prevent myself from scratching in my sleep. I think they would have healed faster if they had been exposed to full air the entire time, but they looked gross and so I kept them covered until they fully crusted over. Three rogue lesions appeared on my back but they were small, itched only mildly and had no associated nerve pain. This is not considered disseminated shingles (20 or more lesions outside of the affected dermatome is considered disseminated). On Day 6 I had a freak-out. I felt so uncomfortable and irritable. I lost all patience and my nerves were completely on edge (literally and figuratively). I screamed and cried for about 5 minutes when my printer refused to scan an important document and I couldn’t figure out how to fix the problem. That’s when I gave up – not on my treatment, but on the idea that I could get any work done while I had this condition. I gave myself acupuncture, took my herbs, and went to bed for 3 days. I should have done that sooner.
No new lesions appeared after Day 7 and the pain was 90% gone (and stayed gone), but I still itched a lot. On Day 8 I still had facial edema so I slept semi-upright in a lounge chair – the herbs cleared much of the edema and remaining upright when I slept prevented it from re-accumulating overnight. Today is Day 10. My skin is still a bit tender to the touch where the lesions are, though they are mostly all scabbed over and healing. The ones on my scalp are healing the fastest, though they are still quite itchy. I get only an occasional twinge of pain and it is very superficial (nothing shooting through my skull). The lymph nodes at the anterior left and posterior left aspect of my neck are half the size they were a few days ago and significantly less tender. I am continuing to take my granule formula (18g per day) and give myself acupuncture daily. My eye was never affected (thank goodness!) but I will see the ophthalmologist to be sure there is no intraocular pressure building or other symptoms I can’t feel.
In about a week, once all the eruptions have healed further and the neuralgia is (hopefully) 100% resolved, I will alter my herbal formula to better addresses my underlying Spleen Qi Xu and Liver Blood Xu and will include herbs to Move Blood (to prevent scarring). Although my account of my experience with shingles sounds rather awful, it really has resolved relatively quickly. However, I made 2 significant mistakes in the diagnosis and treatment of my own shingles: I misdiagnosed my case as Fire in the Liver and Gallbladder Channels (as opposed to Damp Heat in the Spleen; both discussed in the next post) and I underestimated the potential severity of my case. I assessed my patient (myself) based solely on my assumption that I was currently a healthy 39-year-old with a strong constitution, but I neglected 2 very important pieces of information in my patient’s history. Firstly, when I had chicken pox as a kid, it was a very severe case. It was spread over my entire body, including my eyeballs. Does this set me up for a more severe case of shingles? I am not sure, but I should have considered it. Secondly, my face seems to react quite extremely to any acute skin issues I have. When I had chicken pox, my face swelled. When I got poison ivy at age 12, my face swelled and stayed swollen for over a week. When a bee stung my finger, my face swelled even though I am not actually allergic to bees. And when I got a rash around my mouth from allergic contact dermatitis, my eyes also got an itchy rash around them when it was at its worst. I should have taken this info into consideration at the onset of my shingles – perhaps I would have been more aggressive with my herbal treatment and maybe started acupuncture a day or 2 sooner. Maybe it would have made no difference in the course of the illness, but I should not have overlooked it.
We will look at how to assess and treat shingles (not just my case) in the next post - Shingles Part II: TCM Differentiation and Treatment.