Acupuncture in the treatment of herpes and postherpetic neuralgia: A Bibliography

Phil Rogers MVB MRCVS
1, Esker Lawns, Lucan, Dublin, Ireland
e-mail :

Acupuncture Progress output 50 abstracts on May 29 1999 that dealt with herpes. The abstracts, edited slightly to standardise the terminology and point names, are listed alphabetically below. Those with practical details of therapy were summarised.

This bibliography has five elements:

1. Summary of all treatments used in Herpes

2. Summary of the AP- and related- methods in Herpes

3. Summary of the acupoints used in Herpes

4. Other keywords, hyperlinked to the relevant abstracts

5. Edited abstracts, sorted alphabetically

Within the following text, references asterisked (*) have the relevant keyword, or its concept, in the title of the paper.


1. A large body of evidence suggests AP-type therapy to be of great benefit in treating acute or early cases of herpes, especially in the first dew days when the lesions are present.

2. AP-type therapy, as the sole treatment of chronic cases, has not been adequately shown to be of benefit. It may have a role if combined with amitriptyline, topical capsaicin and TENS.

1. Summary of all treatments used in Herpes

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The varicella-zoster virus (2) can infect the skin, mucosa and nerves, initially causing pain, vesicles, scabs and scars (early herpes), and later, postherpetic problems (pain, or rarely paralysis).

In contrast to early cases of herpes, with vesicles or lesions present, postherpetic neuralgia is a very difficult problem to resolve. Chronic cases (>6 months), especially in aged or immuno-compromised people (HIV / AIDS) are especially difficult (2, 8, 16, 17, 29, 30, 31*, 34). The earlier one begins effective therapy, the better is the outcome, and the less likely the case will progress to postherpetic neuralgia or paralysis (2, 5, 8, 35).

Volmink et al (1996) did a systematic review of existing randomized controlled trials. Based on published evidence from those trials, they concluded that tricyclic anti-depressants are the only agents of proven benefit for established postherpetic neuralgia, although topical capsaicin also seemed to help (39). In an earlier study, Carmichael (1991) concluded that the best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and TENS (2). Section 2 will discuss TENS with acupuncture (AP) and related methods.

Other useful therapies were epidural spinal cord stimulation (1*), or anaesthetic blocks of affected nerves (13*, 16), ophthalmic, supraorbital (45), sympathetic nerves (15), Gasserian ganglion (45*) or Stellate ganglion (15*). Tranquilizers (22), carbamazepine (22, 45) and imipramine (45) were said to he useful also.

Acyclovir (2, 39), lorazepam (39), and topical benzydamine (39) had no significant analgesic effect in postherpetic neuralgia. Though acyclovir may speed up the resolution of early cases, it does not prevent recurrence (19). Steroids have questionable efficacy in prevention of recurrence (2) but hydrocortisone (22) and prednisolone (22, 45*) have been tried. Other treatments tried were antihistamine, Bonaphthon, calcium drugs, diuretics, essential oils and vitamin B1 (22) and vitamin E (41). Vincristine iontophoresis had no effect (39).


2. Summary of the AP- and related- methods in Herpes

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TCM makes no differential diagnosis of various skin diseases. They are usually grouped into two large categories: Xuen (dermatitides) and Chuan (ulcerations). They are said to be caused by Wind-qi and Damp-qi pathogens or excessive Heat in the Blood. Wind and Damp pathogens cause itchiness while excessive Blood Heat cause red skin rash. The general principle of AP treatment involves a dispersion of Wind and Damp pathogens and a reduction of the Blood Heat (20).

Most of the abstracts below claim great, or some benefit from AP, or AP-related methods in early herpes, when the lesions are still present, or before the infection becomes chronic.

As mentioned in Section 1, Carmichael (1991) concluded that the best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and TENS (2). Others also found TENS to be useful (15*, 16, 45*), but Broggi et al (1) found it to be of no value.

Three studies (1, 17, 39) found AP to be of no significant value in chronic postherpetic neuralgia, and Hyodo (1988, 13*) found nerve block to be better than AP in that condition.

Very few papers claim good results for AP-type therapy in chronic herpes, or postherpetic neuralgia (25, 26, 28, 35, 38, 42), and the number of cases treated in those papers are few.

AP techniques used in early herpes, and in postherpetic neuralgia, neuritis, pain or paralysis (1, 2*, 5, 8*, 13, 16*, 17*, 25, 26, 28, 29*, 35, 38, 39*, 41, 42*, 45*) were very varied. They included simple acupuncture (AP) needling, but also:

Cupping (6)

Earpoint LU + Chinese ink + Realgar powder painted around lesion (50*)

Electro-AP (5, 30, 31, 37, 42)

Electromagnetic channel activation (46*)

Fire needling (48*)

Gentian violet painted on lesions after treatment of broken herpes (18)

Lamp irradiation (24)

Laser-AP and irradiation of the lesions (3*, 6, 11*, 12*, 14*, 22, 26*, 33*)

Moxibustion (6, 23, 24*, 31, 32*, 35)

Nerve root irradiation (33)

Paediatric massage / tuina (49*)

Plum-blossom needling (4*, 7, 24, 31)

Polyinosinic acid i/m good, but as good as AP (3*)

Pricking to bleed using a three-edged or other needle (18*, 24, 44*, 36*, 44*)

Transcutaneous electroanalgesia (28*)

Warming needle (41)

3. Summary of the acupoints used in Herpes

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Acupoints used to treat herpes infections (early cases) and postherpetic neuralgia were:

AP at parallel lines 2 cm from corresponding vertebrae (4)

Ashi, tender points (14, 23, 35, 40)

Bagua (49)

BL01 (14), BL13 (48), BL18 (48), BL19 (48), BL20 (48), BL23 (35), BL25 (35), BL26 (35), BL43 (23)

Earpoints (17, 50*, Earpoint trigeminus (27))

GB08 (42), GB20 (14, 40, 42), GB22 (40), GB34 (7, 40, 42, 48)

LI04 (3, 14, 40), LI11 (18, 40), LI15 (23), LI20 (41)

Liufu (49)

Circling the Dragon (local needling or moxa; local points around lesions) ( 4, 6, 24, 23, 31, 36, 37, 48)

LV01 (18), LV13 (40), LV14 (40)

Neijianjing outside-GB21 (23)

NZ11-Waiming (Outer Brightness) (14)

Point lateral and right of vertebra C4 (23)

Puncturing the Channels (24)

Qinwei (49)

Scalp AP (47*)

Segmental points (30)

Shangtun (35)

SI11 (23), SI18 (41)

Sihengwen (49)

SP01 (18), SP09 (40), SP10 (40)

ST04 (41), ST06 (41), ST07 (41), ST36 (3, 40), ST40 (40)

TH05 (40), TH06 (7, 40, 48), TH17 (40)

Tianying (lasering the lesion, or needling at or near, but not directly into, the lesion) (3, 4, 6, 7, 11, 14, 37*)

X_35-Huatojiaji (30, 37*, 38, 40)

Xiaochang (49)

Z_08-Qiuhou (Pupils Behind) (14)

Z_09-Taiyang, (14, 41)


4. Other keywords, hyperlinked to the relevant abstracts

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| Abdomen (50) | Above lumbar area (48) | Back lesions (28, 50) | Below lumbar area (48) | Blood stasis (24) | Body weakness (24) | Chest (15, 50) | Chest pain (32*) | Conjunctiva (14*) | Controlled randomized trials (39*) | Controlled trial (3, 17, 46) | Damp-Heat type (24) | Damp-qi (20) | Depression (35*) | Earpoint diagnosis (27*) | Face (25*, 29*, 50) | Facial paralysis (41) | Flank (35) | Head (15, 37, 42) | Herpes (20*) | Herpes genitalis (19) | Herpes simplex (19*, 27*, 44) | Herpes zoster, herpetic infection, pain (2*, 3*, 4*, 5*, 6*, 7*, 9*, 10, 11, 12, 15*, 16, 18*, 21, 22, 23*, 24*, 27*, 30*, 31*, 32, 33, 35, 36*, 37*, 38*, 40*, 41*, 42*, 43, 44, 46*, 47, 48*, 50*) | Herpetic conjunctivitis (14) | Herpetic stomatitis (49*) | Iliac spine (35) | Inguinal region (35) | Limbs (50) | Lumbar lesions (37, 50) | Meta-analysis (39) | Mock-TENS (17) | Naloxone (28*) | Neck lesions (15, 41) | Neuralgia (32) | Ophthalmic area (45) | Oral-labialis (19) | Pain (10*, 11*, 12*) | Placebo (17*, 39) | Postauricular area (41) | Qi-Xue Stasis (40) | Review (39*) | Simple AP (38) | Skin diseases (20*) | SP Xu excessive Damp Type (40) | Toxic Heat type (40) | Trigeminal neuralgia (22*, 42*, 45) | Wind-Damp type (40) | Wind-qi (20) | Xue-Heat (20)|



5. The edited abstracts, sorted alphabetically

[Top of File]

1#Broggi G, Servello D, Dones I, Carbone G (1994) Italian multicentric study on pain treatment with epidural spinal cord stimulation. Stereotact Funct Neurosurg 62(1-4):273-278. Istituto Nazionale Neurologico C. Besta, Milano, Italia. A multicentric study on the treatment of nonmalignant chronic pain with epidural spinal cord stimulation (SCS) has been carried out in 32 Italian centres devoted to pain therapy. Neurosurgical and anaesthesiology units participated in this retrospective study. 410 of the eligible patients were enrolled in the protocol: 48% were male, 52% female. All patients underwent a screening test period (average 21 d) and 74% underwent the definitive implant. The diagnosis was failed back surgery syndrome in 45%, reflex sympathetic dystrophy in 15%, phantom limb pain in 14%, postherpetic neuralgia in 8%, peripheral nerve injury in 5%, others 13%. 84% had received noninvasive unsuccessful treatment (TENS or AP). All had previous pharmacological therapy which was not always discontinued when SCS took place. Pain assessment had been done with the visual analog scale and verbal scale both subjectively and by the physician and nurses. Neuropsychological profile with minimal mental test or MMPI was obtained in 68% of the patients. These results were favourable (i.e. excellent or good; >50% reduction of pain) in 87% of the patients at the 3-mo follow-up, 75% at the 6-mo follow-up, 69% at the 1-yr follow-up, and 58% at the 2-yr follow-up. Complication rate was: dislocation of the electrocatheter 4%, technical problems 3%, infections of the system 2%. The results will be discussed in correlation with the different etiologies of the nonmalignant chronic pain syndrome.

2#Carmichael JK (1991) Treatment of herpes zoster and postherpetic neuralgia. Am Fam Physician Jul;44(1):203-210. Univ of Arizona College of Medicine, Tucson. Herpes zoster results from reactivation of latent varicella-zoster virus. It is most common in elderly patients and immunosuppressed patients, especially those with human immunodeficiency virus (HIV) infection. Zoster is often the earliest indicator of HIV infection. The acute course of herpes zoster is generally benign, but systemic complications may be fatal. Postherpetic neuralgia is the major chronic complication and is a difficult management problem. High-dose acyclovir (800 mg orally 5 times/d) has recently been approved for treatment of herpes zoster and, if started early, decreases the duration and severity of symptoms. In the prevention of postherpetic neuralgia, acyclovir does not appear to be effective, and the efficacy of steroids is questionable. The best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and TENS.

3#Chen Baozhu; Zhao Jianhua (1993) [A comparative observation on therapeutic effects of He-Ne laser and polyinosinic acid on herpes zoster]. Chin Acupunct Moxibust 13(2):59-60. 65 cases of herpes zoster were randomly divided onto the He-Ne laser group (33 cases) and polyinosinic acid group (32 cases). Type JI He-Ne laser apparatus was used to irradiate the lesions and to radiate LI04 and ST36 with photoconductive fibres once everyday in the He-Ne laser group; 2 ml of polyinosinic acid was intramuscularly injected once every other day in the other group. 63/65 cases were cured, and sequela of neuralgia remained in the other two cases of the latter group. Pain was disappeared and scars were formed respectively after 1.48 and 7.56 d of treatment with He-Ne laser therapy, and after 10.5 and 10.4 d with polyinosinic acid treatment. The differences in therapeutic effects between the two groups were noticeably significant (p<.05).

4#Chen JX; Feng SH (1984) [Treatment of herpes zoster by plum-blossom needling: A clinical observation of 110 cases]. J New Chin Med (7):29,20. 110 cases of herpes zoster were treated by plum-blossom needling, with an effective rate of 98%. The analgesic effect is more evident than other therapies. The location for needling may vary with different damaged parts. The needling manipulation included (1) general stimulation, i.e. needling along the parallel lines 2 cm lateral to the corresponding vertebrae, and (2) topical stimulation, i.e., needling around the skin lesion 1 cm distant to the margin of lesion. However, needling at the lesion is absolutely prohibited. In general, a strong stimulation is advisable, but a moderate stimulation may be applied for some cases.

5#Coghlan CJ (1992) Herpes zoster treated by AP. Cent Afr J Med Dec;38(12):466-467. 7th Avenue, Surgical Unit, Mutare. The treatment of Herpes zoster by AP is described. These were 4 patients with acute zoster and 4 with postherpetic neuralgia. In most cases EAP was effective, and this treatment should be instigated as early as possible. Since the treatment of Herpes zoster by drugs is not routinely successful and can prove expensive, AP, whose side effects are minimal, merits a trial.

6#Ding JB (1987) [Current status on AP therapy of herpes zoster]. Shaanxi JTCM (5):44-46. This article reviewed the general aspect of various reports in treating herpes zoster with AP since 1976, including AP, moxibustion, cupping, He-Ne laser local radiation, laser local radiation in acupoints, etc. The author expresses his own understandings on clinical application.

7#Du XS (1985) [AP therapy: Report of 3 cases]. Jiangsu JTCM 6(7):34-35. 1) Migraine: GB20, GB43, GB34 (the open acupoint in midnight-noon ebb-flow, with contralateral puncture) were used. The needles were retained for 90 min. Pain disappeared after 3 treatments. 2) Herpes zoster: TH06, GB34 (reducing method) were punctured on the diseased. Plum-blossom needle was also used to peck local area. Patient recovered after one-week treatments. 3) Facial spasm: First, ST02 and GB01 were punctured, and then magnetic therapy was applied. And LI04 were added bilaterally. Patient recovered after ten treatments.

8#Dung HC (1987) AP for the treatment of postherpetic neuralgia. Am J Acupunct 15(1):5-14. We had 29 cases of postherpetic neuralgia within the past 3 yr. This report reviews the results of using AP as a therapeutic method to control herpetic pain. Incidences of postherpetic neuralgia are most often encountered among elderly people. The pain is a difficult problem to manage. Patients >65 yr-old, with a duration of pain suffering >6mo, and a high degree of pain quantification, are practically hopeless in terms of obtaining relief from pain by AP therapy. Manageability of postherpetic neuralgia is only possible among younger patients with a duration of pain shorter than 6 mo, and a low degree of pain. It is concluded that AP is effective for patient with postherpetic neuralgia, but only if they are treated early in the course of the disease.

9#Erez S (1984) Research the use of AP in the treatment of herpes zoster. Br J Acupunct 7(1):6-20. We have studied the use of AP in the treatment of Herpes Zoster. The investigation is based on a group of 18 subjects of age range 55-80. The research strategy is mainly based on the so called multiple case studies. The patients received 5-20 treatments. The number of needles employed and their location varied according to the location of the symptoms and the patients general condition. The results observed 6 mo after the treatment indicate that 61 of the patients were feeling well, 11 had not responded to the treatment, 11 were showing partial improvement, and 13 were eliminated from the statistics. The influence of other factors, such as sex, medication and the presence of other diseases was also studied.

10#Fischer MV, Behr A, von Reumont J (1984) AP: a therapeutic concept in the treatment of painful conditions and functional disorders: Report on 971 cases. Acupunct Electrother Res 9(1):11-29. The results in 971 outpatients who have been treated with AP for different diseases are reported. The outcome of treatments and number of sessions are discussed in relation to the different diseases. AP treatment was regarded as successful when 1. the patients had no pain at all without medication and 2. there was a significant improvement (no long-term medication, only mild pain under unusual strain, minimal medication under such circumstances). We obtained positive results in cephalalgias, sinusitis, cervical spine syndrome, shoulder-arm syndrome, ischialgias, back pain, constipation, herpes zoster, allergic rhinitis and disturbances of peripheral blood flow. For the following ailments, in order to reduce the medication, we recommend AP despite a high rate of recurrence: Trigeminal neuralgia, colitis ulcerosa, bronchial asthma and cancer pain. Results in the treatment of mental disturbances were unsatisfactory, and in cases of tinnitus results were negative.

11#Hu GZ (1989) [Observation on curative effect of laser needle treatment in 76 cases of pain]. Acupunct Res 14((1-2)):259-260. "Laser Needle", low output laser irradiation analgesia is effective in the therapy of pain. The author used 3mW He-Ne laser irradiation directly on the AP point or on the painful area in a study of herpes zoster, trigeminal neuralgia, aphthous ulcer, and others with 93% effective and 62% cured. Laser needle has the advantage of no pain, no possibility of infection, and especially adequate to aged and children.

12#Hu GZ (1989) Treatment of pain by laser irradiation: A report of 76 cases. JTCM (ENG) 9(4):256-258. 76 cases of pain syndrome due to various etiological factors (herpes zoster, inflammation of nervi occipitalis major, trigeminal neuralgia, parotitis, osteochondritis of ribs, frozen shoulder, oral cavity ulcer, cholecystitis and cholelithiasis, ureteral calculus, sciatica) were treated by laser irradiation. All cases in this series were treated with BXS-1 model He-Ne laser therapeutic machine with a wave length of 6328 angstrom, a light spot of 2 mm in diameter, an output potential of 3 mW, a working current of 1-10 mA, an irradiation distance of about 30-50 cm from exit of laser light to the skin. Focal irradiation was combined with acupoint irradiation. For acupoint irradiation, acupoints were selected according to TCM differentiation. 1-3 acupoints were selected for each session of treatment once daily, with 10 sessions constituting a therapeutic course. It was shown that the analgesic effect was better in oral cavity ulcer and herpes zoster, but less effective in abdominal pain due to cholecystitis and cholelithiasis, the chief reason being that it was difficult for the calculi to be expelled.

13#Hyodo M (1988) [Comparison of the effect between nerve block and AP for various painful diseases]. Orient Med Pain Clin 18(2):58-63. A comparison was made between the effect of nerve block and AP to treat a variety of painful diseases. Nerve block was better in the treatment of headache (especially in its acute stage, neck pain, periarthritis of shoulder joint, low back pain, knee-joint pain, postherpetic neuralgia etc. For such diseases as whiplash injury, pain of frozen neck or shoulder and pain originated form disorder of vegetative nerve or climacteric symptom, AP therapy was more preferable.

14#Jiang ZR (1985) [He-Ne laser radiation on AP points in treatment of 51 cases of conjunctival allergic reaction]. Shanghai J Acupunct Moxibust (3):9-10. 36 cases of spring catarrh conjunctivitis were treated with He-Ne Laser AP at following acupoints: above BL01-Jingming, below BL01-Jingming, Waiming, Qiuhou (Ex24), Ashi (affected conjunctival area) and bilateral GB20. Each point was radiated for 3 min (total radiation time 20-25 min), q.d., 10-15 times/course. The effective rate was 97%. 15 patients with herpetic conjunctivitis were radiated at the following acupoints of affected eye: BL01, Z_09-Taiyang, Ashi, GB20 and bilateral LI04. The effective rate reached 100%.

15#Jungck D (1986) Stellate ganglion block with ramp-impulse-TENS in the treatment of acute herpes zoster. Acupunct Electrother Res 11(3-4):299. Postherpetic neuralgia can safely be prevented by administration of sympathetic nerve blocks during the first days of the disease. In patients under anticoagulant therapy or poor-risk-patients these anaesthesiological methods cannot be used. In these patients we prefer "electric blockades" following the techniques published by JENKNER. Electric stellate ganglion blocks are indicated, when we find cranial, cervical or upper thoracic localisation of herpes zoster. To improve the efficiency, we use the Ramp-Inpulse-TENS, published 1985 (Jungck). R-Tens is characterized by - no painful stimulation at high output (up to 112 V and 400 mA), - rise time less than 0, 5 usec, low output impedance (109,5 Ohm), no direct current. The electric blockades were followed by increase of skin temperature (0, -2, 3 C degree), often by HORNER's syndrome. Pain reduction was sufficient. Postherpetic neuralgia was not been observed in 18 patients. Electric stellate ganglion blocks can be recommended, when anaesthesiologic blocks cannot be used. The efficiency can be improved by the use of the Ramp-Impulse-TENS.

16#Lefkowitz M, Marini RA (1994) Management of postherpetic neuralgia. Ann Acad Med Singapore Nov;23(6 Suppl):139-144. Pain Management Service, Long Island College Hospital, Brooklyn 11201, USA. Postherpetic neuralgia is a perplexing disorder in which pain develops as a result of herpes zoster. It is a common cause of neuropathic pain and may render its effects especially on the elderly and immunocompromised. Once established, postherpetic neuralgia is resistant to most treatment modalities and can lead to much despair. Many therapeutic approaches have been attempted through the years, most with varying results. This review describes clinical manifestations including allodynia, hyperaesthesia and anaesthesia. It also reviews pharmacologic and non-pharmacologic treatment modalities including a review of anaesthetic nerve blocks, neurostimulation, AP and surgical techniques.

17#Lewith GT, Field J, Machin D (1983) AP compared with placebo in postherpetic pain. Pain Dec;17(4):361-368. A single blind randomised controlled study of auricular and body AP compared with placebo (mock transcutaneous nerve stimulation) was performed in 62 patients with postherpetic neuralgia. There was no difference in the amount of pain relief recorded in the two groups during or after treatment; 7 patients in the placebo group and 7 patients in the AP group experienced significant improvement in their pain at the end of treatment. This suggests that AP is of little value as an analgesic therapy for postherpetic neuralgia. However the study method and the use of a mock TENS as a placebo may be of value when assessing the effects of AP in other conditions. Publication Types:. * Clinical trial. * Randomized controlled trial

18#Li LG (1992) [Herpes zoster treated by pricking blood with 3-edged needle: Report of 23 cases]. New JTCM 24(6):33. Three-edged needle was applied to prick 0.1" on spots 0.1" distal to medial and lateral corners of nails of thumbs and big toes (corresponding to LI11, SP01, LV01 and opposite area) on bilateral sides, to cause bleeding. Blood was wiped away after 5-10 min. Treatment was given once every 1-2 d. On broken herpes, 1-2 gentian violet was applied to prevent infection. After 1-9 treatments, all cases were cured.

19#Liao SJ, Liao TA (1991) AP treatment for herpes simplex infections: A clinical case report. Acupunct Electrother Res 16(3-4):135-142. Boston Univ Medical School, Massachusetts. Herpes simplex is a common skin disorder. There is no effective cure. The recent introduction of drugs, such as acyclovir, is indeed a great advance in its therapeutics. However, these drugs may only modestly reduce the length of an attack, but do not lengthen the remission nor prevent recurrences. Our very limited experience in two cases of herpes oral-labialis and 3 cases of herpes genitalis with AP treatment seemed to indicate the possibility of a marked reduction of an episode, a lengthening of the remission, and a prevention of recurrences. We hope our report would encourage our colleagues to try AP in the clinical management of herpes cases and to study its immunologic effects. Publication Types:. * Clinical trial

20#Liao SJ; Lia TA (1985) AP for skin diseases including psoriasis, acne, keloid, herpes, etc. Acupunct Electrother Res 10(4):371-373. The skin is one of the largest vital organs of our body. Its importance to our health and survival is usually not fully appreciated. Pathologically, some skin diseases may cause systemic disorders, such arthritis in psoriasis while systemic diseases may have skin manifestations, such as dermatitis in pellagra. Nevertheless the skin has many disorders of its own. Their pathogeneses are often not well understood. The therapeutic regime in western medicine are usually quite experimental and sometimes even toxic. Thus, patients with skin disorders often search for alternative cures, such as AP. TCM makes no differential diagnosis of various skin diseases. They are usually grouped into two large categories: Xuen (dermatitides) and Chuan (ulcerations). They are said to be caused by Wind-qi and Damp-qi pathogens or excessive Heat in the Blood. Wind and Damp pathogens cause itchiness while excessive Blood Heat cause red skin rash. The general principle of AP treatment involves a dispersion of Wind and Damp pathogens and a reduction of the Blood Heat. We would like to describe our personal experience in the treatment of psoriasis, cystic acne, painful keloids or surgical scars, eczema, urticaria, allergic dermatitis, and herpes. All these patients had received western medical treatments with great disappointment.

21#Liu Jiaying; Yang Deli (1992) [Application of AP in neurological clinic in recent years]. Chin Acupunct Moxibust 12(5):271-274. The article introduced the application of AP in neurological Depts in recent years for treating the common disorders such as cerebrovascular accident, facial paralysis, herpes zoster, sciatica, trigeminal neuralgia, migraine and nervous lesions.

22#Lobzin VS, Elagin VV (1991) [Pathogenetic therapy of trigeminal neuralgia - Article in Russian]. Zh Nevropatol Psikhiatr Im SS Korsakova 91(4):25-27. The authors describe a clinical case of severe neuralgia of the third branch of the trigeminal nerve, in whose etiology and pathogenesis a role was played by allergic vasomotor rhinosinusopathy, general allergization of the body, and recurrent herpetic infection. The patient was treated by carbamazepine, tranquilizers, prednisolone, antihistamine and diuretic agents, calcium drugs, bonaphthon, vitamin B1, essential oils, AP, local hydrocortisone phonophoresis and laser therapy. Such treatment made it possible to effectively remove the neuralgic painful syndrome. The case shows that the syndrome is due to several pathological systems having different pathophysiological and neurochemical organization, demanding a differentiated individual approach and providing evidence for the necessity of carrying out the etiological and pathogenetic therapy.

23#Matsumoto T (1987) [Case study (23): Zoster]. J Jpn Acupunct Moxibust 46(11):11-14. Effective AP treatment of a case of zoster is reported. The patient, male, aged 20 yr came to the clinic because of zoster of right arm. Treatment: AP was first applied on surrounding site of the most painful herpes, and then on the tender spot (lateral and right to the 4th cervical vertebra), right Nei Jianjing Outside-GB21 and l cm posterior to right LI15 (with retaining of needles for 10 min and warm heat therapy added). During his 2nd visit, he complained of more severe pain and increase of herpes, which might result from the development of the disease itself. In addition to above points, right SI11 and right BL43. During his third visit, pain was obviously reduced. It was cured after 6 times of treatment.

24#Ni SN (1990) Comparative studies on various AP-Moxibustion methods in the treatment of herpes zoster. Xinjiang TCM (4):44-45. The paper introduces briefly the following methods of treating herpes zoster: surrounding AP and surrounding moxibustion, cotton moxibustion, plum-blossom needling, puncturing the Channels and blood-letting, lamp radiation, etc. In general, the patients of Damp-Heat type were treated with surrounding AP and surrounding moxibustion, cotton moxibustion; those with body weakness and Blood Stasis were treated with plum-blossom therapy or pricking blood therapy. During treatment, Renshenbaidu San (ginseng detoxic powder) or longdanxiegan wan might be added, and others who were treated with hormones showed unsatisfactory results.

25#Rapson LM (1986) [AP and facial pain; a rational approach to treatment]. Akupunkt Theorie Praxis 14(4):266. The usefulness of AP in the treatment of facial pain was evaluated in all patients treated in a private chronic pain practice over a 10-yr period. Conditions treated included Tic. Douloureux, atypical facial neuralgia, Postherpetic neuralgia, temporomandibular joint (TMJ) dysfunction, facial migraine and mixed cases. A rational approach to these conditions was developed based on empirically and anatomically chosen acupoints. Thorough histories and physical examinations were done to determine the etiology of pain. Appropriate investigations were evaluated of ordered. If TMJ dysfunction was considered to be an important perpetuating factor a short trial of treatment (3) was undertaken prior to referral to an orthodontist or physiotherapist. Others received a trial of 5 treatments; those responding positively to AP treatment were treated thereafter on an individual basis. Outcomes were measured by patients' assessment of relief, duration of relief, change in drug intake and response to medication. The majority of patients showed a good response to treatment. Side effects and complications were virtually non-existent. AP is a safe, effective, conservative modality with which to treat facial neuralgias.

26#Richand P, Boulnois JL (1983) [Laser radiations in medical therapy - Article in Italian]. Minerva Med Jun 30;74(27):1675-1682. The therapeutic effects of various types of laser beams and the various techniques employed are studied. Clinical and experimental research has shown that He-Ne laser beams are most effective as biological stimulants and in reducing inflammation. For this reasons they are best used in dermatological surgery cases (varicose ulcers, decubital and surgical wounds, keloid scars, etc.). Infrared diode laser beams have been shown to be highly effective painkillers especially in painful pathologies like postherpetic neuritis. The various applications of laser therapy in AP, the treatment of reflex dermatologia and optic fibre endocavital therapy are presented. The neurophysiological bases of this therapy are also briefly described.

27#Sachsse H (1985) [Auricularmedical diagnosis and therapy of herpes simplex I and II abortive herpes zoster]. Akupunkturarzt / Aurikulotherapeut 12(6):160-164. It is reported about auricularmedical observations on Herpes simplex I and II and Herpes zoster. A certain combination of points lead to a very good success. According to the principal of genetic line + 1 the treatment consists in a combination of genetic line of laterality and Trigeminus point.

28#Salar G, Iob I (1978) [Transcutaneous electroanalgesia and naloxone: Clinical aspects - Article in French]. Neurochirurgie 24(6):415-417. Mayer (1977) and Adams (1976) proved that both AP and direct ES of deep encephalic structures produce an analgesic effect releasing a neurotransmitter similar to morphine (endorphin). We have verified this hypothesis, using the transcutaneous electrotherapy in 5 patients with chronic pain at the back (postherpetic neuralgia in 3, pain cancer in 2). All patients related a certain analgesic effect during electrotherapy, with a reduction in pain of more than 50 per cent. During electroanalgesia we administered Naloxone (an antagonist of morphine). In 3 cases we observed a clear, although short, return of pain symptomatology. At the contrary, in other two patients Naloxone caused briefly a further and clear reduction in the pain.

29#Schott GD (1980) Neurogenic facial pain. Trans Ophthalmol Soc U K Jul;100( Pt 2):253-256. Neurogenic facial pain can be classified as either paroxysmal or persistent. Trigeminal neuralgia is the commonest example of the former, and postherpetic neuralgia, atypical facial pain, and tension head and facial pains are examples of the latter. The cause of many of these pains is poorly understood, the complex neuroanatomy of the head and neck being a contributory factor. Even when the aetiology is known, the mechanism whereby pain is produced is usually obscure. While treatment with drugs and surgical measures for trigeminal neuralgia are often satisfactory, and AP for pain due to "muscle tension" may be beneficial, there is often little effective treatment for a considerable proportion of patients with neurogenic facial pain.

30#Serres G (1988) Comments on the technique of the treatment of herpes zoster. Acupunct Res 13(1):7-9,5. The author has used AP for treatment of herpes zoster and considers that EAP at X_35-Huatuojiaji points at the vertebral level corresponding to the location of the herpes zoster produce an obvious analgesic effect. But the remaining pains of >1 yr-old herpes zoster are more difficult to treat and relieve very slowly. The older the disease, the longer the treatment.

31#Shi Youqi (1993) [AP treatment for 5 cases of herpes zoster accompanying AIDS]. Shanghai J Acupunct Moxibust 12(3):119. The patient was instructed to lie on bed and expose the herpes region. Surrounding needling was performed around the region with 6-12 filiform needles(0.35 mm * 40 mm). In the meantime, placed a self-made moxibustion box on the affected area and cauterized this area for 60 min. For patients with more severe pain, additional EAP was applied for 15 min; For patients with purulent herpes, tapped the herpes part with a plum-blossom needle, cleaned away the pus and blood and then apply moxibustion over it. The treatment was given once daily to patients in mild type and twice daily for those in severe type. Results showed that all the 5 patients were cured after treatment for 10 or 14 d.

32#Shirota F (1985) [Treatment of chest pain by AP and moxibustion]. J Tradit Sin Jpn 6(2):39-43. A review is made on different kinds of chest pain treated by AP, including: 1. The pain produced at the body surface: (1) Pain of skin scar, (2) Breast pain. 2. Muscle and bone pain: (1) Muscular overstrain, (2) Connective tissue pain, (3) Bone fracture, (4) Acute and chronic infection of bone. 3. Nerve pain: (1) Herpes zoster, (2) Neuritis, (3) Intercostal pain, (4) Cervicobrachial neuralgia. 4. Pain produced from the thoracal viscera: (1) Affected lung, trachea, pleura caused pain, (2) Oesophageal disease, (3) Cardiovascular disease. 5. Cardiovascular neurosis. According to various conditions of these chest pain the AP was applied, some got good efficacy.

33#Song TC; Li QY; Wu XZ (1984) [Clinical uses of He-Ne laser AP]. Shanxi Med J 13(4):207-208. 106 cases of various diseases were treated by 4 kinds of irradiation with laser. 1. Focal irradiation: hordeolum, wound infection, chronic ulcer, chronic chilitis, etc.; 2. Painful point irradiation: temporal jaw arthritis (mandible or maxilla) on the tenderness point; 3. AP point irradiation: acute and subacute pharyngitis, irradiation on points of bilateral Zengyin(EX-HN); 4. Nerve root irradiation: herpes zoster, etc. local irradiation might be used in combination. Results: The total effective rate was 98% and the cure rate 72% (pharyngitis 90%, hordeolum or stye 83%). There was no statistic significant difference as compared with other therapeutic methods.

34#Spoerel WE, Varkey M, Leung CY (1976) AP in chronic pain. Am J Chin Med 4(3):267-279. A course of 10 daily AP treatments was given to 200 patients who suffered from chronic pain syndromes of =/>1 yr duration and the result assessed at the end of the course of treatment and after an interval of at least 2 mo. Treatments were individualized using needling of body loci distally and near the site of pain, and ear AP. In 38 patients suffering from chronic headaches, including 13 cases of migraine-type headache, 81% reported an improvement in their condition, but only one patient was pain free for the 2-mo observation period. In 162 patients with other chronic pain problems, 99 or 61% were improved or pain free at the end of treatment; in 69 of these a worthwhile degree of improvement persisted over the observation period of 2 mo. Thirteen percent of all patients did not respond to AP and in 26% the response was considered as transient only. Daily treatments are not more effective than weekly or biweekly treatments. Pain in the neck and shoulder region, in the knee and low back pain responded to AP with prolonged improvement in over 50% of the patients treated. Facial pain syndromes and pain in the region of the trunk were least responsive and only 3/11 cases with postherpetic neuralgia reported still having less pain after 2 mo. Needling of effective loci and particularly ear needling often causes an instantaneous reduction or disappearance of pain; the speed of this response can only be explained by a mechanism within the nervous system. Based on our experience AP represents a useful therapeutic modality in the management of pain.

35#Sumita K; Kogure K; Sasaki T (1988) [AP therapy of depression (2): Theory and therapy of depression in traditional Oriental medicine]. J Jpn Acupunct Moxibust 47(6):6-13. After healing of herpes zoster, severe neuralgia usually remains, hardly to be cured. A patient with herpes zoster was treated with AP by the author with satisfactory result. The patient was male, 52 yr-old, had suffered from crops of vesicles around the right anterior superior iliac spine since 2 weeks ago, later extended to the right inguinal region. 5-6 d later he experienced severe pain from the right flank to the inguinal region and did not respond well to analgesics. He sought medical care on December 21, 1984, asking for AP treatment. He was then diagnosed as postherpetic neuralgia and treatment was aiming mainly at analgesia. The patient was in the left lateral position, tender points such as BL25, BL26 and Shangtun were used for puncture, the depth of the needle was 3 cm. Moxibustion was applied at BL23 and BL25. After 4 trials of treatment, pain was markedly relieved, only mild uncomfortableness at the affected site. The patient could resume his work. It was suggested that early treatment was essential.

36#Sun Qi Liang (1990) Pricking needling in the treatment of herpes zoster: Report of 57 cases. Xinjiang TCM (1):37. Needling was carried out at the peripheral healthy skin near the lesions. After routine sterilization, a 28-gauge 0.5" needle was used to prick directly (0.4"), by rapid insertion and withdrawal, no needle retaining, once/d for 5 d/course. 42/57 cases were cured within one course, 15 were cured within 2 courses.

37#Sun YZ; Yang JL; Guo WH (1990) Herpes zoster treated by AP at Huatojiaji and needling along lesions: Report of 35 cases. Heilongjiang TCM Mater Med (6):38. Local needling (Circling the Dragon) was used in case the lesions were in head region. It was accompanied by needling the X_35-Huatojiaji points in lumbar lesions. method: Gauge 28 filiform needle (2") was used in puncturing around each herpes zoster lesion through its centre to opposite side and twisting by reducing method. Then the needle was connected with EAP apparatus for 20 min. 7 d of treatments accounted for one course. The course interval was 3 d. Result: Of 35 cases 26 were cured, 8 markedly effective and 1 improved.

38#Tanabe S; Shiba K (1984) [The effect of AP for herpetic pain]. J Jpn Soc Acupunct 33(4):383-387. 41 cases of herpetic pain were treated with AP mainly at X_35-Huatuojiaji points. The treatment was found significantly effective in 69 of fresh cases and 13 of cases of postherpetic neuralgia.

39#Volmink J, Lancaster T, Gray S, Silagy C (1996) Treatments for postherpetic neuralgia: A systematic review of randomized controlled trials. Fam Pract Feb;13(1):84-91. Dept of Public Health and Primary Care, Univ of Oxford, Radcliffe Infirmary, UK. Different therapies have been used for postherpetic neuralgia. We decided to conduct a systematic review of existing randomized controlled trials. OBJECTIVE. To determine the efficacy of available therapies for relieving the pain of established postherpetic neuralgia. We performed a systematic review, including meta-analysis, of existing randomized controlled trials. Eleven published trials and one unpublished trial were identified which met the inclusion criteria and were included in the current review. Pooled analysis of the effect of tricyclic antidepressants show statistically significant pain relief (OR 0.15, CI 0.08-0.27). Pooling of the results of the 3 trials comparing the effects of capsaicin and placebo could not be done due to heterogeneity. This heterogeneity was mainly attributable to an unpublished trial which differed in terms of the dose and duration of treatment. When this study was omitted, no heterogeneity was found and the pooled analysis revealed a statistically significant benefit (OR 0.29, 95% CI 0.16-0.54). However, problems with blinding in patients using capsaicin may have accounted for the positive effect. One small study of vincristine iontophoresis compared to placebo also yielded a favourable result (OR 0.05, 95% CI 0.01-0.26). Other treatment evaluated include lorazepam, acyclovir, topical benzydamine, and AP. We found no evidence that these are effective in relieving pain associated with postherpetic neuralgia. Based on evidence from randomized trials, tricyclic anti-depressants appear to be the only agents of proven benefit for established postherpetic neuralgia.

40#Wang MQ; Yu SF (1987) [Herpes zoster treated by AP: Report of 50 cases]. Beijing JTCM (2):37-38. Treatment varied with the types of herpes zoster. 1. Exopathogenic Wind-Damp Type, GB20, LI11, LI04, TH05, SP10 by reducing method. 2. Toxic heat endopathogenic type, Ashi points, X_35-Huatojiaji, by reducing method. 3. SP Xu excessive Damp type, ST36, LV14, GB22, ST40 by plain reinforcing and reducing method. 4. Qi and Blood Stasis type, LV13, TH17, TH06, GB34, SP09 by plain reinforcing and reducing. Of 50 cases, 76% were cured, 24% improved.

41#Wei L; Yuan GB (1988) [AP in the treatment of herpes zoster]. Shanghai J Acupunct Moxibust 7(4):46. A male patient, aged 45 had herpes zoster on the right neck and postauricular regions improved following Chinese and Western medicinal treatments. In spite of the improvement, he had his mouth angle aslant. Peripheral facial paralysis following herpes zoster was diagnosed. Then, it was treated with vitamins, hormones, physical therapy, etc. without improvement for 25 d. Corresponding Channel points were selected. They were: ST07, SI18, ST06 (warming needle), ST04, Z_09-Taiyang and LI20. The needle was manipulated with normal reinforcement and normal reduction, and retained for 20 min after getting the Qi. Treatment was given once daily; vit E 100 mg was taken t.i.d at the same time. It was cured after 25 times of treatments.

42#Wen XQ (1988) [AP therapy of postherpes zoster trigeminal neuralgia: A case report]. Guangxi JTCM Mater Med 11(6):247. A male, 55 yr-old, come to clinic for herpes zoster on head. He had tried other medications which did not work. Acupoints: GB20 (left side), GB34 (left side). EAP was applied on the two acupoints. GB08 (left side) was punctured with reducing method. After 20 min, headache decreased a lot. The needles were taken off after 45 min. 10 treatments cured the case.

43#Xie QM; Huang JM; Zhang SH (1987) [AP therapy: Report of 5 cases]. Jiangxi JTCM Pharmacol 18(4):36-37. This paper introduced 5 successful cases with AP. They were cases of lacquer ulcer, acute tonsillitis, urticaria, hairline ulcer and herpes zoster (one each).

44#Xiong GT (1988) [Current status of pricking blood therapy of infectious diseases]. Chin Acupunct Moxibust 8(6):41-43. The article has summarized the clinical application of venous bleeding therapy for treating infectious diseases in the past 30 yr in our country, including: epidemic influenza, herpes simplex, herpes zoster, poliomyelitis, encephalitis, epidemic parotitis, pertussis, acute halophil food poisoning, acute bacillary dysentery, malaria, etc. The author held that this method has a bright prospect and merits further study.

45#Yamashiro H, Hara K, Gotoh Y (1990) [Relief of intractable postherpetic neuralgia with gasserian ganglion block using methyl prednisolone acetate and with TENS - Article in Japanese]. Masui Sep;39(9):1239-1244. Dept of Anaesthesia, Hamamatsu Medical Centre. A 58 yr-old man had been suffering from intractable left ophthalmic post herpetic neuralgia (PHN) for 7 yr. He has also been treated for polyarteritis nodosa for 10 yr. For pain relief, he was treated initially with frequent (4 times a day) stellate ganglion block (SGB) and peripheral ophthalmic nerve block for 1 mo without relief. Then supraorbital nerve block with neurolytics, TENS and AP were done with a slight relief of his pain. Recently his pain became worse even with imipramine 75 mg and carbamazepine 100 mg a day which relieved effectively the patient from the pain for the last 3 yr. The pain was so severe to disturb his usual daily activity. Gasserian ganglion block with methyl prednisolone acetate 10 mg was done. After the block, his ADL improved markedly. 3 mo after the block, he had no spontaneous pain and slight pain with light touch on the injured skin did not annoy him. Several days before the block, electric stimulation to control his pain was tested. Stimulation with the electricity (4.5 mA, 10 cycle and 400 microseconds) brought him complete relief from the pain during the stimulation. Trigeminal SEP showed no response to the stimulation of injured skin.

46#Yu ZF; Zhang JQ; Fan XY (1988) [Clinical observation on the effect of herpes zoster treated with electromagnetic Channel-activating apparatus]. Chin Acupunct Moxibust 8(3):15-16. This article presents the treatment of herpes zoster with Electro-Magnetic Channel-Activating Apparatus. Comparison was also done with control group (treated with conventional medicine such as vitamin, hormone, etc). Altogether 105 cases were treated and divided into 2 groups at random. As for the result, there were 66% cured and the total effect reached 97% in the group with the treatment of the Apparatus, while in the control group the cured rate was only 27% and the total effectiveness 90% (p<.01). This result apparently indicates the marked therapeutic effect of Electro-Magnetic Channel-Activating Apparatus.

47#Zhang Z (1992) [General clinical condition of scalp AP in recent ten years]. Hubei JTCM 14(2):45-46. Presented is a review on scalp AP used in treating pathological changes in brain and spinal cord, cardiovascular diseases, pain and arthralgia-syndrome, diseases of the urinary system, hallucination in various types, retrobular neuritis, ophthalmoplegia, nerve deafness and herpes zoster, etc. in recent years.

48#Zheng XL; Huang H; Liu KL (1988) [Fire needle therapy of herpes zoster: Report of 105 cases]. Chin J Integ Tradit West Med 8(7):441-442. In this series, there were 105 cases of herpes zoster. Corresponding Channel point selection: points of the BL foot Taiyang Channel were selected in the main, i.e. BL13, BL18, BL19, BL20. For lesion above lumbar area, TH06 was added; for lesion below lumbar area, GB34 was added. Local points: punctures were made surrounding the region of herpes zoster. After the tip of the needle was burned with an alcohol lamp to bright redness, the needle was perpendicularly inserted into the point to a depth of 3 mm and promptly pulled out. Treatment was every 3 d; generally 1-3 times was enough. All cases were cured after 1-3 sessions.

49#Zheng YZ (1985) [Infantile herpetic stomatitis treated by paediatric massage: Report of 17 cases]. Fujian JTCM 16( 4):53. 17 infants with herpetic stomatitis were treated by infantile tuina therapy. Of them, 16 were cured and 1 failed to have any effect. Manipulations included circulating method performed clockwise on point Bagua and reducing method used by pushing downwards on points Liufu, Qinwei and Xiaochang; by pushing back and forth on point Sihengwen.

50#Zou ZF (1988) [Herpes zoster treated by auricular AP combined with local application of prepared Chinese ink mixed with realgar]. Jiangxi JTCM Pharmacol 19(5):60. Of 45 cases treated, 13 had herpes zoster of the face and upper lip, 8 in the back and the lumbar region, 9 in the chest and abdomen and 5 in the 4 limbs. The handle of a filiform needle was used to near Earpoint LU, and pressed with an even force for several times to locate the sensitive LU Point. After routine sterilization, the needle was inserted into LU perpendicularly (first on the left ear), avoiding damage to the cartilage. The needle was retained for 3-5 min. Then 100 g clean prepared Chinese ink was mixed with 5 g Realgar Powder and the margins of the lesion were painted with the mixture. Treatment was once/d. After 1-2 sessions, 24/45 cases were cured; 16 had marked effects after 3-4 sessions; 5 had some benefit after 5-6 sessions. The total effective rate was 100%.

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