Post Herpetic Neuralgia, Shingles and Chinese Medicine

Any individual who has suffered through shingles (herpes zoster) can attest that the experience can be counted as among the worst that a human being can suffer. Usually shingles manifests as an agonizing, burning pain following one or more nerve paths from the spine outwards, and is accompanied by a fluid-filled rash which gradually evolves into painful scabs.

Cruelly, the visual signs of shingles may vanish after several weeks, but leaving searing nerve pain where it had been yet with little or no outward signs. This pain is termed, post-herpetic neuralgia.

While we often treat acute shingles at the Northside Holistic Center with good effect, it is even more common that people are directed to us by their physician or a peer who has been treated at the clinic for post-herpetic neuralgia. This is because living with the neuralgia is often almost intolerable and acupuncture and Chinese medicine are so effective at alleviating the problem.

Articles and Research

• A recent article compared the effectiveness of acupuncture and Chinese medicine to conventional medical care for shingles and found that the effectiveness was the same and was, ultimately cheaper. The article, reprinted below:

Acupuncture Cost-Effective For Herpes Zoster Care - New Research

12 APRIL 2012

New research published in the Journal of Traditional Chinese Medicine finds acupuncture as effective as pharmacological drugs for the treatment of herpes zoster. The study also notes that acupuncture is more cost-effective as a treatment modality for this ailment. Herpes zoster, also known as shingles, is a viral infection that causes painful skin rashes with blisters. This is the same virus that causes chickenpox. Adults who have had chickenpox earlier in life have a 50 percent chance of contracting a herpes zoster outbreak later in life, however, herpes zoster can attack at any age.

A total of 500 patients with herpes zoster were part of this randomized clinical trial. They were divided into 5 treatment groups to compare Chinese medicine with anti-viral drug therapy. Group 1 received acupuncture and electroacupuncture. Group 2 received moxibustion. Group 3 received red-hot needle treatment. Group 4 received tapping needle technique plus cupping and group 5 received drug therapy. The researchers found no statistical difference between the treatment groups for the “curative effect.” Given the same clinical effects between the treatment groups, the researchers then compared the cost of care and concluded that acupuncture is a more cost-effective modality for the treatment of herpes zoster.

Reference:

Journal of Chinese Medicine. 1-2012. Economic Evaluation of Treating Herpes Zoster with Various Methods of Acupuncture and Moxibustion.

• An Italian study, which can read about here, found that,

...acupuncture is as effective as standard drug treatment for acute pain in patients with herpes zoster (HZ).

• A Yale School of Medicine case report, abstract viewable here, found that with a patient whose post herpetic neuralgia was unresponsive to a variety of Western medical treatments responded well to acupuncture, 

A comprehensive pain treatment regimen, consisting of a stellate ganglia block, medications, transcutaneous electrical nerve stimulation and hypnosis, was administered, but the patient did not gain any incremental pain relief.
The acupuncture service was consulted . . . after acupuncture treatment over a 2-month period, the patient's nausea disappeared. Her left facial pain continued to decline from a maximum of 10 to 0 . . .

[their] conclusions, "Acupuncture and its related techniques may be an effective adjunctive treatment for symptoms associated with post herpetic neuralgia and deserve further study."

Treating Insomnia with Chinese Medicine

I often begin blog entries by defining a disease or condition. With
insomnia, however this is almost not necessary as almost every one has
experienced sleeplessness at one time or another. What make insomnia an issue that people will seek an acupuncturist for is chronicity. The fact that it happens frequently, or even every night.

For some clients, insomnia is their sole concern and what drives them to seek us out. Others experience problems sleeping due to other problems, such as menopausal hot flashes (article to come), pain, digestive issues or anxiety (article to be written). In essence, then insomnia is perceived to arise as a result of some sort of physical discomfort, mental stress or anxiety or - far too frequently -without any sort of trigger - the person simply can’t sleep or finds themselves awakening with no clear trigger.

Chinese medicine is extremely effective in managing insomnia from most causes and can restore normal sleep in the vast majority of cases.

Chinese Medical Approach to Insomnia

As with most health issues, an acupuncturist will approach insomnia by evaluating the whole individual. Questions, which may not appear to have immediate bearings on sleep, will help us to determine which pattern of insomnia the individual is living with. By pattern, Chinese medicine is describing a complex of energetic and functional relationships between body systems which, when taken together, create the symptom or disease the individual possesses. Looking up insomnia in a textbook of Chinese medicine one would see described many patterns, each with a different method for treatment. Proper pattern differentiation will lead to effective results. A well trained and experienced acupuncturist will be able to deduce the appropriate protocol based on how the patient presents to us.

If a pattern is treated successfully the patient will gradually find themselves sleeping longer, deeper and more restfully. An added advantage of such a strategy is that once the problem has been successfully resolved and the course of treatment completed, it is rare for an individual to need further treatment for that particular issue.

Research on Insomnia:

• The Chinese Medical Journal studied one particular technique which might be used by an acupuncturist, electro-acupuncture, and its effect upon sleep quality. The study found that this technique was very effective in the majority of patients and also cited an increase in daytime functioning among this cohort. While most acupuncturists would not use this technique as a first resort - simply because other methods are so useful - it would be considered with unusual or recalcitrant cases.

• The Journal of Alternative and Complementary Medicine published a meta-analysis of 43 studies of acupuncture in the treatment of insomnia. A meta-analysis is a statistical means of analyzing multiple research reports and looking a what the cumulative thrust of them is. This meta analysis showed a dramatic trend toward alleviating insomnia in the large majority of studies.
• A Chinese medical journal, Zhongguo Zhen Jiu citing a university teaching hospital's research, looked at the effect of treating one particular pattern of insomnia. It looked at both outcomes (sleeping through the night) as well as changes in blood flow to the brain. The study found that not only did people suffering from this particular type of insomnia improve with acupuncture, but that there was a corresponding increase in blood flow to the parts of the brain which regulate sleep.

• The medical journal, Sleep Medicine Review performed an meta-analysis of 30 studies on acupuncture and insomnia and cautiously concluded that while there was a substantial positive response to acupuncture treatment of sleep disorders (93% of the participants in these studies manifested positive results) more study would be beneficial.

• The psychiatric monthly, The Journal of Neuropsychiatry and Clinical Neurosciences performed a study on anxiety and insomnia. It concluded that not only was sleeplessness dramatically improved by acupuncture treatment, but that several neurochemical markers which are correlated to a good nights sleep were positively altered by this therapy.

• A study of 55 patients with ADHD and insomnia by Wanzhu Hou, Guangpi Xu, James C. Butler and Hanjie Wang, demonstrated 'exceptional' results with these patients.

• A  page with a survey of current Chinese medical research on insomnia can be found here. Though couched in the jargon of Chinese medicine, it can give one a sense of what type of research is being done in Asia in an attempt to merge Chinese medicine with modern research techniques.

• A Japanese study on acupuncture on an animal model, readable here, concluded that,

acupuncture benefits sleep. A controlled trial conducted on pigs measured sleep outcomes when the subjects received acupuncture at acupoints GV20 and Dafengmen (an acupoint anatomically similar to human GV20, Baihui). Results were measured using an actigraph (Octagonal Basic Motionlogger) and by measuring catecholamine counts in the urine after the application of acupuncture. Pigs receiving acupuncture at Dafengmen for 20 minutes at a depth of 10-20mm showed significant values on the actigraph and urine analysis showed significant changes in the catecholamine count. 

Asthma and Chinese Medicine

At the Northside Holistic Center we see many respiratory problems, ranging from acute diseases like colds, flus and bronchitises to more chronic issues like asthma. Bronchial asthma effects more than 17 million people in the USA and, by some estimates, 7.7% of the population. Over the last half a century, rates of asthma have been dramatically escalating with the Center for Disease control reporting that the rates had increased by 75% between 1980 and 1994.Consequently we are seeing many more cases in the clinic.

Satisfyingly, Chinese medicine can be quite effective in mitigating asthma for our patients and most clients find themselves to very satisfied with this holistic and long lasting approach. Asthma, like most conditions in the Chinese medical view of the body must be differentiated into what we term patterns. Patterns are constellations of symptoms and physical propensities which, when considered as a whole, give a trained practitioner insight into how to treat both the condition and the root of the problem simultaneously. It is what gives Chinese medicine it's considerable power in treating chronic issues, such as asthma.

Research Links on Chinese Medicine, Acupuncture and Asthma:

• A German study on in-patient pediatric patients found significant benefit to adding acupuncture to western interventions. (an article about the study can be read here):

The addition of acupuncture to an inpatient asthma rehabilitation programme results in improvement in bronchial hyper-reactivity and reduced anxiety for paediatric patients.

In the post-treatment acupuncture group, peak expiratory flow variability (a measure of bronchial hyper-reactivity) was found to show significant improvement compared with that of control patients. In addition, the acupuncture group was found to show significantly reduced levels of perceived anxiety on discharge from hospital.

• This article comes from a Chinese journal on pulmonary research and is titled, Effects of Acupuncture on Clinical Symptoms and  Pulmonary Function in Patients with Bronchial Asthma.  The study looks at 104 people suffering from asthma and being treated by acupuncture using a specific protocol with constitutional modifications. It concludes that acupuncture can be very useful in treating asthma, with a good immediate outcome. However the researchers also followed the study cohort for six months afterwards and was able to determine that even after treatment had ended the patients were dramatically less likely to suffer asthma attacks and used far less medication then those who had not been treated by an acupuncturist.

• A research study from a hospital in China, following 100 patient admissions showed a dramatic effect using acupuncture to treat an acute asthma attack. While we in the USA rarely treat this situation because patients' usually already have inhalers and access to the emergency room, it is exciting to see research supporting the contention that acupuncture can be useful to treat all stages of bronchial asthma.

• A 2006 study from the China Academy of Chinese Medical Sciences in Beijing is very interesting, despite being rife with the specific terminology of Chinese medicine. In essence it demonstrates a strong response to acupuncture revealed by an dramatic increase in pulmonary function and significant decrease in heart rate variability during an acute asthma attack.

• A small pilot study in the Journal of the Chinese Medical Association showed immediate bronchiodilating effect and improvement in pulmonary function in those suffering from asthma.

• This article is more of a biomedical discussion of how some of the acupuncture points that we might choose to treat asthma may work, from a western perspective. Still very interesting.

Pregnancy and Acupuncture

While a large part of my practice involves the treatment of infertiliy, once the client has conceived she may opt to continue therapy. There are many reasons that clients who have used Chinese medicine to conceive will continue to work with us through the beginning of their pregnancy, to seek treatment toward the end of term, or use us to help them throughout the entire gestation. In the beginning of the pregnancy, usually through the first trimester, acupuncture can be very useful to minimize the chances of miscarriage due to uterine insufficiency. For women who have had previous miscarriages or who worry that they may carry a risk of such an occurrence may opt for this careful approach by using Chinese medicine. Additionally, acupuncture may be used to minimize or eliminate uncomfortable effects of pregnancy such as morning sickness, digestive problems, lowered energy and musculoskeletal pain - for which it can be extraordinarily effective.

Some women, by virtue of their age, risk factors or general health may opt to work with an acupuncturist throughout the entire pregnancy to ensure that her body remains as strong as possible and to minimize risk to the baby. The added bonus of this type of ongoing work is that labor and delivery is often quite a bit easier as a result.

Finally, many women will use an acupuncturist's services in the last month of pregnancy in order to help with a breach presentation of the baby, induce labor if the child is past term and the mother wants to avoid using chemical means of inducement or Caesarian section; or simply to ease the delivery.

All of these strategies can be very useful for a pregnant woman. Below I've included a few western medical studies demonstrate that the scientific community is beginning to recognize these benefits:

Research:

From the journal, Pain and Symptom Management, and summarized in Acupuncture Today, comes a study which demonstrates dramatic reduction in morning sickness in women receiving acupuncture versus placebo. 

The Journal of Complementary Medicine, 2009 published a study in which it was showed that women who used acupuncture during their pregnancy and labor had much lower rates of Caesarian section and a subjectively higher rate of comfort during the actual labor process.

From the US Pharmacists journal comes a compendium of many other studies demonstrating the utillity of acupuncture for morning sickness.

From the  Scandinavian journal, Acta Obstetricia et Gynecologica Scandinavica comes a study evaluating the treatment of pelvic and low back pain with acupuncture, during preganancy. Not only did the study conclude that acupuncture was very effective at treating this type of pregnancy related pain, but it also found that it obtained a superior result to using physical therapy as the sole treatment for this type of discomfort.

Using acupuncture to treat pregancy and/or post-partum related depression often yields powerful results. And we see this quite often in our clinic. In The Journal of Affective Disorders, there is a study which demonstrates this positive effect.

In the Journal Obstetric and Gynecologic Investigation, a rat model is used to investigate the potential chemical basis for acupuncture's effect in preventing one type of miscarriage.

From an Austrian Obstetrics journal, Wien Klin Wochenschr, comes a study on the effectiveness of using acupuncture to induce labor and ripen the cervix.

A small study in the journal, Acupuncture Medicine, demonstrates the effectiveness of using acupuncture to treat the insomnia which can be connected to pregnancy in many women.

From Science comes this French study on the successful management of  pelvic pain in pregnant women.

Children and Allergies

I treat a lot of children's issues at the Northside Holistic Center and allergies are one of the frequent complaints that children, as well as adults present with. Frequently, my pediatric patients present with a variety of allergy related issues such as asthma, eczema, and digestive problems. This kind of work is very satisfying to most acupuncturists for, while most allergies respond to what we do quite well, children will often appear to be almost magical in their ability to rapidly get well from our work.

The first question that many parents have about using acupuncture as a modality is, "How can you persuade a child to lay still for the placement of the acupuncture filaments?"

The child's parents are usually relieved to find that this is usually much easier than it sounds. Unlike the treatment of adults, children usually only need to retain the filaments for a few minutes per point. This makes keeping them interested much easier. For toddlers and infants, the mother or father can simply hold the child or read them a story. For older kids a toy can be used as a distraction tool while the treatment is proceeding. Most of my clients under fifteen come to enjoy acupuncture therapy as much as adults and parents are surprised to find that many children look forward to their treatment - gratifying to all parties involved!

Links for Other Resources:

This link is from a mother dedicated to helping other parents' with their childrens' allergy issues. Her meetup link allows members to share information about their children's health, recipes, and techniques to help parents cope with and treat their kids.

http://www.meetup.com/no-nutz-mamas/

Research Links and Articles

• From ABC News comes both an article and a video covering the use of acupuncture for seasonal allergies. The entire article can be read and the video viewed here. An excerpt is below:

 Aniko Foldi and Marty Rudolph said they have battled severe allergy symptoms for years with no relief. "You name it, I have every kind of symptom," Aniko said.

"I have had surgery, I've gone to an allergist's office two times a week for shots," Marty said. Both of them desperate for help they turned to acupuncture as a last resort and both said it worked. "It absolutely mitigates the impact," Marty said.

"It's just amazing to me it's like a 100% improvement," said Aniko.

Dr. Marshall Sager in Bala Cynwyd, Montgomery County practiced traditional medicine for years before becoming a certified acupuncturist. He said he's seen great success treating allergies with the ancient technique.

Aniko said Cheryl's treatments have been life changing. "I'm not taking any meds at all," Aniko said. "I would say that she saved my life."

Aniko Foldi and Marty Rudolph said they have battled severe allergy symptoms for years with no relief. "You name it, I have every kind of symptom," Aniko said."I have had surgery, I've gone to an allergist's office two times a week for shots," Marty said.

Both of them desperate for help they turned to acupuncture as a last resort and both said it worked."It absolutely mitigates the impact," Marty said."It's just amazing to me it's like a 100% improvement," said Aniko.

Dr. Marshall Sager in Bala Cynwyd, Montgomery County practiced traditional medicine for years before becoming a certified acupuncturist. He said he's seen great success treating allergies with the ancient technique.Aniko said Cheryl's treatments have been life changing."I'm not taking any meds at all," Aniko said. "I would say that she saved my life."

• From the journal Pediatrics:  A double-blind, randomized, placebo-controlled trial of acupuncture for the treatment of childhood persistent allergic rhinitis.

Department of Paediatrics, Kwong Wah Hospital, 25 Waterloo Rd, Kowloon, SAR, Hong Kong. dkkng@ha.org.hk

OBJECTIVE: To compare active acupuncture with sham acupuncture for the treatment of persistent allergic rhinitis among children. METHODS: Subjects with persistent allergic rhinitis were recruited from the pediatric outpatient clinic. They were randomized to receive either active acupuncture or sham acupuncture. Main outcome measures included daily rhinitis scores, symptom-free days, visual analog scale scores for immediate effects of acupuncture, daily relief medication scores, blood eosinophil counts, serum IgE levels, nasal eosinophil counts, patients' and parents' preferences for treatment modalities, and adverse effects. RESULTS: Eighty-five patients were recruited from the pediatric outpatient clinic at Kwong Wah Hospital, in Hong Kong. Thirteen patients withdrew before randomization; 35 patients (mean age: 11.7 +/- 3.2 years) were randomized to receive active acupuncture for 8 weeks, and 37 patients (mean age: 11 +/- 3.8 years) were randomized to receive sham acupuncture for 8 weeks. Acupuncture was performed twice per week for both groups. Both the assessing pediatricians and the patients were blinded. There were significantly lower daily rhinitis scores and more symptom-free days for the group receiving active acupuncture, during both the treatment and follow-up periods. The visual analog scale scores for immediate improvement after acupuncture were also significantly better for the active acupuncture group. There was no significant difference in the following outcome measures between the active and sham acupuncture groups: daily relief medication scores, blood eosinophil counts, serum IgE levels, and nasal eosinophil counts, except for the IgE levels before and 2 months after acupuncture in the sham acupuncture group. No severe adverse effects were encountered. Numbness, headache, and dizziness were found in both the active and sham acupuncture groups, with no difference in incidence, and the effects were self-limiting.

CONCLUSIONS: This study showed that active acupuncture was more effective than sham acupuncture in decreasing the symptom scores for persistent allergic rhinitis and increasing the symptom-free days. No serious adverse effect was identified.

• From SeatlePi.com comes an article on pediatric acupuncture: www.seattlepi.com: It describes a few practitioners experience with treating children.

• While not specifically child-oriented, but applicable come a study from the International Journal of Immunopharmacology comes a study of more than one hundred Taiwanese patients treated with an herbal formula that we commonly use for allergies:

Xin Yi San reduces nasal symptoms in patients with perennial allergic rhinitis (AR) due to its diverse immunomodulatory effects. One hundred and eight Taiwanese patients with AR received either XYS or a placebo for three months. The investigators found that XYS attenuated the nasal symptoms of sneezing, rhinorrhoea and nasal congestion through reduction of nasal airflow resistance and increase in the cross-sectional area of nostrils. They also observed that XYS exerted diverse in vitro immunomodulatory effects, including suppression of serum IgE levels and increased production of the cytokines IL-10, sICAM-1 and IL-8. (Traditional Chinese medicine, Xin-yi-san, reduces nasal symptoms of patients with perennial allergic rhinitis by its diverse immunomodulatory effects. Int Immunopharmacol. 2010 Aug;10(8):951-8)."

A global study in the prestigious journal Pediatrics, evaluating the saftey of acupuncture with children, found that:

Treating kids with acupuncture is a common practice and generally safe, according to a new study.

“Like adults, acupuncture is very safe when applied to the children’s population,” said Jamie Starkey, an acupuncturist from the Cleveland Clinic, who did not take part in the study. “And so it basically mimics exactly what is seen in the adult population.”

“Any of the serious side effects that they found were definitely due in part to the clinician’s malpractice,” Starkey said. “So, it was certainly somebody who was not necessarily the most trained. The take-home message is that it is absolutely safe in both the adult and pediatric world, but you have to go to somebody who is trained.” [italics mine]

 An article about the study is readable here.