Shingles

What is Shingles?

Shingles (herpes zoster) is a painful rash caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox, which stays dormant in sensory nerve cells after the first infection.^[1] Because treatment works best when started early, anyone who suspects shingles should see a physician promptly.^[2]

Common symptoms

Shingles often begins with abnormal skin sensations, malaise, headache or low-grade fever for two to three days before the rash appears.^[2] The rash is usually on one side of the body, stays within a single band of skin supplied by one nerve, and turns into blisters that turn cloudy and crust over in about 7 to 10 days.^[2]

• Burning, tingling or shooting pain in a band of skin
• Skin that is very sensitive to touch
• Red rash with fluid-filled blisters on one side of the body or face
• Fever, headache or tiredness
• Pain that lasts after the rash heals (postherpetic neuralgia)^[3]

Causes and risk factors

Shingles occurs when the dormant virus is no longer held in check by the immune system, so the risk rises with age and with conditions or medicines that weaken immunity.^{[1, 3]} Patients with decreased cell-mediated immunity are 20 to 100 times more likely to develop it.^[2] The lifetime risk is about 30%.^[2]

Postherpetic neuralgia (PHN) is the most common long-term complication, defined as nerve pain lasting at least 3 months after the onset of shingles, and affects roughly one in five patients.^{[2, 3]}

How it is diagnosed and treated conventionally

Shingles is usually diagnosed from the typical one-sided blistering rash and the history.^[2] Antiviral medicines (acyclovir, valacyclovir or famciclovir) are most effective when started within 72 hours of the rash appearing.^{[2, 4]}

Pain is treated with analgesics, and for nerve pain with medicines such as gabapentin, pregabalin or tricyclic antidepressants. Topical lidocaine or capsaicin is used for PHN.^{[2, 4]} Vaccination lowers the risk of shingles in older adults.^[2] PHN is hard to treat, and treatment is often multimodal.^[3]

Why Shingles calls for a whole-person approach

Shingles is a viral infection, but the pain it causes involves the nerves, the immune system and the brain. Age, immune strength, stress and sleep can all shape how bad the pain is and how long it lasts.

Care that supports pain control, sleep and stress may help alongside antiviral and pain treatment, though research has not shown that it prevents shingles or changes the virus.

The immune system

The virus is normally kept dormant by cell-mediated immunity, and shingles is thought to occur when that surveillance weakens.^[1] That is why shingles is more common with age and with immune-weakening conditions.^[2]

Nerve injury and sensitized pain pathways

PHN involves nerve injury, ongoing inflammation and sensitization of the central nervous system, though its exact mechanisms are not fully understood.^[5]

Sleep, mood and pain

Chronic nerve pain tends to disturb sleep and mood. In a network meta-analysis of PHN trials, acupuncture-related treatments were also assessed for effects on sleep quality and depression scores.^[6]

Acupuncture for Shingles

What the research shows

Research suggests acupuncture may help with the pain of shingles, with the best evidence for PHN. In a sham-controlled trial of 448 people aged 45 to 75 with PHN at 7 hospitals in China, 20 sessions of electroacupuncture over 4 weeks lowered pain scores more than sham electroacupuncture (a 1.52-point versus 0.99-point drop on a 0 to 10 scale), and more people had a 30% or greater pain reduction (about 47% versus 24%). The benefit continued through a one-month follow-up, and no clinically significant adverse events were seen.^[7] The average gap between groups was modest.

Systematic reviews are more cautious. A review of seven trials in PHN found that acupuncture lowered pain better than medicines in two trials, but the studies were low quality and all from China.^[8] A network meta-analysis of 29 trials (1,973 patients) found acupuncture-related treatments better than antiepileptic drugs for PHN pain, again with caution.^[6] A review of 13 trials found moxibustion improved response rates and pain scores in PHN, but quality and consistency were poor.^[9]

For acute shingles, a meta-analysis of 21 trials found less pain and faster crusting with acupuncture than with antiviral therapy, but called for higher-quality trials.^[10] Another meta-analysis of 11 trials found a lower rate of PHN but no clear difference in pain scores.^[11] A network meta-analysis of 59 trials (3,930 patients) judged acupuncture-related therapies effective and safe for acute shingles, with more high-quality trials needed.^[12]

How acupuncture may work

How acupuncture may reduce shingles pain is not settled, and the studies cited here did not test a mechanism. PHN involves nerve injury, inflammation and sensitization of the central nervous system,^[5] but whether acupuncture acts on any of these processes is unknown.

What treatment involves

Treatment uses fine, sterile, single-use needles at points chosen for the individual, usually left in place for about 20 to 40 minutes. A course of several visits is usual, with reassessment. The large PHN trial used 20 sessions over 4 weeks.^[7] Needles are not placed on active blisters or broken skin.

Serious problems from acupuncture are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or soreness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). A weakened immune system also calls for extra care and medical clearance.

Ayurvedic medicine for Shingles

The Ayurvedic view

Ayurveda describes blistering, burning, spreading eruptions such as shingles under Visarpa, linked to aggravated Pitta and impure blood (rakta). The nerve pain that follows is sometimes related to Vata. These are traditional categories used to plan care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Cooling, light diet and regular daily routine, with less spicy, sour and fermented food
• Rest, sleep and stress-calming practices
• Cooling herbal preparations, and herbs such as turmeric or neem, prescribed by a qualified practitioner
• Gentle warm oil massage for lingering nerve pain once the blisters have healed

Panchakarma procedures are not appropriate during an acute shingles outbreak, pregnancy, acute illness or frailty. A herbal preparation applied to the skin (transdermal medication therapy) is used only on intact skin and not on open blisters. Ayurvedic products vary in quality: one study of products bought online found detectable lead, mercury or arsenic in about one fifth of them.^[14]

What the research shows

The research on Ayurveda for shingles is very limited. A PubMed search found no clinical trials or systematic reviews. We found only a single case report of an older man with blisters on one side of the face, labeled oro-facial herpes, whose pain and burning improved over 5 months of Ayurvedic treatment. A single case cannot show the treatment caused the improvement, and shingles pain often eases over time.^[15]

Herbal medicine for Shingles

Herbs and formulas that have been studied

The research is mainly on Chinese herbal formulas. A Gentiana-based formula, built around herbs such as Gentiana (long dan cao), Scutellaria (huang qin) and Gardenia, has been reviewed for shingles.^[16] Herbal preparations applied to acupuncture points (acupoint patching) have also been studied for PHN.^[17]

What the research shows

The evidence is limited and from lower-quality trials. A review of 26 studies (2,955 people) found that modified Gentiana formula resolved pain earlier than drug treatment, and when combined with a topical herbal preparation, was linked to lower PHN rates. The review noted limits in study quality.^[16] A meta-analysis of 12 trials in people with HIV and shingles found Chinese herbal medicine, alone or combined with drugs, lowered pain and PHN rates compared with drugs alone, but most trials had high or unclear risk of bias.^[18]

A review of acupoint herbal patching for PHN (15 studies, 1,362 people) reported better pain, sleep and mood scores.^[17] A Cochrane review of herbal products for long-lasting neuropathic pain found only two small studies (nutmeg spray and St. John's wort), too few to draw conclusions.^[19]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Reviews describe serious interactions, including bleeding with blood thinners and altered levels of antidepressants and immune-suppressing drugs.^[20] Many people with shingles take gabapentin, antidepressants, antivirals or immune-suppressing medicine, so tell us about everything you take, and about pregnancy, breastfeeding, and liver or kidney disease.

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[14] Herbs should come from tested sources and be prescribed individually.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes shingles as damp-heat in the Liver and Gallbladder channels, with qi and blood stagnation in lingering pain. Ayurveda describes aggravated Pitta in the blood, with Vata in the nerve pain. Researchers studying shingles measure things that loosely parallel these ideas: viral reactivation and immune control, inflammation around the nerve, and sensitization of pain pathways.^{[1, 5]} Some of the herbs studied for shingles show anti-inflammatory actions in laboratory research.^[16]

No study has shown that a TCM pattern or a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for shingles is complementary. Keep your physician, take antiviral and pain medicines as prescribed, and do not stop or change them without your prescriber. We do not diagnose shingles or provide antiviral treatment, so a suspected shingles rash needs medical evaluation first, ideally within 72 hours of the rash appearing.^[2]

Please bring your diagnosis, a list of your medicines and supplements, and details of any vaccination, eye involvement or immune-weakening condition. We ask that you are under a physician's care and that your treating team knows you are receiving complementary care.

When to seek urgent medical care

Shingles can cause serious complications, and some situations need care right away.^[2]

• A blistering rash on one side of the face, especially near or on the eye or nose, or any eye pain or vision change
• Shingles with a weakened immune system, such as cancer treatment, HIV or transplant medicines
• A rash that spreads widely, or blisters that become red, hot, swollen or weep pus
• Severe or worsening pain, or a rash with fever
• Facial weakness, hearing loss, dizziness, confusion, severe headache or neck stiffness
• A rash in a person who is pregnant

If any of these occur, call 911 or go to the nearest emergency department.