Shingles

1. Shingles UnaniTibb J. Bhagattjee (2125583)

2. Temperament of condition + organs involved • The disorder is also linked to excess or abnormal phlegmatic humour, with an imbalance of the qualities of moistness and heat. Shingles affect the skin (hot/moist temperament) and may also reflect the inner condition of lung/liver function . • Phlegmatic/Sanguinous individuals more likely to be affected (dominant moisture)

3. Electron micrograph:Approx. 150,000-fold magnification of Varicella zoster virus

4. Definition explaining condition • Allopathic Chickenpox and shingles are caused by the varicella-zoster. Chickenpox is the initial infection and shingles is a reactivation of the virus, usually years later. During chickenpox, the virus spreads in the bloodstream and infects collections of nerve cells (ganglia) of the spinal or cranial nerves. The virus remains in the ganglia in a dormant (latent) state. The virus may never cause symptoms again, or it may reactivate many years later. When it reactivates, the virus travels down the nerve fibers to the skin, where it creates painful sores resembling those of chickenpox. This outbreak of sores (shingles) almost always appears on a strip of the skin over the infected nerve fibers and only on one side of the body. This strip of skin, the area supplied by nerve fibers from a single spinal nerve, is called a dermatome . Adjacent dermatomes may also be infected.

5. Pathophysiology: Herpes Zoster Virus Progression of herpes zoster. A cluster of small bumps (1) turns into blisters (2). The blisters fill with lymph, break open (3), crust over (4), and finally disappear. Postherpetic neuralgia can sometimes occur due to nerve damage (5),

6. Definition explaining condition Tibb Shingles is the response by the body to infection with the varicella zoster virus, the same virus that causes chickenpox. The disorder is also linked to excess or abnormal phlegmatic humour, with an imbalance of the qualities of moistness and heat. After an attack of chicken pox, the virus lies dormant in the patient’s spinal cord, often for a considerable time. Later, in response to one of several influences, the virus migrates down a nerve to affect one or more dermatomes on the skin (Hot/moist temperament). This occurs usually on the trunk, but sometimes on the face, neck and scalp, resulting in the characteristic, painful rash of blisters. Shingles is generally a chronic disorder, so is located on Pathway 2.

7. Signs and Symptoms

8. Signs and Symptoms • During the 2 or 3 days before shingles develops, some people feel ill and have chills, a fever, nausea, diarrhea, or difficulty urinating. Others experience pain, a tingling sensation, or itching in a strip of skin on one side of the body. Clusters of small, fluid-filled blisters surrounded by a small red area then develop on this strip of skin. The blisters occur only on the limited area of skin supplied by the infected nerve fibers. Most often, blisters appear on the trunk, usually on only one side. However, a few blisters may also appear elsewhere. The affected area is usually sensitive to any stimulus, including light touch, and may be very painful. Symptoms are usually less severe in children than in adults.

9. Signs and Symptoms • The blisters begin to dry and form a scab about 5 days after they appear. Until scabs appear, the blisters contain varicella-zoster virus, which, if spread to susceptible people, can cause chickenpox. Blisters that cover large areas of skin or persist for more than 2 weeks usually indicate that the immune system is not functioning normally. • The affected skin, especially in older people and in people with a weakened immune system, may become infected by bacteria. Scratching the blisters increases this risk. Bacterial infections increase the risk of scarring. • One episode of shingles gives most people lifelong immunity from further attacks. Fewer than 4% of people have more than one episode. Scarring or hyperpigmentation of the skin, which can be extensive, may occur, but most people recover without lasting effects. A few people, more commonly older people, continue to have chronic pain in the area (postherpetic neuralgia). • Involvement of the part of the facial nerve leading to the eye can be serious, and if it is not treated adequately, vision may be affected. The part of the facial nerve leading to the ear may also be affected, sometimes leading to pain, partial paralysis of the face, and hearing loss

10. Signs and Symptoms • Pulse- overall cold/moist (Long, wide,deep, regular, slow) • Tongue- overall cold/moist (pale/thick white coating over lung/liver areas)

11. Diagnosis Diagnosis can typically take place when a physician visually inspects the skin. Pain in a vague band on one side of the body suggests shingles. If characteristic blisters appear in the typical pattern (on a strip of skin representing a dermatome), the diagnosis is clear.

12. Diagnosis

13. Diagnosis

14. Diagnosis • If tests are necessary tests of the skin lesions to test for viral infections and culture scrapings, the Tzank test of the skin lesions, a complete blood count to test for white blood cells, and a specific antibody measurement which will reveal elevated antibodies of the varicella virus.

15. Treatment and Management Tibb As shingles is associated with a Cold & Moist frame, the treatment of the Governing Factors will be along the same lines as that for the management of other disorders which belong to the Cold & Moist frame. The treatment frames will include: Cold & Dry, Dry & Hot and Hot & Dry. Additional advice would include: A diet comprising food items with the qualities Cold & Dry (30-40%), Hot & Dry (40-50%) and Hot & Moist (15-20%) Cupping (B1, LE13) Herbal therapy The following ingredients are recommended in simple or compound formulations, for the treatment of patients suffering from shingles: Papaversomniferum (suppresses excess heat);Hyocyamusniger (sedative in nerve affliction & phlegmatic disorders); Aloe barbadensis (accelerates external skin wound healing);Anacyclaspyrethium ;Balsamodendronmukul (antiviral);Valerianawalchi.

16. Treatment and Management Septogard (D/H) (tablets and syrup): Natural antibiotic Increases dryness and heat therefore reducing phlegmatic humour;also concocts phlegmatic humour. Active Ingredients: Balsamodendronmukul- alterative, antiviral, antibacterial, expectorant, mucous membrane healing. Tinosporacordifolia: Alterative, antiperiodic, bittter tonic, diuretic and febrifuge properties Maharasnadiquath: It is a decoction, containing Vanda roxburghii. It has analgesic, antiphlogistic, antipyretic and immunostimulant properties.

17. Treatment and Management Livotibb (M/H) (tablets) Moisture is increased, reducing bilious and melancholic humours. It improves liver functional efficiency, toxin removal, appetite and digestion. Active ingredients Capparicspinosa: Bitter, aperient, diuretic, expectorant properties. Cichoriumintybus: Hepatoprotective, fever, vomiting, abdominal pain, anti-inflammatory. Solanumnigrum: Treats cirrhosis, has emollient, diuretic,antiseptic,laxative properties. Terminaliaarjuna: Reduces hypertriglyceremia

18. Treatment and Management Barshasha (M/H): Unavailable in SA Papaversomniferum;Acoruscalamus; Piper nigrum; Casoreum; Crocus sativum Tibb-Relief (H/D): (tablets: 1 tds) Suitable for phlegmatic and melancholic fevers H/M; M/H; C/M; C/D conditions. Aconitum heterophyllum: Antipyuretic, antiperiodic, diaphoretic, diuretic, chronic fevers. Aconitum ferox: Antiperiodic, antipyuretic, diaphoretic, diuretic Swertiachirata: Astringent, tonic, febrifuge properties

19. Treatment and Management Allopathic Treatment options are typically minimal, as shingles will tend to clear on its own in most cases. Medications to relieve symptoms such as pain may be necessary in an effort to make the patient more comfortable. Antiviral medications may help to reduce the length of the active virus and decrease the strength which it affects the patient, however antiviral medications need to be prescribed early in the infection in order to be effective. Immunosuppressed individuals may require intravenous antiviral medications in order to reduce the chances of serious complications.

20. Alternative Therapies • Use lavender (analgesic) and tea tree oil (anti-viral) on the spinal column, and on the area where it's going to break out. Both lavender and tea tree are safe to use directly on the skin without diluting. Do not use lavender in the first 3 months of pregnancy. • Soak in a tub with 10 to 15 drops lavender, tea tree, roman chamomile, lemon, bergamot or ravensara essential oil in it. • Apply calamine lotion to the rash for the itching. • L-Lysine fights shingle virus growth. You can take this in pill form. Take about 500 mg. three times a day for a couple of weeks. Some foods that are rich in lysine are dairy foods, fish, turkey, eggs, chicken, soy, brewer's yeast, potatoes, lentils, black beans, spinach, peas, asparagus, chinese cabbage, parsley, and butter beans. • Use lavender (analgesic) and tea tree oil (anti-viral) on the spinal column, and on the area where it's going to break out. Both lavender and tea tree are safe to use directly on the skin without diluting. Do not use lavender in the first 3 months of pregnancy. • Antioxidants and vitamins that help fight viruses include: Vitamin C, Vitamin E, Zinc, Beta-carotene, and Selenium. • Flaxseed/Salmon oil contains important fatty acids that support the nervous system • Herbal antibacterial/anti-virals include: garlic, echinacea, olive leaf, elderberry, or oregano oil pills. e shingles faster

21. Alternative Therapies • Acupressure or acupuncture is said to help with shingles and the post shingle pain neuralgia. • Meditation and relaxation helps. Visualization helps to the control the pain. • Qiqong may help release energy blockages and increase healing energy flow to needed areas. this may be worth a try. • The hot component of cayenne pepper, known as capsaicin, is used to relieve the pain of postherpetic neuralgia. In a double-blind trial, a cream containing 0.075% capsaicin, applied three to four times per day to the painful area, greatly reduced pain.In another study, a preparation containing a lower concentration of capsaicin (0.025%) was also effective. Two or more weeks of treatment may be required to get the full benefit of the cream. • Lemon balm/oregano/peppermint/hyssop/rosemary/thyme/sage can be made into a strong tea of 2 teaspoons of dried leaf per cup of boiling water. Apply this tea to the rash several times a day (or a compress can be made). • A Dutch folk- remedy is crushing a leek and placing the juice on the affected area. Repeat as needed. • Antioxidants and vitamins that help fight viruses include: Vitamin C, Vitamin E, Zinc, Beta-carotene, and Selenium. • Flaxseed/Salmon oil contains important fatty acids that support the nervous system • Herbal antibacterial/anti-virals include: garlic, echinacea, olive leaf, elderberry, or oregano oil pills. e shingles faster.

22. Alternative Therapies • Make a paste from turmeric powder. Apply the paste to affected areas of the skin for pain relief and to speed healing. • Crush two aspirin, mix them with 2 tbsp rubbing alcohol, and apply the paste to lesions three times a day. This will provide relief by desensitizing the nerve endings. • Mix 1/2 cup of apple cider vinegar with 2 cups of water. Moisten a clean cotton face-cloth with this solution. Wring slightly and rub affected area with the moist towel upwards towards the heart after the shingles attack subsides and the blisters dry up. Repeat this procedure for an hour daily, as needed. • Dust colloidal oatmeal powder on the parts of the body where clothes rub against your skin. This may reduce pain. • Apply aloe vera gel, raw honey, or fresh leek juice over the rash several times a day. You can also use hydrogen peroxide on infected blisters • A gel made from licorice root appears to be an excellent topical application. • Pear juice is rich in antiviral caffeic acid. Drink it as a fruit juice and eat lots of pears for shingles. • Avoid foods containing the amino acid arginine, such as chocolate, cereal grains, nuts, and seeds. • Baking soda and water solution can also be applied as a cold compress.

23. Prognosis The rash and pain usually subside within three to five weeks, but about one in five patients develops a painful condition called postherpeticneuralgia, which is often difficult to manage. In some patients, herpes zoster can reactivate presenting as zoster sine herpete: pain radiating along the path of a single spinal nerve (a dermatomal distribution), but without an accompanying rash. This condition may involve complications that affect several levels of the nervous system and cause multiple cranialneuropathies, polyneuritis, myelitis, or aseptic meningitis. Other serious effects that may occur in some cases include partial facial paralysis (usually temporary), ear damage, or encephalitis. During pregnancy, first infections with VZV, causing chickenpox, may lead to infection of the fetus and complications in the newborn, but chronic infection or reactivation in shingles are not associated with fetal infection. There is a slightly increased risk of developing cancer after a herpes zoster infection. However, the mechanism is unclear and mortality from cancer did not appear to increase as a direct result of the presence of the virus. Instead, the increased risk may result from the immune suppression that allows the reactivation of the virus.

24. Urban, M. http://www.merck.com/ Revised: [February 2007] • Cohen, J. http://www.health-disease.org/ • http://www.joys-of-lavender.com/shingles.html • http://en.wikipedia.org/wiki/Neuropathy Revised: [August 2010] • Kisten,N. Tibb Pathology notes 2009

25. The End Thnx :>)