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Herpes zoster, also known as shingles, is an acute herpes skin disease caused by the varicella-zoster virus. This condition typically presents acutely, with clinical manifestations of clustered vesicles distributed along a single peripheral nerve in a band-like pattern. The most common affected area is the intercostal nerve distribution, often accompanied by severe neuralgia and local lymphadenopathy, and it can lead to postherpetic neuralgia.
Herpes zoster can occur secondary to other diseases, such as malignant tumors, organ transplants, AIDS, or following major surgeries. It can also lead to conditions such as facial paralysis, trigeminal neuralgia, visceral herpes zoster, and even severe clinical events like blindness, deafness, or death. Postherpetic neuralgia refers to persistent pain lasting more than one month after the clinical resolution of herpes zoster. Clinical evidence shows that the incidence and duration of postherpetic neuralgia are higher in the elderly.
Traditional Chinese Medicine (TCM) has a history of over a thousand years in observing and studying herpes zoster, leading to a clear and relatively unified understanding of its etiology and pathogenesis. Currently, the TCM community commonly adopts the diagnostic criteria for the disease known as “she chuan chuan” (蛇串疮) as outlined in the “Standards for Diagnosis and Efficacy of TCM Diseases and Syndromes,” which classifies the syndromes into three types: liver meridian stagnation heat, spleen deficiency with damp accumulation, and qi stagnation with blood stasis.
The technique of fire needle combined with cupping therapy for treating acute herpes zoster (fire needle puncture method) integrates the advantages of traditional acupuncture methods, including fire needle therapy, bloodletting therapy, cupping therapy, and puncture needle techniques. This method primarily uses fire needles and cupping as the main instruments, combining techniques such as fire needle burning, fire needle puncturing, puncture needle techniques, and cupping. By heating the tip of the fire needle until it glows white, the high temperature is used to cauterize the local lesions. The thick body of the fire needle and the shallow puncturing technique of the puncture needle allow for complete opening of the herpes lesions. Coupled with the strong suction effect of the cupping, this method effectively expels local toxins and stagnant blood, allowing fresh blood to nourish the affected area, thereby achieving pain relief and healing.
Diagnostic Criteria
1. The lesions are typically the size of mung beans, clustered together, with tense vesicle walls, a red base color, and often distributed unilaterally in a band-like arrangement. In severe cases, the lesions may present as hemorrhagic or show necrotic damage. Lesions on the head and face often indicate a more severe condition.
2. Prior to the appearance of the rash, there is often a sensation of skin prickling or burning, which may be accompanied by mild systemic discomfort or fever.
3. Patients experience significant pain, which may include unbearable severe pain or residual pain after the rash has subsided.
Indications
1. Acute phase of herpes zoster (duration < 7 days);
2. Suitable age range: 8 to 85 years;
3. Applicable to all types of herpes zoster in the acute phase.
Contraindications
1. Patients with hemophilia or other bleeding disorders;
2. Patients with severe primary diseases or systemic failure, such as cardiovascular, cerebrovascular, diabetes, malignant tumors, liver, kidney, or hematopoietic system diseases;
3. Long-term use of corticosteroids or immunosuppressants;
4. Patients with mental illness who cannot cooperate with treatment;
5. Patients with a tendency to develop scars;
6. Women who are pregnant, breastfeeding, or planning to become pregnant, and infants;
7. Herpes zoster on the face or perineum.
Technical Operation Method
1. Equipment Preparation
1. Fire needle instruments: Special fire needles made of tungsten steel. The medium fire needle has a diameter of 0.75 mm, and the thick fire needle has a diameter of 1.2 mm.
2. Cupping: General glass cups numbered 1 to 5.
3. Medical cotton balls, hemostatic forceps, 95% alcohol, matches or a lighter.
4. If fire needles are difficult to obtain or in emergency situations, standard acupuncture needles measuring 0.30 mm x 25 mm can be used as a substitute for fire needles, limited to 10 burns.
2. Detailed Operation Steps
1. Patient Position: Depending on the location of the herpes zoster lesions, the patient should be seated or lying down in a position that is comfortable and conducive to relaxation, facilitating the doctor’s operation.
2. Selection of Points, Treatment Order, and Disinfection: Select treatment points at both ends and the middle of the herpes lesions, starting treatment at the earliest site of rash appearance, known as the “snake head” (蛇头), followed by the middle part of the rash, known as the “snake waist” (蛇腰), and the tail end, known as the “snake tail” (蛇尾). If the patient has a large area of lesions with numerous vesicles, treatment can be done in batches. Disinfect the skin with 75% alcohol; if the skin has already broken, use iodine to reduce patient discomfort.
3. Fire Needle Puncture
Number of punctures: Determine the number of punctures based on the size of the vesicle cluster, ideally 1/3 to 1/2 of the number of vesicles in the cluster.
Fire needle burning: Hold a hemostatic forceps in the left hand to grasp a medical cotton ball soaked in 95% alcohol and ignite it, bringing the flame close to the patient’s lesion, maintaining a distance of 10 to 15 cm from the selected puncture site, taking care to prevent the flame or burning alcohol from dripping onto the patient. Hold the needle in the right hand like a pen; insert the needle tip and body into the flame until it glows red or white.
Fire needle puncture: After burning the needle, puncture the vesicle cluster in a “cross” pattern. The puncture should be completed within 1 second while the needle tip is still glowing red, inserting and withdrawing the needle quickly and straight without tilting or dragging. For vesicles, papules, or erythema, use medium or thick fire needles, ensuring the needle tip pierces the vesicle to reach its base. For larger pustules or blood blisters (diameter > 0.5 cm), use a thick fire needle for puncturing, and then use a disinfected cotton ball to squeeze out the vesicle fluid.
4. Cupping and Retention
Based on the size of the vesicle cluster, select an appropriate size of cup to apply suction to the puncture site after fire needle puncturing, ensuring that the cup covers the vesicle cluster and includes the puncture points. If the vesicle cluster is too large, multiple cups can be used. Retain the cup for 5 to 10 minutes until slight bruising appears on the local skin, usually resulting in a small amount of blood or exudate being drawn out. If blood blisters appear after removing the cup, further puncturing with the fire needle may be necessary.
After treatment, clean the surface of the skin with a disinfected cotton ball to remove any exudate.
3. Treatment Time and Course
For the first three days of the patient’s visit, perform this treatment once daily, followed by every other day. There is no fixed treatment course; the number of treatments should be determined based on the patient’s condition and tolerance. Treatment can be stopped when the vesicles crust over and pain subsides. Research results indicate that the cure rate within 9 days of using this method is as high as 90.9%, with no occurrence of postherpetic neuralgia.
4. Key Technical Points
1. Fire needle puncture: Emphasize “red,” “fast,” and “accurate.” Red—ensure the needle is fully heated to guarantee sufficient temperature at the tip. Fast—perform the puncture quickly and decisively to avoid dragging and reduce patient pain. Accurate—maintain focus and steadiness during puncturing, accurately puncturing multiple points on the herpes lesions, ensuring the needle penetrates to the base of the vesicle.
2. Cupping: Use the flash fire method for cupping, selecting an appropriately sized cup based on the area of the vesicle cluster, ensuring the cup covers the cluster and includes the puncture points. To enhance efficacy and ensure an appropriate amount of bleeding, cupping should be applied immediately after fire needle puncturing. The retention time can be adjusted based on changes in skin color, the patient’s constitution and tolerance, and the severity of the condition.
5. Precautions
1. Enhance training to improve clinical operational skills; if the doctor is fearful of using fire needles, they should not easily apply fire needle therapy. 2. Fire needle instruments can become aged due to repeated heating, leading to deformation or softening that affects clinical operation; select quality fire needles and regularly check their condition, replacing any that have deteriorated. 3. Ensure sterile disinfection before fire needle puncturing, and avoid recontamination after disinfection. 4. Take care to prevent flames or burning alcohol from dripping onto the patient during fire needle puncturing and cupping. 5. Use fire needles cautiously around joints, large blood vessels, and important organs. 6. For facial and other thin muscle areas, use fine fire needles to reduce patient pain. 7. During treatment, the doctor should closely observe the skin color and the patient’s reactions, and respond promptly to any unexpected situations such as needle retention, severe pain, bleeding, fainting, or infection according to the emergency response plan.
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