Title: Shingles
1 Shingles
- Unani Tibb
- J. Bhagattjee (2125583)
2Temperament 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)
3Electron micrographApprox. 150,000-fold
magnification of Varicella zoster virus
4Definition 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.
5Pathophysiology 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),
6Definition 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 patients
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.
7Signs and Symptoms
8Signs 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.
9Signs 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
10Signs and Symptoms
- Pulse- overall cold/moist
- (Long, wide,deep, regular, slow)
- Tongue- overall cold/moist
- (pale/thick white coating over lung/liver areas)
11Diagnosis
- 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. -
12Diagnosis
13Diagnosis
14Diagnosis
- 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.
15Treatment 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 -
- Papaver somniferum (suppresses excess heat)
Hyocyamus niger (sedative in nerve affliction
phlegmatic disorders) Aloe barbadensis
(accelerates external skin wound healing)
Anacyclas pyrethium Balsamodendron mukul
(antiviral) Valeriana walchi. -
16Treatment and Management
-
- Septogard (D/H) (tablets and syrup)
-
- Natural antibiotic
- Increases dryness and heat therefore reducing
phlegmatic humouralso concocts phlegmatic
humour. -
- Active Ingredients
- Balsamodendron mukul- alterative, antiviral,
antibacterial, expectorant, mucous membrane
healing. -
- Tinospora cordifolia Alterative, antiperiodic,
bittter tonic, diuretic and febrifuge properties -
- Maharasnadi quath It is a decoction, containing
Vanda roxburghii. It has analgesic,
antiphlogistic, antipyretic and immunostimulant
properties. -
-
-
17Treatment 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
- Capparic spinosa Bitter, aperient, diuretic,
expectorant properties. - Cichorium intybus Hepatoprotective, fever,
vomiting, abdominal pain, - anti-inflammatory.
- Solanum nigrum Treats cirrhosis, has emollient,
diuretic,antiseptic,laxative - properties.
- Terminalia arjuna Reduces hypertriglyceremia
18Treatment and Management
- Barshasha (M/H) Unavailable in SA
- Papaver somniferumAcorus calamus 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
- Swertia chirata
- Astringent, tonic, febrifuge properties
19Treatment 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.
20Alternative 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
21Alternative 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/thym
e/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.
22Alternative 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.
23Prognosis
-
- The rash and pain usually subside within three
to five weeks, but about one in five patients
develops a painful condition called postherpetic
neuralgia, 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 cranial
neuropathies, 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
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