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Shingles

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Title: Shingles


1
Shingles
  • Unani Tibb
  • 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 micrographApprox. 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 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.

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
  •  
  • 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.

16
Treatment 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.
  •  

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
  • 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

18
Treatment 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

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/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.

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 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

25
  • The End
  • Thnx
  • gt)
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