xiao chai hu tang for post-herpetic neuralgia?

January 4, 2006

Hi All,

I was pondering my elderly patient with post-herpetic neuralgia today. His

pain is along the gallbladder and san jiao channels around the ear, down the

neck, and across the ribs of his right side. This latter pain, in the ribs, is

new, even through his rash has been " healed " since late summer. His pain is

quite severe, stabbing, burning, and causes him to grab his neck or head or back

when it comes on, and he grimaces terribly. Acupuncture has lessened the

severity of his symptoms, but not enough to keep him from thoughts of dying.

His health is complicated by severe COPD and emphysema. His pulse is rapid,

wiry, choppy, and shakes quite alot. Today for the first time, it was more

deficient and weak than excess. His tongue is enlarged, quite deviated, and

deeply reddish-purple; in the past he exhibited a thick, yellow, dry,

cottage-cheesy coat, but today it was almost a mirror tongue with a small patch

of thick dry coat in the rear.

In the past 2 weeks he as been on a high dose of a drug called lyrica, to

control the pain, and discontinued his acupuncture treatments. During this

time, his symptoms became more severe, and he developed the new area of pain

along the ribside. I suspect the changes in his tongue and pulse are also due

to the medication, as I can find no other logical explanation.

As I was noticing the involvement of the gallbladder and san jiao channels, I

found myself thinking of his case of shingles as a shao yang type of disease,

and so the question came to mind: can xiao chai hu tang be useful in his case?

Has anyone used xiao chai hu tang for this type of presentation or anything

similar? I have not recommended herbs to date due to the large number of

prescription medicines his doctors have him taking, but if he is saying life

isn't worth living with this pain, I think it may be appropriate to offer herbal

medicine.

Thank you for your assistance,

Photos

Ring in the New Year with Photo Calendars. Add photos, events, holidays,

whatever.

January 4, 2006

My first thought would be that the mirror tongue and weakened pulses

are indicating Yin damage, whether from progression of the Interior

Heat or from medication side effects, or both. In any case, xiao chai

hu tang would not seem to be appropriate, as it may likely aggravate

the Yin Deficiency even more.

How about considering a formula like Artemisia Annua and Soft-shelled

Turtle Shell [Qing- Hao\ Bie- Jia~ Tang-] or Clear the Nutritive

Level Decoction [Qing- Ying/ Tang-]? (Artemisia Annua will vent heat

from the ShaoYang without damaging the Yin.) With perhaps a few

cooling blood-movers added like dan shen and chi shao, since there

seems to be a relatively severe blood stasis (stabbing pains, purple

tongue hue, choppy pulse). Without enough cooling blood movers, an

ordinary Yin-tonic+Clear Heat Toxins formula might not work well,

because the Blood Stasis prevents the herbs' effects from penetrating

the affected tissues.

I've used tu fu ling (Rz Smilacis Glabrae) with good results for

herpes associated with Heat Toxin signs, which would seem to fit here

also.

---Roger Wicke PhD

Rocky Mountain Herbal Institute