Case Study: Herpes Zoster with a Background of Cancer
By Jin Zhao DTCM
Recorded by Inbar Cohen Licensed Acupuncturist
The patient: A 71-year-old male with a history of lung cancer and metastases to the thyroid gland. In the past two days, he has suffered from herpes zoster with an outbreak around his waist. He is taking Western medication and is in the recovery process. Sweating exacerbates the itching on his skin.
Herpes Zoster part 1
Herpes zoster part 2
Additional Symptoms:
Difficulty sleeping
Foamy urine
Pain all over the body when it is cold. Additionally, pain in his fingers and a swollen pain in his lower back.
Coughing with white, sticky, and hard-to-excrete sputum
Post-nasal drip
A burning sensation in the thyroid gland
Medical History:
Underwent chemotherapy and radiation to treat cancer
Previously had pleural effusion
Type 2 diabetes
Currently, his white blood cell count is normal
Pulse: Wiry, slippery, fast, a little weak
Tongue: Pale with a slightly red tip, small cracks, and a dry, oily, and thin coating.
The prescription:
Jing Jie 10
Fang Feng 10
Zhu Ye Chai Hu 10
Jiu Chuan Xiong 5
Fu Ling 20
Sheng Jiang 5
Bo He 5
Ren Shen 3
Yin Chen 10
Dong Gua Zi (Ren) 20
Lu Gen 20
Huo Xiang 20
Bai Zhi 10
Explanation and Analysis:
When discussing herpes zoster, we often talk about an external pathogen,usually involving the Shao Yang in one variation.
Many Chinese medicine practitioners tend to prescribe very cold herbs, such as Long Dan Xie Gan Tang. However, in this patient’s case, there are no signs of excessive heat, but rather indications of wind and cold. Choosing such a prescription would not only fail to address the condition but could also weaken the patient’s Qi.
Based on the chosen prescription, we can see that in Dr. Jin’s view, the pathogen in this case resides in both Tai Yang and Shao Yang.
This patient has a history of cancer, chemotherapy, and radiation treatments. While his white blood cell count is currently within normal range, his medical background includes periods of immunosuppression and deficiency.
The primary formula selected for his condition is Jing Fang Bai Du San, a variation of Ren Shen Bai Du San.
The patient’s tongue appeared slightly dark in photographs, but in the clinic, it was observed as pale, and the pulse is a little weak. This is likely the reason Dr. Jin added Ren Shen, as a nod to the original formula.
Along with the formula, we see modifications that help expel the pathogen from the Shao Yang layer in various ways.
The slippery part of the pulse and the oily coating on the tongue indicate the presence of dampness, addressed throughout the prescription, primarily with aromatic and percolating (urinating) herbs.
Additionally, there are herbs addressing the Xuan Fu pores in the body at various levels, stimulating the spleen and renewing the function of the Qi mechanism, allowing the body to generate healing for itself.
Let’s review the prescription.
Jing Fang Bai Du San
Jing Jie
Fang Feng
Zhu Ye Chai Hu - Similar to Chai Hu. More common in Chengdu, where Dr. Jin practices; slightly weaker and cooler.
Jiu Chuan Xiong - Processed with alcohol
Fu Ling
Sheng Jiang
Bo He
Addition:
Ren Shen
The classic formula treats the invasion of wind cold and dampness into Tai Yang and wind dampness. In this patient, the dampness source is internal, not external; thus, the herbs Qian Hu, Du Huo, Qiang Huo, which are less suitable here, were removed.
The herb Zhi Ke was removed because there is no need for Qi movement, and Qi-moving herbs might weaken a frail patient’s Qi.
The herb Gan Cao was removed as it is sweet and might encourage further dampness production.
The herb Chuan Xiong is relevant to the patient’s pain and is particularly suitable for pain involving the exterior and the Shao Yang. It is prepared with alcohol, which makes it warmer and enhances its ability to invigorate blood in the channels.
As mentioned before, Ren Shen is added here to support the patient’s Qi, referencing the original formula Ren Shen Bai Du San.
Addressing Pathogen in Shao Yang Layer:
Yin Chen
(Zhu Ye Chai Hu)
(Bo He)
Interesting point about Yin Chen: Dr. Jin regards Yin Chen as a refined version of Huang Qin. Both are cold and bitter, clearing hot dampness from the liver and gallbladder. Their treatment approach to dampness is slightly different - Yin Chen percolate while Huang Qin dries. Yin Chen is less cold and less bitter, thus less depleting to the patient’s Qi, and serves as an updated version of the original herb.
Joined by herbs from the main formula - Zhu Ye Chai Hu, Bo He, which also help treating the pathogen in the Shao Yang.
Addressing Heat:
Lu Gen
Dong Gua Zi (Ren)
(Yin Chen)
The herb Lu Gen clears heat, manifesting in the fast pulse and the red tongue tip. The patient's tongue is dry, so Lu Gen is particularly suitable as it nourishes body fluids.
Another point for choosing this herb is that it addresses the Yang Ming layer, helping prevent the pathogen from getting deeper, currently located in Tai-Yang-Shao-Yang.
Together with Dong Gua Zi, which is slightly cool and helps drain dampness, and Yin Chen, as previously discussed.
The combination of Lu Gen and Dong Gua Zi references the formula Qian Jin Wei Jing Tang, with Chuan Xiong replacing Tao Ren, and Yin Chen replacing Yi Yi Ren. This modified formula transforms and clears phlegm-heat from the lungs while also addressing the underlying cancer.
In response to the dampness, greasy tongue coating, and rolling pulse, the diuretics Dong Gua Zi and Yin Chen are supported by Fu Ling, which is included in the primary formula.
Exterior-releasing herbs addressing dampness:
Bai Zhi
Huo Xiang
The herb Bai Zhi knows how to clear dampness from the nasal passages, helps with the cough, and the post-nasal drip. Additionally, it helps with pain.
The herb Huo Xiang is aromatic and transforms dampness and helps stimulate the spleen to renew the body’s Qi mechanism function.
Both herbs are aromatic and warm, which means their direction is upward and outward. They are part of a group of herbs called Wind Herbs - herbs that help the clear Qi ascend, assisting in opening the body’s Xuan Fu pores.
In short, the Xuan Fu theory discusses how our body is filled with pores similar to the microscopic pores in our skin that help secrete sweat and create proper communication between the body and the external environment and nature. The internal pores in the body have a similar function. The Xuan Fu pores are located on the muscles, tendons, bones, marrow, and internal organs, facilitating the flow of Qi, blood, fluids, Shen, and Jing. When the Xuan Fu pores are open, there is continuous, good, and healthy communication among all parts of the body, allowing the body to function smoothly and heal itself. When they are blocked, the body's self-healing ability is impaired.
When Dr. Jin is treating the body's Xuan Fu pores, he helps the patient renew his self-healing capability, thus treating the root issue and not just the branch.
Looking at the prescription, nearly all the herbs are Wind Herbs. The herbs Huo Xiang + Bai Zhi join the rest of the prescription and help complete a whole therapeutic idea.