Shingles - Wokingham, Berkshire

On this page

1. Overview
2. Symptoms
3. Causes
4. Shingles in Chinese medicine
5. Acupuncture for shingles
6. Postherpetic neuralgia (PHN)
7. Chinese herbal medicine for shingles
8. Self-care tips
9. Treatment at my clinic
10. Frequently asked questions
11. References

1. Overview

Shingles (herpes zoster) is a painful viral condition caused by the reactivation of the varicella-zoster virus (VZV) — the same virus that causes chickenpox. After a person recovers from chickenpox, VZV does not leave the body; it lies dormant in the sensory nerve ganglia along the spinal cord. When the immune system is sufficiently weakened — by ageing, illness, stress, immunosuppressive medication or other factors — the virus reactivates, travels down the sensory nerve to the skin and causes the characteristic unilateral, dermatomal rash and severe nerve pain of shingles. It is estimated that around one in three people will develop shingles in their lifetime, with an incidence of 3–5 per 1,000 person-years rising to 6–12 per 1,000 per year in people aged over 60.

Conventional treatment relies on antiviral drugs (aciclovir, valaciclovir, famciclovir), which must be started within 72 hours of rash onset to be most effective, alongside analgesics for pain relief. However, antivirals do not reliably prevent the most serious complication of shingles — postherpetic neuralgia (PHN) — a chronic, debilitating nerve pain that persists for months or years after the rash has healed and affects up to 20% of shingles patients over 60. Acupuncture and Chinese herbal medicine are effective treatments for both the acute phase of shingles and for preventing and treating postherpetic neuralgia. A systematic review and meta-analysis of 11 studies involving 1,156 patients found that acupuncture significantly reduced the incidence of PHN (OR=0.07) compared to conventional medicine — meaning patients treated with acupuncture were far less likely to develop this debilitating long-term complication. A 2024 network meta-analysis of 59 RCTs involving 3,930 patients confirmed the superiority of acupuncture combined with pricking and cupping over pharmacotherapy alone.

2. Symptoms

Shingles produces a characteristic sequence of symptoms that follow the course of the affected sensory nerve, always confined to one side of the body (unilateral) in a dermatomal distribution:

1. Prodromal symptoms (1–5 days before rash) — pain, burning, tingling, itching or numbness in the area of skin supplied by the affected nerve, often before any visible skin changes; flu-like symptoms including fever, fatigue and headache may accompany the prodrome; the prodromal pain is frequently misdiagnosed as musculoskeletal pain, pleurisy or other conditions depending on the nerve affected
2. Rash and blisters — a unilateral, band-like rash of red patches and fluid-filled blisters appears in the dermatomal distribution of the affected nerve; the rash most commonly affects the thoracic dermatomes of the trunk (causing a painful stripe around one side of the chest or abdomen), but can affect the face (trigeminal nerve, including the eye in herpes zoster ophthalmicus), neck, arm or leg; the blisters typically crust over and heal within 2–4 weeks
3. Acute pain — severe, burning, stabbing or electric-shock pain along the affected dermatomal distribution is the dominant symptom throughout the rash phase; the pain is typically disproportionately intense relative to the appearance of the rash and can be incapacitating; it is caused by direct VZV-induced inflammation and damage of the sensory nerve
4. Allodynia and hyperalgesia — the skin in the affected dermatome becomes exquisitely sensitive; even light touch (allodynia), clothing contact or temperature change causes intense pain; this hypersensitivity reflects the central sensitisation and nerve damage produced by the virus in the sensory ganglion
5. Postherpetic neuralgia (PHN) — the most feared and debilitating complication; pain that persists in the affected dermatome for more than 90 days after the acute rash onset; affects 10–20% of all shingles patients and up to 30% of those over 60; the pain can last months or years and is characterised by constant burning pain, intermittent stabbing or electric-shock pain and severe allodynia that severely impairs sleep, mood, daily function and quality of life. See section 6 below
6. Other complications — herpes zoster ophthalmicus (VZV affecting the ophthalmic branch of the trigeminal nerve) can cause eye complications including keratitis and vision loss; Ramsay Hunt syndrome (VZV affecting the facial nerve) causes facial paralysis, ear pain and hearing loss; rarely, shingles can cause encephalitis, stroke or pneumonia in immunocompromised individuals

3. Causes

Shingles is caused by the reactivation of the varicella-zoster virus that has lain dormant in the sensory ganglia since the original chickenpox infection (which may have occurred decades earlier). The key factor determining whether the dormant virus reactivates is the state of the person’s cell-mediated immunity. Factors that weaken immunity and trigger reactivation include:

1. Ageing and immune senescence — the most important risk factor; VZV-specific cell-mediated immunity declines progressively with age, explaining the dramatic rise in shingles incidence in people over 60; about one in two people who live to the age of 85 will develop shingles
2. Psychological stress — sustained psychological stress significantly suppresses cell-mediated immunity, including VZV-specific T-cell responses; acute and chronic stress are recognised clinical triggers for shingles reactivation; this is directly relevant to TCM treatment, as addressing stress and supporting the immune system are central goals of acupuncture and herbal treatment
3. Immunosuppression — any condition or medication that suppresses the immune system significantly increases the risk of shingles; this includes HIV infection, cancer chemotherapy, corticosteroid therapy, organ transplant immunosuppression and biologics used in autoimmune diseases such as rheumatoid arthritis
4. Illness and physical depletion — any significant illness, surgery, injury or period of physical depletion that taxes the immune system can trigger shingles reactivation; in TCM terms, these all deplete Zheng Qi (correct/upright Qi) and allow the latent pathogenic factor to emerge
5. Fatigue and chronic fatigue — states of constitutional depletion and persistent fatigue weaken the body’s defensive Qi (Wei Qi), reducing its capacity to contain the dormant virus

4. Shingles in Chinese medicine

In traditional Chinese medicine, shingles is described as a “latent pathogen” (fu xie) condition — a pathogenic factor that was not fully expelled from the body during the original chickenpox infection, instead becoming lodged in the channels and waiting for a period of constitutional weakness to re-emerge and cause disease. This TCM understanding closely mirrors the modern virological explanation of VZV lying dormant in the sensory ganglia and reactivating when cell-mediated immunity falls. The classical Chinese term for shingles is “chan yao huo dan” (wrapping fire cinnabar) or “she chuan chuang” (snake thread sore), reflecting the band-like, burning, snake-like course of the rash along the dermatomal distribution. The most common TCM patterns in shingles are:

1. Liver-Gallbladder Damp-Heat (most common acute pattern) — the dominant pattern in most acute shingles presentations; shingles most commonly affects the thoracic and lumbar dermatomes which correspond to the Liver-Gallbladder channel distribution; when Liver Qi stagnates (due to emotional stress, frustration or anger) and transforms into Heat, combined with pre-existing Dampness, the resulting Damp-Heat pours into the Liver-Gallbladder channels and erupts to the skin surface as the hot, burning, vesicular shingles rash; the severe burning pain, redness and vesicles are expressions of Fire and Damp-Heat in the Liver channel; emotional stress as a trigger for shingles reactivation maps directly onto the TCM Liver Qi stagnation—Damp-Heat pathological progression. Treatment clears Liver-Gallbladder Damp-Heat, cools Blood and relieves pain
2. Spleen Damp with Heat (milder acute pattern) — seen in patients with constitutional Spleen deficiency and Damp accumulation where the rash is less intensely red, with more prominent vesicles, oozing and swelling; the Damp component is more pronounced than the Heat; treatment strengthens the Spleen, resolves Damp and clears mild Heat
3. Latent pathogen emerging from constitutional deficiency — the fundamental TCM explanation for shingles reactivation; the body’s Zheng Qi (upright/correct Qi) — the sum of its defensive and immune functions — has been depleted by ageing, illness, stress or overwork; when Zheng Qi is insufficient, the latent pathogenic factor (fu xie) that has been lurking in the channels since the original chickenpox infection is no longer held in check and erupts to the surface; treatment simultaneously expels the emerging pathogen and tonifies Zheng Qi to prevent further eruption
4. Qi-Blood stagnation in the channels with residual Heat (postherpetic neuralgia) — the dominant TCM pattern in postherpetic neuralgia; after the acute rash phase, the viral inflammation damages the sensory nerve and leaves Heat and Blood stagnation trapped in the channels of the affected dermatome; this produces the fixed, burning, stabbing nerve pain, skin hypersensitivity and allodynia of PHN; the residual Heat and Blood stagnation obstruct Qi and Blood flow in the local channels, perpetuating the pain long after the rash has healed. Treatment moves Blood, resolves stasis, clears residual Heat and opens the collaterals to restore normal Qi and Blood flow in the affected channels
5. Qi and Blood deficiency with channel malnourishment (late-stage PHN) — in long-standing PHN, chronic pain and the underlying constitutional depletion that triggered the original reactivation lead to progressive Qi and Blood deficiency; the depleted channels fail to nourish and regulate the affected skin and nerve; the pain becomes more aching and less intense, the skin loses its vitality, and the patient develops insomnia, fatigue and anxiety; treatment tonifies Qi and Blood, nourishes the channels and continues to resolve the residual stasis

5. Acupuncture for shingles

Traditional acupuncture helps people suffering from shingles by directly addressing the underlying TCM patterns, boosting the immune system, relieving acute pain and — critically — significantly reducing the risk of developing postherpetic neuralgia. Both the acute phase (rash and pain) and the post-rash PHN phase respond well to acupuncture treatment. Specific treatment approaches include:

1. Surrounding needling (围刺 wei ci) — a classical acupuncture technique specifically for shingles in which needles are placed around the perimeter of the rash and along the affected dermatome, encircling the affected channels; this technique directly opens the local channels, disperses the Damp-Heat pathogen trapped in the skin, promotes healing of the blisters and rash, reduces local inflammation and relieves acute pain
2. Channel point treatment — acupuncture at principal Liver-Gallbladder clearing points (LV2 Xingjian, LV3 Taichong, GB34 Yanglingquan, GB41 Zulinqi) clears Liver-Gallbladder Damp-Heat; at Blood-cooling and Heat-clearing points (SP10 Xuehai, LI11 Quchi, BL17 Geshu); at immune-supporting points (ST36 Zusanli, SP6 Sanyinjiao, CV4 Guanyuan) to tonify Zheng Qi and support immune function
3. Pricking and cupping (刺络拔罐 ci luo ba guan) — a specialised TCM technique in which fine needles or a lancet are used to prick specific points along the affected dermatome, followed immediately by cupping; this powerfully expels the Damp-Heat pathogen from the skin, drains the Fire from the local channels, reduces the inflammatory blister fluid, promotes rapid healing of the rash and is one of the most effective techniques for preventing PHN; the 2024 network meta-analysis of 59 RCTs confirmed that electroacupuncture combined with pricking and cupping was the most effective approach for pain relief and healing speed in acute herpes zoster
4. Fire needling (火针 huo zhen) — a specialised technique in which needles are briefly heated in a flame before rapid insertion; fire needling directly burns out Damp-Heat from the rash vesicles, promotes rapid drying and crusting of blisters and has specific evidence for preventing PHN; fire needling at and around the shingles rash is used in both the acute phase and in early PHN
5. Immune support and constitutional treatment — beyond the local treatment of the rash and affected dermatome, acupuncture addresses the constitutional Zheng Qi deficiency that allowed the latent pathogen to emerge; regular acupuncture at ST36 (Zusanli), SP6 (Sanyinjiao), CV4 (Guanyuan) and BL23 (Shenshu) supports immune function, strengthens the body’s resistance and helps prevent future reactivation

Research evidence

A systematic review and meta-analysis by Qi et al. (2022), published in the Annals of Palliative Medicine, included 11 studies with 1,156 patients and found that acupuncture significantly outperformed conventional Western medicine treatment in total treatment efficiency (OR=6.76; 95% CI: 3.46–13.21), dramatically reduced the incidence of postherpetic neuralgia (OR=0.07; 95% CI: 0.02–0.21), and significantly shortened pain-relief time (MD −2.17 days), shingles duration (MD −1.61 days) and scabbing time (MD −1.62 days). A network meta-analysis by Liang et al. (2024), published in Medicine (Baltimore), included 59 RCTs with 3,930 patients from 9 databases and found that electroacupuncture combined with pricking and cupping was the most effective treatment combination for improving VAS pain scores and accelerating rash healing in acute herpes zoster. An earlier case report by Kotlyar et al. (2010) documented the successful use of traditional Chinese acupuncture to relieve pain and skin rash associated with shingles in a 67-year-old patient.

6. Postherpetic neuralgia (PHN)

Postherpetic neuralgia is the most important and debilitating complication of shingles — chronic nerve pain that persists in the affected dermatome for more than 90 days after the acute rash onset. It affects 10–20% of all shingles patients, rising to 30% in those over 60, and can last for months or years. The pain is characterised by constant burning or aching, intermittent stabbing or electric-shock pain, severe allodynia (where even the lightest touch of clothing triggers intense pain), and hyperalgesia. PHN severely impairs sleep, mood, concentration and daily activities; depression, anxiety and insomnia are common co-morbidities.

Acupuncture is particularly important for PHN for two reasons. First, it dramatically reduces the risk of PHN developing in the first place: the SR/MA by Qi et al. (2022) found an OR of 0.07 for PHN incidence with acupuncture — indicating that patients who receive acupuncture during acute shingles are far less likely to develop PHN than those treated with antivirals alone. Second, for established PHN, acupuncture is one of the most effective available treatments. In TCM, PHN corresponds to Qi-Blood stagnation in the channels with residual Heat; acupuncture moves Blood, resolves stasis, clears residual pathogenic Heat and opens the collaterals to restore normal Qi and Blood flow, directly addressing the neuropathic pain mechanism. A Bayesian network meta-analysis of acupuncture therapies for PHN (Cui et al. 2023) searched 8 databases and confirmed that multiple acupuncture modalities — including electroacupuncture, fire needling, warm needling and surrounding acupuncture — are effective for PHN. Chinese herbal medicine also plays an important role in PHN treatment, providing daily systemic treatment to clear residual Heat and Blood stagnation.

7. Chinese herbal medicine for shingles

Chinese herbal medicine is highly effective for both acute shingles and postherpetic neuralgia, providing daily systemic treatment that clears the Damp-Heat pathogen, cools Blood, relieves pain and supports immune function. Dietary and lifestyle advice alongside Chinese herbs boosts the body’s immune system, helping it fight the virus and prevent complications. Classical formulae used in TCM treatment of shingles include:

1. Long Dan Xie Gan Tang (Gentiana Drain the Liver Decoction) modifications — the principal formula for Liver-Gallbladder Damp-Heat; powerfully clears Liver and Gallbladder Heat, drains Damp-Heat downward and cools Blood; directly addresses the dominant acute shingles pattern; contains Long Dan Cao (Gentiana scabra), Huang Qin (Scutellaria baicalensis), Zhi Zi (Gardenia), Ze Xie (Alisma), Mu Tong (Akebia), Che Qian Zi (Plantago), Chai Hu (Bupleurum), Sheng Di Huang (Rehmannia), Dang Gui (Angelica sinensis) and Gan Cao (Licorice); clinical research confirms strong antiviral and anti-inflammatory actions of many constituents of this formula
2. Pi Fu Bing Xue Du Wan (Skin Disease Blood Toxin Pills) modifications — clears Heat-Toxin from the Blood and skin, cools Blood and relieves itching and pain; used when Heat-Toxin is prominent with intensely burning, vesicular rash; combines Blood-cooling and Heat-clearing herbs such as Sheng Di Huang, Chi Shao (red Paeonia), Mu Dan Pi (Cortex Moutan), Jin Yin Hua (Lonicera), Lian Qiao (Forsythia) and Ban Lan Gen (Isatis root)
3. Xue Fu Zhu Yu Tang (Drive Out Blood Stasis from the Mansion of Blood) modifications — the primary formula for postherpetic neuralgia (Qi-Blood stagnation pattern); moves Blood, resolves stasis and opens the collaterals to relieve the fixed, stabbing or burning nerve pain of established PHN; contains Tao Ren (Prunus persica), Hong Hua (Carthamus), Dang Gui, Sheng Di Huang, Chuan Xiong (Ligusticum), Chi Shao, Niu Xi (Achyranthes), Jie Geng (Platycodon), Chai Hu, Zhi Ke (Citrus aurantium) and Gan Cao; modified with Yan Hu Suo (Corydalis) — one of the most powerful single herbs for nerve pain in the Chinese pharmacopoeia — and Di Long (Earthworm) to open the collaterals
4. Ba Zhen Tang (Eight Treasure Decoction) modifications — for late-stage PHN with pronounced Qi and Blood deficiency; tonifies both Qi and Blood simultaneously to nourish the depleted channels, improve sleep and energy, and support continued pain relief alongside Blood-moving herbs; particularly appropriate for older, debilitated patients with long-standing PHN and significant fatigue, insomnia and mood disturbance

Herbs are prescribed as pharmaceutical-grade granules from Sun Ten (Taiwan), dissolved in warm water and taken daily. An online Chinese herbal consultation is available for patients who cannot attend the clinic in person.

8. Self-care tips

The following measures help manage shingles symptoms and support recovery:

1. Seek treatment promptly — both antiviral medication (which is most effective within 72 hours of rash onset) and acupuncture treatment should be started as early as possible in the shingles episode; early treatment dramatically reduces the severity of the acute illness and — crucially — reduces the risk of developing postherpetic neuralgia; do not wait for the rash to fully develop before seeking help if you suspect shingles
2. Rest and support the immune system — shingles is a sign that the immune system is depleted; adequate rest, sleep and reduction of all non-essential demands is important during the acute phase; overworking, staying up late and continuing to exercise intensively all further deplete Zheng Qi and prolong the illness
3. Keep the rash cool and covered — keep the affected area clean and covered with a non-stick, non-adhesive dressing; cool (not cold), damp compresses can reduce the burning discomfort of the rash; avoid scratching, which can introduce secondary bacterial infection; avoid tight clothing over the rash, which worsens allodynia
4. Avoid contact with vulnerable people — while shingles itself is not directly contagious (you cannot catch shingles from someone with shingles), a person with active shingles can transmit the varicella-zoster virus to someone who has never had chickenpox or who is immunocompromised, causing chickenpox in them; avoid close contact with pregnant women who have not had chickenpox, newborns and immunosuppressed individuals until all blisters have crusted over
5. Diet for Damp-Heat and immune support — during acute shingles, avoid damp-forming and heating foods that worsen the Liver-Gallbladder Damp-Heat pattern: alcohol, fatty/fried foods, spicy food, sugar, shellfish and rich dairy; eat cooling, Damp-clearing foods: bitter gourd, mung beans, lotus root, chrysanthemum tea, barley water and green vegetables; include immune-supporting foods: ginger, garlic, shiitake mushrooms, astragalus (huang qi) soup; adequate hydration is important. See Chinese food therapy for further guidance
6. Manage stress — since stress is a major trigger for shingles reactivation and worsens Liver Qi stagnation — the TCM pattern underlying the Damp-Heat that drives acute shingles — stress reduction is both a preventive and therapeutic measure; regular acupuncture, adequate sleep and mindfulness support immune function and help prevent future reactivation
7. Post-rash care for PHN prevention — continue acupuncture treatment after the rash has healed if any nerve pain persists; the window between rash resolution and the establishment of entrenched PHN is an important treatment opportunity; early and consistent acupuncture in the post-rash phase moves Blood stagnation and clears residual Heat before the PHN pattern becomes fixed and harder to treat

9. Treatment at my clinic

I treat shingles and postherpetic neuralgia at my clinic in Wokingham, Berkshire. Treatment combines acupuncture (including surrounding needling, pricking and cupping, and electroacupuncture) with Chinese herbal medicine, tailored to the specific TCM pattern — whether Liver-Gallbladder Damp-Heat in the acute phase, Qi-Blood stagnation for PHN, or Qi-Blood deficiency in late-stage disease. Acupuncture treatment works alongside, and not instead of, conventional antiviral treatment and should be started as early as possible for best results. Related conditions co-treated alongside shingles include nerve pain, insomnia, anxiety, depression and stress.

Visit the prices page for treatment costs or book an online Chinese herbal consultation if you cannot attend in person.

10. Frequently asked questions

Can acupuncture help shingles?

Yes — acupuncture is an effective treatment for both the acute phase of shingles and postherpetic neuralgia. A systematic review and meta-analysis of 11 studies with 1,156 patients found that acupuncture significantly outperformed conventional Western medicine in total treatment efficiency (OR=6.76), dramatically reduced the incidence of postherpetic neuralgia (OR=0.07) and significantly shortened pain-relief, shingles duration and scabbing times. A 2024 network meta-analysis of 59 RCTs with 3,930 patients confirmed the superiority of acupuncture combined with pricking and cupping over pharmacotherapy for pain relief and healing speed.

What is postherpetic neuralgia?

Postherpetic neuralgia (PHN) is chronic nerve pain that persists in the affected skin area for more than 90 days after the shingles rash has healed. It is caused by nerve damage inflicted by the varicella-zoster virus during the acute infection, leaving the sensory nerves sensitised and firing abnormally. PHN affects up to 20% of shingles patients overall and up to 30% of those over 60, and can last for months or years. In TCM, it is understood as Qi and Blood stagnation with residual Heat trapped in the channels of the affected dermatome. Acupuncture is one of the most effective treatments available for PHN, moving Blood stagnation, clearing residual Heat and restoring normal Qi flow in the damaged channels.

Can acupuncture prevent postherpetic neuralgia?

Evidence strongly suggests that starting acupuncture during the acute phase of shingles dramatically reduces the risk of developing postherpetic neuralgia. The 2022 systematic review and meta-analysis by Qi et al. found an OR of 0.07 for PHN incidence in patients treated with acupuncture compared to those treated with conventional medicine alone — indicating a dramatic reduction in PHN risk. The mechanism involves clearing the Damp-Heat pathogen and moving Blood before permanent nerve sensitisation can become established. Treatment should be started as early as possible in the acute rash phase for maximum effect.

What Chinese herbs are used for shingles?

Chinese herbal medicine for acute shingles centres on formulae that clear Liver-Gallbladder Damp-Heat, the dominant TCM pattern. Long Dan Xie Gan Tang modifications powerfully clear Liver Heat and drain Damp-Heat, directly addressing the burning rash and severe pain. For postherpetic neuralgia, Xue Fu Zhu Yu Tang modifications move Blood, resolve stasis and open the collaterals, combined with Yan Hu Suo (Corydalis) for nerve pain and Di Long (Earthworm) to open the channels. All herbs are prescribed as pharmaceutical-grade Sun Ten granules, taken daily.

How soon should I start acupuncture treatment for shingles?

As early as possible — ideally within the first few days of the rash appearing, concurrent with starting antiviral medication. The earlier acupuncture treatment is started during the acute phase, the more effectively it reduces the severity of the acute illness and — most importantly — reduces the risk of postherpetic neuralgia developing. The window between acute rash onset and the establishment of chronic PHN is a critical treatment opportunity. Even starting acupuncture after the rash has healed can prevent or reduce PHN if residual nerve pain is present.

11. References

Liang XY, Chen X, Li XM, Yang S, Wang SY, Ma DD, Guo MM, Zhang H. Efficacy and safety of therapies related to acupuncture for acute herpes zoster: a PRISMA systematic review and network meta-analysis. 59 RCTs, 3,930 patients, 9 databases to December 2022; electroacupuncture + pricking and cupping showed best efficacy for VAS score and date of cessation of herpes increase. Medicine (Baltimore). 2024 May 17;103(20):e38006. doi: 10.1097/MD.0000000000038006. PMID: 38758864.

Qi T, Lan H, Zhong C, Zhang R, Zhang H, Zhu F, Ji B. Systematic review and meta-analysis: the effectiveness and safety of acupuncture in the treatment of herpes zoster. 11 studies, 1,156 patients; acupuncture significantly better total treatment efficiency (OR=6.76; 95% CI: 3.46–13.21); PHN incidence OR=0.07 (95% CI: 0.02–0.21); pain-relief time MD −2.17 days; shingles time MD −1.61 days; scabbing time MD −1.62 days. Ann Palliat Med. 2022 Feb;11(2):756–765. doi: 10.21037/apm-22-109. PMID: 35249352.

Kotlyar A, et al. Use of Traditional Chinese Acupuncture for Treatment of Pain and Skin Rash Associated with Shingles in a 67-Year-Old Patient: A Case Report. Deutsche Zeitschrift für Akupunktur. 2010;53(3):27–30.