Acute herpes zoster treated with surrounding fire needling combined with electroacupuncture at Jiājĭ (夹脊EX-B2): A randomized controlled trial

Objectives

To investigate the clinical efficacy of surrounding fire needling combined with electroacupuncture (EA) at Jiājĭ (夹脊EX-B2) on acute herpes zoster, and explore the potential mechanism of this combined treatment by measuring the changes of serum inflammatory cytokines and pain mediators.

Methods

Sixty patients with acute herpes zoster were randomly assigned to either acupuncture plus western medicine group or western medicine group. In the western medicine group, the patients took orally mecobalamin and ganciclovir for 14 consecutive days. In the acupuncture plus western medicine group, on the base of the western medicine, the surrounding fire needling (fire needling was operated swiftly toward the center of skin lesions.) combined with EA at EX-B2 was provided. Acupoints of EX-B2 were selected based on the nerve ganglion corresponding to the skin lesions, as well as two adjacent nerve ganglions(one level upwards and one downwards) to the lesions, and were stimulated with EA once daily for 14 days. The change of symptoms from the blister eruption to scabbing and decrustation were observed. The score of visual analogue scale (VAS), serum inflammatory cytokines (interleukin-1β, interleukin-6, tumor necrosis factor-α) and pain mediators (calcitonin gene related peptide, substance P) before and after treatment, the scores of Pittsburgh sleep quality index (PSQI) and Hamilton depression scale (HAMD) before and after treatment as well as at 1 month of follow-up, and the overall effective rate and the incidence of post-hepatic neuralgia at 1 month of follow-up were assessed and compared between two groups, respectively.

Results

After treatment completion, the time of blister relief, scabbing and decrustation in the acupuncture plus western medicine group was significantly shorter when compared with that of the western medicine group (all P < 0.05). After treatment, VAS score, PSQI score and HAMD score were all reduced significantly when compared with that before treatment within group (P < 0.05). These scores in the acupuncture plus western medicine were reduced significantly compared with the western medicine group at the same time point (all P < 0.05). After treatment, the incidence of post-hepatic neuralgia was 6.89%, lower than that in western medicine group (50.00%, P < 0.05). After treatment, the values of serum inflammatory cytokines (IL-1β, IL-6, TNT-a) and pain mediators (CGRP, SP) were reduced when compared with the those before treatment within group (P < 0.05), and the reduction in the acupuncture plus western medicine group was larger than that in the western medicine group (P < 0.05). The total effective rate was 96.67% in the acupuncture plus western medicine group, higher than western medicine group (86.67%, P < 0.05).

Conclusions

Surrounding fire needling therapy combined with EA at EX-B2 on the base of western medicine obtained better therapeutic effect on acute herpes zoster when compared with western medicine. This combined treatment may effectively relieve pain and depressive emotions, improve sleep quality and reduce the incidence of post-hepatic neuralgia. The underlying mechanism may related to regulation of pain mediators and reduction of inflammatory cytokines.