Nghiên cứu đặc điểm lâm sàng, yếu tố liên quan và hiệu quả của điện châm kết hợp acyclovir trong điều trị bệnh zona tt tiếng anh

INTRODUCTION
Shingle (Herpes Zoster) is a common disease among skin viral
infections. It is caused by a virus in skin and nerve called Varicella Zoster
Virus (VZV). The condition makes up 10-20% of the population and it can
occur in any season of the year. Anyone at any age can be subceptible to
shingle but aldults are the most likely.
Pain is the most predominal symptom of shingle. Primary pain is
neuralgia due to loss of fibric nerve Myelin, causing great damage and
neurologic symptoms and affecting the patient’s life quality. Especially, it
may leave aftereffects and the most common is postherpetic neuralgia.
Modern medicine has effective drugs and plan treatments for Zona but the
the time to pain relief is still long-lasting, the rate of postherpetic neuralgia
aftereffect is high. Particularly, a few drugs have such side effects as
digestive disorders, dizziness, etc. that they can be contraindicated.
Up to the present, Acyclovir has always been considered as the first
choice to treat shingle. Additionally, many studies have proved that
acupuncture is quite effective for pain relief, anti-inflammatory, trauma
healing and nerve recovery. Therefore, a study of clinical features and
related factors and the effectiveness of electronic acupuncture in
combination of acyclovir in shingle treatment was conducted.
Objectives of the Study:
1. To identify clinical features and some factors related to Shingle
hospitalization treatment in Friendship Hospital from March 2016 to March
2018.
2.To evaluate efficacies of the treatments with a combinations of electroacupunture of acyclovir in shingle.
3.To evaluate the changes of peri clinical vectors in pre- and post-shingle
treatment.

1

Practical Significance and Contribution of the Study
Shingle is a viral skin infection caused by Varicella Zoster virus
causing skin lesion and pain in the nerve. The condition affects quality of
life and may leave the patient with a lot of nerve after effects ADN
discomfort.
There have been many cures for the ailment in medicine where
using Acyclovir is always considered the first choice. With other drugs
although they are effective, the time to pain relief is still long-lasting and
the rate of patients with of postherpetic shingle is high. Besides medicines,
acupuncture especially electronic acupuncture is a classic method to deal
with pain - one of the main shingle symptoms. Thus, the combination of
electronic acupunture and Acyclovir is a proper way to cure this condiction.
The thesis has a practical significance in research of zona treatment
with traditional and modern medicine. It also has a scientific significance in
the need to identify the effectiveness of electronic acupuncture in
combination of modern drug - a new therapy for shingle.
In addtion to the effectiveness evaluation of the combination therapy,
the study also has a new contribution to the survey about pain scales made
by ANI (Analgesia Nociception Index) - a machine that measures pain
scales used in and post surgery in oncology hopitals. The changes in betaendorphin and cortisol levels after using electronic acupuncture in
combination of acyclovir are basis points in explaining the effectiveness of
electronic acupuncture in shingle treatment.
Thesis Layout
The thesis includes 129 pages: the rationale is 02 pages long; the literature
review is 36 pages; the research population and method is 19 pages, the
results is 33 pages; the discussion is 36 pages; the conclusion is 02 pages;
the recommedation is 01 page. There are 135 references including 56
references in Vietnamese, 73 in English and 16 in Chinese, 17 figures, 45
tables, 05 graphs and 06 appendixes in the thesis.
2

CHAPTER 1 OVERVIEW
1.1. Modern Medicine
1.1.1. Concepts of Shingle
Shingle (Herpes Zoster) is caused by Varicella - Zoster virus
(VZV). The condition is related to the damage to the nerves and skin. It
occurs in any sex, race and age but those over 50 are more likely to get it.
1.1.2. Pathogenetic Mechanism
In 1991, Agut supposed that VZV spreads through the upper
respiratory tract in which it multiplies and is transported by lymphocytes to
the reticuloendothelial system then enters the blood after 5 days, causing
the initial virus infection in the blood. The virus stays located in the liver,
pancreas and the blood resulting in the secondary viral blood infection and
chickenpox.
The virus being along with the sensory nerve roots travels towards
the sympathetic ganglia and lies dormant there. The VZV reactivates to
cause shingle with proper conditions. The virus multiplies in the
sympathetic ganglia, causing infections and gangrene in nerve cells,
followed by the onset of pain in the patient. Afterward, the virus moves
centrifugally along sensory nerves, producing inflammation of the nerves
and skin leading to skin lesions.
VZV causing trauma to sensory nerve cells at the affected skin area, is
attached to the large diameter myelinated fibers and makes damage to
myelin sheath triggering trauma to the sensory tracts of nerve impulses.
1.1.3. Clinical Features of Shingle
The onset usually last for a few days with different kinds of pain.
Within 48h-72h after the onset, groups of rash and blisters appear rapidly.
- Basic trauma: inflammed skin on which there are red blisters (12mm), bullae (1-2cm), developed into clusters along the dorminant nerves
and ending at the linings of the body.

3


- Physical symptoms: Pain, preceding the skin lesion changes all
the time during the progresive period of the disease and even lasts for a
long time in some cases, which affects the patient life quality.
1.1.4. Treatment
Antiviral drug acyclovir is usually used to treat shingle. It has good
response within 72h after the onset of blisters. Painkillers, tricyclic
antidepressants, antiepileptics, synthetic anti-histamines and antibiotics are
also used when superinfection is present.
1.2. Traditional Medicine
1.2.1. Concepts of Shingle in Traditional Medicine
In tradictional medicine, zona belongs to the terms (blister like snake skin
leision), (rash around waist), (blister like spider net).
1.2.2. Etiology and Pathogenesis of Shingle
In tradictional medicine, it is believed that this condition is caused by toxic
infection, moisture, wind, heat pressed from hearts, lungs, livers, kidneys,
pancreas, blockage of never systems and poor blood flow. It is also
triggered by internal trauma, poor appetite, thap nhiet hoa doc (thap nhiet
hoa doc) affecting on skin. In the initial stage, the outset is mainly a
complication of thap nhiet (thap nhiet khon tro); in the middle mainly a
stage of thap doc hoa thinh (thap đoc hoa thinh) and the final stage is
mainly a complication of yin heat injury, blockage of never system and
poor blood circulation.
1.2.3. Types of Shingle in Traditional Medicine
* Thap nhiet group
- Appearance: blister during dormant periods, aching, burning pain,
malaise, poor appetite, yellow urine, dry or bulky stools, pink tongue with

yellow thrush,
rapid pulse.
* Thap doc hoa thinh group
- Appearance: blisters in activity are numerous, big and widespread, at the
back of blisters with fresh pink color accompanied with burning, pain or
blisters with mucus. The blisters may break leaking mucus accompanied
4


with headache and fever. Some symptoms appear such as malaise, dry
mouth with bitter taste, yellow unire, constipation, pink tongue with yellow
thrush, rapid pulse
* Khi tre huyet u group
- Appearance: at the terminal illness, blisters become dry and flaky.
Occasionally, throbbing pain is present as well as dry mouth, depression,
reddish tongue, bruising, pink tongue with yellow thrush, rapid pulse.
1.2.4. Concepts of acupuncture
- Concepts of acupuncture points
According to Thousand Principles of Acupunctures by Ling,
chakras are points where spiritual air is circulated, in and out, and scattered
on the whole body.
- Definition of Meridian System
The meridian system is a general concept of the jingmai or meridian
channels and the luomai or associated vessels (sometimes called
"collaterals").
Electronic acupuncture method
Acupuncture involves inserting needles into selective sites on the
surface of the body to stimulate the body to regulate the airways, clean the
bloodstream to balance the mind, body and soul. That means to recover the
physiology state, exclude pathology one and help the body work well

again.
Electronic acupuncture includes using an electrical machine to produce
an electric impulse at low frequency to stimulate and regulate the
bloodstream, muscular motor, nerves and other organs in order to boost
nutrition for organs to make a stable balance by inserting needles into sites.

5


Chapter 2 POPULATION AND METHOD
2.1. Research population
* Population
136 hospitalized Zona patients and 60 persons with medical check-ups in
the Friendship Hospital
* Diagnostic standard: based on Habif diagnostic standard
* Research samples:
- Objective 1: 136 patients diagnosed with zona and treated
- Objective 2: 120 zona patients randomly divided into 2 groups, 60
patients per each: Group I (treated with electronic acupuncture and
acyclovir), Group II (control group: treated with acyclovir and neurotin).
- Objective 3: Group I patients, Group II patients and Group III patients
(60 healthy persons with medical check-ups at the Friendship Hospital)
2.3. Research Method
* Research design
- Objective 1: descriptive cross- sectional study
- Objective 2: comparative controlled clinical trials
- Objective 3: descriptive cross- sectional study with comparative control
* Research targets
- Objective 1: age, sex, time of having a disease, trauma site, disease
dergee, other clinical symptoms, pre syndrome time, pre syndrome pain

features, disease season, other combined diseases,....
- Objective 2:
Time of recovery, time healing, variation of pain scales (VAS scales),
variation of pain point (made by ANI), patient’s sleeping time, overall
results, pain rate of postherpetic zona
- Objective 3: changes in

-endorphin levels, cortisol levles in blood,

biochemistry parameters (ure, creatinin, ALT, AST, bilirubin, glucose),
hematological parameters (red blood cells, white blood cells and platelets )
2.3. Research conducting methods
6


Standard patients are selected randomly into 2 groups:
- Research groups (Group I) Patients treated with electronic
acupuncture and acyclovir
- Outline of Acupuncture Pints: the whole body:
Hop Coc, Khuc Tri, Huyet Hai, Tuc Tam Ly
Giap Tich (infected areas)
A Thi (edge of infected areas)
- Management: a 14- day treatment course, acupuncture is once a day
for 30 minutes.
- acyclovir: 800mg x 5 times a day, every 4 hours for 7 days.
- Controlled group (Group II): patients treated with Acyclovir and
Neurontin.
- Acyclovir: 800mg x 5 times a day, every 4 hours for 7 days.
- Ointment: Cream Acyclovir 5% 5 times a day for 2 weeks.
- Neurontin: 300mg x 2 times a day, each time one table after meals

for 2 weeks.
2.4. Target evaluation methods
- skin lesion: assessing the healing degree daily and the scars as well.
- pain levels: assessing the patient’s feeling pain according to VAS scales.
- pain point assessment: made by ANI (Analgesia Nociception Index).
- sleeping time assessment: how many hours.
- assessing the variation of clinical parameters: pre and post one-week
treatment.
+ β-endorphin level and cortisol level in the blood.
+ Parameters: Ure, Creatinin, SGOT, SGPT, Bilirubin, Glucose.
+ Parameters: red blood cells, white blood cells and platelets. 
- Overall assessment: 4 degrees: good, quite good, fair, poor.
- assessment for pain rate of postherpetic shingle.
- result assessment in traditional medicine: 4 degrees: good, quite
good, fair, poor for 2 clinical features; assessment for some undesirable
side effects.
7


2.5 Data analysis: the collected data were processed by biomedical
statistical software SPSS 23.0.
2.6. Research Ethics: the study was approved by the Board for ethics in
research, Military Institue of Traditional Medicine; the patients voluteered
to get involved in the research, patient information was to be kept in top
secret; only the overall results were made public.
Chapter 3 RESEARCH RESULTS
3.1. Some related factors and clinical features of Zona patients
Table 3.2. Patient age distribution(n=136)
Age

n

%

60

2

1.47

61-70

41

30.15

71-80

66

48.53

> 80

27

19.85

Toal

136

100

Average age

74.01 ± 7.15

Most patients are over 60s; average patient age is 74.01 ± 7.15
Table 3.3. Patient distribution in time of pre syndrome pain (n=136)
Time
n
%
1 - 3 days
65
47.79
4 - 5 days
49
36.03
> 5 days
22
16.18
Total
136
100
The time for pre syndrome pain is < 5 days, accounting for 83.82%. The
time for pre syndrome pain is > 5 days (16.18%). The average time for pre
syndrome pain is 4.35 ± 1.65 days.
8

Table 3.7. Distribution of diseases related to Zona (n=136)
Disease

Turns

%

Hypertension

51

37.50

Diabetes

41

30.15

Lipid metabolism disorder

36

26.47

Gastroenterology syndromes

25

18.38

Gout and arthritis

23

16.91

Cancer

18

13.24

Asthma, bronchitis, COPD

12

8.82

Others

9

6.62

Patients with hypertension, diabetes and lipid metabolism disorder makes
up from 26.47% to 37.5%, while the ratio of patients with gastroenterology
syndromes, gout and arthritis, asthma, bronchitis and cancer is from 8.82%
to 18.38%.

Table 3.8. Patient distribution in season disease (n=136)
Season
n
%
Spring
47
34.56
Summer
36
26.47
Autumn
33
24.26
Winter
20
14.71
Total
136
100
34.56% of patients go to hopital for checkups in spring - the highest
percentage. The number of patients visiting hospital in summer and autumn
is equal while it in winter is the least (14.71%).
Table 3.9. Patient distribution in trauma location (n=136)
Location

n
9

%

chest ribs - arm
52
38.24
head face neck
36
26.48
waist
26
19.12
the small
15
11.03
others
7
5.15
Total
136
100
The trauma location in chest ribs - arm is the most common (38.24%),
followed by the location of head-face- neck (26.48%) while locations of
waist and the small is less (from 5.15% to 19.12%).
Table 3.12. Patient distribution in disease dergee(n=136)
Dergee
n
Slight
17
Mild
46
Severe

73
Total
136
The severe and mild diseases have the highest percentage
percentage of slight ones is 12.50%.
Table 3.13. Patient distribution in kind of pain (n=136)

%
12.50
33.82
53.68
100
(87.50%). The

Kinds of pain
Turns
%
throbbing
109
80.15
burning pain
95
69.85
shooting
92
67.64
numbness pain
85
62.50
paresthesia

73
53.68
tingling
68
50.00
80.15% of patients have a kind of throbbing pain while 69.85% of them
have burning pain. Moreover, paresthesia, tingling and numbness pain have
a smaller percentage.
3.2. Zona treatment results from using electronic acupunture in
combination of acyclovir on clinical practice
- Changes of pain level of two groups based on VAS

10


10
9
8

VSA scales
VAS

7
6

6.66
6.55

5.88

5

electronic
acupuncture
Drugs

4.75
4.22

4
3

2.72

2

2.28
1.95

1
0
D0

D1

D7
point of time

D14

Graph 1. Results of pain treatment based on VAS scales in two research
patient groups
On the first day (D1) and the seventh (D7), there is a sharp increase
in the average point of pain level in Group I compared with the one in
Group II. The differentiation at p < 0.05 is statistically significant. After
14-day treatment, the average point of pain level in Group I falls in
comparison with Group II but there is no differentiation at p > 0.05.

11


Table 3.24. Comparison
Resul
t

of pain point in research groups

Group I
(n=60)

Group II
(n=60)
P

Point
D0 (1)
D1 (2)
D7 (3)
D14 (4)
Group III (5)

( X ± SD)

( X ± SD)

51.85 ± 11.48
62.12 ± 11.46
72.68 ± 9.80
79.53 ± 8.61

50.93 ± 10.98
53.53 ± 11.73
63.32 ± 10.92
77.15 ± 9.55

PI-II > 0.05
PI-II < 0.05
PI-II < 0.05
PI-II > 0.05

81.10 ± 5.57

(n=60)
P

PI(1-2) < 0.05, PII(1-2) > 0.05, PI(4-5) > 0.05, PII(4-5)
< 0.05
On the first day (D1) and the seventh (D7), the pain point in group I

rises more highly than in group II, the differentiation (p<0.05) has statistic

significance.
- After 14-day treatment (D14), the pain point in group I rises more

-

highly than in group II, but the differentiation (p<0.05) has no
statistic significance.
In group of patients after 14-day treatment the pain point is equal to
the one in group III (healthy persons), there is no differentiation at
p > 0.05. In group of patients taking drugs after after 14-day
treatment, the pain point in group III (healthy persons) has the
differentiation at p < 0.05.

12


Table 3.25. The average sleeing time in two groups (hours)
Result
Group I
(n=60)

Group II
(n=60)

( X ± SD)

( X ± SD)

6.35 ± 0.85

6.26 ± 0.86

D0 (2)

3.45 ± 0.76

3.39 ± 0.69

D1 (3)

4.35 ± 0.82

3.71 ± 0.80

D7 (4)

5.33 ± 0.92

4.48 ± 0.73

D14 (5)

5.82 ± 0.83

5.58 ± 0.78

Point of time
Before being sick
(1)

p

PI-II > 0.05
PI-II > 0.05
PI-II < 0.05
PI-II < 0.05
PI-II > 0.05

PI(1-2) < 0.05, PII(1-2) < 0.05, PI(2-3) < 0.05, PII(2-3) >
0.05;
There is no differentiation about sleeping time before and when

p

being sick between two groups at p > 0.05. On the first day(D1) and the
seventh (D7), there is a marked increase in the average sleeping time in
group I compaed with the one in patients from group II with the
differentiation at p < 0,05. After 14-day treatment, the sleeping time in
group I increases more highly than the one in group II, yet the
differentiation at p < 0.05 has no statistic significance.
Table 3.26. Result distribution in trauma healing in two groups
Group
Result
≤ 5 - day treatment
5< day treatment ≤ 10
10< day treatment ≤ 15
> 15 day treatment
Total

Group I

n
%
19
31.67
29
48.33
12
20.00
0
0
60
100
13

Group II
n
%
15
25.00
27
45.00
18
30.00
0
0
60
100

p

P > 0.05


Average time

8.02 ± 2.41

9.58 ± 2.32

P < 0.05

Trauma patients heal after no more than 10 days (80%), which is higher
than in group II (70%). In two groups, there are no trauma patients healing
after 15- day treatment.
- The average time for trauma healing in group I is 8.02 ± 2.41 days, which
is shorter than the one in group II (9.58 ± 2.32 days), the differentiation has
no statistic significance at p < 0.05.
Table 3.28. Overall results in two groups after 14- day treatment
Group
Result
good
quite good
fair
poor
total

Group I
n
35
19

6
0
60

Group II

%
58.33
31.67
10.00
0
100

n
31
18
11
0
60

%
51.67
30.00
18.33
0
100

P
P > 0.05

90% of patients in group I and 81.67% in group II have good and quite
good results.
- Patients in two research groups have no poor result.
- No differentiation about treatment result between two groups at p > 0.05.
Table 3.32. Pain results after one- month Zona treatment in two groups
Group

Group I
Group II
n
%
n
%
Result
P
Painless
55
91.67
46
76.67
Slight
5
8.33
9
15.00
P < 0.05
Mild
0
0
5

8.33
Total
60
100
60
100
The pain result after Zona treatment in group I is that there are only
5 patients with pain (8.33%), which is less than in group II (23.33%). It
includes 9 patients with slight pain and 5 patients with mild pain. The
differentiation has statistic significance at p < 0.05.
3.3. Research results of changes in peri clinical parameters
14


Table 3.36. Results of

-endorphin content in 3 groups

Group
Point of time
Before treatment (1)
After one week treatment
(2)
Group III
(healthy persons) (3)

Group I

Group II

X ± SD

X ± SD (pg/

(pg/ml)

ml)

60.19 ±
31.90
78.08 ±
35.93

60.51 ±
34.00
58.30 ±
33.08

P
P1-2 > 0.05
P1-2 < 0.05

54.44 ± 16.11

P

PI (1-2) < 0.05, PII (1-2) > 0.05
PI (1-3) > 0.05, PII (1-3) > 0.05
PI(2-3) < 0.05, PII (2-3) > 0.05
After 7 day treatment beta-endorphin content in patients from

group I increases from 60.19 ± 31.90 pg/ml to 78.08 ± 35.93 pg/ml, which
is higher than the one in group II (60.51 ± 34.00 pg/ml and 58.30 ± 33.08
pg/ml). The differentiation has statistic significance at p < 0.05.
In comparison with group III ( healthy persons) after treatment, the
beta-endorphin content in the group of patients treated with electronic
acupunture rises more highly than the one in healthy persons. The
differentiation has statistic significance at p < 0.05. In group of patients
treated with drugs, there is no differentiation at p > 0.05. Before treatment,
in both groups, the beta-endorphin content is equivalent to the one in healthy
persons. There is no differentiation at p > 0.05.
Table 3.37. Results of cortisol content in three groups

15


Group
Point of time

Group I
X ± SD (pg/ml)

Before treatment (1)

314.03 ± 112.33

After one week
treatment (2)
Group III
(healthy persons) (3)
P

392.81 ± 115.80

Group II
X ± SD

P

(pg/ml)

307.94 ±
104.61
287.60 ± 92.02

P1-2 > 0.05
P1-2 < 0.05

280.37 ± 59.62
PI (1-2) < 0.05, PII (1-2) > 0.05
PI (1-3) > 0.05, PII (1-3) > 0.05
PI (2-3) < 0.05, PII (2-3) > 0.05

After 7 day treatment, the cortisol content in group I increases
more highly than the one in group II. The differentiation between two
groups has statistic significance at p < 0.05. After treatment, the cortisol
content in group I goes up more sharply than the one in healthy persons.
The differentiation has statistic significance at p < 0.05. In group II, after
treatment there is no differentiation at p > 0.05.
Before treatment, the cortisol content in both groups is equivalent
to the one in healthy persons, there is no differentiation at p > 0.05.

3.3.4. Overall results of two groups in traditional medicine
16


Table 3.44. Overall results of two groups in traditional medicine

Types

Thap nhiet
group
(1)
n

Thap doc hoa
thinh group
(2)

%

n

%

Total
(3)

n

%

Results
good

72.4
35
58.33
14
45.16
1
Group I quite
27.5
19
31.67
8
11
35.48
(n = 60) good
9
fair
0
0
6
19.36
6
10.00
poor
0
0
0

0
0
0
Total
29
100
31
100
60
100
good
61.2
31
51.67
19
12
41.38
9
quite
38.7
18
30.00
Group II
12
6
20.69
1
(n = 60) good
fair
0

0
11
37.93
11
18.33
poor
0
0
0
0
0
0
Total
31
100
29
100
60
100
Total
49.1
120
100
59
61
50.83
7
P
PI(1-2) < 0.05; PII(1-2) < 0.05; PI-II > 0.05
In both research groups, patients with the Thap nhiet group have a

better result than patients with the Thap doc hoa thinh group. The
differentiation has statistic significance at p < 0.05. There is no
differentiation of treatment result between two groups at p > 0.05.
Table 3.45. Undesirable side effects in two groups
Group
Symptoms
Nausea, vomiting

21

Group I
(n = 60)
Yes
No
n %
n
%
1 1.6 59 98.3
17

Group II
(n = 60)
Yes
No
n %
n
%
2 3.33 58 96.67

7
3
Loosen stools
0
0
60 100 0
0
60
100
Diziness
0
0
60 100 3 5.00 57 95.00
Ichiness
0
0
60 100 0
0
60
100
Rash
0
0
60 100 0
0
60
100
Bleeding
0
0

60 100 0
0
60
100
Abscess
0
0
60 100 0
0
60
100
In group treated with drugs, two patients (3.33%) have nausea, three
patients (5%) have diziness. In group treated with electronic acupunture
nausea occurs in one patient (1.67%).
Chapter 4 DISCUSSION
4.1. Several related factors and clinical features of zona patient
In 136 research patients, it it recognized that most elferly patients
are affected with the disease, the ratio of patients over 70s is 68.38%. The
main pre syndrome symptom faced in the research is pain, 100% of patients
have pre syndrome pain symptom. According to Oaklander AL and
Associates, if the time of acute pre syndrome is long and arduous, it can
cause risks for the development of pain after zona treatment rather than non
pre syndrome.
In the research, is is found that the time of getting sick (<5 days)
accounts for the majority (72.8%), the time of getting sick (> 5 days)
accounts for 27.2%. It is possible that the patients under the Friendship
Hospital care are knowledgeable and aware of sicknessess. In terms of
other diseases, the most common condition is raised blood pressure
(37.50%), followed by diabetes (30.00%), lipid metabolism disorder
(26.67%), gastroenterology syndromes (19.17%), gout and arthritis

(17.50%) and cancer (12.50%). Others are less common. Most related
diseases require long treatment, more or less affect the body organs and can
weaken immune system – the factors that enable the virus to activate and
cause Zona.
The season when the disease mostly occurs is spring (34.56%),
followed summer (26.47%) and autumn (24.26%) while in winter the
problem rarely strikes (14.47%). The findings show that the damage caused
by thoracic nerves accounts for the majority (39.17%), followed by cranial

18


nerves (25.83%), waist (18.33%) while damage in the small and others is
less common.
In terms of pain level, after the blisters appear, patients mostly
have mild and severe pain. Severe pain makes up 50.74%; mild pain has
35.29% while slight pain is 13.97%. Therefore, it is very important to carry
out intensive treatment to relieve pain symptoms, pain levels and time of
pain. In zona pain comes from peritheral nervous system (called peritheral
neuropathic pain). The research indicates that the most common symptom
is throbbing pain (80.15%) followed by burning pain (69.85%), shooting
pain (67.64%) and tingling pain (50%). The patients with parethesia usually
feel numb in site while the ones with hyperesthesia get shooting pain when
they are touched or stimulated.
4.2. The effectivess of Zona treatment in clinical practice
The study reveals that on the first days (D1, D7) the average point of
pain level in patients from group I desreases more enormously than the one
in group II at p < 0.05. On the following days of the treatment course (D14)
the average point of pain level in two groups is equal without
differentiation at p > 0.05. This can show that using eletronic acupunture in

zona treatment especailly on the first days of the course is extremely
effective for pain.
Many authors think that eletronic acupunture may cause a reflex. The
arc reflex has a sensory part which lies in points where an active voltage is
produced and trasmitted along the cetripetal nerves (fiber A, A, C) to the
centre to activate the central nerves. The centrifugal lines travel to the
traumas to incresase the point of pain and the catecholamin and
acetylcholin content…. These chemicals are proved to be important roles in
pain mechanism of electronic acupunture.
Pain point is human tolerance to pain agents. Pain is a warning signal
of something wrong with human health. In traditional medicine pain is
called “agony”. Electronic acupunture helps in regulating body functions.
Electrical impulses originated from the points work under the mechanism
of the nerve and fluid. Electronic acupuncture has an effect on latent
inhibition that transmit sense of pain in the arc reflex. Therefore, it can
make pain relief.
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Electronic acupuncture can increase the content of neutralized
chemicals involved in the mechanism of pain relief such as endorphin,
enkephalin, serotonin in serum and cerebral tissues which work like
analgesics. Additionally,
electronic acupuncture helps to control the functions of the autonomic
nervous system: blood pressure stabilizing, muscle stretching and immune
regulating.
In group I, at the beginning of the treatment course (D 1, D7) the pain point
increases more highly than the one in group II. The pain point in group I
increases from 51,85 to 62,17 scores immediately after the first treatment
day, especially after 7 days of the treatment, the gap of pain point between

two groups pre and post treatment is rather big (72.68 and 63.32 scores).
The differentiation has statistic significance at p < 0.05.
Scientists have proved that electronic acupuncture stimulates
electrical impulses on cell organs to increase the activity of pain-killer
chemicals. It is endorphin in the cerebrospinal fluid (endorphin helps to
decrease pain sharply at 200 times compared with morphine). The human
response to stimulant reduces gradually with time so the endorphin content
secretes in the cerebrospinal fluid reduces too, leading to the pain relief
falls.
In group I, at the moment of D1, D7 the average sleeping time is
higher than the one in group II at p < 0.05. After the treatment, the patient
sleeping has improved. In comparison with the patient’s sleeping time on
admission there is 2.13 hrs added to the average sleeping time (on
admission it was 3.68  1.16 hrs, after treatment 5.81  1.02 hrs). Feeling
pain is always closely related to the patient’s sleep. When the feeling pain
relieves, the sleep improves.
The time for trauma healing in group I is 8.02 ± 2.41days, which is
9.58 ± 2.32 days shorter in group II with the differentiation at p < 0.05. In
the research by Vương Diễm and Associates (2015), 78 zona patients were
divided into 2 groups, including the controlled and combined ones and 39
patients in each group. The patients in the controlled group were treated
with drugs while the patients in the combined group were treated with
drugs and electronic acupuncture. Comparisons of time healing, pain level,
score putting (VAS) and statistically significant differentiation (p<0.05)
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were made. The authors concluded that zona treatment carried out by the
combination of electronic acupuncture and drugs has obviously effective
clinical results and dominant pain relief, which helps patients to make a

rapid recovery. The therapy is reliably safe and it deserves widespread
applications.
As electronic acupuncture works in reducing permeation in the
arterial wall, it can help to normalize the metabolic process between the
blood and tissues and improve the micro-circulatory system. Electronic
acupuncture also affects the metabolic process in cells, increases the
absorption speed in tissues and the CO 2 releases, inhabits acid products and
involves in balancing acid base.
In zona treatment, besides trauma healing, a more important matter
in which doctors are interested is the time for pain relief, especially the pain
after zona treatment. The symptoms that a patient has experienced after a
month since the onset of the disease are called post zona pain.
In the research group of patients treated with electronic acupuncture in
combination of drugs, only 5 patients (8.33%) experience post zona pain
while in the group of patients treated with drugs, the number is 14 patients
with post zona pain (23.33%), the differentiation has statistic significance
at p < 0.05.
According to Vương Thế Bích Thanh (2013) working in the Ho Chi
Minh Dematology Hospital, among 150 zona patients, there are 29
suffering post zona pain, accounting for 19.33% in his study. The research
by Yawn BP and Associates (2007) in the US indicates that the patients
with post Zona pain makes up 18%. Therefore, patients with post zona pain
in group I makes up a smaller proportion to patients in group II (treated
with drugs) and much smaller one in other authors’.
4.3. The effectivess of Zona treatment in peri clinical practice
In research group I, the beta-endorphin content (78.08 ± 35.93 pg/
ml) after 7-day treatment is higher than the one in group II (58.30 ± 33.08
pg/ml), at p < 0.05. The increase in beta-endorphin content in the
effectiveness of electronic acupuncture makes a contribution to prove that
the anti pain mechanism is a combination of the inhibition of pain

transmission and activation of the bodily anti pain system, leading to the
secret of endogenous opiat. It reveals the effectiveness of electronic
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acupuncture in nerve pathways of fluid. Electronic acupuncture helps to
activate anti pain system in the body, produce neutrilized chemicals,
causingpain relief in clinical practice.
In our study, like the beta – endorphin content, the cortisol content
in the blood in group I is 314.03 ± 112.33 ng/ml, after 7- day treatment, it goes
up to 392.81 ± 115.81 ng/ml, in the group of patients treated with drugs it is
307.94 ± 104.61 ng/ml and after 7-day treatment is 287.60 ± 92.02 ng/ml with
the differentiation at p < 0.05. Our research results are consistant with what
have been found by Nghiem Huu Thanh, using eletronic acupuncture for a
group of patients with back pain. After 7-day treatment, the cortisol content
increased from 386.16 ng/ml to 560.45 ng/ml. Cortisol is a hormone
secreted from the adrenal cortex. In addition to its effects on the metabolic
process, cortisol has other important roles in anti inflammation, anti allergy
and anti stress. Hence, the stimulation of electronic acupuncture to the
points causes an increase in cortisol in the adrenal cortex, enabling the
brain to escape from the inflammation and bring back the body functions.
Those hormones help with blood pressure stabilization and pain relief.
4.4. Results in two groups in tradictional medicine
In the research, among 28 patients with the Thap nhiet group
treated with electronic acupuncture, 20 patients (71.43%) have good
treatment result while 8 patients (28.57%) have quite good results, no one
has poor result. In the Thap doc hoa thinh group, there are 32 patients, 13
of whom (40.63%) obtain good results while 11 patients (34.37%) get quite
good ones, 8 patients (31.25%) have fair results, nobody gets a poor
result.

If the results are compared in two groups of patients treated with
electronic acupuncture and drugs in each type, there is no differentiation at
p > 0.05.
In both groups, Thap nhiet group has a better result than the Thap
doc hoa thinh group. The differentiation has statistic significance at p <
0.05. Thus, patients in the Thap nhiet group recover more quikly than the
ones in the Thap doc hoa thinh group.
As the characteristics and features of the prodromal period are
small blisters and mild nerves trauma, patients are recognized and treated in
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this period and their skin and nerves are not badly damaged. For that
reason, the blisters get crusted, the bleeding stops soon, the disease makes a
good progression in a short period of time.
While the Thap doc hoa thinh group is characterized by numerous
big and widespread blisters, at the back there is fresh pink color
accompanied with headache and fever, badly damaged nerves, malaise, dry
mouth with bitter taste, yellow unire, constipation, pink tongue with yellow
thrush, rapid pulse. At the moment, the nerves and the epidermis are badly
damaged, it may take a long time to recover.
4.5. Undesirable side effects
Patients from group I hardly ever experience any bad side effects.
CONCLUSION
From this study, in which 136 hospitalized patients treated for
shingle and 60 healthy persons with medical check-ups in the Friendship
Hospital got involved, we can conclude the following
1. Clinical features and related factors of the research population
The age over 70s accounts for the majority (68.33%). The time of
getting sick < 5 days makes up (79.17%). The season in which the

condition mostly occurs is spring. The disease is often accompanied by
hypertension, diabetes, lipid metabolic dirorder, gastroenterology
syndromes, …
100% patients experience pre syndrome pain. The time of pre syndrome
pain < 5 days makes up the majority (83.33%). The common location of
disease is chest, ribs and arms (39.17%).
2. The effectiveness in clinical practice with electronic acupuncture in
combination of acyclovir
- The time for trauma healing in group I is 8.02 ± 2.41days, which is
shorter than the one in group II is 9.58 ± 2.32 days The differentiation has
statistic significance at p < 0.05.
- The VAS scores in group I fall sharply in comparison with the ones in
group II at the beginning of the treatment course (D1, D7) . The
differentiation has statistic significance at p < 0.05.
- The pain point in group I increases more highly than the ones in group II
at the beginning of the treatment course (D1, D7) . After one-day treatment,
the pain point in group of patients treated with combined electronic acupuncture
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increases from 52.26 ± 12.46 scores to 66.57 ± 14.54 scores compared with the
increase in group of patients treated with drugs from 50 .85 ± 11.23 to 52.36 ±
13.85. The differentiation has statistic significance at p < 0.05.
- The sleeping time in group I at the beginning of the treatment course (D1,
D7) improves better than the one in group II (5.33h compared with 4.48 h), with
the differentiation at p < 0.05.
- The overall result in group I is better than in group II, yet there is no
differentiation at p > 0.05.
- In group of patients treated with combined electronic acupuncture, only 5
patients (8.33%) suffer post zona pain. This condition rarely strikes in group

of patients treated with drugs: only 14 patients have it (23.33%). The
differentiation has statistic significance at p < 0.05.
- In traditional medicine, in both groups of patients, the treatment results
from the Thap nhiet group is better than the Thap doc hoa thinh group. The
differentiation has statistic significance at p < 0.05.
3. The effectiveness in peri clinical practice pre and post treatment
- After 7-day treatment, the beta-endorphin content in patients form group I
increases from 60.19 ± 31.90 pg/ml to 78.08 ± 35.93 pg/ml, which is higher
than the one in group II, before treatment it is 6051 ± 34.00 pg/ml and after
treatment 58.30 ± 33.08 pg/ml. The differentiation has statistic significance
at p < 0.05.
- After 7-day treatment, in group I the cortisol content increases from 314.03 ±
112.33 nmol/l to 392.81 ± 115.81 nmol/l while in the group of patients treated
with drugs, there is no increase in the cortisol content. Before treatment it is
307.94 ± 104.61 nmol/l and after 7-day treatment it is 287.60 ± 92.02 nmol/l.
The differentiation between two groups has statistic significance at p <
0.05.
RECOMMENDATIONS
From the research results, it is recommended that:
Eletronic acupunture combined with Acyclovir in zona treament is
extremely effective, which should be widespread.

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