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临床病案针灸治疗带状疱疹ACase
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Previously,wehavesharedacaseofpost-herpeticneuralgia.Inclinicalpractice,weoftenencountersomepatientsattackedbyacuteherpeszosterwithdurationof1or2days.Tideerythemaoftenappearsontheaffectedareaatthebeginning,andsoondevelopsintopapulae,withasizerangingfromgrainstosoybeans.Theyaredistributedasclusterswithoutfusionandquicklydevelopintoblisters.Theblisterwallistenseandshiny,withclearfluidsinside.Ablushofredsurroundseachclusterofpapulae.Patientsoftenfeelseverepain.Thedurationisusually2to3weeks;afterwardsblistersdryupandscab,leavingtemporarylight-colorederythemaorpigmentation.Acupuncturetherapyforherpeszosterintheacutestageisdifferentfromthatinthesequelastage.Herearesomeofourviewsasreference.
前面分享了一篇带状疱疹后遗神经痛的贴子。在临床中经常可以碰到一些带状疱疹急性期的患者，往往出疹1-2天。患处常首先出现潮红斑，很快出现米粒至黄豆大小的丘疹，丛集状分布而不融合，很快变为水疱，疱壁紧张发亮，疱液澄清，外周绕以红晕，疼痛剧烈。病程一般持续2～3周，而后水疱干涸、结痂脱落后留有暂时性淡红斑或色素沉着。这种急性期疱疹的针灸治疗与后遗症期的治疗侧重点有所不同，现将我们的一些观点分享，供大家参考。
Foracuteherpeszoster,weoftenusefourtherapies:surroundingneedling,fireneedling,bloodletting,andmedicatedthreadmoxibustion,mainlytorelievepain,preventlesionexpansion,andpromoteherpestodryup,scabquicklyforhealing;asaresult,theincidence/degreeofpost-herpeticneuralgiaisreduced.
治疗急性期疱疹我们常采用的方法有4种：围针、火针、放血疗法和药线点灸，主要是用来减轻疼痛，阻止病灶面积进一步扩大，促进疱疹的快速干涸结痂愈合，进而可以最大程度减少后遗疼痛的发生。
Tips
Theplumneedleishelpfulfordiseasesequelae,butpatientsmaynottoleratethepainduetohypersensitivityinthelesionareatogetherwiththepainfromneedling,soplumneedleshouldbeusedwithcautions.
Forthosepatientswhohaveseverepaininlocallesionswhichhavenegativeimpactsontheirdailyactivitiesandcannotberelievedbyacupuncture,externalapplicationofpasteswithmixtureof(collateral-activating)medicinaloilandYunnanBaiyaopowderonlocallesions,2-3timesaday,mayhelprelieve/stopthepain.
小贴士
梅花针的使用对带状疱疹后遗症的治疗有一定帮助，但在应用梅花针的治疗过程中，患者一般难以同时耐受本身病灶处的痛觉过敏和针刺的疼痛，因此建议慎重使用此治疗方法。
针对局部疼痛剧烈，经针刺治疗后仍难以忍受者，甚至影响工作休息的患者，可用活络油将云南白药粉调和成糊状，外敷在病灶处，每日二至三次，止痛效果较好。
