Column June 2, 2025
Postherpetic Neuralgia — When Blisters Heal but Pain Remains
Hyo-seop Kim
Chief Director
Table of Contents
The skin has cleared, but the pain is still there
Postherpetic neuralgia (PHN) is a condition in which pain persists in the affected dermatome for more than three months after shingles blisters have healed. About 20–30% of shingles patients aged 60 or older progress to PHN. It is characterized by a burning sensation, stabbing pain, and allodynia — pain triggered even by clothing brushing the skin.
Korean medicine diagnosis: qi stagnation with blood stasis (氣滯血瘀) and residual toxins (餘毒)
- Residual toxins: Remnant toxins of the varicella-zoster virus (VZV) continue to irritate the nerves
- Qi stagnation with blood stasis: Impaired circulation of qi and blood delays recovery of damaged tissue → chronic pain
- Combined deficiency of qi and blood: Immune exhaustion lowers nerve regeneration capacity
Treatment
- Invigorate blood and tonify qi: Combined Taohong-siwu-tang and Bojungikgi-tang to remove blood stasis while restoring vitality
- Bee-venom pharmacopuncture: A pharmacopuncture that uses the anti-inflammatory and analgesic effects of bee venom — especially effective for PHN
- Acupuncture and electroacupuncture: Low-frequency electroacupuncture around the painful area blocks pain signals
- Moxibustion: Promotes local blood flow and improves nerve nourishment
Prevention is the best strategy
- Starting antiviral medication within 72 hours of shingles onset is the key to preventing PHN.
- For people aged 50 and older, a shingles vaccine (Shingrix) should be considered.
- Adding Korean medicine treatment from the early stage of shingles can lower the risk of developing PHN.