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: 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 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 CHAPTER 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 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 - 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 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 Chapter 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 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 Standard patients are selected randomly into 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 times a day, every hours for days - Controlled group (Group II): patients treated with Acyclovir and Neurontin - Acyclovir: 800mg x times a day, every hours for days - Ointment: Cream Acyclovir 5% times a day for weeks - Neurontin: 300mg x times a day, each time one table after meals for 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: degrees: good, quite good, fair, poor - assessment for pain rate of postherpetic shingle - result assessment in traditional medicine: degrees: good, quite good, fair, poor for clinical features; assessment for some undesirable side effects 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 RESEARCH RESULTS 3.1 Some related factors and clinical features of Zona patients Table 3.2 Patient age distribution(n=136) Age n % 60 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 % - days 65 47.79 - days 49 36.03 > days 22 16.18 Total 136 100 The time for pre syndrome pain is < days, accounting for 83.82% The time for pre syndrome pain is > days (16.18%) The average time for pre syndrome pain is 4.35 ± 1.65 days 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 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 % chest ribs - arm 52 38.24 head face neck 36 26.48 waist 26 19.12 the small 15 11.03 others 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 VSA scales VAS 6.66 6.55 5.88 electronic acupuncture Drugs 4.75 4.22 2.72 2.28 1.95 D0 D1 D7 point of time D14 Graph 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 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 ≤ - 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 60 100 13 Group II n % 15 25.00 27 45.00 18 30.00 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 60 Group II % 58.33 31.67 10.00 100 n 31 18 11 60 % 51.67 30.00 18.33 100 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 8.33 15.00 P < 0.05 Mild 0 8.33 Total 60 100 60 100 The pain result after Zona treatment in group I is that there are only patients with pain (8.33%), which is less than in group II (23.33%) It includes patients with slight pain and 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 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 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 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 Group I quite 27.5 19 31.67 11 35.48 (n = 60) good fair 0 19.36 10.00 poor 0 0 0 Total 29 100 31 100 60 100 good 61.2 31 51.67 19 12 41.38 quite 38.7 18 30.00 Group II 12 20.69 (n = 60) good fair 0 11 37.93 11 18.33 poor 0 0 0 Total 31 100 29 100 60 100 Total 49.1 120 100 59 61 50.83 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 % 1.6 59 98.3 17 Group II (n = 60) Yes No n % n % 3.33 58 96.67 Loosen stools 0 60 100 0 60 100 Diziness 0 60 100 5.00 57 95.00 Ichiness 0 60 100 0 60 100 Rash 0 60 100 0 60 100 Bleeding 0 60 100 0 60 100 Abscess 0 60 100 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 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 ( 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 19 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 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 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 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 22 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 Clinical features and related factors of the research population The age over 70s accounts for the majority (68.33%) The time of getting sick < 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 < days makes up the majority (83.33%) The common location of disease is chest, ribs and arms (39.17%) 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 23 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 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 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 24 ... patients diagnosed with zona and treated - Objective 2: 120 zona patients randomly divided into groups, 60 patients per each: Group I (treated with electronic acupuncture and acyclovir) , Group II... is once a day for 30 minutes - acyclovir: 800mg x times a day, every hours for days - Controlled group (Group II): patients treated with Acyclovir and Neurontin - Acyclovir: 800mg x times a day,... of pain after zona treatment rather than non pre syndrome In the research, is is found that the time of getting sick ( days)