Integrated Western and Traditional Chinese Medicine Approaches for Herpes Zoster and Post-Herpetic Neuralgia: A Narrative Review.

Background: Herpes zoster (HZ) and postherpetic neuralgia (PHN) impose a substantial global burden, particularly in older and immunocompromised adults. Western therapies (antivirals, vaccination, and analgesics) reduce viral replication and acute pain but frequently fail to prevent chronic neuropathic pain or fully restore function. Traditional Chinese Medicine (TCM) is widely used as an adjunctive treatment in routine practice, yet its integration with Western care remains variably implemented and synthesized. Objective: To provide a clinically oriented narrative synthesis of epidemiology, mechanisms, and treatment strategies for HZ/PHN from Western and TCM perspectives; to summarize the evidence base for integrated Western-TCM management; and to identify safety considerations, evidence gaps, and priorities for future research. Methods: We conducted a narrative review of English- and Chinese-language literature on HZ/PHN by searching PubMed, Embase, Web of Science, and major Chinese databases (eg, CNKI) up to 2025. We included clinical trials, observational studies, and mechanistic research evaluating Western therapies, TCM interventions (herbal medicine, acupuncture/electroacupuncture, and other external modalities), or integrated regimens used alongside standard Western care. Study quality and risk of bias were appraised qualitatively with attention to sample size, blinding, outcome measures, and reporting of adverse events. Results: HZ pathobiology involves varicella-zoster virus reactivation, neuroinflammation, peripheral and central sensitization, and small-fiber loss, which together drive acute pain and the transition to PHN. Western care provides effective viral suppression and evidence-based analgesia but offers limited strategies for neural repair. TCM interventions have demonstrated complementary effects on pain relief, lesion healing, and functional recovery in small randomized and practice-based studies. Across trials, integrated Western-TCM approaches are associated with faster rash healing, greater reductions in acute pain (particularly with acupuncture-based techniques), a possible reduction in PHN incidence, and improvements in sleep, mood, and quality of life. However, the certainty of the evidence is constrained by small sample sizes, protocol heterogeneity, non-standard outcome measures, and incomplete reporting of adverse events. Safety considerations include herb-drug interactions and quality control of herbal products; acupuncture- and moxibustion-related adverse events are uncommon and typically mild when performed by trained practitioners. Conclusion: Integration of Western and TCM modalities for HZ/PHN is mechanistically plausible and clinically promising, targeting viral burden, neuroinflammation, pain modulation, and neural repair along complementary pathways. Current data support the cautious use of selected TCM therapies as adjuncts to guideline-based Western care in appropriate patients, while underscoring the need for high-quality pragmatic trials with standardized endpoints, mechanistic biomarkers, and robust safety monitoring to establish the effectiveness, safety, and cost-effectiveness of scalable integrated care pathways.