The Treatment of Recurrent Herpes Simplex Virus of the Second Branch of the Trigeminal Nerve with the Systems Approach of Integrative Manual Therapy: A Case Report
Author: Deborah Ann Pinnock
Abstract: This case report is a single subject study of a patient who had Recurrent herpes Simplex Virus. The patient presented with a cold sore lesion that covered the entire naso-labial space, and half of the upper lip along the entire length of the lip. The patient was treated with Integrative Manual Therapy (IMT) focusing on skin (Skin Motilities) to the lesion. After treatment was completed, the patient reported that the entire lesion sloughed off between twelve and twenty hours after the time of the treatment and application of the poultice. The skin was intact without scarring.
Key Words: Herpes Virus, Trigeminal Nerve, Face, Cold Sore
This single subject case report documents the efficacy of using the Systems Approach of Integrative Manual Therapy (c) to assess and treat recurrent Herpes Simplex Virus oro-facial lesions. There are many kinds of herpes viruses and different ones infect most animal species. There are seven herpes viruses known to infect human beings: Herpes Simplex Virus (HSV) type 1 and type 2, Varicella-Zoster Virus, Cytomegalovirus, Epstein-Barr Virus, Human Herpesvirus 6, and Human Herpesvirus 7.
Structure of the Virus: Herpes viruses are morphologically identical. Each kind has a large double stranded DNA genome comprised of an icosahedral nucleocapsid approximately 100 nm in diameter surrounded by a layer of proteins, the tegument, which is covered by a lipid bilayer envelope.
Pathogenesis: Following primary infection, all herpes viruses establish a latent infection in the host, and may reactivate at any stage. More than one-third of the world's population is infected with the Herpes Simplex Virus (HSV).1 Of the two distinct types of Herpes Simplex Virus, HSV-1 and HSV-2, ninety percent of infections caused by HSV-1 are oral and ninety percent of infections caused by HSV-2 are genital. The reason for the different body site affinity is not known.2
Epithelial cells are the initial site of primary infection by HSV. The virus may enter through abraded skin or intact mucous membranes.1 Once infected, the cells die releasing clear fluid intradermally to form vesicles and merging with other cells to create multinucleated giant cells.3 Retrograde transport from neural tissue at the infected site to sensory ganglia leads to commonly considered lifelong latent infection.1,3 The virus may become reactivated due to immunodeficiency, trauma, fever, menstruation, ultraviolet light, and sexual intercourse.1,3,4 The virus is transported by the neuron back to the epithelium where replication occurs and another outbreak ensues.
Orolabial Herpes: Orolabial herpes (gingivostomatitis) is the most prevalent form of muco-cutaneous herpes infection with 35 to 60 percent of the U.S. population showing serologic evidence of having been infected by HSV-1.1,5 Recurrent herpes labialis affects 20 percent of the U.S. adult population.6 In HSV-1 recurrence, new lesions appear over a several day period. Following prodromal symptoms of 2 to 24 hours, the cold sores or fever blisters clinically manifest. The vesicles rapidly become pustules with encrustation within 48 hours. Viral shedding occurs over 3 to 5 days, with the lesions lasting from 2 to 10 days.7
Client Presentation: The client presented with a cold sore lesion that covered the entire naso-labial space, and half of the upper lip along the entire length of the lip. The lesion contained a few small grouped vesicles on erythematous bases, some pustules with the rest of the lesion already umbilicated and in various stages of encrustation. The client had a history of reactivation with cold sores appearing 2-3 times a year which is the typical pattern of recurrence with orofacial herpes simplex. The second branch of the trigeminal nerve mapped positive bilaterally.
The client was being seen to address multiorgan system involvement due to an extensive history of childhood physical and incestuous sexual abuse, and an eight year history of obstetrical trauma that resulted in prolapse of the bladder, vagina and rectum. She was treated surgically at two major teaching hospitals with followup evaluations at Mayo and Cleveland Clinics to address the postsurgical complications resulting in a marked decrease in mobility (unable to walk up or down a flight of stairs), tactile defensiveness, reflex sympathetic dystrophy (RSD), and social emotional challenges, such as not having enough strength to drive a car or turn the dial to start the washing machine.
Treatment: The client was treated with skin motilities (IDS-3) to the lesion with the client's hand placed over the lesion with the therapist's hand on top; an alternative method would be to use a glove. The second branch of the trigeminal nerve was treated for the immune deficiency motility (IDM) that was palpated, and the client was instructed to rehydrate green tea leaves to place over the lesion (a poultice). She was also instructed to do Neurofascial Process (NFP) by taking the naso-labial region to the process centers, with the arm across the spine below the ribs and above the sacrum first, for three hours.
Outcomes: The client was seen two weeks later and reported the entire lesion sloughed off between twelve and twenty hours after the time of the treatment and application of the poultice. The skin was intact without scarring, with no aberrant skin motility palpated. However, bilaterally along the second branch of the trigeminal nerve, IDM was palpated although it was dampened compared to its expression two weeks earlier.
Discussion and Conclusions: Green tea, camellia sinensis, has been found through extensive research and documentation to have many properties supporting healthy biologic functioning.8,9,10,11,12 Had the client not had gastrointestinal issues yet to be addressed, the client would have been instructed to rehydrate green tea leaves and line the inside of the mouth between the upper gum and buccal mucosa with one layer of hydrated green tea leaves daily before bed. With other clients, this has been found to eliminate the IDM in the second branch of the trigeminal nerve when used in conjunction with techniques of Integrative Manual Therapy (c). In conclusion, the Systems approach to assessing and treating lesions from recurrent herpes simplex virus of the second branch of the trigeminal nerve is demonstrated in this single subject case report.
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