Acne is a common inflammatory disease of the sebaceous follicles, characterized by comedones, papules, pustules, nodules, and in some cases, scarring. In Chinese, this condition is called “white thornsâ€, because of the resemblance of the lesions to thorns, and because of the white fluid that is exuded when the lesions are drained. Other Chinese names for acne include “lung-wind white thorns†(fei feng fen ci) and “wine thorns†(jiu ci).
Signs and Symptoms
Acne lesions appear most frequently on the face, chest, and back, where the sebaceous follicles are the largest. The first lesions to appear in an outbreak of acne are the noninflammatory comedones, which include open comedones (known as blackheads) and closed comedones (known as whiteheads). As time progresses, these dome-shaped comedones may develop into inflamed papules, superficial cysts, and pustules. In severe cases, deeply inflamed nodules and pus-filled cysts can develop, some having their openings on the skin surface, where their contents are discharged. It is this latter type of inflammation that results in scarring.
Traditional Chinese Medicine Etiology
In TCM, three types of heat are nearly always involved in the etiology of acne: wind-heat, heat in the blood, and damp-heat in the stomach and intestines, all three of which appear in cases of severe acne. Other contributors to the condition are strong emotions, which result in stagnated heat that can develop into acne; and spleen deficiency, which results in dampness that can accumulate in the skin as acne. This essay discusses the following four patterns and their treatment: 1) Wind-heat in the lung meridian and heat in the blood; 2) Damp-heat in the stomach and intestines; 3) Spleen deficiency with phlegm and dampness; and 4) Liver Qi stagnation with blood stasis.
Pattern Identification and Treatment
- Wind-heat in the Lung meridian and heat in the blood
Main Symptoms: Red face, affected lesions are red, hot, and painful, or with pus, red tongue, thin yellow coating, floating and rapid pulse.
Treatment Principle: Disperse wind, clear heat, cool blood.
Formula: Modified Pi Pa Qing Fei Yin
Pi Pa Ye 12g, Huang Lian 10g, Gan Cao 6, Sang Bai Pi 15g, Di Gu Pi 15g, Huang Bai 10g, Sang Ye 10g.
Acupuncture: LI 4, LI 11, BL 13, DU 14, T 2, SI 18, ST 7, ST 6
- Damp-heat in the Stomach and intestines
Main Symptoms: Affected skin lesions are red, papules, nodules, cysts, dry stool, yellow urination, red tongue, yellow greasy coating, slippery and rapid pulse.
Treatment Principle: Clear heat and transform dampness, purge the Fu organ.
Formula: Modified Yin Chen Hao Tang
Sheng Di 15g, Chi Shao 12g, Yin Chen Hao 12g, Sheng Shan Zhi 10g, Huang Qin 12g, Huang Bai 10g, Sheng Da Huang 10g, Pu Gong Ying 12g, Sheng Yi Yi Ren 15g, Che Qian Cao 12g, Sheng Gan Cao 6g.
Acupuncture: LI 4, DU 14, BL 25, ST 36, ST 40, T 2, SI 18, ST 7, ST 6
- Spleen deficiency with phlegm and dampness
Main Symptoms: Affected skin lesions with pus, nodules, cysts, pitted scars, accompanied by poor appetite, pale tongue, yellow greasy tongue coating, slippery pulse.
Treatment Principle: Strengthen spleen, resolve phlegm, clear heat, dry dampness.
Formula: Modified Shen Ling Bai Zhu San
Dang Shen 12g, Bai Zhu 12g, Fu Ling 12g, Shan Yao 12g, Jiang Ban Xia 12g, Chen Pi 10g, Bai Jie Zi 10g, Dan Shen 15g, Che Qian Zi 12g, Bai Hua She She Cao 10g.
Acupuncture: LI 4, DU 14, BL 25, ST 36, ST 40, SP 9, T 2, SI 18, ST 7, ST 6
- Liver Qi stagnation with blood stasis
Main Symptoms: Affected skin lesions are purple, protracted process, irritability, females worse before and after periods, purple or with spots on the tongue, wiry pulse.
Treatment Principle: Move Liver Qi and invigorate blood.
Formula: Modified Xiao Yao San and Tao Hong Si Wu Tang
Chai Hu 10g, Bai Zhu 12g, Chi Shao 10g, Fu Ling 12g, Dang Gui 10g, Tao Ren 10g, Hong Hua 10g, Chuan Xiong 10g, Sheng Di 12g, Chuan Niu Xi 10g, Dan Pi 10g.
Acupuncture: LI 4, LR 2, LR 3, SP 10, BL 17, ST 36, T 2, SI 18, ST 7, ST 6
Auricular Acupuncture (included in all treatments ): Lung, kidney, endocrine.
Prevention
The course of acne varies greatly, depending on the individual. Untreated acne can last for several years. Patients should be advised not to pick the lesions, particularly the crust covering an opened lesion, which may delay healing and produce a pitted scar. Women should avoid using comedogenic cosmetics, especially those that contain oils. Foods and beverages that can produce dampness and heat, such as spicy foods and greasy foods, should be avoided. Alcohol and smoking can make acne worse by increasing internal heat and dampness.
