Acne is something I am passionate about helping people with, because I know first hand what it is like to not feel confident in your skin.
From a Chinese medicine point of view, acne is mainly due to heat, dampness and stagnation. Just like in Western medicine, it is always easy to treat and can take several months to clear up. However, with persistence and adherence to dietary changes it can be cleared up!
Definitions:
Acne is a chronic inflammatory (heat) condition which arises due to blockage of the follicles (stagnation) caused by sebaceous overactivity (dampness, yang excess). Bacteria are then trapped in this sebum plug and further result in infection (heat and dampness). Androgen hormones (a yang hormone) activate sebaceous glands and therefore can result in more sebum and further blockage of the follicles. This is why it is more common in puberty.
In Chinese medicine, acne can be caused by*:
Lung Heat- this is usually due to pre-existing heat in the Lung channel combined with an external invasion of wind causing accumulation of Heat in the skin. This could be a constitutional tendency toward skin issues. It results in white heads and black heads that are papular and sometimes itchy. Areas affected are mostly the forehead and above the nose. Other symptoms may include dry mouth/nose, dry stools and a slight red tongue. The pulse is often slippery and floating. Herbal medicine in this case could be a modified 'PI PA QING FEI YIN' (pipaye, sangbaipi, huanglian, huangbai, renshen, gan cao) or Ling Xue Qing Fei Yin.
Stomach Heat- due to a high fat diet, or excessive intake of fried, processed or spicy foods, leads to accumulation of heat in the SP/ST which can over time rise up and lodge in the skin. This could also be a result of improper eating times, overeating or foods that are hot in nature (such as chocolate). It is characterised by white heads and blackheads that are papular. Commonly seen around the mouth, chest and upper back. The face tends to be oily, there is a tendency to eat large amounts of food, bad breath, dry mouth and tongue, desire for cold drinks and dry stools. The pulse is slippery, submerged and forceful. Herbal medicine treatment may be with TIAO WEI CHENG QI TANG (dahuang, gan cao, mangxiao). Addressing diet and eating habits is essential.
Blood heat- this is often due to emotional disturbances which results in Qi stagnation, which over time accumulates and transforms into heat, which enters the Blood and lodges in the skin. Lesions are papular and near the nose, mouth and between the eyebrows. The facial capillaries are dilated which results in a facial flush (the heat is trying to get out!). Women may experience a worsening of lesions premenstrually. Other symptoms may include dry stools, yellow urine, red tongue tip, and a thin slippery rapid pulse. Herbal medicine could include TAO HONG SI WU TANG (honghua, taoren, shengdihuang, chishao, danggui, chuanxiong) or LIANG XUE WU HUA TANG (honghua, jiguanhua, lingxiaohua, meiguihua, yejuhua). Addressing emotional factors such as stress, repressed emotions or trauma are key.
Heat toxin- this results as a combination of Lung and Stomach Heat with an external toxin that rises upward and lodges in the skin. Acne lesions are pustular with an erythematous base (i.e. red with a pus head). The lesions may be painful and could result in inflamed nodules. Areas mainly include the upper back and chest, often with residual scarring after healing. Other symptoms can include constipation, scanty yellow urine, a red tongue with dry/yellow coat, wiry/slippery/rapid pulse. Herbal medicine treatment could include CUO CHUANG JIAN JI (jinyinhua, lianqiao, huangqin, chuanxiong, danggui, jiegeng, niuxi, yejuhua). Address diet and skincare.
Damp toxin with Blood stasis- this is commonly when there is pre-existing Dampness that accumulates in the skin after an attack of a toxin to become a Damp-toxin. This leads to blockage of the channels and collaterals which leads to Qi and Blood stagnation. Acne lesions are deep, painful and inflamed nodules with pus-filled cysts on an erythematous base. Areas involve the face, chest and back. Other symptoms include oily skin, residual scarring and pitting, headaches, a sensation of heat, a purple tongue, choppy/slow/submerged pulse. Chinese herbal medicine treatment focus is to invigorate blood, eliminate damp, relieve toxicity and dispel blood stasis, with CHU SHI JIE DU TANG (baixianpi, doujuan, yiyiren, tufuling, zhizi, mudanpi, jinyinhua, lianqiao, zihuadiding, mutong, huashi, gancao).
*note that the Chinese herbal medicines included in this list will always be modified in dosage and ingredients to suit the individual!
Other treatment options:
External herbal medicine- topical use of herbal medicine can be a great way to clear heat and dampness locally from the acne and promote good blood circulation which helps the healing process. This is because some of the herbs used have anti-bacterial and anti-inflammatory properties. The herbs are in a powder form, mixed with water or a base cream to form a paste. It can be applied to the affected areas 1-2x a day. This will be tailored specifically to the individual. You can expect to see a reduction in the redness and enhanced healing of the skin.
ACUPUNCTURE!! Acupuncture is a great way to clear heat, regulate blood circulation, calm the mind, support digestion, and promote healing of the skin. Various acupuncture points will be used, which can also include local acupuncture around the acne lesions (this essentially is telling the body to send a healing army to the area). Another technique is to use blood-letting which involves massaging a point, pricking the point with an acupuncture needle and squeezing 2-3 drops of blood from the point. This can be done on back points that correspond to specific organs to drain out the heat (such as the Lung, Liver, and Stomach).
Cupping therapy- cupping is a GREAT way to clear out heat. I love doing cupping on the back for acne. The cups will be placed over specific areas that can clear heat and toxins from specific organs.
Auricular acupuncture- needling the ear points or placing little metal ear seeds on the points so you can massage them at home to enhance the treatment.
Prevention and management:
Avoid picking the lesions as doing so can delay healing and produce pitted scar.
Avoid cosmetics that clog pores.
Frequent (gentle!) washing of the face with soap and water is recommended, but avoid abrasive cleansers that aggravate the skin.
Avoid spicy and greasy foods, processed foods, alcohol and smoking. Eat more cooked warm nourishing meals.
Consume coffee in moderation, limiting to 1-2 per day.
Reduce stress and manage emotions. I can help with this by calming the nervous system and releasing any stored emotions, but seeking further support from a trusted psychologist is always recommended.
Treatment goals:
Elimination of the issue at the root is the goal, which requires correct diagnosis and treatment. This is why we will do a thorough Q&A in the first appointment, diving into all aspects of your life. You will then get specific advice and a treatment plan that works in alignment with your goals. Treatments will often be weekly for 6-8 weeks and then we will reassess for long term management. Everyone is different and therefore each plan will be different. But we want to give the body time to do what it does best... HEAL.
I hope this helps give you some peace of mind. I understand just how frustrating, embarrassing and stubborn acne can be.
*Manual of Dermatology in Chinese Medicine