Treatment of acne based on syndrome differentiation in traditional Chinese medicine

When treating a disease in traditional Chinese medicine, the root cause of the disease will be sought. Only then can the problem be fundamentally solved. I believe that acne patients will try many methods to treat acne, but most of them are not very effective. At this time, acne patients will look for treatment in traditional Chinese medicine. What is the diagnosis and treatment of acne in traditional Chinese medicine?

Etiology, pathogenesis and treatment

1. Excessive heat in the lungs and stomach

According to traditional Chinese medicine, the face and nose are dominated by the lung and stomach meridians. If the body's yang and heat are excessive, the lung meridian is hot and depressed, and the body is attacked by wind evil (wind is prone to attack the upper part of the body), "lung wind acne" will occur. The lung and large intestine are the exterior and interior of each other, and if the visceral qi is blocked and damp heat attacks the face, acne will also occur.

This type is most common in inflammatory acne. Patients are often in adolescence. The rash is prone to occur on the face, and there may be a small amount of rash on the chest and back. The skin lesions are mainly red papules, some of which have pus heads, and are itchy and painful. The tongue is red, with a thin white or thin yellow coating, a slippery or slightly thin pulse, and dry stools. The treatment method of "purging instead of clearing" is adopted to clear the bowels and purge the wind-heat in the lung meridian. The prescription is loquat lung clearing drink with modifications: 30g of Hedyotis diffusa, 20g of Paris polyphylla, 30g of raw hawthorn, 20g of Alisma orientalis, 15g of loquat leaf, 15g of honey mulberry bark, 10g of Scutellaria baicalensis, 20g of Salvia miltiorrhiza, 10g of raw rhubarb (decocted together), and 10g of raw licorice. If accompanied by heat in the palms and soles, add 20g of Ligustrum lucidum and 20g of Eclipta prostrata to cool the blood and regulate hormone levels. If loose stools occur after taking the medicine, remove the raw rhubarb and add stir-fried Citrus aurantium 15g to slow down the effect of the medicine. If there are more rashes on the forehead, take Daochi San. If there are more rashes on the cheeks, add 20g of Curcuma aromatica to soothe the liver and promote qi circulation.

2. Dampness accumulation

From the perspective of clinical symptoms, oily face is the most common skin lesion manifestation of acne, which is caused by the vigorous vitality of the body during adolescence. In Western medicine, it is explained by the imbalance of hormone levels during adolescence, and the sebaceous glands secrete too much sebum. The accumulation of sebum is the cause of acne formation. Therefore, reducing oil secretion is the focus of treatment. Traditional Chinese medicine believes that oil is related to "dampness", and the source of dampness has two reasons: first, eating spicy and irritating foods on a daily basis will damage the spleen and stomach, causing the spleen to lose its healthy function and dampness to be generated endogenously. Second, the kidney yang is weak and cannot warm the spleen yang, which leads to the accumulation of water and dampness. When dampness accumulates for a long time, it turns into phlegm and forms nodules and cysts. When dampness turns into heat and the heat is too strong, the flesh rots and turns into pus and forms pus heads. Therefore, clinical treatment should be based on strengthening the spleen and eliminating dampness, warming the yang and transforming dampness, clearing away heat and removing dampness, and eliminating accumulation and relieving stagnation.

The typical symptoms of this type of patients are oily face, often in adolescence, rash on the face, skin lesions are mainly red papules and acne, the face is usually oily, especially in the "T" area, itchy and painful, pale tongue or with teeth marks on the edges, thin white tongue coating, slippery pulse, and regular bowel movements. If the rash is mainly located around the mouth, the patient often has loose stools.

The prescription is Baohe Pills combined with Erchen Decoction: raw hawthorn 30g, scorched Shenqu 15g, stir-fried malt 30g, stir-fried coix seed 30g, Poria 20g, Alisma orientalis 20g, tangerine peel 15g, Polygonum cuspidatum 15g, raw Atractylodes macrocephala 15g (if the stool is loose, change to stir-fried Atractylodes macrocephala), raw licorice 10g. If the affected area is mainly around the mouth, add Gardenia 15g and Patchouli 15g (modified Xiehuang San) to drain the hidden fire in the spleen meridian; if the stool is loose, add Saposhnikovia divaricata 15g, Notopterygium incisum 15g, and dried ginger 10g to raise yang and remove dampness. If there are many acnes, add Pinellia ternata 15g, Fritillaria thunbergii 30g, and Oyster 30g to resolve phlegm and soften hard masses.

3. Chong and Ren disorders

This type is common in patients with post-pubertal onset disease. Chong and Ren meridians belong to the liver and kidneys. Before menstruation, menstrual blood is full and easily irritated by liver qi. Excess qi becomes fire, and fire is inflammatory in nature, refining body fluid into phlegm, forming acne. Therefore, the patient's skin lesions often worsen before menstruation. The kidneys are responsible for storage. Disorders in the liver and kidney storage and discharge can lead to menstrual disorders, endocrine disorders and acne. The kidney can be divided into yin deficiency and yang deficiency. If the patient has systemic symptoms such as hot hands and feet, night sweats, etc., it is mostly due to kidney yin deficiency and the ascending of virtual fire, and the treatment is to nourish yin and reduce fire. If the patient has cold hands and feet, abdominal pain during menstruation, and blood clots during menstruation, it is mostly due to kidney yang deficiency and the floating of virtual yang, and the treatment is to clear the upper part and warm the lower part, and guide the fire back to its origin. Because the liver and kidney have the same origin, they should be taken into consideration in treatment, nourishing kidney yin while clearing liver fire, warming kidney yang while warming liver yang.

This type of skin lesions are concentrated on the face, mainly dark red papules and nodules, with occasional pain, pale tongue with thin white coating, slippery or thin pulse, accompanied by irregular menstruation, often with blood clots. It is treated by regulating Chong and Ren meridians, with Danggui Shaoyao San and Erxian Decoction with modifications: 15g of Angelica sinensis, 15g of white peony root, 15g of raw Atractylodes macrocephala, 20g of Poria cocos, 15g of Qingbanxia, ​​15g of Angelica dahurica, 20g of Leonurus japonicus, 15g of Curculigo orchioides, 15g of Epimedium, 20g of Morinda officinalis, 15g of Phellodendron chinense, and 10g of Anemarrhena asphodeloides. If the main lesions are nodules, add 30g of Fritillaria thunbergii, 30g of raw oyster, 15g of Prunella vulgaris, and 1 centipede to dredge the meridians, soften the hard masses and disperse the nodules.

4. Excessive heat and toxicity

There are three types of poisons: wind poison, dampness poison, blood stasis poison, heat poison, and fire poison. The "Inner Canon of the Yellow Emperor" proposes that poisons "are all symptoms of extreme hyperactivity of yang and heat." Acne fulminans has an acute onset, a rapid onset, and obvious symptoms of heat and fire, which is consistent with the pathogenic characteristics of "fire poison" in traditional Chinese medicine.

This type of patients develop the disease rapidly, with severe clinical symptoms, oily face, and skin lesions mainly consisting of nodules, cysts, abscesses, and blackheads. It falls into the category of cystic and conglomerate acne in Western medicine. Some patients also have perforating folliculitis on the head (known as "mole cricket boil" in traditional Chinese medicine), suppurative hidradenitis under the armpits, red tongue, thin yellow or greasy coating, and slippery or rapid pulse. The skin lesions of this type of patients are mainly purulent, and the treatment should start with the sores and ulcers, with large doses of blood-cooling, heat-clearing and detoxifying drugs, as well as cooling blood, removing dampness, softening and dispersing nodules. The prescription is a modification of Wuwei Xiaodu Yin combined with Xianfang Huoming Yin: 30g of honeysuckle, 15g of forsythia, 30g of dandelion, 20g of viola yedoensis, 20g of angelica dahurica, 30g of thunbergia thunbergii, 20g of root of trichosanthes, 15g of capillaris, 15g of angelica sinensis, 15g of roasted frankincense, 10g of dried tangerine peel, and 10g of raw licorice. If the skin is itchy, add 15g of saposhnikovia divaricata and 15g of notopterygium wilfordii to dispel wind and stop itching, and also to overcome dampness (wind can overcome dampness); if there are many abscesses and nodules, add 10g of Jiazhu, 20g of soapberry thorn, and 2 centipedes to break up blood and soften hard masses; if the stool is dry and hard, add 15g of raw rhubarb to have a laxative effect, remove blood stasis and promote new blood circulation. It can be combined with external application of golden loose bandage to reduce swelling. If an abscess is formed, surgical incision and drainage are required.

5. Heat on the upper body and cold on the lower body

Most patients of this type are in adolescence, with inflammatory papules on the face, cold hands and feet, abdominal pain during menstruation, a pale tongue with a thin white coating or ecchymosis on the edge of the tongue tip, a slippery or thin or slow pulse, and loose or sometimes dry stools. It is caused by deficiency of Yang in the body, and the deficiency Yang floats upwards and causes the disease. The treatment method of "leading fire back to its origin" is adopted, clearing the upper part and warming the lower part. Jiaotai Pills are combined with Shaofu Zhuyu Decoction with modifications: Paris polyphylla 20g, Scutellaria 10g, Coptis chinensis 10g, Cyathula officinalis 15g, Fennel 15g, Cinnamon bark 5g, Paeonia lactiflora 20g, Salvia miltiorrhiza 15g, Curcuma 20g, Licorice root 10g. If the stool is loose, add dried ginger 10g and Poria 20g to warm the middle and stop diarrhea; if the stool is dry, add Angelica 15g and Scrophularia 15g to clear the floating fire in the upper part and have a bowel movement.

In addition, the treatment should also take into account the site of the disease and use appropriate medication. The site of the disease is the heart in the forehead, which is often caused by hyperactivity of heart fire. The heart fire moves downward to the small intestine, so yellow urine is common clinically. The left cheek represents the liver, and the right cheek represents the lungs, so problems occurring on the cheeks are often caused by liver fire invading the lungs. The area around the mouth belongs to the spleen and is often caused by damp heat in the spleen and stomach. The back is governed by the Yangming Meridian, and is often caused by deficiency of Yang Qi that is unable to protect the body from external damage.