Acne cases

Case 1 :
Male, 20y
Clinical manifestations: The patient had been healthy throughout his childhood and adolescence. At the age of 18, red papules and open comedones ( blackheads ) started to appear on the face. In the following year, successive crops of increasingly severe red papules and pustules appeared. Lesions of different sizes were distributed over the forehead and chin and around the nose. Comedones were noted in the center of some of the papules, which were most densely concentrated around the nose. The patient’s face was very greasy. He was keen on sports, had a good appetite and tended to eat llarge amounts. Accompanying symptoms and signs included dry mouth and dry and smelly stools, with boewl movements only once every few days. the tongue body was red with a thin yellow coating, the pulse was wiry and slippery.
Pattern : Heat accumulating in the lung and stomach with external contraction of pathogenic toxins
Treatment principle: Clear heat from the lung and stomach and relieve toxicity
Formula : jin yin hua 15g, lian qiao 15g, pu gong ying 30g, zihua di ding 15g, sang bai pi 15g, huang qin 10g, zhi zi 10g, chi shao 10g, mu dan pi 10g, sheng di huang 30g, gua lou 15g, shu da huang 10g, ye ju hua 15g, dig u pi 15g .
one bag a day was used to prepare a decoction, taken twice a day.
Second visit: After 14 bags of the prescription, stool was passed once a day and the dry mouth was relieved. No new red papules had appeared. The pustules had disappeared but the oily secretion was still pronounced. Numerous open and closed comedones also remained. The patient was told to continue with the prescription for another 28days. in addition, Liu Lei xi ji and lu liu ding were applied externally once a day.
Third visit: The red papules had disappeared completely, leaving pale pigmented spots. The dkin was still greasy and slightly red on both sides of the nose. The prescription was modified by moving gua liu and shu da huang and adding mei gui hua10g, ji guan hua 10g, and ling xiao hua 10g. the patient followed the revised prescription for one month to consolidate the improvement. The external wash prescription was changed to washing the face with alkaline soap three times a day. The patient was also advied not to eat deep-fried food and sweet food.
Outcome:
At the end of the course, the condition had resolved.

Case 2:
Female, 21y
Clinical manifestations: Papules started to appear on the patient’s face at the age of 16 with intermittent exacerbation and alleviation. The papules gradually increased in number and turned redder, some of them becoming confluent. When the papules burst, a white secretion came out. The patient was diagnosed with cystic acne with secondary inflammation. Examination revealed closed comedones, papules and pustules of different size concentrated on the forehead and both cheeks. A number of hard nodules 10mm in diameter were noted on various parts of the face. Some of the nodules were mobile and discharged a white plug when squeezed. The patient’s face was very greasy. Accompanying symptoms and signs included dry mouth and a liking for cold drinks. Stool and urine were normal. The tongue body was red with a white and greasy coating, the pulse was wiry and slippery.
Pattern: Damp-heat in the lungs and stomach, external contraction of pathogenic toxins, blood-heat accumulating and binding.
Treatment principle: Clear damp-heat in the lung and stomach, cool the blood and relieve toxicity, soften hardness and dissipate lumps.
Prescription : sang bai pi 15g, dig u pi 15g, huang qin 15g, zhi zi 10g, huang lian 10g, ye ju hua 15g, ji guan hua 10g, jin yin hua 15g, lian qiao 15g, pu gong ying 15g, zi hua di ding 10g, chi shao 10g, mu dan pi 10g, xia ku cao 15g, che qian zi 15g, yi yi ren 30g
one bag a day was used to prepare a decoction, taken twice a day.
External treatment: liu lei xi ji, hei bu yao gao and hua du san gao.
Second visit: after three days, the skin lesions had improved, and some of the papules and pustules had begun to subside. The patient was told t continue the prescription and external application for another 7 days. the hard nodules and cystic area began to shrink and flatten. He was told to continue for another four days.
Third visit: after 14 bags overall, most of the lesions were flat and no new papules had appeared. The oily secretion was disappearing and the cysts were smaller. The tongue body was dark red with a white coating, the pulse was wiry and slippery. The prescription was modified by removing ji guan hua and huang qin and adding dan shen 15g, and hong hua 15g. the external application continued as before.
Outcome: After 14 bags of amended prescription, the skin lesions had disappeared completely, leaving pale pigmented spots and shallow scarring.

Xu.Y, 2004.Dermatoloty in Traditional Chinese Medicine. Donica Publishing