Acne is a disorder of the hair follicle sebaceous glands, consisting of non-inflammatory lesions ( open and closed comedones ) and inflammatory lesions ( papules, pustules and nodules ). Acne is common among adolescents and young adults, usually starting between the ages of 12 and 14 and peaking between the ages of 16 and 19. Females are normally affected earlier than males. Although acne generally disappears once puberty and growth are over, it may persist into adulthood. It may reappear in adult life after hormone treatment for other disorders, in some women, acne may be exacerbated in the premenstrual phase. Lesions generally appear on the face, the chest, the back and the interscapular area.

TCM: Fenci , Feifeng

TCM Aetiology and pathology:
1.underlying heat in the blood is the main internal factor responsible for the onset of the disease, whereas improper diet and invasion by external pathogenic factors are the main external causes. Blood stasis and binding of phlegm result in complications and aggravation of the condition.
2.A tendency toward exuberance of constitutional Yang-heat during adolescence gradually warms up the ying and xue levels. Blood-heat moves out to the exterior and congests the vessels, resulting in stagnation of qi and blood.
3.Spicy food has a hot, yang nature and transforms into heat if too much is eaten over a long period. Over-indulgence in fishy and fatty foods impairs the transformation and transportation function of the middle burner and generates fir and heat from prolonged accumulation. Fire and heat tend to steam upward to affect the face, giving rise to small red eruptions.
4. General poor health resulting in repeated contraction of pathogenic wind-heat or washing in cold water resulting in binding of blood-heat gradually leads to clusters of inflamed lesions or blackheads.
5.Stagnation of qi and blood in the channels and network vessels due to persistent illness or emotional disturbance, or blood stasis and binding of phlegm due to prolonged accumulation of heat in the lungs and stomach, which transforms into damp and generates phlegm, will result in widespread eruptions or the formation of nodules and cysts.

TCM patterns:

1.Accumulation of heat in the lung
Main symptoms and signs:
This pattern arises when heat in the lung channel is complicated by external contraction of pathogenic wind, which causes the retention of lung-heat in the skin and flesh. Lesions are distributed over the cheeks and forehead and around the nose, manifesting as discrete pinpoint to 2mm red or pale red papules. In severe cases, lesions may involve the chest and back. Blackheads may be seen on some lesions. Pressure may produce excretion of a plug of greasy matter or thick, yellow purulent discharge. The skin looks oily and shiny. Accompanying symptoms include a dry mouth and nose, a red tongue body with a thin yellow coating, and a floating pulse.
Treatment principle
Clear heat from the lung
Modified pi pa qing fei yin
Pi pa ye 10g, jiao zhi zi 10g, lian qiao 10g, chi shao 10g, san bai pi 10g, huang qin 6g, chao mu dan pi 6g, hong hua 6g, ling xiao hua 6g, sheng di huang 12g, jin yin hua 12g, dong gua pi 12g, dong guar en 12g

2.Accumulation of heat in the stomach
Stomach-heat arises from accumulated heat in the spleen and stomach caused by over indulgence in spicy, fatty and fried foods, with heat then being retained in the skin and flesh. Lesions are similar to those in the lung heat pattern, except that they are mainly distributed around the mouth. Accompanying symptoms and signs include bad breath, aversion to heat, thirst with a desire for cold drinks, constipation, and dark yellow urine. The tongue body is red with a thin yellow or thick and greasy coating, the pulse is slippery and rapid.
Treatment principle
Ckear geat from the yangming channel
Tiao wei cheng qi tang
Jiu zhi da huang 12g, zhi gan cao 6g, mang xiao 12g

Main symptoms and signs:
Internal damage due to emotional disturbances leads to qi depression , eventually transforming into heat. Latent heat in the ying and xue levels finally results in acne. Lesions manifest as 1-2 mm red papules on the face, concentrated around the nose and mouth and between the eyebrows, accompanied by telangiectasia, tidal reddening of the face and a sensation of scorching heat. For women, papules normally increase before and after menstruation. Accompanying symptoms include dry stools and yellow or reddish urine. The tongue tip is red with a thin yellow coating, pulse is thread, slippery and rapid.
Treatment principle
Cool the blood and clear heat, transform stasis and reduce erythema
Modified tao hong si wu tang and liang xue wu hua tang
tao ren 6g, hong hua 6g, ling xiao hua 6g, chuan xiong 6g, chao mu dan pi 10g, sheng di huang 10g, chi shao 10g, jin yin hua 10g, chao huai hua 10g, ji guan hua 10g, shi gao 12g, huang qin 6g

4. Blood stasis and binding of phlegm
Main symptoms and signs:
This pattern manifests as repeated and persistent eruptions on the cheeks and lower jaw, gradually enlarging into 3-5 mm or larger, unevenly protruding, purplish-red lumps that feel soft on palpation, with excretion of pus and blood or stichy yellow matter on pressure. Scars from after rupture. The tongue body is pale red with a slippery and greasy coating, the pulse is soggy and slippery
Treatment principle
Invigorate the blood and transform blood stasis, disperse phlegm and soften hardness
Modified hai zao yu hu tang
hai zao 10g, zhe bei mu 10g, chen pi 10g, kun bu 10g, fa ban xia 10g, lian qiao 12g, xia ku cao 12g, long gu 12g, mu li 12g, dang gui 6g, chuan xiong 6g, qing pi 6g, ju he 10g
Acupuncture and other treatment

Clear damp-heat: hegu, quchi, shenmen, fengshi, xuehai, yinlingquan.
Clear heat and cooling blood: shaofu, laogong, quchi, jueg

Compiled by Hao Chen from:
Dermatology in Traditional Chinese Medicine, Donica Publishing

Hao Chen: According to my experience, the common pattern of Acne is damp-heat due to spleen and blood deficiency, combined with exterior wind-cold blocking on skin. Red papules can be caused by inner heat, pustules and nodules can be caused by inner dampness, since heat flares upward, so the heat can ascend the damp reaching skin. In the meantime, wind-cold blocking the skin, so the damp and heat can’t really be released from skin but stucked underneath skin. Knowing this pathogenesis, treatment can be clear damp-heat by regulating spleen and stomach and tonifying blood, remove the wind-cold blockage of exterior.