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Acne is a common inflammation of the hair follicles and sebaceous glands, primarily caused by excessive sebum production, abnormal keratin metabolism, proliferation of Cutibacterium acnes, and inflammatory redness and swelling. It commonly occurs on the face, chest, and back, with clinical manifestations including comedones, papules, pustules, or nodules.

"Comedones" are a mild form of acne and belong to "non-inflammatory" lesions. "Pimples" is a colloquial term often referring to already inflamed and red papules or pustules. Acne is the formal medical term, serving as an umbrella term that encompasses both comedones and pimples.

Apart from comedones, traditional Chinese medicine (TCM) ancient texts do not have the disease names "acne" or "pimples." Instead, based on their symptoms, common locations, and characteristics, they were given different names.

Discoveries of Modern Medicine

Modern medicine considers acne an inflammatory disease of the pilosebaceous unit. It is associated with the following four key factors:

• Excessive sebum secretion: Stimulated by androgens (present in both males and females), the sebaceous glands produce too much oil.
• Follicular hyperkeratinization: Keratinocytes at the follicular opening shed abnormally and clog, forming microcomedones.
• Overgrowth of Cutibacterium acnes: After the follicle is blocked, an anaerobic environment forms, allowing Cutibacterium acnes, which feeds on sebum, to proliferate extensively.
• Inflammatory response: Substances produced by bacterial breakdown of sebum trigger intense inflammation, leading to redness, swelling, and pain.

Other factors: Genetics, stress, staying up late, cosmetics, certain medications like steroids, and diet such as high sugar and high dairy products may all induce or worsen the condition.

Modern Medical Treatment

Topical Medications

Suitable for: Mild to moderate acne.
Common types:

• Vitamin A acid derivatives: Improve follicular keratinization, unclog pores, commonly used in dermatology.
• Benzoyl peroxide: Bactericidal, anti-inflammatory, and mildly exfoliating.
• Antibiotics: Kill Cutibacterium acnes and reduce inflammation.
• Salicylic acid, Alpha hydroxy acids (AHAs): Help with keratin metabolism and unclog pores.

Oral Medications

Suitable for: Moderate to severe acne, or cases where topical medications are ineffective.
Common types:

• Antibiotics: Mainly used to control inflammation and bacteria, but long-term use requires attention to side effects.
• Oral isotretinoin: Currently the most potent anti-acne drug, acting on all four pathogenic links. Typically used for severe, stubborn cystic acne, but has serious side effects such as dry skin and mucous membranes, increased sun sensitivity, muscle aches, headaches, hair loss, thinning nails, blood lipid abnormalities, liver function abnormalities, and teratogenicity. It must be used under strict medical supervision.
• Hormonal treatments: Such as oral contraceptives and anti-androgen drugs, mainly used for adult female acne, especially types that cyclically flare around the chin, by regulating hormones to suppress sebum secretion.

Other adjuvant therapies also focus solely on the local affected area, lacking a holistic concept, thus only providing temporary relief and leading to recurrent outbreaks that never cease.

The Holistic View of Traditional Chinese Medicine

The human body is an interconnected whole. Merely applying medication to the affected area may seem temporarily effective, but recurrence is easy once the medication is stopped, because the underlying major causes and overall internal environment have not improved.

The causes recorded in ancient TCM texts are mainly related to dysfunction of the Zang-fu organs such as the Lung, Stomach, and Spleen. The etiology and pathogenesis often involve the mutual struggle of wind-heat, blood-heat, dampness-heat, and phlegm-stasis, which steam upward to the face, chest, and back.

Modern TCM clinical practice usually categorizes acne into the following common patterns, and treatment varies accordingly:

• Lung Meridian Wind-Heat Pattern
  Manifestations: Bright red pimples, possibly itchy or painful, mainly papules (small red bumps), may be accompanied by blackheads or whiteheads. Often accompanied by dry mouth and dark yellow urine.
• Dampness-heat of Spleen and Stomach Pattern
  Manifestations: Red, swollen, painful pimples, mainly pustules and inflammatory papules, with excessive oiliness. Often accompanied by bad breath, constipation, and preference for cold drinks.
• Phlegm and Blood Stasis Intermingling
  Manifestations: Long-standing, unhealed pimples, dark red in color, hard texture, presenting as nodules and cysts, prone to scarring and pigmentation. Pain is not obvious but discomfort is felt upon touch.
• Thoroughfare and Conception Vessel Disharmony Pattern
  Manifestations: More common in women, the severity of acne is closely related to the menstrual cycle (usually worsening premenstrually), accompanied by irregular menstruation, irritability, and easy anger.
• External Cold with Internal Heat Pattern
  Also known as "cold wrapping fire," it is caused by the skin being constrained externally by improper wind, cold, and dampness (e.g., exposure to wind/cold after sweating, getting caught in the rain), affecting the microcirculation of the skin surface. This prevents the smooth discharge of metabolic waste and oil from the skin's pores and sweat glands, leading to accumulation. Immunity also cannot reach the skin surface effectively, causing pore blockage, bacterial growth, and disease. Modern medicine is not yet aware of this factor, making it impossible to cure acne caused by this etiology.

Adolescent Acne (Pimples)

Characteristics: Mainly occurs during adolescence, closely related to the development of secondary sexual characteristics and increased levels of androgens in the body.

TCM believes that during adolescence, Yang Qi is vigorous, belonging to a "body of pure Yang," prone to a "Yang heat" state. Coupled with academic pressure, staying up late, and dietary irregularities (e.g., preference for fried foods, sweets), it easily leads to exuberant Lung and Stomach heat. Therefore, the Lung Channel Wind-Heat and Stomach and Intestines Dampness-Heat patterns mentioned above are most common. Treatment focuses on clearing heat and draining fire.

Hormonal Acne (in Women)

This refers to adult acne related to endocrine factors.

• Characteristics: More common in adult women, especially deep, painful cystic acne recurring around the chin, jawline, and neck, strongly correlated with the menstrual cycle. TCM Interpretation: This directly corresponds to the TCM patterns of Thoroughfare and Conception Vessel Disharmony and the pathogenesis of Liver Qi Stagnation.
• Disease Location: Mainly related to dysfunction of the Liver, Kidney, Thoroughfare (Chong) Vessel, and Conception (Ren) Vessel.
• Core Pathogenesis:
  • Liver Qi Depression: Emotional stress and staying up late cause Liver Qi to fail to flow freely, stagnating and transforming into fire, which flares upward to the face.
  • Thoroughfare and Conception Vessel Disharmony: Deficiency of Kidney Essence or imbalance of Yin and Yang leads to disharmony of Qi and Blood in the "Chong and Ren" vessels, which govern menstruation. Pre-menstrually, Qi and Blood are congested and abundant, easily pushing internal heat, toxins, and stasis to the body surface, triggering acne.
  • Often combined with Blood Stasis and Phlegm Congealing: Prolonged illness easily leads to the formation of stubborn nodules and cysts that are difficult to resolve.

Treatment is not solely about clearing heat; it must also soothe the Liver and regulate Qi, harmonize the Thoroughfare and Conception Vessels, or invigorate blood and resolve stasis. Great emphasis is placed on regulating the menstrual cycle, with different focuses in medication during different cycle phases (post-menstruation, ovulation, pre-menstruation, menstruation). It must be combined with emotional management and a regular daily routine (balanced work-rest schedule), otherwise a radical cure is difficult.

TCM Also Has External Treatment Methods

For severe acne where the affected area is seriously damaged and bad bacteria are entrenched, TCM also has topical ointments; made by decocting natural medicines with bactericidal, anti-inflammatory, and swelling-reducing effects, they have almost no side effects and no drug resistance.

For recurrent, severely pustular lesions, because the affected area has already developed some fibrosis and microcirculation blockage, the efficacy of oral or topical medication struggles to fully reach the lesion, greatly reducing effectiveness. TCM can assist with bloodletting (pricking) and applying anti-inflammatory Chinese medicine powder, which can lead to recovery in a surprisingly short time.

Even for those who already have scars or severe pits, TCM has corresponding Chinese medicines that can help them contract or fill in as much as possible.

Daily Health Maintenance

Preventing and improving acne is crucially dependent on daily regulation. A multi-pronged approach involving diet, a healthy daily routine, and external care is necessary.

• Diet: Avoid high-sugar, high-fat, high-dairy, spicy and stimulating, barbecued, and fried foods that easily cause "excessive internal heat" (heatiness), as these stimulate excessive sebum secretion and inflammation. Increase intake of fresh vegetables, fruits, and foods rich in zinc and Omega-3, which help fight inflammation and balance oil.
• Work-Rest Schedule: Avoid staying up late, ensure adequate sleep to maintain endocrine stability and reduce stress.
• Emotional Management: Maintain a relaxed and happy mood. Moderate exercise helps relieve stress, preventing Liver Stagnation transforming into fire and worsening the condition.
• Cleansing and Care: Choose gentle cleansing products without irritating ingredients. Avoid over-cleansing or using heavy, oily cosmetics that clog pores. Pay attention to sun protection, but choose lightweight, non-comedogenic sunscreen. Dry sweat promptly after perspiring; avoid exposure to wind while sweaty or staying in damp environments for long periods to prevent external pathogens constraining the exterior and impairing metabolism.
• Do not squeeze pimples yourself: To avoid worsening inflammation, leaving scars, or causing infection to spread.

Cultivating good habits can effectively assist treatment, reduce recurrence rates, and fundamentally maintain skin health.

Summary

The advantage of TCM in treating acne lies in truly considering you as a complete individual for holistic regulation. Based on your acne morphology, oiliness, accompanying symptoms, menstruation, tongue coating, pulse condition, etc., it determines which pattern (Zheng) you belong to and tailors a treatment plan accordingly. It adjusts your constitution from the root cause, not only treating the symptoms but also addressing the root, decisively outperforming modern medicine.