Acne Vulgaris - Zhuo Chuang

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1 Definition
2 Causes and Pathological Mechanisms
3 Patterns
4 References
5 Articles
6 Books

Definition

A disorder of the pilosebaceous follicles causing comedones (blackheads and whiteheads), papules and pustules of the face, chest and the upper back.

Mild acne valgaris is almost universal at some stage of human development especially in the second decade (teenagers). Girls develop acne 2-3 year early than boys but boys have more persistent lesions.

In TCM, acne is also called “Fen Ci” – powder thorn, for the prick-like papules and their whitish content that can be squeezed out.

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Causes and Pathological Mechanisms

Blood Heat: constitutional Yang Exuberance exacerbated by booming growth in puberty. Blood heat gradually accumulates and blocks qi and blood in the skin
Lung Wind Heat: wind heat invades the lung affecting the skin on the upper part of the body (lung controls skin and hair)
Stomach damp-heat: improper diets (rich, greasy and spicy food) causes accumulation of Damp Heat to jam up the face and the chest through its channel
Liver Qi Stagnation with Blood Stasis: emotional disorder with disharmony in Chong Ren, Liver Qi Stagnation transforms into fire
Persistent papules for a long time will lead to Qi and Blood Stagnation in the skin and the formation of phlegm. Phlegm and stagnated blood make it difficult to clear – chronic acne.

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Patterns

Blood Heat

Symptoms: Red papules, red face, vexation, insomnia and many dreams.
Tongue: Red tongue with yellow coating
Pulse: Rapid
Treatment strategy: Clear away heat and cool blood
Formula: Qing Ying Tang and Xian Fang Huo Ming Yin with modifications, Shui Niu Jiao replaces Xi Jiao
Acupoints:

Lung Wind Heat

Symptoms: Red papules and some with pustules, itch and a little pain, red face.
Tongue: Red tongue tip, thin and yellow coating
Pulse: Rapid
Treatment strategy: Dispel wind and clear away lung heat
Formula: Pi Pa Qing Fei Yin with modifications, minus Ren Shen, plus Bai Hua She She Cao and Yu Xing Cao
Acupoints:

Stomach Damp Heat

Symptoms: Red and swollen papules with pustules, granuloma formation, halitosis (foul breath), greasy skin, sticky sweat, constipation or sticky and foul faeces, dark yellow urine.
Tongue: Red tongue with yellow and greasy coating
Pulse: Slippery and Rapid
Treatment strategy: Clear away heat and resolve dampness
Formula: Ying Chen Huo Tang plus Huang Lian Jie Du Tang with modifications, add Ku Shen, Yi Yi Ren and Tu Fu Ling
Acupoints:

Chong Ren disharmony

Symptoms: Cyclical changes in acne with a close relationship with menstruation, mostly worse before and during menstruation and better afterwards, painful period, irritable and angry, chest and abdominal distension.
Tongue: Dull red tongue with thin and yellow coating
Pulse: Wiry, Thready and Rapid
Treatment strategy: Harmonise Chong Ren and soothe the liver
Formula: Dan Zhi Xiao Yao San with modifications, add Hong Hua, Sheng di Huang and Yi Mu Cao
Acupoints:

Phlegm and stagnated blood knotted together

Symptoms: Acne for a long period, granuloma and cyst formation, granulation tissue, scar formation, bloated abdomen, reduced appetite, loose feces.
Tongue: Puffy tongue with thin and moist coating
Pulse: Slippery
Treatment strategy: Resolve phlegm and remove blood stasis
Formula: Hai Zao Yu Hu Tang and Tao Hong Si Wu Tang
Acupoints:

External treatments

Dian Dao San: Da Huang and Liu Huang, equal portions, powdered. Cold boiled water to mix and apply; or Da Huang and Liu Huang 7.5 g each to mix with 100 ml limewash (lime water) and apply. 3-4 times per day.
San Huang Xi Ji: Da Huang, Huang Bai, Huang Qin and Ku Shen, equal portions, powdered. 10-15 g to mix with 100 ml distilled water and 1 ml medicated carbolic acid and apply 4-5 times per day.

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