Acne is a common chronic disfiguring disease that occurs in adolescence. It is clinically manifested as pinpoint-sized, blackheaded papules that can develop into pustular nodules, cysts, or even scars, mostly on the face, chest, and back. Acne is not a major medical disease, but it affects people’s appearance and causes varying degrees of mental stress and mental burden. Traditional Chinese medicine has always emphasized the importance of treating diseases with the disease mechanism in mind. The Su Wen not only contains nineteen articles classifying the disease mechanism, but also emphasizes the universal significance of the disease mechanism in clinical practice. The establishment of the disease mechanism guides the legislation, prescription selection, dispensing and treatment of Chinese medicine. In this article, we take “fire and heat” as the entry point and discuss the pathogenesis of acne from the aspects of Yang fire, Yin fire, depression fire, and damp fire.
The source of the diseases is described in Volume 27 of the Treatise on the Origin of the Diseases: “Facial blisters are sores on the face with wind and heat, with heads as big as rice or as big as grain, and white.” The medical zong jinjian records: “lung wind acne, this disease from the lung meridian blood heat and become, every hair in the nose and face, the rise of broken pimples, shaped like millet crumbs, red swelling pain, broken out of the white powder juice.” The day of “Surgery Zhengzong”: “acne …… stomach in the taste of dregs, fumigation of the lungs and become.” The ancients have long discussed acne in terms of external wind-heat, lung and stomach heat, and blood-heat prevalence. The lung is the master of the skin and hair, so when the external wind evil enters the lung through the meridian, it turns into heat for a long time and moves heat to the lung. The spleen and stomach are the main transporters of acne. If the spleen is not careful with its diet and eats too much hot and spicy food, heat and dampness will accumulate and dry out the Yang Ming stomach meridian, causing the dampness and heat of the lungs and stomach to rush up to the head and face without being able to vent. The acne is mostly manifested as scattered red corn on the face and back of the chest, pinhead to sesame size, light red or bright red, with a black head at the top, and yellow-white powder residue can be squeezed out.
In acne caused by Yang fire, the internal organs are mostly responsible for the lungs and stomach, and the nature of the disease is real. However, the method of clearing and diarrhea varies depending on the location of the evil fire, as stated in the Treatise on Typhoid: “Look at the pulse and evidence, know what is wrong, and treat it according to the symptoms”. The method of attacking the evil, can be referred to the son and, according to the situation, to sweat, down, clear mainly. If the evil heat is on the surface, the method is to remove the wind and clear the heat, so that the evil comes out with the sweat; if the evil heat is in the lining, and the tangible evil is knotted, and the Qi and blood are stagnant and cannot be promoted, the method is to clear and release the heat, so that the heat is removed from the lower intestine.
2, Yin does not control Yang, false fire on the inflammation, reconciliation of Yin and Yang, nourishing Yin and lowering fire Chinese medicine emphasizes the balance of Yin and Yang, “Yin and Yang, the way of heaven and earth, the outline of everything ……”, “Yin inside, Yang’s guard; Yang outside, Yin’s make also “. The yin essence is secretly consumed inside, yin does not converge on yang, yin and yang are out of balance, yang is relatively hyperactive and hot, and develops into the fire of yin deficiency, floating over the top. It is true that, as stated in Jing Yue Quan Shu, “Those who have Yin deficiency can develop heat. This is because of the loss of true Yin, and water does not control fire”. In terms of the pathogenesis of acne, on the one hand, deficiency fires upwards burn the lungs and consume fluid, causing lung fever and blood fever. When the liver meridians are depressed and hot, the liver loses its circulation, the qi is not smooth, the internal organs are disturbed, and the emotions are out of balance. The term “Yin fire” and “deficiency fire” here refers to Yin deficiency and fire. Acne is characterized by red or dark red papules, pimples, small pustules, nodules and scars on the face, a red tongue with yellow or little moss, and a thin string or string pulse; accompanied by dry mouth, bitterness, tinnitus, irritability, insomnia, dreaminess, dry stools and yellow urine. Before menstruation, yin blood gathers in the uterus, and yang heat and deficiency fire float over the top, so acne lesions increase and worsen before menstruation.
In acne caused by Yin fire, the internal organs are mostly blamed on the liver and kidneys, and the nature of the disease is deficiency.
The human body is a small circumference, with water and fire working together in one furnace. Yin fire is not the fire of the only hyper, water is not enough to control and for, if the clear diarrhea is not hyperactive fire, it will damage the people living and breathing machine. The Inner Classic says: “The treatment of disease must seek its root”, not visible evidence of fire, so the method of clearing and lowering. The proper way of treatment is to replenish the deficient yin, fill up the yin liquid to control the hyperactive yang, so that the yin essence will be abundant and the yang energy will return to the body, so that it will be safe.
3, the congestion of Fries closed depression, depression of internal fire, open up and disperse the knots, solve the depression and promote fire For “depression of fire”, there is no clear definition in Chinese medicine. The author defines it as a pathological state in which all pathological factors lead to the depression of Yang Qi, resulting in a surplus of Yang Qi. Regarding the specific pathogenesis of yu huo, few people have discussed it, and the Concise Chinese Medical Dictionary has explained the five organs of yu huo as follows: “Generally, it refers to the evidence of internal heat due to depression of yang qi and the evidence of internal heat caused by excessive depression of emotion and will.” Three elements are required for the establishment of yu hua: one is evil qi, the other is yang qi, and the third is stagnation. Evil qi is the cause of yu huo, yang qi is the quality of yu huo, and yu huo is the change of yang qi [1]. In the book “The Authentic Book of Surgery”, it is said that “three species of lung wind, acne and rosacea are the same, acne belongs to the lung, rosacea belongs to the spleen, and all of them are blood-heat stagnation.” In the development of acne, qi stagnation, blood stasis, and phlegm knots are all important links. If the disease persists for a long period of time, the evil qi is suppressed, the meridians are not smoothly flowing, and the blood is stagnant. All of the above lead to internal trapping of Yang Qi, depression without development, and prolonged heat, which accumulates on the face and results in acne. This type of acne is characterized by recurrent acne, which does not go away over time and gradually becomes nodules the size of soybeans or broad beans, swollen and painful or like a sac when pressed. They become swollen, hard and painful, or like a sac when pressed. Over time, they fuse together and become uneven, with scarring and rough skin.
In acne caused by depression and fire, most of the evidence is based on qi, blood, phlegm and dampness, and the nature of the disease is real. When treating acne, we should take into account the three causes of fire, namely, the elimination of evil to intercept the cause of fire, the passage of Yang to isolate the potential of fire, the management of Qi to break the cause of fire, and the promotion of stagnation to prevent the gathering of fire and heat. In some patients with acne, after the application of the method of clearing heat and detoxifying the toxin, the redness, swelling, and pain improve, but often a lump remains and recurs in the same place. The root of the disease is still there, and it will recur when the evil is felt.
4, dampness attack, Yin evil heat, Fang Xuan dry seepage, dispel dampness and clear the fire dampness and fire, named after the cause of “dampness” and the nature of the disease “fire”, this evidence is common in the Lingnan area, mostly due to dietary inappropriate, improper conditioning. Excessive consumption of yin and soft products, the middle qi is suppressed, the spleen qi does not rise, the stomach qi does not descend, the yang qi does not spread, depression and heat; excessive consumption of sweet and warm products, sweet taste helps dampness, warm and dry help fire, dampness and fire in the ambush, curb qi. If the diet is not regulated, the dampness and turbidity are blocked and the Qi is not raised and lowered properly, which results in heat. Dampness and fire are caused by dietary imbalance, which leads to trapped qi in the spleen and stomach, and dampness and heat, which fills the three jiao and runs through the meridians. It is different from the dampness of the skin, hair, mouth, and nose in wet-warm disease, and from the cold dampness of the summer rainy season, which gradually injures the spleen and yin and starts to show signs of heat [2]. This type of acne is characterized by frequent acne, redness, swelling, pain, or pus cells, and a lot of facial oil.
In acne caused by dampness and fire, the internal organs are mostly blamed on the spleen and stomach, and the nature of the disease is real. In the upper part of the body, aroma should be used to penetrate the evil and clear heat; in the middle part of the body, bitter cold should be used to clear heat and dry dampness; in the lower part of the body, pungent openness and bitterness should be used to drain and eliminate dampness. Damp fire evidence of the use of drugs, more hard dry cold, so in the disease that is to, too much fear of injury to the stomach and depletion. In addition, most of the blame for the formation of damp fire lies in the lack of diet, so dietary regulation is especially important.
5. Conclusion The onset of acne is closely related to “fire and heat”, but the condition is complex and variable, and often intertwined with each other, so when treating the disease, we should clearly identify the pathogenic mechanism, the actual is diarrhea, deficiency is supplementation, depression is development, and dampness is transformation.