Acne is a common skin disease that affects facial beauty, and is mostly discussed in Chinese medical literature as “acne” and “pulmonary wind acne”. With the continuous improvement of people’s living standards, more attention has been paid to the study of this disease. I would like to discuss some of the problems of its treatment with my colleagues in order to promote academic development. The definition of acne, as defined in the textbook “Chinese Medicine Surgery” (1), is: “A papule like a thorn on the face, chest, back, etc., which can squeeze out white rice-like powder juice, hence the name acne”. The definition in the corresponding teaching reference series “Chinese Medicine Surgery” (2) is: “This is a skin disease in which the lesions on the face, chest, back, etc. are papules like spines and can squeeze out white rice-like powder juice, which is the acne of modern medicine”. Acne is a chronic inflammatory disease of the hair follicles and sebaceous glands that occurs on the face and, in severe cases, on the chest and back, forming pimples, papules, nodules or cysts, often accompanied by seborrhea. It is called pulmonary wind acne in Chinese medicine”. By definition, the definition of acne disease in TCM seems to refer exclusively to those with a rash like a thorn, which can squeeze out white powder juice. In contrast, acne in Dermatology not only includes pimples, but also nodules, cysts, and other manifestations. It can be seen that acne is only one of the symptoms of acne, and the concept of equating acne with acne is not comprehensive enough. In addition, some ancient Chinese medical texts and current dictionaries state that the term “pulmonary wind acne” refers to wine bites rather than acne. For example, the Concise Dictionary of Chinese Medicine (4) treats pulmonary wind, pulmonary wind acne, and acne bruise as the same concept. Therefore, the reference to “acne, which is called pulmonary wind acne in Chinese medicine” is inappropriate. The term “acne” is not a modern medical term; it was already recorded as “acne” in the Nei Jing era. In the Su Wen? The book “The Book of Living Qi and Tongtian” says: “Laborious sweat when the wind, cold thin for, Yu is acne”. Zhang Jiebin note: “form labor sweat, sitting and lying when the wind, cold thin, liquid condensation for, that is, acne, if the depression and slightly larger, is a small section, is named acne.” (5) The author believes that acne, acne, acne and the word “yu” in between, combined with modern medicine about acne “the initial damage is mostly non-inflammatory acne, …… can evolve into papules, pustules, broken or absorbed, leaving a temporary In severe cases, it can develop into nodules, abscesses, cysts, etc., and after breaking down, sinus tracts or scarring are formed (3). In terms of the strict definition of the disease, the concepts of acne and acne are not exactly equivalent. According to the modern classification of acne, acne is only a mild form of acne. Therefore, TCM textbooks should not use the definition of acne to discuss acne in general. Western medicine textbooks should not say that “acne is known in Chinese medicine as pulmonary wind acne”. Since the term “acne” was already recorded in the Nei Jing era, why don’t we use the concept of acne instead of pimples? Is the terminology of TCM the only way to be old-fashioned? This is really a problem that must be addressed in the development of modern Chinese medicine and must be dealt with appropriately. As for the etiology of acne, the textbook of “Chinese Medicine Surgery” (6) believes that it is caused by the heat of Yang in the body and the heat of the blood in the body during adolescence, which leads to the onset of the disease. As for the description in the textbook, “If the disease does not heal over a long period of time, qi and blood are stagnant and the channels are not smooth, or if the accumulated heat in the lung and stomach does not resolve, dampness and phlegm are generated, and phlegm and stasis are intertwined, resulting in the gradual expansion of the corn rash, or the local appearance of nodules, which are connected. The Teaching Reference Book of Chinese Medicine Surgery (2) states that the etiology of acne is due to lung-heat, blood-heat, gastrointestinal damp-heat, spleen-deficiency, phlegm-dampness, incompatibility of the couples, and external stimuli. However, it should be noted that the proper discussion of the etiology and location of acne should be Lung Wind rather than Lung Heat, and the Lung meridian rather than the lung. This is because the conventional connotation of Chinese medical terminology is that the lung governs the lung and is responsible for respiration; the outer lung goes to the surface and is responsible for the skin. When the lung meridian is windy, it produces acne; when the lung is internally hot, it produces cough and fever. In addition, the author believes that the treatise of the Nei Jing, “Laborious sweating when the wind, cold and thin for, depression is acne” should not be neglected. As Wang Bing said in the “Yellow Emperor’s Classic of Internal Medicine” commentary: “when the cold months, the form of labor sweat, bleak wind outside the thin, the muscle coup dwelling cold, the fat is condensed, the animal in the Xuanfu, according to the empty seepage dry, thorns long in the skin, shaped like rice, or like a needle, long on the black, long a point, the rest of the color white and yellow and thin in the Xuanfu, commonly called acne.” (7) That is, when the wind is cold, qi and blood stagnation, lipid condensation, hair congestion and hair, also when the cause of the pathology of an aspect of the pathology. In recent years, others (8) have pointed out that “the pathogenesis of acne is not limited to wind-heat in the lung and damp-heat in the spleen and stomach, but should also involve a lack of kidney water and surplus liver fire. There is both a Yang-heat aspect of the actual evidence and an imbalance of Yin and Yang of the liver and kidney.” The liver and kidney are clearly mentioned here, and combined with modern medical research on endocrine dysfunction in this disease (9), it is worth drawing our attention to the study. However, from the epidemiological point of view, these are, after all, relatively rare and do not account for several percent of epidemiological investigations, and should not be taken as the main etiological mechanism. 3. Identification and typing The identification of acne should start with acne as the main symptom. The classical surgical works on acne are mainly concerned with wind-heat of the lung meridian, which is also known as loquat clearing lung drink. In the contemporary textbook of the 5th edition of Chinese Medicine Surgery (1), the classification of acne is wind-heat of the lung meridian, damp-heat of the gastrointestinal tract, and loss of health of the spleen. In the sixth edition of the textbook (6), the classification of acne is: wind-heat in the lung, damp-heat accumulation, and phlegm-damp condensation. The textbook is clearly a combination of local and systemic, etiology and internal organs typing for the different manifestations of acne, such as acne, abscesses, cysts and nodules. According to most doctors, acne can be classified into the following types: wind-heat in the lung meridian, damp-heat in the spleen and stomach, dysregulation of the flushing process, and phlegm-stasis condensation. The main points are: a total of acne as the main symptom. In cases of wind-heat in the lung, the majority of acne is blackheads or whiteheads on the face, accompanied by red papules, itching and pain, hot nose, red tongue, thin coating, and counted pulse; in cases of damp-heat in the spleen and stomach, the skin is greasy with nodules, or accompanied by bad breath, constipation and drowning, yellow coating, and smooth pulse; in cases of pustular cysts, the condition is lingering, and the rash rises and falls. In cases of phlegm and stagnation, the rash is persistent, hard and painful, dark and unpleasant, or accompanied by nodular cysts, scarring and pigmentation, with a dull red tongue and slippery pulse. Obviously, the four types are more comprehensive than the three types in the textbook. Of course, the clinical evidence of acne can be divided into other subtypes, such as kidney water deficiency, but after all, they are not common, so there is no need to discuss them all. It is easy to see from the textbook that it reflects the general pattern of the disease and the clinical characteristics of acne, which are mostly solid and hot. This is the main aspect of the identification and typing of acne. In addition, as a rash skin disease, the identification of local rash patterns and sites in relation to the meridians and internal organs is a distinctive and worthwhile study. Some studies have reported [10] that the site of acne is identified with the five viscera, pointing out that the forehead belongs to the heart, nose to the spleen, chin to the kidney, left cheek to the liver, and right cheek to the lung. Others [11] have divided the face into vertical and horizontal directions, with the frontal, paranasal, and perioral areas being treated from the spleen and the horizontal areas such as the cheek and chin being treated from the liver. Obviously, there are inconsistencies in these studies. As a study of the theory of the division of acne onset sites and the five organs, more and more systematic studies are needed. With regard to the identification of skin lesions, some studies [12] point out that blackhead acne is a case of dampness over heat, which is difficult to remove; whitehead acne is a case of heat over dampness, which is easy to turn poison into pus and heal when the pus comes out. Nodules are usually caused by blood stasis in the skin and couples, resulting in Qi stagnation and lumps. Cysts are phlegm, dampness, and blood stasis. These understandings reflect the results of localized rash identification. I believe that the integrated use of systemic and localized identification methods, including rash, etiology, meridians, and internal organs, will definitely help improve the clinical efficacy of acne. There are many treatment methods for acne. In terms of internal treatment methods, due to the concept of pulmonary wind acne, the loquat and lung clearing drink in The Golden Guide to Medicine has been regarded as the main formula for acne treatment, which means that clearing the wind and lung is the main method for acne treatment. In recent years, research on the treatment of acne has seen a richer development by many physicians who are not bound by the frame of lung wind, and there are many reports (13). There are those who use Hai Zao Yu Hu Tang with addition and subtraction to treat dampness and phlegm; there are even those who use Tao Hong Si Wu Tang to activate blood circulation and remove blood stasis; and so on, and the list goes on, greatly enriching the theory of treatment. Although there are many reports from all over the world and it is difficult to standardize them, it seems that in general, there are still many people who base their knowledge of acne on the understanding that the symptoms of acne are more real and more hot, and the main treatment principle is to clear heat and treat the sores. In terms of the internal organs and meridians, they include clearing the heart, promoting the lungs, managing the spleen, draining the liver, regulating the rheumatism, clearing the three jiao, and promoting diarrhea of the large intestine. Tonic methods, especially pure tonic methods, are not often used in the treatment of acne, but are occasionally used to nourish kidney yin, kidney essence and strengthen the spleen. Wang Bing’s commentary on the Huangdi Nei Jing Su Wen, “Cold and thin for”, points out that “acne, relieving the surface.” The treatment of acne with the method of relieving superficiality was clearly proposed. Modern medical practitioners have also reported on the treatment of acne with the method of relieving superficial manifestations (14), which states that for wind-cold cases, it is advisable to remove wind and disperse cold. The wind-heat type (pimple type) is characterized by flushing of the face, pimples {heat, pain or pustules, with Qing Ping San. It has been reported that more than 200 cases of acne have been treated with outstanding success and without any side effects. I personally believe that the theoretical significance of “acne, relieving the surface” can also be used to guide us in the dispensing of medicine to avoid overuse of cold, icy, evil qi, and pore occlusion, especially for chronic recurrent patients with phlegm and stagnation. Some people (15) have chosen to treat this disease with warm dispersing and blood-activating herbs such as thorny mustard and angelica root applied to the lung-heat-clearing herbs to improve the efficacy, which is worth learning from. Some authors point out that from the perspective of combining Chinese and Western medicine, it is advisable to clear the lung and stomach in the treatment of papulopustular acne; for pustular acne, it is advisable to detoxify and disperse the nodules; for aggregated acne and acne with pigmentation or scarring after healing, it is advisable to activate blood circulation and disperse blood stasis. Some authors have also summarized their clinical experience and pointed out that acne patients have different degrees of kidney-yin deficiency and liver-fire surplus, so the treatment focuses on regulating liver and kidney yin and yang. It is also believed that the kidney-yin nourishing drugs can regulate the endocrine function of the human gonads (16). In terms of formula research, the main famous formulas involved in clinical application are Loquat Clear Lung Drink, Rhizoma Dihuang Tang, Huang Lian Detoxification Tang, Yin Chen Artemisia Tang, Yi Yao San, Er Zhi Wan, Zhi Bai Dihuang Wan, Hai Zao Yu Hu Tang, Tao Hong Si Wu Tang, and so on. However, there are fewer pharmacological experimental studies on the effects of these compound prescriptions on acne. Experimental studies on the pharmacological effects of Chinese herbs for acne have been designed to address the pathogenesis of acne, focusing on several aspects such as inhibition of Propionibacterium acnes, inhibition of sebum secretion and anti-inflammatory immunity. More studies have been reported on both empirical prescriptions and single herbs. For example, experimental results on the treatment of acne with compound snake grass soup at the Department of Dermatology, Guang’anmen Hospital of the Chinese Academy of Traditional Chinese Medicine showed that the formula had an in vitro inhibitory effect on Propionibacterium acnes; it had a good repair effect on skin lesions in acne patients [17]. Most of the above antibacterial herbs are heat-clearing agents and some are blood-activating agents, which are consistent with the therapeutic principles of heat-clearing and blood-activating commonly used in Chinese medicine to treat acne. Studies on the effects of active ingredients of Chinese herbal medicines on P. acnes have reported that P. acnes is highly sensitive to eugenol and pressin, and moderately sensitive to baicalin, tanshinone I, aloe-emodin, huperzine, cork base, rhodopsin, glucosaminoglycan, gentian bitter glycoside, tannin, and tanshinone II [19]. Tanshinin has inhibitory function on cellular immunity [20]. Rhodopsin inhibits the biosynthesis of the inflammatory mediator leukotriene B4 and has anti-inflammatory effects [21]. Other studies have reported that Daphyllanthus, Salvia, Angelica, Zingiber officinale, Radix et Rhizoma, and Inula are high in zinc and can improve the efficacy of acne treatment when used appropriately [22]. In this regard, it is easy to see that an important aspect of the development of Chinese medicine prescription research today and in the future is the purposeful application of modern pharmacological experimental research methods to elucidate the efficacy, pharmacology, mechanism of action, and potency sites of effective prescriptions in order to screen out prescriptions with precise efficacy and composition. This is a kind of methodological means and technical achievements with clear research purposes, which can be easily confused as the development direction of TCM. In fact, the experience of countless famous doctors shows that as a clinical worker in TCM, one still cannot leave the guidance of the holistic concept and the idea of discriminatory treatment. The clinical treatment of acne in TCM and the study of prescriptions and medicines cannot be an exception. In summary, the author believes that acne, strictly speaking, is only one of the evidence types of acne disease, and therefore is not exactly equivalent to acne. Therefore, it is recommended that TCM textbooks do not use “acne” as a general term for “acne”. The etiology of acne/acne is not only wind-heat of the lung meridian, but also has many other aspects. Although the main principle of treatment is still to clear heat and heal sores, the ideas of regulating the flushing and the yin and yang of the liver and kidneys proposed in recent years are worthy of further study, especially for patients for whom conventional therapy is ineffective, and the application of the theory of tonifying the liver and kidneys in the treatment of refractory skin diseases.