Acne vulgaris, known in Chinese medicine as “lung wind acne”, “wine acne”, “face”, etc., occurs on the face. At the beginning, it is a skin-colored papule, white or black head acne, pustules, and later nodules and cysts, enlarged pores, scarring and pigmentation, which seriously affects the appearance. Therefore, in accordance with the “Nei Jing” principle of “detecting the color and pressing the pulse to distinguish between yin and yang”, I advocate that acne should be treated by first distinguishing between yin and yang.
Discussions of acne in literature through the ages
In the literature, it is said in the following words: “Acne belongs to the lung and bruises belong to the spleen, but blood heat and stagnation cannot be dispersed. …… Take Loquat Leaf Pill and Baicalin Clear Lung Drink. ” Surgery Dacheng – lung wind wine thorn” said: “lung wind by the lung blood heat stagnation does not work and produce wine thorn.” The “Medical Zongjinjian・Surgical Heart Method Essentials” said: “This evidence from the blood heat of the lung meridian.
Every occurrence in the nose, the start of broken pimples, shaped like millet crumbs, red swelling pain, broken out of white powder juice, day after day are into white crumbs, shaped like millet white crumbs. It is advisable to take loquat clear lung drink, external application of inverted powder, slowly from the work also.” But among the many “blood heat” said there is no lack of unique views, such as “Surgery Qixuan” said “lung gas unclear, wind, or cold water wash face, hot blood condensation and become”, this said with the “Su Wen – angry through the day theory” of “sweating See wet, is born acne …… labor sweat when the wind, cold thin for, depression is acne” has quite an origin.
The Chinese medicine of the Han Dynasty and before the Han Dynasty attached great importance to cold-caused diseases, but with the changing climate of the times and the overkill of medical doctors, the Chinese medicine of the Tang Dynasty and after the Tang Dynasty attached more and more importance to warm-caused diseases. This is the background of disciplinary changes that must be understood when referring to the vast literature of Chinese medicine. How to respond to today’s clinical problems with ancient Chinese medicine? In the author’s opinion, there are two principles: one is to refer to the changes in heaven and earth, the ancient and modern sayings; the second is to see the symptoms prevail and not to stick to a fixed view.
Do not ignore the “Yin” side of acne causes
The TCM yin and yang identification of acne is extremely compatible with the Western dermatological classification of acne. The two commonly used methods for grading acne in the West are the Pillsbury method and the Gollnick (1998) method. Both methods classify acne into four levels according to the severity of the disease, namely, I, II, III, IV, and mild, moderate, severe, and very severe. The author categorized the above two grading methods into yin and yang, and found that the Pillsbury method has Ⅰ, Ⅱ, Ⅲ, and Ⅳ degrees in the depth of the lesion site, such as Ⅱ degree is only superficial pustules, while Ⅲ degree appears deep inflammatory rashes;
Gollnick’s method is based on the morphology of the lesions for grading, with mild and moderate degrees having only pimples and papular pustules, while severe and very severe degrees have nodules, cystic sinus tracts and scarring. As a matter of course, the author simply identifies acne with shallow lesions that are not characterized by pimples and papules and pustules as Yang acne, and acne with deep lesions that are characterized by nodules, cystic sinus tracts, and scarring as Yin acne.
In fact, most Chinese medical literature also mentions the “Yin” side of acne formation. In the Su Wen, it is said that “the blood heat stagnates and cannot be dispersed”; in the Surgery Zheng Zong, it is said that “the blood heat stagnates and does not work in the lung meridian”; and in the Surgery Qi Xuan, it is said that “heat and blood clotting”. Among them, the “depression”, “stagnation”, “condensation” are not pass the meaning, that is, the author’s so-called “Yin evidence The meaning of “yin evidence”.
But unfortunately, when it comes to the “Jinjian of Medicine”, which had a great influence on later generations, only “yang evidence” is left. The statement that “this evidence is caused by blood-heat in the lung meridian” kept the very important “yin” aspect of acne out of the eyes of later generations of doctors and patients.
Identifying the cause of acne from “yin” to “heat” is not just a paper exercise, it is directly related to the direction of treatment.
In Grade I acne, acne is mainly acne, with heat being heavy and depression being light; in Grade II acne, superficial inflammation is the main cause, manifesting as redness, swelling, heat and pain, and heavy heat toxicity, but depression cannot be ignored; in Grade III acne, the disease is deeper and characterized by the appearance of nodules, which are sometimes less obvious than Grade II inflammation, but treatment is needed to remove the nodules that have already taken shape (Nei Jing, “Yang turns into qi and yin into form”). “However, the treatment must take more time and patience than the treatment of Grade II acne, and the treatment should not only be about clearing heat, but also about opening up and dispersing nodules;
In particular, for Grade IV acne, which is characterized by qi stagnation, blood stasis, and phlegm condensation, worm medicines such as gunpowder beads and whole scorpions are often used to disperse and open up the depression.
Classification and treatment of acne
The loquat and lung-clearing drink that has been promoted in literature for generations is only applicable to Grade I acne, but because the proportion of patients who seek medical treatment for Grade I acne is very small, its use is rare. Patients with Grade I acne are more likely to purchase topical medications and cosmetics on their own. The oiliness of the skin is a local reflection of the overall condition of the body, and topical medications to control the oiliness will only lead to a situation where the more you control the oiliness, the more you will get. If there is a convenient Chinese medicine that can be purchased, it will be a blessing for patients with Grade I acne.
For degree II acne, the author often treats it with warm wine, or with a decoction of five flavors of disinfectant drink and half of wine and water. Depending on the dryness or wetness of the lesions, the topical medication can be mixed with fragrant oil, tea, wine or vinegar. Unfortunately, it is not available in the market today.
For degree III acne, the author mostly uses Gui Zhi Fu Ling Wan and Bao He Wan in combination, and the tongue and pulse without obvious heat signs can be served with warm wine. Without a clear understanding of the yin evidence of acne, physicians are afraid to use this formula. The doctor and the patient should reach a consensus that the treatment must be patient and determined, and should not be rushed, otherwise the desire for speed will not be achieved.
Acne of degree IV is more closely related to the body type. For skin lesions, the author uses Zhao Bingnan’s whole worm formula, Xianfang’s living life drink, and rhubarb ko courtesan’s bee burning chrysoprase, while for the body type, only round machine living method can be used, because it is a yin evidence, so no matter how to identify and treat, we should not forget to warm the pass.
Seven years ago, I treated a 20-year-old woman with acne that had been recurring for several years, and the symptoms of Yang were no longer present. Her mouth was dry and she could not drink, but if she drank, she would immediately piss, and her tongue and pulse showed no signs of heat. After several years of follow-up, he was in good health and his skin lesions had not recurred.
All of the above is a general description of the treatment of acne based on the skin lesions, and is intended to remind the practitioner not to ignore the yin evidence of acne. The more difficult to treat acne is, the more it requires the support of the body as a whole. Simple and easy to treat acne can rely more on disease identification and skin lesion identification, while complex and difficult to treat acne is related to the body’s constitution, diet, sleep, menstruation, emotions and work rhythm.