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In Traditional Chinese Medicine (TCM), acne is considered a disease primarily related to the Pathogenic Influence of Heat and Damp Heat on the meridians, Zang Fu, and Fundamental Substances. This Heat may be a product of poor diet, stress, overwork, a congenital condition, or the natural ascendance of Yang energy, which is typical in adolescence.

Heat may affect the Lung or Stomach Meridians, from where it is transmitted to the skin of the face and chest, causing the condition's inflammatory response. If the Heat tries to escape from the Tai Yang channel, acne occurs on the back. Heat usually is exacerbated in the Lung Meridian by the External Wind Pathogen, which causes skin redness. In the Stomach Meridian, it can be aggravated by a diet of greasy and spicy foods, which weakens and creates more Damp Heat in the Spleen Zang and the Stomach Fu.

Heat also may enter into the Blood or transmute into Toxic Heat, both of which can cause lesions. Finally, emotional health can contribute to acne. Extreme emotions of sadness, anxiety, stress, or anger can cause Disharmony in the body. This can lead to stagnation of Qi and cause Heat and Dampness to rise to the skin.

Traditional Chinese Medicine Categories of Acne

In TCM, Heat affects the different Meridians, Zang Fu Organs, and Fundamental Substances, providing the substratum that allows acne to occur. The different manifestations of Heat in these aspects of the body's energetics appear as different complexes of signs and symptoms. Acne requires a careful differentiation of Heat so that proper treatment can be formulated to match the Pattern of Disharmony.

Lung Heat and Stomach Heat are the most common forms of acne. If Dampness is present, the skin will be greasy. Sores and bleeding signify toxicity. Itchiness can be caused by Wind and Dampness. The most common form of itchiness in acne is from Wind that arises from Heat.

The major signs and symptoms of the common Heat Patterns of Disharmony, differentiated by location on the body, are as follows:

• Lung Heat: Symptoms include acne with a predominance of lesions on the forehead and near the nose. There may be slight itching as well. In cases with a rapid onset of new lesions, the patient may complain of chills or sensitivity to Wind. The patient may have an aversion to heat and feel thirsty. The tongue is generally red with a thin yellow coat, and the pulse may be rapid and floating.
• Stomach Heat: Symptoms include acne with a predominance of lesions around the mouth and on the chest, shoulders, and back. The patient may have an aversion to heat; have a large appetite and thirst; and prefer greasy, spicy foods. There may be a tendency to pass dry stools as well. The tongue is usually red with a thick yellow coating, and the pulse is rapid and forceful.
• Toxic Heat: Symptoms include severe acne, strongly inflamed with pus-filled nodules and much reddening of the skin around the lesions. The patient may have an aversion to heat as well and may complain of malaise. The tongue is generally red with a dry yellow coating, and the pulse is rapid.
• Damp Heat: Symptoms include acne composed of deep, pus-filled, inflamed nodules. The skin usually is oily, and the patient may have an aversion to heat. He or she may be thirsty but have no desire to take fluids. The tongue generally is red or crimson, with a greasy or sticky coating. The pulse is rapid and may have slippery or wiry qualities as well.
• Blood Heat: Symptoms include acne that is accompanied by a flushed face and strong aversion to heat. The patient may complain of thirst, dark urine, and dry stools. The tongue usually is red (with a redder tip) and has a yellow coating, or may be crimson in color. The pulse usually is rapid and thin.

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