Acne
Definition
Western
Acne [1-2] is an inflammatory disease of the sebaceous glands and hair follicles of the skin, which are characterised by red bumps (pimples), blackheads and whiteheads (comedones), pustules (bumps with pus) and deep inflamed lesions (cysts) which can often lead to scarring. Typically appear on the face, neck, chest and back where most of sebaceous glands are located. It occurs most commonly during adolescence, but it can also affect people of all ages. Acne usually develops when pores or hair follicles get clogged with sebum and dead skin cells. Sebum is a natural substance that lubricates and protects the skin, but excess sebum, dead skin cells and bacteria build-up will cause the pore or follicle blockage, thus leading to acne. Heredity [4], improper diet [5] and bacterial infections [6] are amongst the common causes of acne. Hormonal changes during puberty [3] can also trigger the condition.
Traditional Chinese Medicine (TCM)
TCM describes acne as “Zuo Chuang - 座疮”, which is simply defined as thorn-like pimples found on the face, chest and back with extrude whitish contents. According to TCM theories, acne is usually caused by the dysfunctioning of the Lungs, Spleen, Liver and Kidney systems. The skin is the outward manifestation of the Lungs system, whereby dysfuctioning of any part of this system would trigger skin conditions such as eczema, rashes or acne. The Liver system helps to contain negative emotions such as anger, depression and fear, and helps individuals to cope with stress, both physiological and emotional, so as to keep acne under control. Excessive intakes of spicy or oily food or alcohol consumption could also impair the digestive system. In addition, the Kidney system governs the excretory process and is often impaired due to the natural aging process. Disruptions to the functions of these systems have encouraged unnecessary accumulations of substances in the body, thus giving rise to outbreaks, such as acne.
Classifications and Accompanying Symptoms in TCM Context
Relating to the Lungs System
In TCM, the Lungs system plays an important role in defending the body against pathogenic agents. It is often regarded as the first line of defence of the body. Environmental conditions such as warm and humid weather often account for symptoms such as flushed cheeks, red and/or itchy pimples or pustules, accompanied by blackheads and whiteheads and heavy breathing.
Relating to the Spleen and Stomach systems
The Spleen and Stomach systems govern the overall digestive systems in the body, i.e. the digestion and absorption of the food consumed. According to TCM theories, the Spleen system is also involved in the water metabolism and its related excretory processes. Regular intakes of alcohol and oily spicy foods or being in warm humid weather can impact the digestion and the bodily fluids being produced. Symptoms include constipation, indigestion, stomach bloatedness, pimples, itchiness and greasy skin.
Relating to the Liver system
Negative emotions or constant stress levels may cause disruptions to the functioning of the Liver system, which in turn, affect its detoxification function and cause the outbreak of acne. Often seen among females and is closely related to the menstrual cycle [7]. Symptoms include fullness experienced in the lower abdominal region, irregular lumps could be felt on the surface of skin, and pain experienced in different parts of body.
Relating to the Kidney system
Apart from the role in governing the excretion of water, the Kidney system also plays an important role in excreting the waste products from the body. However, the physiological functions of the Liver and Kidney systems decrease with age, and this may lead to a decrease in the waste products being excreted, leading to increase of toxin accumulation in the body. Commonly known as acne which is seen in adults of age 30 and above. Symptoms include dark complexion, dark pigmentation of infected areas and fatigue.
Causes and Risk Factors
Heredity [8-9, 24-27]
Individual with a family history of acne are more susceptible to develop acne conditions.
Lifestyle
· Diet [5, 10, 24, 27]: People who eat spicy, heavily sweetened or oily foods or regular alcohol consumption put themselves at higher risk of getting acne.
· Sleep[27]: Poor sleeping habits, such as keeping late nights regularly or not getting enough sleep will increase the chances of contracting acne.
· Negative emotions[ 11-13, 26-27]: People who are under constant stress or depression have a higher probability of getting acne.
Treatments
Herbs commonly used in treatment include:
1. Ku Shen – 苦参
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English/ Common name
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Bitter root
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Latin species
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Sophora flavescens
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Park of plant used
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Roots
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Action/s
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Commonly used to relieve skin inflammations [14-15].
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Precaution/s
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Individuals with poor digestive system should use with caution. Prohibited to be used together with Veratrum nigrum L.
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2. Jin Yin Hua –金银花
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English/ Common name
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Honeysuckle
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Latin species
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Lonicera japonica Thunb
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Park of plant used
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Flowers
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Action/s
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Helps to reduce inflammations [16] and detoxify the body [28].
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Precaution/s
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Individuals with weak stomach should use with caution.
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3. Fan Xie Ye –番泻叶
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English/ Common name
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Senna Leaf
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Latin species
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Cassia angustifolia Vahl or Cassia acutifolia Delile
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Park of plant used
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Leaves
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Action/s
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Commonly used to relieve constipation [17-18, 28].
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Precaution/s
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Not to be used during pregnancy. Users with weak stomach should consume with caution or seek professional advice.
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4. Pu Gong Ying –蒲公英
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English/ Common name
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Dandelion
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Latin species
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Taraxacum officinale and Taraxacum erythrospermum
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Park of plant used
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Whole plant
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Action/s
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Commonly used as an inflammatory agent for dermatitis [19]. Recent studies shown its natural diuretic properties [20] which also helps to improve lipid metabolism [21]
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Precaution/s
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No significant side effects.
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5. Yu Xing Cao – 鱼腥草
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English/ Common name
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Heartleaf Houttuynia Herb
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Latin species
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Houttuynia cordata Thunb.
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Park of plant used
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Whole plant
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Action/s
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Studies shown it has anti-oxidative and anti-mutagenic effects [22]. Commonly used in Chinese prescriptions for its anti-infectious and anti-inflammatory effects [23, 28].
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Precaution/s
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Individuals who are generally weak, having cold limbs, chronic diarrhoea should use under professional supervision.
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Tests & Diagnosis
Acne can be diagnosed base on the appearance of the skin by professional medicals. Testing is usually not required.
Home Remedies
Chrysanthemum + Honeysuckle + Barley + Rock sugar
a) Put all ingredients in a cooking pot and pour enough water to fill half the pot.
b) Bring to boil for 10 minutes.
c) Simmer for a further 30 minutes.
d) Remove from heat. Serve warm.
References
1. Acne. Original article can be found at http://www.mayoclinic.com/health/acne/DS00169
2. Acne. The American Heritage® Science Dictionary. Houghton Mifflin Company. 26 Aug. 2010.
3. Frequently Asked Questions: Acne". U.S. Department of Health and Human Services, Office of Public Health and Science, Office on Women's Health. 2009-07-16. http://www.womenshealth.gov/faq/acne.cfm. Retrieved 2009-07-30
4. Heredity: A Prognostic Factor for Acne. F. Ballangera, P. Baudrya, J.M. N’Guyenb, A. Khammaria, B. Dréno. Dermatology 2006;212:145-149
5. "Does diet really affect acne?". Ferdowsian HR, Levin S (March 2010). Skin Therapy Lett. 15 (3): 1–2, 5.
6. Antibiotic-resistant Propionibacterium acnes on the skin of patients with moderate to severe acne in Stockholm. Cristina Oprica, Lennart Emtestam, Jan Lapins, Erik Borglund, Filippa Nyberg, Kajsa Stenlund, Lena Lundeberg, Eva Sillerström, Carl Erik Nord. Anaerobe, Volume 10, Issue 3, June 2004, Pages 155-164
7. The effect of the menstrual cycle on acne. Steven Stoll, Alan R. Shalita, Guy F. Webster, Richard Kaplan, Sid Danesh, Alyson Penstein. Journal of the American Academy of Dermatology, Volume 45, Issue 6, December 2001, Pages 957-960
8. The prevalence of facial acne in Peruvian adolescents and its relation to their ethnicity. EA, F., R. RM, and S. DA, Journal of Adolescent Health, 1998. 6.
9. Acne and Genetics. Zhi, Y. and H. Li, Foreign Medical Sciences Section Of Dermatology And Venereology 2005. 31(1).
10. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial.Smith, R.N., et al., American Journal of Clinical Nutrition, 2007. 86(1): p. 107-115.
11. The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress. Chiu, A., S.Y. Chon, and A.B. Kimball, Archives of Dermatology, 2003. 139(7): p. 897-900.
12. Psychologic Aspects of Acne., Koo, J.Y.M. and u.L. Smith, Pediatric Dermatology 2008. 8(3): p. 185-188
13. Academic Stress Worsens Acne. JWatch Pediatrics, 2003. 5(5).
14. Anti-inflammatory and anti-arthritic activity of total flavonoids of the roots of Sophora flavescens. Jin JH, Kim JS, Kang SS, Son KH, Chang HW, Kim HP. J Ethnopharmacol. 2010 Feb 17;127(3):589-95. Epub 2009 Dec 23.
16. The analgesic and anti-inflammatory effect of WIN-34B, a new herbal formula for osteoarthritis composed of Lonicera japonica Thunb and Anemarrhena asphodeloides BUNGE in vivo. Moonkyu Kang, Inho Jung, Jonghyun Hur, Soon Han Kim, Jeong Hun Lee, Ji-Yun Kang, Kyoung Chul Jung, Kyoung Soo Kim, Myung Chul Yoo, Dong-Suk Park, Jae-Dong Lee, Yong-Baik Cho. Journal of Ethnopharmacology, Available online 17 July 2010.
17. Efficacy of traditional Chinese medicine for the management of constipation: a systematic review.Lin LW, Fu YT, Dunning T, Zhang AL, Ho TH, Duke M, Lo SK.: J Altern Complement Med. 2009 Dec;15(12):1335-46. Review.
19. Complementary and alternative interventions in atopic dermatitis. Leonard Bielory, Mansi Kanuga. Immunology and Allergy Clinics of North America, Volume 22, Issue 1, February 2002, Pages 153-173
20. The diuretic effect in human subjects of an extract of Taraxacum officinale folium over a single day. Clare BA, Conroy RS, Spelman K. J Altern Complement Med. 2009 Aug;15(8):929-34.
21. Alternation of hepatic antioxidant enzyme activities and lipid profile in streptozotocin-induced diabetic rats by supplementation of dandelion water extract.Cho SY, Park JY, Park EM, Choi MS, Lee MK, Jeon SM, Jang MK, Kim MJ, Park YB, Clin Chim Acta. 2002 Mar;317(1-2):109-17.
22. A study of the antioxidative and antimutagenic effects of Houttuynia cordata Thunb. using an oxidized frying oil-fed model. Chen YY, Liu JF, Chen CM, Chao PY, Chang TJ, J Nutr Sci Vitaminol (Tokyo). 2003 Oct;49(5):327-33.
23. Anti-enterovirus 71 activity screening of chinese herbs with anti-infection and inflammation activities.Lin TY, Liu YC, Jheng JR, Tsai HP, Jan JT, Wong WR, Horng JT. Am J Chin Med. 2009;37(1):143-58.
24. Factors related to acne in adult women. Li, L., L. Wei, and W. Xi, China Journal of Leprosy and Skin Diseases, 2004. 6.
25. A study on Acne and Genetics. Ying, P., H.C. Di, and C.G. Ze., China Journal Of Leprosy And Skin Diseases 2006. 22(9)
26. Analysis of genetic factors in 348 cases of acne vulgaris.Zhi Y. et al., Chinese Journal of Dermatology 2007. 40(6).
27. Zhong Yi Wai Ke Xue, L.Y.Qing Co., 2007, Zhong Guo Zhong Yi Yao Publishing House. p. 207-209.
28. 《中藥學》高学敏主編中国中医药出版社, 2002年9月。Chinese Medicine, Gao Xue Min, ed. China Chinese Medicine Publication. 2002. ISBN 7-80156-318-2/R.318