A case analysis: from "acne" to "acne" cognitive misunderstandings

A 12-year-old patient seen in August 2024 was densely distributed on the forehead at the time of initial consultationconical papuleThe blackheads can be seen at the top of some of them, accompanied by inflammatory pustules and slight itching. Parents mistakenly think that it is "normal acne during puberty", but the Chinese medicine diagnosis shows that it has a white and greasy tongue, and a dull and slippery pulse.syndrome of internal heat and toxicity with phlegm-dampness obstruction (TCM)The

[Initial diagnosis and prescription]
Angelica dahurica 10g Forsythia 10g Soapwort 10g Dandelion 30g Astragalus membranaceus 30g Codonopsis pilosulae 15g Atractylodes macrocephala 15g Pericarpium Citri Reticulatae 15g Dried Ginger 10g Scutellaria baicalensis 15g Curcuma longa 20g Hesunpian 10g (decocted) Licorice 6g Six doses

In addition with the external medicine: Angelica dahurica 10g forsythia 10g fried mustard seeds 10g fried stiff silkworms 10g safflower 10g powdered white vinegar external compresses

[Analysis] Nowadays, a lot of the acne that grows in your teens is not normal acne anymore, but it really turns into acne.In this case, heat-toxicity was embedded within the body, with phlegm-dampness blockage. In addition, the spleen and stomach were cold.

[Before and after tongue coating]
Before and after taking the medicine for a week before and after the comparison can be seen that the tongue became thin, which is the performance of dampness reduction, but the tongue is still white and greasy, continue to regulate, a total of three weeks, but the case of the child's mother did not give the child to take the medicine on time, so the recovery is still slower, and then returned to the gradual recovery.

The mother of the child had thought that taking the medicine for 10 days can see obvious results, often have encountered anxious patients, convenient time or need to be more patient communication.

Core Points of Differentiation::

​hallmark	​common acne	​acne
​etiology	Simple sebum secretion	Heat toxicity + phlegm dampness + liver depression + spleen deficiency compound etiology
​Patterns of skin lesions	Isolates whiteheads/blackheads acne	Pustules/nodules/cysts with polymorphic coexistence
​concomitant symptom	No generalized discomfort	Dry mouth and bitter mouth, constipation, bloating and other internal organs disorder manifestations
​Difficulty of treatment	It can be self-healing with dietary modifications	Requires systematic internal and external treatments, with a course of treatment lasting several months

Chinese medicine pathogenesis analysis::
The patient's summer diet of cold food (preferring cold drinks) and academic stress led to adeficiency of the spleen and stomach (TCM)(tongue pale with white moss),(TCM) inflammation of the liver and constipation of internal heat(irritability), dampness, heat and stagnant toxins congest the Yang Ming meridian in the face, forming stubborn acne.

---

​II. 4 Core Strategies for Acne Treatment in TCM

1. ​clear away heat and detoxify the body
   • ​medication: forsythia, dandelion, scutellaria (clearing heat and toxins from the lungs and stomach)
   • ​principle: For acute inflammation with red, swollen pustules, "clearing heat and removing toxins reduces suppurative lesions."
2. ​detoxify and expel pus
   • ​medication: Angelica dahurica, Saponaria dahurica (promotes drainage of pus)
   • ​apply externally: Angelica dahurica + forsythia powder vinegar dressing, through the skin penetration to enhance the efficacy of local medicine.
3. ​strengthen the spleen and transform phlegm (TCM)
   • ​medicationAstragalus, Radix et Rhizoma Ginseng, Rhizoma Atractylodis Macrocephalae, Pericarpium Citri Reticulatae (to strengthen the transportation of the middle jiao and eliminate the source of phlegm)
   • ​gauge: "Spleen deficiency and dampness are the root causes of recurring acne".
4. ​warm the yang and disperse cold (idiom); fig. to relieve cold and heat
   • ​medication: Heishun tablets (decocted first) + dried ginger (to dispel coldness in the spleen and stomach)
   • ​investigateThe patient's tongue is white and greasy, suggesting cold and dampness, which needs to be warmed to break the cold-heat stagnation.

---

​III. 3 key cognitions that must be known

1. ​Be wary of "fake acne".
   • smallpoxRedness, swelling, heat, and pain that are obvious and recurring for more than 2 months.If you have a problem with acne, it is more likely to be acne than common pimples, and you need to seek medical attention.
2. ​Contraindications to the use of topicals
   • Angelica dahurica and saponaria dahurica are pungent and warm in nature.Not for use on broken skin, avoiding irritation that aggravates inflammation.
3. ​Key points of treatment management
   • The child is suffering fromFailure to take medication on timeThis leads to a prolonged course of the disease and "acne needs to be treated consistently for 1-2 months."

---

​IV. Guidelines for the selection of proprietary Chinese medicines

​symptomatic behavior	​Recommended proprietary Chinese medicines	​mechanism of action
Localized redness and swelling that does not go away	Yin Qiao Antidote Granules	Diffuse wind and heat to relieve acute inflammation
Cystic nodules are hard to get rid of	Chinese ground beetle (Eupolyphaga sinensis) pill	Activate blood circulation and break up blood stasis, improve microcirculation
Constipation aggravates acne	antifungal and commune-sacred pill (Chinese medicine)	Clearing the bowels of the body and removing heat, relieving both the surface and the inside of the body
Recurring acne during menstruation	Jiawei Yuyi Puan (Chinese medicine)	Relaxing the liver and strengthening the spleen, regulating the endocrine system

---

​V. Advanced Guide for Chinese Medicine Enthusiasts

1. ​Tongue Recognition Techniques
   • White and greasy tongue coating at first diagnosis → Dampness traps the spleen
   • Tongue thinning after three weeks → Dampness gradually recedes, but residual heat is not yet clear
2. ​Outer treatment multiplier program
   • ​body piercing and cupping (TCM): Bloodletting at the ear tips and back reaction points to dissipate heat and detoxify toxins
   • ​burying of buried wires at acupuncture points: Taking foot Sanli and Quchi points for long-lasting regulation of the spleen and stomach functions
3. ​List of dietary taboos
   • ❌ Milk and dairy products (increase sebum production)
   • ❌ Fried food (aggravates phlegm-dampness)
   • ✅ Job's barley and red bean porridge (strengthens the spleen and promotes dampness)

From a Chinese medicine perspective.Normal pimples are still a lot different from acne. Acne doesn't have to be specifically regulated, but acne is something that needs to be taken seriously, and it's not just a skin problem either, it still needs to be regulated internally.

morphological characteristics

Normal acne: Normal acne is mostly caused by keratinization of the follicular opening and excessive sebum secretion. Often manifested as skin color or light red pimples, such as small rice grains to mung bean size, usually more isolated, not fusion, there may be white or black pimples at the top, white pimples for the white head, is the follicle mouth is blocked by keratin formation; black pimples for the black head, is the sebum oxidation formation.

Acne:Acne is relatively more severe and complex, and in addition to pimples, it can take the form of pustules, nodules, and cysts.Pustules are pus-filled inflammation within the hair follicle, appearing as red papules topped with yellowish-white pustules; nodules are hard lumps formed by inflammation deep under the skin; and cysts are pus-filled, pus-containing cystic structures within the nodule, which are often accompanied by pain and are prone to scarring.

pathogenesis

Normal acne: mostly due to adolescent Yang Qi exuberance, or over-eating spicy, sweet and thick flavors, resulting in gastrointestinal heat, through the meridian on the face, fumigation of the skin and hair. The main location of the disease in the skin coupling, the condition is relatively mild.

Acne: In addition to dietary factors, it is also related to emotional disorders and phlegm-dampness stagnation. Long-term emotional disorders, liver depression and stagnation of qi, qi stagnation and fire, or spleen deficiency, phlegm and dampness, blockage of meridians, poor qi and blood flow, heat and toxicity, phlegm and dampness, blood stasis and mutual agglomeration in the face, the hair for acne. The disease location is not only in the skin, but also involves the liver, spleen and other internal organs, and the condition is more serious and the course of the disease is longer.

concomitant symptom

Normal acne: There are usually no obvious systemic symptoms, and there may be only slight itching or discomfort locally.

Acne: It is often accompanied by systemic symptoms such as dry mouth and bitterness, dry stools, yellow and red urine, irritability and other signs of heat, or with loss of appetite, abdominal distension, loose stools and other manifestations of spleen deficiency and phlegm-dampness.Simply put, if it is a normal acne, pay attention to eat a light diet, get up early and go to bed early, it will naturally be good. If this can not be good, that is the body is not in tune, have to be adjusted.Problems in children will not be as obvious as in adults, so adjusting them as early as possible will make recovery much easier. However, if the problem is already obvious, in addition to adjusting daily habits, you still need to be patient during the medication, and there is a process to get better slowly.

Although the root cause of skin problems is still in the conditioning 臓腑, but with the effect of external medicine will still be much faster.

Based on the complex causes of acne, it is regulated in a number of ways:

Ideas for medication for acne

Clearing heat and removing toxins:Forsythia, Dandelion and Scutellaria have the effect of clearing heat and removing toxins from the skin, targeting the symptoms of localized redness, swelling and heat pain of acne. Forsythia can disperse wind-heat and eliminate swelling and nodules; dandelion is good at clearing heat and removing toxins and eliminating swelling; Scutellaria baicalensis can clear heat and dry dampness, diaphoretic and detoxifying, and the combination of the three herbs can remove heat and toxins in the body and reduce the inflammatory reaction of acne.

Toxin detoxification:Angelica dahurica and Soapwort can play a role in toxin drainage, swelling and pain, help acne within the toxic evil out of the body, promote the dissipation of sores and healing.

strengthen the spleen and benefit the qiRadix Astragali, Radix et Rhizoma Ginseng, Rhizoma Atractylodis Macrocephalae, Pericarpium Citri Reticulatae, Radix et Rhizoma Ginger officinalis play the roles of strengthening the spleen and benefiting the vital energy, drying dampness and resolving phlegm. The spleen and stomach are the foundation of the later life, if the spleen and stomach function properly, there will be a source of qi and blood biochemistry, and the transportation of water and dampness will be normal. Regulating the functions of the spleen and stomach can fundamentally improve the pathogenesis of acne.

warm the yang and disperse cold (idiom); fig. to relieve cold and heat: Heishun tablets are first decocted to warm and tonify the kidney yang, dissipate cold and relieve pain, which helps to improve the physical state of yang deficiency and cold condensation, and promotes the operation of qi and blood, so that the medicinal power can better penetrate into the whole body.

alleviate hepatitis and regulate qi: Tulip gold has the efficacy of dredging the liver and regulating qi, activating blood circulation and removing blood stasis, which can regulate emotions and relieve liver depression and stagnation of qi, so that qi can be cleared up, which is beneficial to the treatment of acne.

apply externally

Angelica dahurica and Forsythia dahurica clear heat and remove toxins, eliminate swelling and relieve pain; fried mustard seed warms the meridians and collaterals, resolves phlegm and disperses knots; fried silkworms dispel wind and resolve phlegm, disperse knots and open the collaterals; safflower invigorates blood circulation and removes blood stasis, improves local blood circulation. The external application of white vinegar can make the drugs penetrate the skin better and act directly on the acne area, enhancing the effect of clearing heat and removing toxins, eliminating swelling and dissipating knots, activating blood circulation and removing blood stasis.