Acne generally refers to follicular red papules, pustules, nodules, cysts, etc., occurring on the face, chest, and back.

As early as in the Neijing, there were detailed discussions on the formation of acne. Suwen. Shengqi Tongtian Lun states: "Sweating and exposure to dampness lead to the formation of acne," and "Sweating during labor and exposure to wind, with cold pressing, leads to acne." By the Sui Dynasty, Zhubing Yuanhou Lun referred to it as "facial sores." In the Qing Dynasty, Yizong Jinjian directly called it "acne," and Waike Dacheng referred to it as "wine thorns." Nowadays, it is commonly known as "acne."

bubble_chart Pattern Analysis

1. Lung Heat︰There are papules on the face consistent with hair follicles, resembling the size of foxtail millet, from which white-pink oily substance can be squeezed out. The rash is more concentrated around the nose but can also be seen on the forehead, occasionally accompanied by acne. There is grade I itching, often accompanied by dryness of the mouth and nose, dry stools, a slightly red tongue texture, thin white or thin yellow tongue coating, and a floating-slippery pulse. The condition is primarily due to heat at the qi aspect, most commonly seen around the nose, mostly caused by lung heat combined with external wind pathogens, leading to stagnation of lung heat in the skin that cannot be dispersed, hence the symptoms of dryness in the mouth and nose, thin coating, and floating pulse. The treatment should focus on clearing lung heat, using the prescription Loquat Lung-Clearing Decoction, with external application of Inverted Powder mixed with water.
2. Stomach Heat︰There are scattered follicular papules on the face, the size of foxtail millet, from which white-pink oily substance can be squeezed out, occasionally with acne, more concentrated around the mouth but also seen on the back and chest. The face is excessively oily with enlarged pores, often accompanied by symptoms such as excessive eating, fetid mouth odor, dry mouth, thirst with a preference for cold drinks, and severe constipation. The tongue texture is red with a greasy coating, and the pulse is deep, slippery, and forceful. The condition is primarily due to heat at the qi aspect, most commonly seen around the mouth, caused by dietary irregularities, excessive consumption of roasted and rich foods, leading to Yangming dryness accumulation, spleen-stomach heat retention, and stagnation in the skin. Hence, symptoms such as excessive eating, fetid mouth odor, aversion to heat, thirst with a preference for cold drinks, and dryness accumulation in the stool often occur. Treatment should focus on clearing heat from the Yangming fu organs. The prescription used is Stomach-Regulating Purgative Decoction, with external application of Inverted Powder mixed with water.
3. Blood Heat︰There are scattered reddish papules the size of rice grains on both cheeks of the face, with more rashes around the mouth, nose, and between the eyebrows. The face often exhibits capillary dilation, and flushing becomes noticeably worse with heat or emotional agitation, accompanied by a subjective burning sensation. Women often experience increased rashes before and after menstruation, along with dry stool, dark urine, a red tongue tip with thin coating, and a fine, slippery, rapid pulse. This condition is mostly caused by emotional internal damage, stagnation of qi, prolonged stagnation transforming into heat, and heat lurking in the nutrient-blood level, leading to eruption. The characteristic symptoms include scattered red papules on the face, more pronounced around the mouth, nose, and between the eyebrows, often accompanied by capillary dilation on the cheeks and obvious facial flushing. Treatment should focus on cooling blood and clearing heat, using a modified combination of Peach Kernel, Carthamus and Four-Ingredient Decoction and the blood-cooling Five-Flower Decoction.
4. Toxic Heat︰There are scattered millet-sized papules on the face, often with small pustules at the apex of the papules or grade I redness and swelling around them, accompanied by subjective pain. The pustules come and go repeatedly, and after they subside, small depressed scars may remain on the skin surface, resembling orange peel. The chest and back are often affected. Dry stool or constipation, lasting for several days, dark urine, a red tongue texture with yellow and dry coating, and a wiry-slippery or rapid pulse. The external cause is the upward steaming of lung and stomach heat, compounded by exposure to external toxic pathogens, leading to the binding of toxic heat and its accumulation in the striae and interstice of the muscles. Therefore, the characteristic symptoms include scattered papules on the face, primarily small pustules, often surrounded by a red halo, with subjective pain. In severe cases, there may be intense redness, swelling, and pain, accompanied by fever, a yellow and dry tongue coating, and a slippery-rapid pulse. Treatment should focus on clearing heat and removing toxin, using the Five-Ingredient Toxin-Eliminating Decoction, or modified Forsythia Detoxification Pills.
5. Dampness Toxinblood Stasis︰In addition to millet-sized papules on the face, chest, and back, soybean or cherry-sized nodules or cysts often develop, making the skin surface uneven. In severe cases, infection leads to pustules, accompanied by local redness, swelling, and pain, as well as systemic discomfort such as headache and fever. The facial skin tends to be oily, and similar lesions often appear on the chest and back. The tongue appears dark red with a yellow or white coating, and the pulse is slow or deep and rough. This condition is usually caused by inherent dampness accumulation, stagnation in the skin, and exposure to external toxins, leading to the coagulation of dampness-toxin, blockage of meridians, and disharmony of qi and blood. The characteristic symptoms, besides papules and pustules, often include prominent nodules and cysts, along with excessive skin oiliness, often leaving scars after healing. Treatment should focus on eliminating dampness and toxins, invigorating blood, and resolving stasis, using the Dampness-Removing and Toxin-Resolving Decoction. For nodules and cysts, additional remedies such as the Nodule-Resolving Spirit or Rhubarb and Ground Beetle Pill can be used in combination.

bubble_chart Documentation

1. Yizong Jinjian．Waike Xinfa Key Points．acne》: "This condition is caused by blood heat in the lung meridian. It often occurs on both sides of the nose, with small, broken bumps resembling millet husks, red in color, swollen and painful, oozing white powder-like fluid. Over time, they all turn into white flakes, resembling millet husks."