Seeing several red, swollen, even pus-capped pimples reappear on your forehead, chin, and even cheeks in the mirror? Tried countless acne products, ditched hotpot and bubble tea, kept early hours – why do they still keep "sprouting back like weeds"?
What causes acne?
According to Singapore TCM physician and dermatology expert Dr. Que Poh Yuen Albert from Gong Fang Tang TCM, acne is known in Traditional Chinese Medicine (TCM) as "fenshi" (粉刺), "lung wind fenshi" (肺风粉刺), or "mianpao" (面疱). Its occurrence is closely related to functional imbalances in organs like the lungs, spleen/stomach, liver/gallbladder, and the Thoroughfare and Conception Vessels (Chong and Ren Mai). It is far more complex than simply being "heaty" or "dirty skin."
Dr. Que emphasizes that in Singapore's hot and humid climate, coupled with the common lifestyle of dietary indiscretion and high stress among young people, one specific syndrome pattern is particularly common and stubborn:
"Spleen-Stomach Damp-Heat" Type Acne – Dr. Que observes this accounts for nearly half of clinical cases!
Core Pathogenesis: Excessive consumption of spicy, greasy, sweet, or raw/cold foods, or prolonged stress damages the spleen and stomach's transportation and transformation functions. Food cannot be properly converted into Qi, blood, and essence. Instead, it brews dampness and heat. This damp-heat pathogen, like steam in a sauna, ascends along the meridians to the head and face, clogging pores, stagnating, and transforming into toxin. This ultimately forms red, swollen, painful pimples, often with pus.
Typical Manifestations (Dr. Que's Key Diagnostic Points):
Pimple Morphology: Primarily red papules and pustules, with obvious redness, swelling, heat, and pain; skin is oily and shiny with enlarged pores.
Affected Areas: Around the mouth, chin, cheeks, and sides of the nose (related to spleen/stomach meridian pathways).
Accompanying Symptoms:
Bitter taste in mouth, bad breath, dry mouth without desire to drink.
Sticky, unsatisfactory bowel movements; or constipation; or diarrhea (loose, foul-smelling stools).
Fullness and distension in the stomach area, poor appetite, or excessive appetite with poor digestion.
Crucial Tongue Sign! Red tongue body with a yellow, greasy coating (like a layer of butter) – the most visual signal of damp-heat!
Pulse: Slippery and rapid (Hua Shu), or soggy and rapid (Ru Shu).
What Chinese herbs are good for facial acne?
Faced with this stubborn Spleen-Stomach Damp-Heat type acne, Dr. Que Poh Yuen Albert, with decades of clinical experience, particularly advocates and excels at using the classic formula from the Sage of Medicine, Zhang Zhongjing – Yin Chen Hao Tang (Artemisia Decoction). Originally from the Treatise on Cold Damage Disorders (Shang Han Lun) for treating damp-heat jaundice, Dr. Que deeply understands its core function of "clearing heat, draining dampness, and abating jaundice." He skillfully "transplants" its use to treat severe acne caused by upward steaming of damp-heat, achieving remarkable results.
Yin Chen Hao Tang's "Assault Weapons":
Yin Chen Hao (Artemisia capillaris) (Monarch Herb) 18-30g: The "Dampness Vanguard"! Bitter to drain downward, slightly cold to clear heat; excels at draining dampness and abating jaundice, especially skilled at clearing damp-heat turbidity from the liver/gallbladder and spleen/stomach. It acts like a powerful "cleanser," guiding the damp-heat turbidity downward to be expelled via urine. Dr. Khoo often uses a heavy dose of this herb.
Zhi Zi (Gardenia jasminoides) (Minister Herb) 12-15g: The "Heat Clearing Expert"! Bitter and cold to drain downward; clears fire from the San Jiao (Triple Burner), guiding heat downward. Particularly adept at clearing pervasive stagnant heat that attacks the head and face, reducing acne redness, swelling, heat, and pain.
Da Huang (Rhubarb) (Minister Herb) 6-10g: The "Bowel Purging Commander"! Bitter and cold to sink and purge; drains heat, unblocks the bowels, breaks stasis, and resolves toxin. It acts like a key, opening the "drainage outlet" of the intestines, allowing the congested internal damp-heat toxins to be vigorously expelled via stool! Dr. Khoo emphasizes that Da Huang in this formula is not just for moving the bowels; the principle of "treating stagnation by promoting discharge" and "giving the pathogen an exit" is crucial. Once the bowels move freely, the damp-heat toxins have a pathway out, and acne naturally clears faster.
Modifications & Ingenious Uses:
Numerous pustules, intense redness/swelling/heat/pain (Exuberant Heat Toxin): Must add Pu Gong Ying (Dandelion), Zi Hua Di Ding (Viola), Lian Qiao (Forsythia), Ye Ju Hua (Wild Chrysanthemum) to enhance heat-clearing, toxin-resolving, and abscess-dispersing power.
Exceptionally strong sebum secretion: Add Sheng Shan Zha (Crataegus, raw), He Ye (Lotus Leaf), Jue Ming Zi (Cassia Seed) to help digest fat turbidity and reduce sebum production.
Accompanied by nodules, cysts, hard lumps (Phlegm-Stasis Intermingling): Add Dan Shen (Salvia), Chi Shao (Red Peony Root), Zao Jiao Ci (Gleditsia Spine), Xia Ku Cao (Prunella) to invigorate blood, resolve stasis, transform phlegm, soften hardness, and dissipate masses.
Abdominal distension, belching, indigestion (Significant Qi Stagnation): Add Chen Pi (Tangerine Peel), Hou Po (Magnolia Bark), Zhi Ke (Aurantium Fruit) to move Qi, relieve distension, and aid transportation/transformation.
Dr. Que's Singapore-Style Additions: Often incorporates Tu Fu Ling (Smilax glabra) and Bai Hua She She Cao (Hedyotis diffusa) considering the local damp-heat environment, to enhance toxin-resolving, dampness-draining, and immune-regulating effects.
Medical Case
Patient: Ms. Lin, 25 years old.
Chief Complaint: Recurrent facial acne for over 5 years, worsening significantly in the past 6 months. Dense red papules and pustules on cheeks, around the mouth, and chin, red, swollen, painful. Skin oily and shiny, greasy upon waking. Accompanied by severe bitter taste/bad breath, abdominal distension, sticky and difficult bowel movements (once every 2-3 days), straining and incomplete evacuation. Long-term reliance on foundation for coverage. Emotionally anxious.
Initial Visit: Tongue red body, thick yellow greasy coating. Pulse slippery and rapid.
Western Diagnosis: Moderate inflammatory acne.
TCM Diagnosis: Fenshi (Acne) (Pattern: Damp-Heat Accumulation in Spleen-Stomach).
Prescription: Modified Yin Chen Hao Tang.
Formula: Yin Chen Hao 25g, Zhi Zi 15g, Sheng Da Huang 8g (added later), Pu Gong Ying 20g, Zi Hua Di Ding 15g, Lian Qiao 12g (clear heat, resolve toxin, disperse abscesses), Tu Fu Ling 20g, Sheng Shan Zha 15g (drain dampness, resolve toxin, transform turbidity, lower lipids), Hou Po 10g, Chen Pi 10g (move Qi, relieve distension, aid transformation).
Usage: 7 doses. Decoct in water, one dose daily. Take warm 1 hour after meals. Strict dietary avoidance as advised.
Second Visit: Starting day 2 of medication, bowel movements became regular (1-2 times/day), formed and effortless. Abdominal distension greatly reduced. Acne improved: significantly fewer new pimples; existing pustules markedly reduced in redness/swelling and pain. Facial oiliness decreased. Formula unchanged. Dosage adjusted (Da Huang reduced to 6g, Pu Gong Ying to 15g). Continued for 7 doses.
Third Visit: Facial pustules essentially resolved, only a few red papules and acne marks remain. Skin oiliness further improved. Bitter taste/bad breath no longer noticeable. Bowel movements smooth and regular. Dr. Khoo adjusted the prescription: reduced purging strength; added Dan Shen (Salvia), Chi Shao (Red Peony Root) to invigorate blood, resolve stasis, fade marks; combined with spleen-fortifying and dampness-transforming herbs (e.g., Fu Ling (Poria), Bai Zhu (Atractylodes macrocephala)) to consolidate results and prevent relapse.
Results: After persisting with treatment for one and a half months, Ms. Lin's facial skin regained smoothness, with only faint acne marks remaining. She was in good spirits and very satisfied with the outcome.
