Humanity has probably seen millions of medical schools over its whole existence, ranging from the four humours of the Greek physician Hippocrates to wise medicine men of old Native American tribes, but the one that remains the most popular today is Traditional Chinese Medicine.
Traditional Chinese Medicine is about as traditional as it gets; it dates back 5000 years, through generation after generation of trial and error and experience. Its grip has loosened in modern China, thanks to modern science, but traditional remedies are still widely stocked, with some Chinamen ignoring modern medicine completely.
One on hand, Traditional Chinese Medicine and Indian Ayurvedic Medicine have a cult-like following, of true believers who accept every ancient strategy without question, and advise their own followers accordingly…
…but on the other hand, some excellent herbal acne remedies began life in Traditional Chinese Medicine, including ginseng, burdock root and berberine. It exclusively relies on hard experience rather than trials in a laboratory, so there’s a lot of interesting knowledge to gleamed.
Many acne patients are now following the teachings of Traditional Chinese Medicine, after having failed repeatedly with pharmaceutical treatments. Do 3000 year old Chinese monks have any lessons to teach today’s dermatologists?
The principles of Traditional Chinese Medicine
Developed in an age of barbarism when there was no next to modern science, Traditional Chinese Medicine relies on theories which apply several natural laws to the world of health, seeking to explain every possible ailment. Similarly to the four humours, there are said to be five main medicinal elements: fire, earth, wood, metal, and water.
One of the main beliefs of TCM is that in the human body and all of nature, a bio-electric and vibrational energy current called Qi energy is vital for life. Qi energy flows through the body, to every organ and cell, and is critical for health and vitality. The human body is connected through channels of Qi energy called meridians, and when these channels are inhibited, poor health is the inevitable result. Unblocking these channels is how acupuncture is intended to heal. In total, there are 14 of these vital channels.
Traditional Chinese Medicine holds unity of the body as a dearly held principle, believing that everything is interconnected. A disease or organ should not be treated in isolation; it should be treated cohesively, with consideration that one part of the body can affect another.
Then there’s yin and yang; this now widespread saying originated in Traditional Chinese Medicine. Yin and yang are said to be opposing forces of nature which are the overriding law not just in human health, but in the whole of existence. The earliest reference to yin and yang in a medical text occurred in 700BC. TMC applies the yin and yang theory to health, believing that every element much be balanced. An excess of either yin or yang can ruin your health.
Within this idea, there are several broader elemental states: heat, damp, dryness, and cold. Certain foods can add excess heat or dryness, while many medical herbs can remove it. Again, it has similarities to the Greek four humours theory.
These are the millenia old principles of Traditional Chinese Medicine; the treatments such as foods, herbal medicines and acupuncture all relate back to these theories.
The principles of acne
While hunter gatherers have next to no acne, poor skin is not just a feature of modern industrial civilisation. Acne dates back to even the most rustic of civilisations, with Ancient Egyptian pharaohs suffering from the disease…
…so it’s not surprising that Traditional Chinese Medicine has its own set of ancient solutions. The broad theory is that acne vulgaris is caused by an excess of heat and dampness in the human body. Blocking of meridian channels is also said to play a role, with reduced flow of Qi energy encouraging the rise of heat. An excess of yang is the main problem.
When the body is filled with too much heat, it rises up through the skin’s layers and manifests on the face. The dampness encourages the rise of phlegm, moisture and microbes. Based on today’s acne science, you could boil it down to the heat being inflammation, and the dampness representing bacteria…
…but which is accurate? The dampness theory is a failed one. Microbes, AKA acne bacteria, flourish because of clogged pores and sebum. Sebum flourishes not because of dampness, but because of wild hormones and deficiencies in nutrients like zinc and vitamin A; dampness doesn’t come into it.
However, the Chinese gurus were correct with the heat theory. Inflammation is the main cause of acne, and it’s interesting how they made the connection long before science did.
The ancient facemap
The theories continue with the Traditional Chinese Medicine facemap. Acne patients today are speculating on certain diseases correlating to different acne locations, but Chinese doctors have been hammering away in their temples, perfecting their own system for thousands of years.
The accepted theory begins with forehead acne being closely correlated to distress of the nervous system and intestines. Acne on the corners of the forehead indicates kidney and bladder heat, as does eyebrow acne. Acne inbeween the eyebrows is strongly indicative of poor liver function, while acne on the nose indicates heat and dampness of the heart.
Mouth and chin acne is a clear sign of excess heat in the stomach which must be remedied. Finally, acne of the cheeks, the most common area, represents high heat in the stomach and spleen.
Is there any truth to these interesting theories? Sadly, the answer is no.
If we ignore the whole heat and dampness theory to start with, few of these correlations make any sense. The best proven fact about acne locations we have today is that hormonal acne is strongly connected to acne in the jawline, front neck, chin and mouth. This is because those areas have a high androgen receptor density, the same receptors that stimulate hair beard growth but also cause acne.
The Traditional Chinese Medicine theory of stomach heat makes no sense because stomach problems would manifest all over the face; poor digestion of food would result in higher inflammation of the face that leaves no area untouched.
The forehead/gut connection has actually spread to the mainstream acne-clearing community, to people who’ve never heard of TCM, but again, gut problems increase inflammation. An increase in the pro-inflammatory response to p.acnes bacteria happens in the skin pores across every area of the skin. This process is the main cause of acne, after all.
Heart function has little connection to acne and neither does bladder disruption. There is blood flow, but if your heart was pumping so feebly that your skin wasn’t being replenished with blood, you would have much bigger problems.
There’s one positive factor though. There’s a huge chance that over 5000 years, Chinese medical gurus have noticed correlations between stress and chin acne, humid weather and forehead acne, or any possible combination which appeared too consistently to be denied. Perhaps the fact that it makes no sense is a good thing, with years of experience revealing a connection lab residents haven’t grasped.
What about the solutions? The diet
The acne-friendly diet prescribed by Traditional Chinese Medicine relates back to the dampness and heat theories. Your goal is to avoid the foods which increase the dampness and heat connected to any disease, and eat foods which decrease it. Sugar is said to increase fire, oils are said to increase dampness, but TMC has classified every single food:
Increases heat – ginger root, black beans, cinnamon bark and twig, cloves, basil, rosemary, oats, quinoa, sunflower seed, sesame seed, walnuts, pine nuts, chestnuts, fennel, dill, anise, carraway, carob pod, cumin, sweet brown rice, parsnip, parsley, cabbage, kale, onion, leek, butter, chicken, beef, lamb.
Clears heat – apple, banana, pear, persimmon, cantaloupe, watermelon, tomato, all citrus, lettuce, radish, spinach, summer squash, Chinese cabbage, bock choy, broccoli, cauliflower, tempeh, alfalfa sprouts, millet, barley, wheat and its products, kelp and all seaweed, wheat and barley grass, yogurt, crab, clam.
A mixed set of ideas. There’s some ideas which are extremely basic even for a traditional medical school like this. For example, spicy foods like cumin, caraway seeds and ginger are mostly classified as “heat” foods. Yet assuming that their idea of heat is essentially inflammation, ginger is proven today to be monstrously anti-inflammatory thanks to its gingerols and shagoals.
However, Traditional Chinese Medicine is spot on with sugar being hot, because it is highly inflammatory. Casting aside the theories about different organs, a lot of the judgements on fiery foods correlate with what’s proven today. Apples, bananas, broccoli, citrus fruits, and cauliflower are all anti-inflammatory. Most nuts and seeds are pro-inflammatory according to Chinese gurus, which is often correct if not always.
The damp greasy foods idea seems to be a simplistic oil being pumped out of skin pores theory though; inflammation is the bigger problem with certain oils. They’ve categorised wheat and barley as heat-clearing foods, but the comparatively acne-friendly oats are heat-promoting. Like the facemap, many of the recommendations make no sense.
Acupuncture for acne
Acupuncture is the mainstay of Traditional Chinese Medicine. The ancient theory is that expertly applied needles unblock the vital meridian channels.
Its main application is for pain, back, shoulder or otherwise. Acupuncture is intended to relieve blockages of Qi energy in the 14 channels, relieving pain, since stagnant Qi flow is believed to cause chronic pain. The method was developed over thousands of years, and only acupuncture specialists know the certain places to insert the needles.
To clear meridian blockages more effectively, practitioners twist the needles for several minutes as well. They accomplish all this with tiny, hair-thin needles which are hardly noticeable.
Lying on a bed while Chinese women stick needles in your back seems like the strangest health tactic in the world, but does acupuncture work, given that blocked meridian channels are said to cause acne? The evidence for acupuncture is actually decent. It turns out that when the needles are inserted into the acupoints and properly twisted, a burst of nitric oxide is released into the bloodstream. This only occurs in combination with mild electric shocks; this is the traditional Chinese form of acupuncture, but Westerners are scared of the idea and most Western clinics thus skip the electricity entirely.
Firstly, nitric oxide is a vasodilating gas, which might explain the theory of meridian channel clearance. This study tested acupuncture on 20 patients and confirmed an increase in both nitric oxide and localised blood flow. Secondly, nitric oxide is known to soothe pain locally.
Theretically, acupuncture will have limited benefits for acne, since the main role of nitric oxide is vasodilating your bloodstream. You might enjoy increased blood flow and gold coloured skin, but lowered inflammation? Probably not. There are also studies which show that acupuncture has little effect on anything, in addition to the positive studies.
But leaving the sceptics dazed and confused, we have a study where its effectiveness for acne was demonstrated. It was a review which analysed 43 different trials involving 3453 acne patients. It was concluded that “acupoint stimulation therapies combined with other treatments appears to be effective for acne.”
This study examined the far eviller acne conglobata and observed a big reduction among the 26 patients subjected to acupuncture. Acupuncture patients were compared to accutane patients: the rates of effectiveness were 88.5% versus 84.6%. It was proven that acupuncture can lower levels of the pro-inflammatory chemical interleukin 6, which is proven to cause acne. It’s highly likely that nitric oxide isn’t the only immune system player involved.
There’s a few flaws; the nitric oxide burst seems to be highly localised, and nitric oxide has a very low half life. Therefore, it might never even affect your face. There’s no chance that acupuncture will address the real root causes of acne, a poor diet and lifestyle, and the evidence is pretty limited. A few of the studies included in the meta-analysis noticed no change; maybe it only works in certain, mysterious circumstances.
Overall though, the Chinese may have blessed us with an interesting bonus treatment, if you can be bothered. The only worrying thing is how exactly 3000 year old doctors “perfected” the remedy when there wasn’t the technology to make hair thin needles like today. Some Chinamen might have had to make a very noble sacrifice while the Egyptians were living it up in their pyramids all those years ago.
Aside from acupuncture, Traditional Chinese Medicine is best known for its endless array of herbal medicines. Some companies are so reverent and mystical that they don’t include ingredients on their herbal supplements, but many popular ones are found on ingredients lists everywhere:
Phellodendron amurense – one of the 50 fundamental herbs in traditional Chinese medicine. Said to remove heat, eliminate toxicity, and purge the pathogenic fire. The reality: very rich in antioxidants, and may be an adaptogen, a natural plant which reduces stress. Contains a highly anti-inflammatory compound called phenyl-β-D-glucopyranoside.
Rhemannia root (sheng di) – another member of the glorious 50. Traditionally used for hearing loss. Believed to balance the yin. The reality: reduces c-reactive protein, the strongest indicator of high inflammation levels, and lowers inflammation in numerous studies. There’s also evidence that it lowers fasting blood sugar.
Gingseng – we have a quote from 1AD, where ginseng was reportedly good for “quietening the spirit, curbing the emotion, stopping agitation, removing noxious influence, brightening the eyes, enlightening the mind and increasing wisdom“. The reality: the ancient Chinamen were right. Korean ginseng is one of the strongest adaptogens known to mankind. It normalises your stress response, prevents anxiety, and any acne from that anxiety. The ancient quote matches this. Ginseng also lowers free radicals called lipid peroxides, which deplete vitamin E.
Astragulus – another member of the fundamental 50. A yang boosting herb which can tonify the blood. The reality: an excellent herb for antioxidants, containing its own and increasing antioxidant enzymes like superoxide dismutase in numerous studies.
Burdock root – considered to be a strong detoxification agent and a blood purifier. The reality: excellent at reducing inflammation and rich in inulin, a strong prebiotic. Contains antioxidants such as arctigenin, arctiin, beta-eudesmol, caffeic acid, and chlorogenic acid.
Scuttellaria (huang qin) – said to remove heat and invigorate the blood. Another essential 50 member. The reality: reduces free radicals effectively, including those generated by sunlight.
We have an interesting result. Traditional Chinese Medicine’s understanding of how acne arises is fatally flawed, but many of their herbal remedies are excellent.
It makes sense when you think about it. Chinese doctors didn’t have 4000 years to understand the intricacies of human biology – it was impossible – but they were able to test hundreds of herbs and plants on their patients. They have much more experience of which herbs succeed rather than how they succeeded.
The potential of Traditional Chinese Medicine does not lie within its theories of how acne is formed. The dampness and meridian channel theories are flawed, and we know how acne is born anyway.
The promise is in the vast array of herbal remedies, and to a limited extent, acupuncture. So many herbs, like ginseng with its anti-stress properties, have turned out to be excellent for acne.
When you have a school of medicine which has 5000 years of experience, treating literally millions of humans and advancing through nothing but observation, you have a goldmine of information which you should never ignore. Ineffective remedies will occur, but if it wasn’t for traditional Chinese remedies, would we know about berberine, which was proven in one study to lower acne by 45%?
So that’s the verdict on Traditional Chinese Medicine for acne: it’s not a school to follow rigidly, but a never-ending sea of herbs and secrets to investigate and experiment with.
Thanks for reading!