Acne PDF

ACNE OVERVIEW Comedones A comedo, or basic acne lesion, is a hair follicle that has become clogged with oil and dead skin cells. Comedones (the plural of comedo) can develop into bumps called whiteheads and blackheads. Products that may trigger comedones are called "comedogenic." Makeup labeled "...

ACNE OVERVIEW Comedones A comedo, or basic acne lesion, is a hair follicle that has become clogged with oil and dead skin cells. Comedones (the plural of comedo) can develop into bumps called whiteheads and blackheads. Products that may trigger comedones are called "comedogenic." Makeup labeled "noncomedogenic" is less likely to clog pores and contribute to acne. TCM: 1. It is most important to differentiate the type of lesions present, and the proportion of each, in order to target the treatment to the right depth and pathogenic factor - small open comedones (whiteheads) : little pimples that can easily be popped, come and go quickly and do not leave a mark = superficial fire toxin, lung and stomach heat - closed papules: larger zits that do not easily come to a head, but instead stay deep, reddish purple, and hard, and often leave a red, brown or purple mark = deep fire toxin, blood stasis - cysts: large lumpy boils deeply rooted in the skin, with indurated ice pick scars, may last for weeks or months = deep fire toxin, phlegm heat, masses 2. Also important to differentiate accompanying symptoms: - greasy, oily complexion = dampness - accompanying flushing = blood, lung and stomach heat if transient, blood stasis if permanent - digestive symptoms: foul stools, gas, etc = damp heat - worse with menstruation or ovulation = liver qi stasis with heat 3. All cases should avoid alcohol, spicy food, shellfish, sweets, fried foods, smoking 1. Simple, superficial acne: LUNG AND STOMACH HEAT Lesions are mostly small whiteheads which come and go quickly and do not leave any scar or hyperpigmented mark upon resolution. Red tongue or tip, thirst. Pi pa ye / Fm. Eriobotrya 12 Di gu pi / Cx. Mori 12 Sang bai pi / Cx. Mori 12 Shi gao / Gypsum 20 Zhi mu / Rz. Anemarrhena 10 Huang qin / Rx. Scutellaria 9 Zhi zi / Fr. Gardenia 10 Lian qiao / Fr. Forsythia 9 Jin yin hua / Fl. Lonicera 9 Ju hua / Fl. Crysanthemi 9 Gan cao / Rx. Glycyrrhizae 6g Modifications: - very red: Sheng di huang / Rx. Rhemannia, Mu dan pi/ Cx. Moutan, Chi shao / Rx. Paeonia rubra - greasy skin: Yi yi ren / Sm. Coix, Zhi ke / Fr. Citri immaturus, Fu ling/ Poria EXTERNAL: Dian Dao cream 2. Deeper, oily acne: Yang Ming Damp Heat, Fire Toxin and Blood Stasis Large closed painful papules, reddish purple, greasy skin and scalp, constipation or foul diarrhea, bad breath. Lesions worst at temples and top of cheekbones. Red or purple tongue, slippery yellow coat Huang Lian Jie Du Tang modified Huang lian / Rz. Coptidis 6 - 9 Huang qin / Rx. Scutellaria baicalensis 9 Zhi zi / Fr. Gardenia 9 Yin chen hao / Hb. Artemesia capillaris 12 Da huang / Rz. Rhei 9 Bai hua she she cao / Hb. Oldenlandia 20 Xia ku cao / Spica Prunella 12 Pu gong ying / Hb. Taraxacum 15 Chi shao / Rx. Paeonia rubra 12 Dan shen / Rx. Salvia miltiorrhizae 20 Shi gao / Gypsum 30 Gan cao / Rx. Glycyrrhizae Modifications: - diarrhea, reduce Da Huang, add Bai jiang cao / Hb. Patrinia 15 - severe and widespread: Ye ju hua / Fl. Crysanthemi indici , Zi hua di ding / Hb. Viola - very greasy skin: Yi yi ren / Sm. Coix 30, Shan zha / Fr. Crataegi 30, Chen pi / Pericarpium Citri 12 EXTERNAL: Dian Dao Cream 3. Cystic acne: Fire Toxin, Phlegm masses, blood stasis Large, nodular lumpy cysts and boils, indurated ice pick scarring, very slow to come up and disperse. Tongue has greasy coating, variable colour. Er Chen tang + Tao Hong Si Wu Tang, modified  Chen pi / Pericarpium Citri 12 Ban xia / Rz. Pinellia 12 Fu ling / Poria cocos 12 Zhe bei mu / Bl. Fritillaria thunbergii 12 Ju he / Sm. Citri 9 Lian qiao / Fr. Forsythia suspensa 15 Hong hua / Fl. Carthami 9 Tao ren / Sm. Persica 9 Dang gui wei / Extremitas Angelica s. 9 San leng / Rz. Sparganii 9 E zhu / Rz. Zedoaria 9 Xia ku cao / Sp. Prunella 12 Zi hua di ding / Hb. Viola 20 Gan cao / Rx. Glycyrhhizae 6 Modifications: severe: hai zao 12, kun bu 12 erythema: huang qin, huang bo, pu gong ying keloid scars: jie geng, mu li very slow to form and disperse, hard boils: zao jiao ci, bai zhi premenstrual: xiang fu, yi mu cao purple lesions and hyperpigmentation: dan shen 30 4. Menstrual type: Liver Qi Stagnation with Heat - muzzle acne, mostly around mouth, chin, jaw line. Aggravation around ovulation or post ovulation. Accompanied by other pms symptoms. Usually an adult acne. If mild: Dan Zhi Xiao Yao Wan with Tao Hong Si Wu Tang in pill form, or as decoction: Dan Zhi Xiao Yao Wan + Tao Hong Si Wu Tang + Yue Ju WAn = modified chai hu 9 chi shao 12 dang gui 9 mu dan pi 9 yu jin 9 qing pi 9 xiang fu 9 yi mu cao 12 huang qin 9 zhi zi 9 bai hua she she cao 20 Modifications: - clotted painful menses: e zhu, san leng - constipation: pu gong ying 15, da huang, zhi shi - depression: he huan pi 20, dan shen 20