Holistic Acne Treatment with Chinese Herbal Medicine Part I: An Overview
- Sean Dugan
- Sep 26
- 13 min read
Skin problems like acne can be physically uncomfortable, but they also have a unique psychological challenge - they are hard to hide.
People deal with health problems that can’t be seen every day, and that has its own set of difficulties. But with acne, you seldom have a choice about whether people know your business or not - our skin is the surface we show to the world.
Acne is rarely a sign of serious health issues, but it is caused by imbalances that indicate our body is dealing with some challenges.
I’ve helped dozens of clients to resolve the underlying health issues causing their acne so they could move on to having problem-free clear skin, all with the natural power of Chinese herbal medicine.
In this article I’m going to cover the most important things you need to understand about the underlying causes of acne and how you can resolve it.
First, I’ll outline the logistics of how I help get you on your way to clear and healthy skin. Next, I’ll take you on a deep dive into the how and why of it all.
Table of Contents
Holistic pathophysiology of acne
How I treat acne in my herbal medicine clinic
I’ve been successful at treating acne in people of all ages. My approach includes three components.
Chinese herbal medicine. I evaluate each case individually to determine the best course of treatment based on your specific pattern of symptoms, overall health and constitution. Most acne treatment is done with custom formulas, granule extracts or raw herb formulas. In some cases I may use capsule formulas, but this is not as common because of the complex nature of acne presentations. To get started with herbal medicine treatment, you can schedule a consultation and fill out my intake form.
Herbal facial masks. My herbal facial masks are designed to help prevent breakouts, stimulate faster skin healing, and reduce acne scarring. They are a great addition to a treatment plan with internal herbs. Purchase here.
Dietary therapy. Whenever possible, I do my best to not recommend any dietary changes. If I can help fix your problem with just internal and topical herbs, we will do that. In some cases, diet changes can rapidly speed up the treatment process. And in some cases a degree of dietary change may be needed for long term success.
If you’re ready to jump right in, you can schedule now and get started.
To learn more about how I treat acne with Chinese herbal medicine, read on!
Holistic Pathophysiology of Acne
Since you’ve surely googled “what causes acne” already, you’re familiar with the answer “acne is caused by the bacteria Propionibacterium acnes that grows when hair follicles become clogged with sebum, a natural skin oil.”
That’s not wrong.
It’s just not all that helpful, either.
Propionibacterium acnes is a naturally-occurring bacteria, and sebum is an essential part of your skin, so neither of these things are going anywhere anytime soon.
In holistic medicine, we know that we have to look at the big picture, to ask more specific questions in order to find more meaningful answers.
The truth is that the human body is deeply complex.
And the answer “acne bacteria + sebum = acne” just doesn’t cut it. If we all have acne bacteria and sebum, why don’t we all have acne?
The answer is that there are many factors behind acne problems, and it’s important to consider them all in order to treat it effectively.
The skin is a purification organ
In Traditional Chinese Medicine (TCM), ancient doctors observed and categorized the body into organ systems. Instead of looking only at what individual organs do, they paid attention to the relationship between different organs.
The skin is an organ, and in TCM is grouped with the lungs and large intestine.
These three organs have several things in common. One, they are all semipermeable surfaces that interact with the outside world. Second, they all function to excrete things that are no longer needed inside our body. The lungs exhale carbon dioxide, the metabolic byproduct of respiration. The large intestine excretes the waste byproducts of our digestive system.
The skin has many functions, and its primary role is not to excrete waste products. It does this job on a backup basis, when the lungs and large intestine can’t handle the load by themselves. If there are excess metabolic wastes, or the lung or large intestine function is impaired - then the skin takes up the slack.
In most cases, this is going to take the form of the skin secreting metabolic wastes through sweat or excess sebum. A good example is how excess sugar is secreted via sweat in uncontrolled Diabetes.
When the skin is working overtime to help the body manage metabolic waste, the skin’s excretions will increase the likelihood of skin problems like acne.
In Chinese Medicine, we use herbal medicine to make sure the lungs and large intestine are working well, and we address problems with excretion, metabolism and toxin removal so that the skin doesn’t have to do this job. This is one reason that regular healthy bowel movements are so important.
Microbiome
The human body is an ecosystem, also referred to as the human microbiome, with trillions of microorganisms like bacteria, fungi, and viruses calling it their home. Most of the time we talk about the microbiome in the context of intestinal flora, or gut flora.
But your skin is absolutely part of the microbiome and, like it or not - there are trillions of microorganisms that inhabit your skin’s ecosystem.
Ecosystems need to be balanced in order to be healthy, and that means they must be diverse. In people dealing with acne, the microbiome is imbalanced and this has led to an overabundance of Propionibacterium acnes.
The conventional approach of internal or external antibiotic treatment only makes it worse. For a short time antibiotics may improve your acne, but in the long term they will invariably make it worse. Antibiotics will never wipe out all the acne-causing bacteria, but they will lay waste to your beneficial bacteria. This reduces your skin’s flora diversity, and aggressive bacteria like Propionibacterium acnes will be the ones that recolonize faster than others once the antibiotics have stopped flowing.
So the solution is not to kill off all bacteria, but actually to nourish beneficial microorganisms, so your skin’s ecosystem is diverse and healthy.
Chinese herbal medicine is holistic in nature, and the herbs we use work with your body to gently shift the microbiome towards greater balance. We use herbs that suppress pathogenic bacteria without wiping out your entire microbiome.
Toxin metabolism and excretion
Unfortunately the words “toxin” and “toxic” have been so overused in the field of natural medicine and popular culture that they have begun to lose all meaning.
The term toxin in Chinese Medicine is used to describe anything in your body that needs to be metabolized, recycled, or removed.
An overload of toxins can contribute to acne, and it can be generated from several different sources. Toxin overload can come from synthetic chemicals such as herbicides, insecticides, plastics (BPA etc), petroleum byproducts (red 40 etc), naturally-occurring chemicals like lead, mercury, and arsenic, or from the most overlooked source - internally generated toxins, aka metabolic waste. Internally generated toxins are by far the most common issue that contribute to acne.
There’s nothing more natural than breathing, right? But as I mentioned before, carbon dioxide is a metabolic byproduct of respiration that must be exhaled - otherwise it would be toxic to us.
Our bodies are constantly creating chemicals, using them, and then either excreting or recycling them. For example, your body is constantly making new red blood cells. The old ones break down over time, and then are recycled to make new ones. All kinds of chemicals in the body go through this process⸺including hormones!
Hormones
You’re likely already familiar with the relationship between hormones and acne. Acne often occurs around puberty, and hormonal acne related to the menstrual cycle is common.
Our body makes hormones, over time they break down, and are recycled or excreted.
During puberty, there is such a dramatic increase in the production of hormones that the body’s metabolic pathway to recycle the chemicals often can’t keep up. When these pathways are overloaded, whatever chemical it is metabolizing becomes a toxin which then must be excreted.
This overloads the system and the skin takes up the slack in excreting excess metabolites - increasing the propensity to acne during puberty.
A similar process happens during hormonal acne related to the menstrual cycle, but we’ll cover that in more detail on its own.
Digestion
Digestive problems frequently contribute to internally generated toxins, and are frequently concurrent with acne.
Leaky gut is a digestive problem which is a common source of toxin overload. In leaky gut syndrome, the small intestine has been damaged - most often by infection, overuse of NSAIDS (like ibuprofen), dysbiosis (H.pylori, Candida, etc), or celiac disease with continued gluten exposure.
The damage results in the intestinal lining becoming permeable. This means that tiny particles of partly digested food - such as sugars or proteins - can escape the small intestine. Now that these particles are outside the digestive system, they are harmful rather than helpful to your body and must be metabolized as toxins. This can overload your body’s detoxification pathways.
Constipation is another very common source of toxin overload. Your large intestine is supposed to be removing toxic metabolic byproducts via your stool. In a healthy system, a person has a bowel movement every day. The bowel movement should be formed, and it should feel complete and relieving. If the stool is coming less frequent, feels incomplete, or is hard to pass - this indicates an imbalance. If the stool is not moving out at the rate it should, the body’s toxin clearance slows down and can get overloaded.
Hormonal Acne
While acne during puberty is certainly related to hormones, the term “hormonal acne” is most often used to describe acne that occurs during specific parts of the menstrual cycle.
The most common hormonal acne pattern presents as acne that flares up the week before and during menstruation.
Some women also experience acne flares around ovulation.
Much of my clinical practice involves helping women with difficult menstrual cycles - including PCOS, dysmenorrhea, PMDD, uterine fibroids, and endometriosis - and many of my patients end up with clearer skin as a positive side effect of treating their menstrual cycle imbalance. In other cases, hormonal acne is the chief complaint - and along with clear skin we see the positive side effects of less painful and difficult periods.
As we discussed above, hormonal acne is ultimately caused by the body being overloaded with metabolites as a result of hormone imbalance that are then expressed through the skin. Additionally, acne that occurs relative to the menstrual cycle is often related to the menstrual blood itself.
Menstruation is the process of shedding the uterine lining each month. This is a prime example of the body’s constant cycle of generating new cells and getting rid of old ones. Difficult menses, like painful menstruation, PMS, and hormonal acne - are all fundamentally related to an imbalance in that process. The body isn’t able to smoothly get rid of the old blood cells and uterine lining - and the hiccup in this process causes all kinds of difficulty along the way.
With Chinese herbal medicine, we can simultaneously address menstrual difficulties and hormonal imbalance because they are directly linked. We use herbs that encourage the metabolism and excretion of old blood cells so that they don’t overwhelm the system.
Traditional Chinese Medicine Theory in Acne Pathophysiology
You may find this section interesting, or you may find it confusing due to the nature of Chinese Medical terminology. If you find yourself scratching your head, please feel free to skip past this section, or read my article “About Chinese Medicine” to learn more about the practice in general.
In Traditional Chinese Medicine terminology, acne is characterized by these pathological factors: Dampness, Phlegm, Blood Stagnation, and Heat.
Dampness and Blood Stagnation are the most predominant factors.
If these unusual terms seem mystical or nonsensical, it’s mainly because they are unfamiliar.
Chinese Medicine is rooted in understanding the body as a part of nature, and understanding the workings in the human body as a microcosm of natural ecosystems. So the terms tend to sound poetic, and in a sense they are. But it’s through this poetic interpretation of the human body that we’re able to understand it more deeply in a holistic way. This provides us with practical solutions that work.
Dampness reflects a pathological excess of fluid or metabolic waste. This can be the result of metabolic dysfunction like excessive sex hormones that aren’t being broken down properly, or elevated blood sugar levels. It can be the result of excessive consumption of sugar, carbohydrates, and rich foods like dairy products. Dampness can also be related to your external environment, in its most obvious sense. For example, if you live in a very humid climate your body will absorb moisture from your surroundings.
Many skin conditions are the result of Dampness. Fungal skin conditions are obvious; fungi love humidity, and so they can only thrive in a damp environment. You might develop a fungal skin condition from living in a humid climate, from sweating up your gym socks and not changing them enough, or even from putting too much oily skin or hair products on your body. Some fungal - aka Damp - skin conditions can seem at first glance like dryness, rather than dampness. Dandruff and seborrheic dermatitis are classic red-herrings. The flaking makes you think it’s dry, but in fact the skin is infected with a damp-loving fungus and so the body sheds skin at an increased rate in an effort to slough it off. Moisturizing will only make the fungus happier!
Dampness in acne is reflected in the over-secretion of sebum. Over-secretion of sebum is a prime example of pathologic fluid, aka Dampness. Acne pustules that are very small, or pustules that express thin clear fluid are primarily Dampness type Acne.
But Dampness is not the only pathological fluid pattern in Acne. Blood Stagnation and Phlegm are also types of body fluid pathologies.
In TCM, Phlegm includes not just the literal phlegm that you might blow out of your nose or cough up from your lungs. The term Phlegm also includes other pathological body fluids that have thickened, including things like pus. Acne pustules that are filled with white or yellow fluid or pus are reflections of Phlegm type acne.
Blood is also categorized as a type of body fluid, and Blood Stagnation occurs when blood movement and metabolism is impaired. Cystic acne always involves Phlegm and Blood Stagnation. Hormonal acne patterns with breakouts worse at ovulation, before menstruation, or during menstruation are always related to Blood Stagnation patterns. This pattern most often shows up around the mouth, chin, and jawline, but can also present on other parts of the body or face. Blood Stagnation type acne pustules can be difficult or impossible to express (aka pop), and they can be filled with blood or pus. They can also present as small pustules filled with clear fluid or pus, as Blood Stagnation acne patterns frequently overlap with Dampness and Phlegm patterns.
In my clinical experience, Heat patterns are the least common and most overdiagnosed. All acne patterns can present with Heat, indicated by redness of the skin and also by fiery emotions like anger, frustration, rage, and irritability. But in acne patterns, Heat is most often caused by constraint. Heat from Constraint is generated from the friction of stagnant body fluids like Blood, Phlegm, and Dampness. Thus it’s not the primary pathological factor, and often doesn’t need to be addressed to any great degree.
This is one of the reasons that antibiotics are never a good long term solution. Antibiotics are Cold in nature, and they only address Heat patterns. Cold-natured substances (including cold-natured herbs) tend to worsen any type of stagnation, because cold inhibits movement. Antibiotics will damage the digestion, and over time they will lead to the generation of more Dampness, more Phlegm, and more Blood Stagnation - perpetuating the acne cycle.
The Problem with Antibiotics
I’m going to step back into Western medical terminology here. Antibiotics suppress the Propionibacterium acnes bacteria. But they will never kill it all; it’s simply not possible to do that. In the process of trying, they will kill all manner of beneficial bacteria, damaging your digestive flora and your skin flora. Essentially, this just digs you deeper and deeper into a chronic acne problem.
In fact, for some people antibiotic treatment of other infections is what kicks off their acne in the first place! I recently helped a client who developed adult acne after taking months of antibiotics. The antibiotics hadn’t successfully treated their chronic sinus infection, and had left them with the additional problem of acne. Chinese herbal medicine treatment through my clinic was able to successfully treat the chronic infection and restore their digestion and skin to normal.
The Problem with Accutane
There’s already been a lot written on this, including right on the FDA label for the drug, so I don’t feel that I need to cover it in great detail. In short, Accutane is dangerous and an incredibly short-sighted treatment for acne. Drug safety data is public and easily accessible simply by searching “FDA label (drug name).” The cliff notes are often included on the instructions, but most people do not read the label or the instructions all that carefully. Many common drugs have pretty horrific safety labels, but I’ve never seen one that compares to accutane - it’s just insane.
I have seen adults in their 40s and 50s with permanent liver damage from 6 months of Accutane treatment as teens. In these cases I have been able to help restore liver function to some degree, but never to pre-Accutane normal function. It’s simply not worth the risks, not when Chinese herbal medicine treatment is effective, can work just as well or better, and has zero safety risks.
Topical Treatments for Acne
The majority of Chinese herbal medicine treatment for acne works through internal herbs, not through topical treatments. Acne is internally-generated, and to correct it naturally we need to address the internal mechanisms that drive it.
That said, there are some topical treatments that can be helpful. I make an herbal mud mask that can be used alongside internal herbal treatment for acne to help prevent breakouts, speed up blemish healing, and promote scar healing. Treatment of scarring can be challenging, but I have seen my internal and topical treatments help with new and old scarring.
Ready for a natural solution to clear and healthy skin? Your herbs are waiting!
Hopefully you found the information in this article helpful. You can visit my clinic page to schedule your first consultation, find more information on the treatment process, cost, herb quality, and more. I look forward to working with you.
Sincerely, Sean Dugan L.Ac.
Sean Dugan L.Ac. is a licensed and board-certified herbalist and acupuncturist. He holds a Master’s degree in Chinese Medicine from the Oregon College of Oriental Medicine as well as a Diplomate in Chinese Medicine from the NCCAOM. He has studied under many Master Herbalists including Dr. Guohui Liu, Dr. Jimmy Wei-Yin Chang, Dr. Fang Zhang, Dr. Greg Livingston, and Dr. Darren Huckle. Sean’s herbal medicine practice draws from both Traditional Chinese Medicine and Classical Chinese Medicine treatment methods, with a focus on clinical efficacy above all. He has been treating patients with Chinese Herbal Medicine since 2013.
Sean works with clients all over the US through the Folkwise Herbal Clinic. In-person appointments are available at our Boise, Idaho clinic.
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