Hormonal Acne Treatment with Acupuncture, Ayurveda, and Chinese Medicine
When considering Hormonal Acne Treatment with Acupuncture, Ayurveda, or Chinese Medicine, its worth noting that in a certain sense all acne is hormonal– teenaged acne is associated with increased levels of testosterone and progesterone, whereas adult acne is associated with hormonal fluctuation, in both men and women– either the monthly fluctuations of estrogen and progesterone, or the daily fluctuations of stress hormones Cortisol and Adrenalin, which in turn strongly affect both estrogen and progesterone, as well as testosterone.
The most common adult hormonal fluctuation associated with acne is the menstrual cycle. But that begs the question of why Sally gets acne with her cycle and Louisa does not. One factor is simple predisposition; some of us have oilier skin and higher testosterone levels, but a big factor, too, is stress and your reaction to it.
Role of Stress
Stress increases nervous system activity and adrenalin, which set in motion cascades of hormonal and neurotransmitter repercussions, not the least of which involve the adrenal glands and ovaries. When the adrenal glands get overstimulated by stress they increase the production of adrenalin and cortisol, this in turn sends messages that suppress ovarian function. Progesterone and estrogen levels become unstable. This is called the adrenal ovarian “axis.” It explains why nervous system and emotional factors can influence all aspects of the menstrual cycle, from PMS to Ovulation to Bleeding. It is why worry and stress can be a significant factor in infertility. Stress hormones also affect testosterone levels and affect the acid base balance on the skin directly, creating ideal conditions for growth of the staph bacteria that is associated with acne.
This is mother nature’s way of protecting women. She does not want you getting pregnant during times of great stress. This is a huge issue with fertility, too. Women that allow themselves to become stressed out about getting pregnant, have a much harder time getting pregnant. Not to mention the stress they already have from modern life. This is one reason why acupuncture works so well with fertility and acne; it takes you out of the stress response and into the relaxation response.
What the Face Tells You–The Geographic Distribution of Acne
Stress Hormone Type Acne–Temples and Cheeks in front of Ears
When you see acne that is due to stress hormone elevation without significant menstrual hormone imbalance or elevated testosterone, it typically presents either all over the face, anywhere on the face at random or, most often, sat the temples, and on the cheeks in front of the ears, another words on what Acupuncture theory calls the Gall Bladder and Stomach acupuncture channels. This is the easiest type of acne to treat with Acupuncture and Chinese Medicine, because it is relatively uncomplicated, and you just have to help the person get into the relaxation response and out of the stress response.
Menstrual Hormonal Imbalance Acne–Cyclic Fluctuation Along Mouth and Cheeks
In females, especially under 36, when you see dramatic flare-ups in acne the week or so before the period, especially that improves after bleeding, you know there is a relationship to the menstrual hormones, with or without stress as a main factor. In these cases the acne is often alongside the mouth almost in a line from the cheeks to the chin, or in a circle around the mouth. This corresponds to heat in the Chong vessel in Acupuncture theory, the acupuncture channel that carries reproductive and also digestive energy. In the treatment of hormonal acne with acupuncture we open the flow of Qi in the Chong acupuncture channel because it has a homeostatic effect on the menstrual hormones. We also use the Dai acupuncture channel, called the belt channel, because it opens up the flow of Qi through the ovaries, uterus, and lower abdomen in general. This is a great channel to open when there is constipation due to heat or tension, because, as the Belt channel it opens or closes the flow of Qi in the torso, especially the lower torso.
Menstrual Hormonal Imbalance Acne with Digestive Issues–Cyclic Fluctuation along Mouth and Cheeks that Stays All Month
These patients have acne along the mouth and cheeks that gets worse premensturally, but that stays the whole month. In these cases we also use We also use the Chong acupuncture channel when people have digestive issues, especially if associated with emotional factors. It is not uncommon for people with menstrual hormonal imbalance acne to also suffer from digestive issues related to the the Liver Qi or the nervous system and emotions. This is interesting because stress induced digestive issues involve pathological heat in the Stomach acupuncture channel, and the Stomach acupuncture channel begins under the eyes, falls in a line from the pupils down to the chin alongside the mouth, and continues down the body and all the way down the front of the leg to the web between the 2nd and 3rd toes. The point in the web, Stomach 44, is an important point to clear heat from the upper reaches of the stomach channel. Its like turning on a tap to drain a barrel of water.
Testosterone Type Hormonal Acne–Hot, Red Cystic Acne with Pus Over Whole Face or T-Zone
This is the kind of acne you see often in young males, or in women with high testosterone levels. It can be complicated by stomach heat if the diet is wrong for the person’s bodymind type, or if they eat cold food, raw food, heavy food, and iced drinks. In that case you will see a thick tongue coat and perhaps a red or swollen tongue. This person may simply have high testosterone quite naturally, as with the hormonal surges of adolescence.
These patient may also, especially if over 20, have issues with stress that creates frustration or anger, such as is not uncommon with “angry young men.” Its also interesting that sometimes you have to look for what is below the defense mechanism of anger and stress. I had a patient with the worst case of cystic acne I have ever seen. His entire face was red and covered in purple cysts. He was very intense. In the end his acne cleared up 100% when I began treating what Chinese medicine calls heart Qi, in addition to the Liver and Gall bladder Qi associated with high testosterone levels. Heart Qi can relate to any of the 6 emotions, but in his case there was a tender kind of sadness underneath his demanding exterior.
Heat in the Stomach Channel Acne- Red face, Oily skin, Thick Tongue Coat, Pimples and Whiteheads on Cheeks, and Forehead
This is the kind of acne that is very related to diet, and it follows the pathway of the Stomach acupuncture channel and the patient usually has a diet that engenders acne with lots of iced beverages and heavy greasy food like fast food hamburgers and fries. I had one case like this with big red pus filled pimples right on the Stomach channel along the mouth and cheeks, text book case, that cleared up completely in three weeks with an herbal formula that dredges the dampness and heat that collects in the stomach with iced beverages and heavy greasy food.
That formula, Long Dan Xie Gan Tang, “Gentiana Decoction to Purge the Gall Bladder” also addresses stress issues and intensity. This patient, a young male around 35 also had a very high pressure job, which however, did not change during his treatment. But his diet did. After two weeks of herbs and two acupuncture treatments he came in and his skin was 100% better. I thought he had gone on acu-tane or something the improvement was so dramatic. No. All he had done was eliminate his daily Big Gulp, and quit the hamburgers and start eating vegetables. And he had gone thorough a bottle of his herbs which had already begun to help by the 2nd treatment, and he had had 2 acupuncture treatments to dredge the Qi from the Gall bladder ,Liver,and Stomach acupuncture channels.
Menstrual Hormones vs. Stress Hormones
When we see acne anywhere on the face or back that is dramatically worse pre-menstrually, or occurs only pre-menstrually, then this points us towards an acupuncture treatment to regulate the Chong and Ren extraordinary channels that bring progesterone and estrogen back to healthy levels. Our herbal therapy restores balance to the hormones with formulas like Dan Zhi Xiao Yao Wan or Xiao Chai Hu Tang, while other formula that clears damp-heat and nourishes the blood in the skin.
On the other hand, when you see acne along the side of the face, in front of the ears up to the temples, especially if it is unchanged through the cycle, it is generally stress induced. This is a completely different pattern, requiring a different acupuncture and herbal treatment one that clears “damp-heat from the liver and gall bladder channel,” using the Dai vessel and points like San Yin Jiao.
Different Pattern, Different Treatment
In the hormonal acne treatment with acupuncture, Ayurveda, and Chinese herbal medicine, I have been very successful tailoring the treatment according to the geographical and temporal patterns of the skin disruption. Each of the above described patterns requires a different treatment method in terms of the logic of the acupuncture point selection, and in terms of herbal formula used.
So each pattern will require different acupuncture point locations, and in the case of pre-menstrual acne, you must treat twice a month, just before ovulation and a week before menstruation. If there are cramps and other problems with the bleeding we may do acupuncture treatment or cupping during the actual menstrual period..
A typical course of hormonal acne treatment with acupuncture is from 4 to 12 visits over two to five months. If your acne is clearly hormonal then you want to treat over three menstrual cycles, two times a month. The first month should have three treatments a week apart.
Diet and Acne
I have also found that in all cases it is very important to correct errors in the diet, such as the consumption of ice cold beverages that lead to hot stagnation in the stomach, (the stomach’s normal function is interfered with by cold things, and it overheats in response to compensate, or just fails to work properly at all, –to know if this is a factor look at your tongue and see if there is a thick greasy coat, especially a dark one).
It is also important when treating acne with Ayurveda and Chinese medicine nutrition to look at the individual diet and see if it matches your dosha. But the general rule of treatment is to avoid hot spicy greasy heavy damp foods, including fried food, alcoholic beverages, ice cream, sweet deserts, gluten, bread, and more than minimal amounts of cheese. Its also very valuable to be eating lots of cooked vegetables, lots of bitter green vegetables, and to be sure not to overconsume water, and to drink lots of oolong or pu-er tea with chrysanthamum.
Tea for Acne
In China Oolong tea is classically used to promote healthy skin. Oolong tea clears heat from the stomach channel which is nearly always involved in acne, no matter what else the pattern. Pu-er tea with Chrysanthemum flower is also excellent, especially for those with hot type oily skin. These cases will have oily skin with a reddish inflammed cast, often with cystic acne. Ju-hua Pu Er, Chinese for Pu Er with Chrysanthemum is a favorite at dim sum, where lots of the food is very heat producing and also greasy. These teas are excellent digestives for anyone, and anyone with acne can use either Oolong tea or Ju-hua Pu Er.
Ayurvedic Herbal Therapies for Acne
Herbal prescriptions are tailored according to the pattern of disharmony in Chinese medicine, as explained above. In Ayurveda all acne is Pitta elevation, and usually Pitta with Kapha. . For severe cases of cystic acne on the face and or back, unrelated to the cycle, and/or in men, I often use the Ayurvedic formula Neem Plus, a product made by Ayush that contains Neem leaf, that has been cooked with Triphala, the traditional and correct way, to reduce toxicity and maximize absorption and make it safe for long term use, otherwise Neem will aggravate Vata and Kapha due to its very strong cold energy.
If the person has a lot of mucus and phlegm and is overweight I often like to add the Ayurvedic herb Guggal which scrapes Ama/digestive toxins or “gunk” from all the shrotas or channels.
If the bowels are not moving, you must address that, which I typically do with diet and Triphala. Good Triphala should taste bitter, astringent, salty, spicy, sour and sweet all at once. But more astringent than anything else. Triphala is a fantastically gentle stool softener that is safe for extended use and actually good for you. Read more about Triphala here
If there is Liver/Gall Bladder toxicity, I like to address this with Chinese Herb prescriptions, such as Long Dan Xie Gan Tang. I only use Blue Poppy brand herbs in this case, because they are tested for heavy metal and pesticide residue by a third party testing lab in the USA, and I can see those reports. I may also use the Ayurvedic formula Livit 2, which is very similar and cleanses toxins from the Liver and Gall Bladder. Its a formula that is widely used for Hepatitis A in India.
For young women under 36 with menstrual irregularity and acne I often combine my Hormonal Acne Treatment with Acupuncture with the Ayurvedic formula Young Fem, by Ayush, and may combine that with Neem or a Chinese herb formula called Xiao Zhen by Sun Ten depending on the pattern.
The beauty and brilliance of Asian medicine, practiced in the classical way, is that we never treat a disease, we always treat a person.
And each individual person has their own unique pattern that is manifesting at this point in time.
The disease is the unhealthy plant growing in the soil. The soil is the person.
To cure the disease in a plant, the first thing you do is check the soil. Then you cut off the diseased branches and spray what medicines you will. But the foundation of a garden is the soil. And my idea of being a physician is that I am a gardener and my patients are the garden.
copyright Eyton J. Shalom, M.S., L.Ac. San Diego, CA May 2010, All Rights Reserved, Use With Permission Ayurveda, Acupuncture, and Chinese Medicine in San Diego http://new.bodymindwellnesscenter.com