TCM and Western Acne Treatment

ABSTRACT

Acne vulgaris is a common chronic skin disorder over decades throughout the world. It is caused by different etiological factors and it affected the development of a person adversely, especially for in the young age. In this report, it presents differences between TCM and western medicine approaches towards acne treatment.

INTRODUCTION

According to a research conducted by Ghodsi, Wrawa and Aouboulis (2009), there are more than 80% of teenagers and adults experience acne vulgaris during lifetime and 15% to 20% of the cases have been classified as moderate to severe acne in terms of severity. This shows that acne vulgaris has affected a large population in the world and it is a common disease. Furthermore, it is noted that facial acne may cause adverse psychosocial effects including depression, poor confidence (Lepkowska, 2012), anxiety, low self-esteem, negative body image or even suicide ideation (Hedden, Davidson, & Smith, 2008), which hinder personal development of a person. Besides, the estimated cost for acne treatment exceeds US$1 billion every year (Ramli, Malik, Hani, & Jamil, 2012). Therefore, it is important to investigate and explore acne treatment to lessen the risk of acne. On the other side, since traditional Chinese medicine (TCM) and western adopt different methods to treat the same disease, it is worth to compare the treatment between them. It is hoped that effectiveness and mechanism of the treatment will be figured out. In the paragraphs follow, treatments of acne of TCM and western medicine are discussed and elucidated clearly.

CONTENT & DISCUSSION

DEFINITION OF ACNE

Acne is defined as “a chronic inflammatory skin condition, is characterized by comedones (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders, and upper arms” (American Academy of Dermatology [AAD], 2015).

PATHOPHYSIOLOGY

There are different interpretations towards the pathophysiology of the same disorder, acne between TCM and western medicine. From the western point of view, there are four main pathophysiologic events participate in origin of acne vulgaris. Accumulation of keratinocytes with monofilaments and lipid droplets interrupt the normal excretion process in the follicles and this result in follicular plugging. Besides, proliferation of the bacterium Propionibacterium acnes, inflammation and androgen-mediated stimulation of sebaceous gland activity contribute to prevalence of acne as well (Haider, & Shaw, 2004; Nguyen, 2013). In the TCM perspective, it is believed that acne or Fen Ci is due to the stomach, lung heat, which causes blood heat, and dampness (Jin, & Sun, 2008). The heat may prompt to inflammation in the skin due to its transmission through lung or stomach meridians (Alban & Swierzewski, 2015). Moreover, heat causes skin redness as it is promoted in the lung meridian by the external wind pathogen (Alban & Swierzewski, 2015). Nevertheless, according to the holism concept of TCM, the local changes of lung, which is the main location of disease may interrelated to Five Zang and Six Fu and reflect the whole body condition (Chen, & Min, 2015).

ETIOLOGY

Apart from the explanations concerning pathophysiology, there are several risk factors for acne. In the perspective of western medicine, emotional and physical stress may increase the chance of getting acne and the latter is usually connected to excessive fiction on the skin triggered by sweat bands or helmet strips (Nguyen, 2013). Besides, it is noted that cosmetics may block the follicles and it results in acne (Nguyen, 2013). Moreover, genetics affect the risk of acne and the heritability of acne was 78% in first-degree relatives (Williams, Dellavalle, & Garner, 2012). In the view of TCM, diet may plays an important role in the prevalence of acne in terms of yin and yang concept, which allows syndrome differentiation. Law, Chuh, Molinari and Lee, (2010) mention in the study results that yin predominant group with higher intake of street stall foods was corresponded to a lower possibility of having acne because those oily and fatty food are considered to be yang-rich, which balance out the yin and yang entitles. In the contrary, yang predominant group may worsen their acne in this situation as the yang entitles become excessive. Therefore, for the TCM, origin of acne may be explained by imbalance of yin and yang.

DIFFERENCES BETWEEN WESTERN MEDICINE AND TCM

From these explanations of pathophysiology and etiology, different beliefs and concepts between western medicine and TCM are discovered. First, western medicine illustrates the causes of acne in with specific diversified scientific terms, however, in TCM, causes are explained with traditional and consistent concepts like external or internal, heat and Zang Fu. Second, western approach focus on the main problem area, which is narrow, whereas, TCM seeks to treat the body as a whole. Third, in term of the causes of disease, western medicine belives that disease and viruses are caused by bacteria, rogue cells as well as genetic disorders. However, TCM believes that it is a matter of imbalance of yin-yang.

LOCATIONS OF ACNE

Western medicine mention that acne occurs in sites which are rich in sebaceous glands including face, neck, chest, back, shoulders, and upper arms (Nguyen, 2013; AAD, 2015) without any associations with organs. However, TCM has a unique approach that various locations of acne respond to particular internal disharmonies. A study by Cheng and Li (2008) suggest relationship between acne distributions on face and the Five Zang Organs. It reveals that left and right sides of the face are the reflecting area of liver and lungs, lower part is related to kidney, middle part represents spleen and the upper part is the reflecting area of heart.

WESTERN TREATMENT

In western medicine, topical treatments are the fundamental methods used in curing comedonal and inflammatory acne (Nguyen, 2013), in which chiefly consists of benzoyl peroxide, topical retinoids and topical antibiotics . In addition to topical treatments, oral treatments are popular as well including oral antibiotics, oral contraceptives and oral isotretinoin. There are others alternatives such as hormonal therapy, steroid injection, chemical peel and laser therapy for acne care as well. Although significant results are shown in these methods, safety of the usage is concerned. For example, topical retiniods, which effectively reduce the amounts of acne in the range of 40% to 70% (Haider, & Shaw, 2004), may contribute to irritation, erythema, desquamation, pruritus and burning (Nguyen, 2013). Besides, the prolonged use of topical and oral antibiotics, which possess antimicrobial and anti-inflammatory properties, may result in bacterial resistance (Haider, & Shaw, 2004; Nguyen, 2013). For the use of oral isotretinoin, which is considered the most effective medicine to severe acne with clinical cure in 85% of cases (Haider, & Shaw, 2004), it might cause dry skin, mucosa, hepatitis, hypertriglyceridemia, arthralgia, myalgias and inflammatory bowel disease (Nguyen, 2013). Therefore, patients should be pay extra attention to the correct use of western medicine to decrease the risk of the above safety issues.

TCM TREAETMENT

While western treatment have serious adverse effects to the acne patients, TCM seems a safer choice to go. Various methods are adopted in treating acne by TCM including formulae as well as external therapy (facial herbal mask, acupuncture and cupping) in order to adjust Zang, Fu, qi and blood to the equilibrium between yin and yang (Chen, & Min, 2015). They can be used solely or in combination, which aids in achieving better clinical outcomes.

Specific formulae are used based on syndrome differentiation to mitigate and cure acne. Teoh, Xi, Wang and Qian (2012) mention six formulae for four syndromes plainly:

(1) For accumulated heat in lung meridian syndrome, Pipa Qing Fei Decoction (Decoction of Loquat Leaf for Clearing Lungheat) is used to clear lung heat with 100% effective rate (Fang, Lia, Pan, & Li, 2008);

(2) For phlegm-dampness and blood stasis syndrome, Tao Hong Si Wu Decoction (Four-ingredient Decoction with Peach Seed and Safflower) is used to promote better blood circulation as well as menstruation with 72% curative rate (Li, Zhang, & Wu, 2012)

(3) For phlegm-dampness and blood stasis syndrome, Er Chen Decoction (Two-cured Herb Decoction) is used to remove dampness as well as harmonize the middle Jiao;

(4) For heat-toxicity syndrome, Wu Wei Xiao Du Decoction (Five-ingredient Decoction to Eliminate Toxin) is used to remove toxin and clear heat;

(5) For heat-toxicity syndrome, Huanglian Jie Du Decoction (Coptis Decoction for Relieving Toxicity) is used to drain fire and clear toxicity;

(6) For blood-heat of liver meridian syndrome, Dan Zhi Xiao Yao Powder (Rambling Powder with Tree Peony Root-bark and Common Gardenia Fruit) is used to clear blood heat with 94.4% effective rate (Fang et al., 2008).

Through categorizing the patients into different syndromes, it helps to cure the acne problem in a more specific and adaptive way. The prescription may suit the need of an individual and therefore high curative rate is shown through the studies. This is different with the western medicine as they treat the all the patients with same diseases as the same in treatment.

For the external application, Chinese herbs facial mask is one of the popular ways to ameliorate acne. As mentioned by Teoh et al., (2012), due to requiring long time for decocting, poor skills in decocting and being afraid of the bitter taste of the decoctions, people seek external method to cure acne rather than choosing oral method. Facial herbal mask is one of the examples. The major components of the mask are Baizhi (Radix angelicae formosanae) and Baifuzi (Rhizoma typhonii gigantei). They are then mixed with other helper constituents or produced in herb powder to apply the paste on the face, neck or back. Bai Zhi reduces swelling and pus, restricts the growth of bacteria and skin pathomycete and relieve inflammation. In the meanwhile, Bai Fu zi may help to inhibit bacteria, reduce scar on skin, reduce stagnation through detoxification and diminish wrinkles. They act together as a strong agent in combating acne and promote beauty. Studies conducted by Guo (2005) and Ma (2009) reveals that with a high total effective rate, 94% and 94.2% respectively and no allergic conditions occurred in the use of Baizhicuokang, Chinese herbs facial mask may be considered as successful in healing acne.

The other external method is treating acne with the combination of acupuncture plus moving cupping and blood-letting. The result of the related study by Wang and Wang (2008) shows that the combination of using acupuncture as well as moving cupping and blood-letting method is superior in acne therapy with 96.7% total effective rate when comparing with the control group who only received acupuncture treatment, with 80% total effective rate in a month. It can be explained through TCM that the combined therapy may adjust the entire body by the means of regulating neurohumors. The blood-letting and cupping method may promote better blood circulation, regulate qi and blood, diminish stasis, and repel pathogenic factors so as to strike a balance between yin and yang. Through the acne treatment, patients received high recovery rate and it shows the high effectiveness and efficacy in curing acne.

CONCLUSION

In conclusion, there are different approaches and concepts in both TCM and western medicine in acne treatment. While western medicine has adverse effects in the treatment process, TCM provide a safer choice with a high effective rate. It is believed that more scientific research in the acne treatment should be done and researchers should investigate whether the recovery lasts for a long period in the use of TCM approach.

REFERENCES

Alban, J. & Swierzewski S. J. (2015). Acne & Traditional Chinese Medicine (TCM). Retrieved from http://www.healthcommunities.com/acne/alternative-medicine/traditional-chinese-medicine.shtml

American Academy of Dermatology. (2015). Acne. Retrieved from https://www.aad.org/media-resources/stats-and-facts/conditions/acne

Chen, F. Y., & Min, Z. S. (2015). Combining Chinese and Western medicine treatment of severe acne. Jilin Journal of Traditional Chinese Medicine. 35(5).

Cheng, G. X., & Li, C. D. (2008). Correlativity research on acne vulgaris' distributions in face and the five organs. Journal of Zhejiang University of Traditional Chinese Medicine, 32(4), 452-453.

Fang, Y. W., Liao, P. C., Pan, H. R., & Li, Y. L. (2008). Syndrome differentiation and treatment of 562 cases of acne vulgaris. Journal of Beijing University of Traditional Chinese Medicine, 15(5), 8-11.

. Chinese Archives of Traditional Chinese Medicine, 27(5), 1117-1118.

Ghodsi, S. Z., Orawa, H., & Zouboulis, C. C. (2009). Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. Journal of Investigative Dermatology, 129(9), 2136-2141.

Guo, S. H., (2005). Acne treated by baizhicuokang. Journal of Henan Medical College For Staff and Workers, 17(1), 41-42.

Haider, A., & Shaw, J. C. (2004). Treatment of acne vulgaris. Jama, 292(6), 726-735.

Hedden, S. L., Davidson, S., & Smith, C. B. (2008). Cause and effect: The relationship between acne and self-esteem in the adolescent years. The Journal for Nurse Practitioners, 4(8), 595-600.

Jin, Y. X., & Sun, H. (2008). The actual situation of the treatment of acne by traditional and western medicine. Dermatology and Venereology, 30(4), 25-27.

Law, M. P. M., Chuh, A. A. T., Molinari, N., & Lee, A. (2010). An investigation of the association between diet and occurrence of acne: a rational approach from a traditional Chinese medicine perspective. Clinical and Experimental Dermatology, 35(1), 31-35.

Lepkowska, D. (2012). Taking the impact of severe acne on self-esteem seriously. British Journal of School Nursing, 7(8), 375-376.

Li, S., Zhang, X. Z., & Wu, S. F. (2012). Study on clinical efficacy of Tao Hong Si Wu decoction in treatment of diabetic foot. Journal of Clinical and Experimental Medicine, 10, 010.

Ma, G. Y. (2009). Self-made facial mask combined with TCM treatment for curcitive effect acne vulgaris

Nguyen, T. T. (2013). Acne treatment: Easy ways to improve your care. The Journal of Family Practice, 62(2).

Ramli, R., Malik, A. S., Hani, A. F. M., & Jamil, A. (2012). Acne analysis, grading and computational assessment methods: an overview. Skin Research and Technology, 18(1), 1-14.

Teoh, S. M., Xi, S. Y., Wang, Y. H., & Qian, X. Y. (2012). Comprehension and experience of acne treated with traditional Chinese medicine facial mask of Bai Zhi (Radix angelicae formosanae) and Bai Fu Zi (Rhizoma typhonii gigantei) as the basis formula by external application. Chinese Medicine, 3, 87-93.

Wang, Q. F., & Wang, G. Y. (2008). Therapeutic effect observation on treatment of acne with acupuncture plus moving cupping and blood-letting. Journal of Acupuncture and Tuina Science, 6, 212-214.

Williams, H. C., Dellavalle, R. P., & Garner, S. (2012). Acne vulgaris. The Lancet, 379(9813), 361-372.

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