CLINICAL APPLICATIONS

* Acne  vulgaris (acne or pimples) in youth and adults

§ Inflammatory types (papules, pustules, cysts)

§ Non-inflammatory types (black heads, white heads)

* Rosacea

 

WESTERN THERAPEUTIC ACTIONS

* Regulates and balances the hormones

* Antibiotic effect to treat infection

* Anti-inflammatory effect to reduce swelling and inflammation

 

CHINESE THERAPEUTIC ACTIONS

* Clears Lung heat and detoxifies the skin

* Clears Liver and Kidney fire

* Drains pus

* Purges heat

 

DOSAGE

Take 3 to 4 capsules three times daily. Dosage can be increased up to 6 to 8 capsules three times daily in acute cases. This formula should not be taken for more than two months continuously.

 

INGREDIENTS

Bai Zhi (Radix Angelicae Dahuricae)

Bo He (Herba Menthae)

Chuan Xiong (Rhizoma Chuanxiong)

Da Huang (Radix et Rhizoma Rhei)

Hu Zhang (Rhizoma et Radix Polygoni Cuspidati)

Huang Bo (Cortex Phellodendri Chinensis)

Huang Lian (Rhizoma Coptidis)

Huang Qin (Radix Scutellariae)

Jie Geng (Radix Platycodonis)

Lian Qiao (Fructus Forsythiae)

Yi Yi Ren (Semen Coicis)

Yin Yang Huo (Herba Epimedii)

Zao Jiao (Fructus Gleditsiae)

Zhi Zi (Fructus Gardeniae)

 

BACKGROUND

Acne vulgaris (acne) is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of hair follicles and the sebaceous gland. Acne is a common disorder in youths, and is becoming more common in older individuals (up to age 40), due to modern dietary and lifestyle habits that consist of rich foods, and dietary and environmental toxins. Individuals who are more prone to be affected include youths who are experiencing hormonal fluctuations, women who have irregular menstruation, and people who suffer from excessive stress due to work, family, or other emotional factors.

        Commonly seen types of acne in the clinic include inflammatory types (papules, pustules, cysts) and non-inflammatory types (black heads, white heads). Modern research has found that acne is closely tied to hormonal imbalances – acne in young women is most often related to menstrual cycles, and overproduction of testosterone can cause pore enlargement and overproduction of sebaceous glands, leading to acne all over the body. Acne can also be caused by improper hygiene, leading to the excessive growth of acne-causing bacteria. Regrettably, acne is not viewed as a serious disorder, with most people carrying the viewpoint that it will naturally dissipate after age 25. However, if not treated properly, acne may leave behind scarring [physically and emotionally], leading to a lifetime of self-esteem issues.

 

FORMULA EXPLANATION

Dermatrol (Clear) is an herbal formula that treats acne by releasing wind-heat from the exterior and clearing heat and fire from the interior.

        Bo He (Herba Menthae) and Lian Qiao (Fructus Forsythiae) are two herbs that effectively clear wind-heat from the exterior. As the skin and the Lung are closely related, Huang Qin (Radix Scutellariae) clears heat and eliminates toxins from the Lung, and Jie Geng (Radix Platycodonis) guides these herbs to the Lung. By clearing heat from the Lung and the skin, these herbs help to directly treat acne.

        Huang Qin (Radix Scutellariae), Huang Lian (Rhizoma Coptidis), and Huang Bo (Cortex Phellodendri Chinensis) are all bitter and cold herbs that clear heat and fire from upper, middle, and lower jiaos, respectively. Furthermore, Zhi Zi (Fructus Gardeniae) clears excess heat and fire throughout the body, and Da Huang (Radix et Rhizoma Rhei) drains all the heat out of the body through its laxative and purgative functions. Overall, these herbs clear and drain heat and fire from the interior aspects of the entire body.

        Beyond clearing heat from the exterior and the interior, additional herbs are utilized to clear heat from specific areas of the body. The location of acne may indicate pathology relating to the organ systems of that particular region. Acne on the forehead indicates a problem in the Heart. The Heart dominates the shen (spirit), and people who have acne in this area tend to think and worry excessively, such as students who are under a lot of academic and social stress. This condition can be treated with Zhi Zi (Fructus Gardeniae), which sedates fire in all three jiaos, especially the Heart. Acne around the nose indicates heat in the Stomach and Spleen, or the digestive system. Individuals with acne in this region tend to stay up late, and have inflammatory bowels after ingesting foods that are pungent and spicy. This condition is best treated with Huang Lian (Rhizoma Coptidis), an herb that clears fire from the middle jiao. Acne on the chin indicates Kidney imbalance, or hormonal dysfunction. This type of acne tends to happen in females around their menstrual cycles when hormone levels fluctuate. Huang Bo (Cortex Phellodendri Chinensis) is the best herb to treat this condition, since it clears heat in the lower jiao. Liver is the organ that is responsible for feelings and emotions. Therefore, acne on the cheeks or acne outbreak associated with stress and anxiety tends to be characterized by Liver qi stagnation or Liver fire. Hu Zhang (Rhizoma et Radix Polygoni Cuspidati) is included to clear Liver heat and Liver fire.

        In addition to clearing heat and fire, this formula uses Bai Zhi (Radix Angelicae Dahuricae), Yi Yi Ren (Semen Coicis), Yin Yang Huo (Herba Epimedii) and Zao Jiao (Fructus Gleditsiae) to clear dampness and drain pus. Chuan Xiong (Rhizoma Chuanxiong) is added to invigorate blood circulation, remove blood stasis, and relieve pain. Finally, Da Huang (Radix et Rhizoma Rhei) clears fire and drains toxic heat downward through defecation.

        Overall, Dermatrol (Clear) is an excellent formula to treat acne by releasing wind-heat from the exterior, clearing heat and fire from the interior, and draining heat downward.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated in cases of cold or deficiency.

* Do not use this formula during pregnancy and nursing.

* The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”

 

CLINICAL NOTES

* One very effective folk remedy for acne is to use high quality, wild honey with extra virgin olive oil. Mix two drops of honey and olive oil in a clean bowl thoroughly. Apply to the acne before bedtime and leave it on overnight. This is very effective for acne that has just started to develop and is painful but has not yet manifested in redness or swelling on the face. During the day time, apply a thinner amount on the local area to prevent the acne from breaking out. This method is only useful when the honey and the olive oil are mixed and used right away. Using the same mixture the day after, or applying honey on the face first, and then olive oil next are all ineffective and may contribute to more breakouts. Note: Be sure to pick high quality honey and extra virgin olive oil to see results.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Deep, short and convex pulse on the right cun

* Acne due to poor diet (Stomach fire): convex, forceful, and superficial pulse on the right guan

* Acne due to hormones (Kidney fire): Taiyang pulse, a thick, long wiry, and forceful pulse, on both chi positions

* Acne due to stress (Liver qi stagnation): convex and forceful in the left guan

 

SUPPLEMENTARY FORMULAS

* For pimples that are hard and painful, add Resolve (AI).

* For pimples that are infected with pus and abscesses, add Herbal ABX.

* For excessive heat manifesting in red face, red tongue and/or heat sensation and irritability, add Gardenia Complex.

* For excess heat in the Liver, add Liver DTX.

* For deficiency heat in the Kidney, add Balance (Heat).

* With constipation, add Gentle Lax (Excess).

* With stress, add Calm (ES).

* For hormone-related acne where breakouts occur during or before menstruation, add Calm.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Main points: Baihui (GV 20), Chize (LU 5), Quchi (LI 11), Dazhui (GV 14), Hegu (LI 4), Feishu (BL 13), Weizhong (BL 40)

* Supplementary points: Sibai (ST 2), Xiaguan (ST 7), Jiache (ST 6)

* Use the sedation method, retain needles for 30 minutes, one time daily for ten days, or until symptoms decrease, then switch to one time every other day.

 

Classic Master Tung Points:

* Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Waisanguan (T 77.27), Linggu (T 22.05), Dabai (T 22.04), Huoying (T 66.03), Tianhuangfu [Shenguan] (T 77.18)

 

Balance Method by Dr. Richard Tan:

* Right side: Sanjian (LI 3), Quchi (LI 11), Taibai (SP 3), Yinlingquan (SP 9), Dadun (LR 1), Zhongfeng (LR 4)

* Left side: Chize (LU 5), Taiyuan (LU 9), Zusanli (ST 36), Xiangu (ST 43)

* Alternate sides from treatment to treatment.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Endocrine, Cheek Area, Liver, Spleen, Lung, Large Intestine, Adrenal Gland. Bleed Ear Apex, Helix 4, or Cheek Area.

* For acne that worsen during the menstrual cycle, add Uterus, Ovary, Pituitary

 

NUTRITION

* Besides establishing a normal pattern of work and rest, individuals should incorporate more fresh fruits and vegetables into their diets. Cook and eat fresh foods by steaming, boiling, and light dry-frying.

* Drink more water to maintain normal bowel movements.

* Consume foods that are low calorie, low fat, and low carbohydrate.

* Incorporate more of the following cooling foods in the diet: tofu, tomato, celery, asparagus, bamboo, seaweed, kelp, bitter melon, cucumber, gourd, luffa, winter melon, orange, grapefruit, pear, banana, papaya, watermelon, white radish, mustard leaf, potherb mustard, cactus, Chinese kale, napa, and bamboo sprout. However, long-term consumption of cold fruits and vegetables like the ones listed above may be damaging to the Spleen. To make the property more neutral, add about 20 pieces of Gou Qi Zi (Fructus Lycii) when cooking.

* Avoid certain fruits that produce heat and aggravate acne, such as mango, lychee, and durian.

* Avoid spicy foods, deep-fried foods, and canned foods.

* Avoid spicy, pungent, aromatic vegetables such as pepper, garlic, onions, ginger, basil, rosemary, cumin, fennel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, wasabi, and cardamon.

* Avoid drinks such as coffee, alcohol, sodas, and energy drinks.

* Avoid foods that may trigger a skin response, such as chocolate, sweets, and peanuts.

* Avoid foods and drinks with artificial coloring. Limit the intake of foods high in sugar and carbohydrates.

* Consume as few meat products as possible, especially meats high in fat. Do not eat processed meats such as lunch meats, hot dogs, and sausages as they contain nitrites that are associated with inflammation and chronic disease.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Eat more squash, cucumbers, watermelon, winter melon, celery, carrots, cabbage, beet tops, dandelions, aloe vera, mulberry leaf, carrot tops, lettuce, potato, cherries, papaya, pear, persimmon, raspberries, buckwheat, alfalfa sprouts, millet, brown rice, and mung beans.

* Drink plenty of water.

* Blend a cucumber, apply externally; leave on for 20 minutes then wash off.

* Apply plain, low fat organic yogurt; leave on for 20 minutes then wash off.

* Rub watermelon rind on the acne.

* Apply aloe vera to the affected area.

* Eat watermelon or drink watermelon juice.

* Drink dandelion and beet top tea.

* Boil raspberries to a concentrate and wash area with it.

* For oozing acne conditions, cover area with pearl barley powder overnight, wash off with water; or mix pearl barley powder with aloe vera gel into a paste and leave on area overnight, then wash off with water.

 

LIFESTYLE INSTRUCTIONS

* Wash the face often, but not excessively. Excessive washing may lead to more oil production.

* After perspiring or washing the face, make sure to dry the face with a clean towel or cloth.

* Use natural skin care products instead of products that contain chemicals and artificial ingredients.

* Use proper moisturizers, e.g., moisturizers that are suitable for the skin type.

* Be sure to rinse off excess facial cleanser, soap, and lotion from the face as the chemical or the oil may contribute to more breakouts.

* Always remove cosmetic products from the face before bedtime.

* Go to bed before 10:00 p.m. and make sure to have adequate amount of sleep.

* Drink more water throughout the day.

* Avoid humidity and sweating, which may trigger acne.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Acne vulgaris (acne) is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of hair follicles and the sebaceous glands. Optimal treatment requires use of herbs to target various aspects of acne, including herbs with regulatory effects on the hormones, herbs with antibiotic effects to treat the infection, herbs with anti-inflammatory effects to reduce swelling and inflammation.

        The most common cause of acne in puberty is the overproduction of sebum due to the stimulation of androgen. Therefore, use of herbs to regulate and balance the hormones will greatly reduce the number and severity of acne outbreaks. Yin Yang Huo (Herba Epimedii) is one of the most effective herbs to influence the production and release of sex hormones, including corticosterone, cortisol, testosterone, and estrogen.[1]^,[2],[3] Another herb of great importance is Huang Qin (Radix Scutellariae), which has an antiandrogenic effect through inhibition of the androgen receptor signaling pathway.[4] Together, these two herbs regulate and balance the endogenous hormones, which in turn control sebaceous gland function and excessive production of sebum.[5]

        Infection is an important cause and complication of acne. As a cause, proliferation of Propionibacterium acnes in the keratinocytes directly contributes to infection and inflammation of the follicles. As a complication, cases of acne with open comedones are prone to contact infection from skin bacteria, which in turn form abscesses and increase the risks of scarring. Therefore, the use of herbs with antibiotic effects is very important for optimal treatment of acne. According to a study that evaluated 119 plants, Yin Yang Huo (Herba Epimedii) and Hu Zhang (Rhizoma et Radix Polygoni Cuspidati) have been identified as two herbs with potent antibiofilm activity against Propionibacterium acnes. In fact, these two herbs showed marked antibiofilm activity when used in subinhibitory concentrations, indicating that killing of microbial cells is not their only mode of action.[6] Furthermore, this formula contains many other herbs with antibiotic effects, including but not limited to Huang Bo (Cortex Phellodendri Chinensis),[7]^,[8] Huang Lian (Rhizoma Coptidis),[9] Huang Qin (Radix Scutellariae),[10]^,[11] and Lian Qiao (Fructus Forsythiae).[12]

        Obstruction of pilosebaceous duct is also an important aspect of acne. Therefore, use of herbs with anti-inflammatory effects is important to reduce swelling and inflammation, and eliminate the obstruction. In this formula, Bo He (Herba Menthae) and Zao Jiao (Fructus Gleditsiae) have antiallergic and anti-inflammatory effects to suppress histamine release and prostaglandin D(2) synthesis from mast cells.[13],[14]^,[15] Da Huang (Radix et Rhizoma Rhei), Huang Lian (Rhizoma Coptidis), and Huang Qin (Radix Scutellariae) all have anti-inflammatory activity to reduce swelling and inflammation and treat skin disorders.[16] Finally, other herbs with anti-inflammatory effects include Bai Zhi (Radix Angelicae Dahuricae),[17] Chuan Xiong (Rhizoma Chuanxiong),[18] Hu Zhang (Rhizoma et Radix Polygoni Cuspidati),[19] Yi Yi Ren (Semen Coicis),[20] Zhi Zi (Fructus Gardeniae),[21] and Yin Yang Huo (Herba Epimedii).[22] Together, these herbs reduce swelling and inflammation to eliminate obstruction of the pilosebaceous duct in acne.

        In summary, Dermatrol (Clear) has an excellent effect to treat acne through its pharmacological effect to regulate the hormones, control and suppress infection, and reduce swelling and inflammation.

 

COMPARATIVE ANALYSIS

Acne vulgaris (acne) is the formation of comedones, papules, pustules, nodules, and/or cysts characterized as inflammatory (papules, pustules, cysts) and non-inflammatory types (black heads, white heads). Common causes of acne include hormonal imbalance, use of occlusive cosmetics, cleansing agents, clothing, and environment (humidity). Proper treatment of acne is important for many reasons: to avoid infection, to prevent scarring, and possible short- and long-term self-esteem issues.

        In Western medicine, acne is treated with four main types of drugs. First are topical antibacterial drugs, such as benzoyl peroxide, clindamycin, and erythromycin. Though the use of these drugs topically is generally well tolerated, they may still cause adverse reactions such as dry skin and allergic responses. Second is the use of topical exfoliants to remove the old and dead skin cells, such as Retin A (tretinoin) or Tazorac (tazarotene). The main adverse reactions of these types of drugs are skin irritation, increased sun sensitivity, and stinging sensations. Third is the use of oral antibiotics, such as tetracycline, doxycycline, or erythromycin. Though these drugs are effective and inexpensive, use of them will likely cause increased sun sensitivity and upset stomach. Finally, when all else fails, oral retinoid such as Accutane (isotretinoin) may be prescribed. However, this should be avoided if at all possible because this drug causes many short- and long-term side effects, such as damages to the blood cells, the liver, arthralgias, depression, and risks of birth defects.

        In Chinese herbal medicine, acne is generally diagnosed as a heat condition. As such, herbs that dispel wind-heat from the exterior and clear damp-heat from the interior are generally prescribed with great success. From pharmacological perspectives, these heat-clearing herbs are ones with antibiotic and anti-inflammatory effects. Furthermore, since hormonal imbalance is also a common cause of acne, an effective, but often under-utilized approach, is the use of herbs to regulate and balance the hormones. In this formula, herbs are used to clear heat from the exterior and balance the hormones from the interior to achieve a synergistic and optimal result for acne treatment.

        Overall, both herbs and drugs treat acne safely and effectively. In most cases, herbs can be used to treat mild to moderate cases of acne with good effect and little or no side effects. Short-term use of antibiotic drugs or topical exfoliants is also well-tolerated in most cases. However, oral retinoid such as Accutane (isotretinoin) or oral corticosteroids such as prednisone should not be used unless the acne condition is very severe, and all other options have been proven ineffective, as these drugs often carry more long-term risks than short-term benefits.