Acne vulgaris (1)
(痤瘡)
Acne vulgaris is termed by TCM as “lipid prick” (粉刺) and is considered to be the product of stagnation of fire in the lung and kidney channel. Clinically, acne is in fact one of the most common dermal complications seen in chronic hepatitis patients. In our group of 2654 cases of abnormal liver dullness, 512 patients had dermal complications, amounting 19.33%. That is, in patients with abnormal liver dullness, one fifth have clinical manifestations of dermal lesions, and in this part, 202 cases have acne; in other words, in 512 cases showing dermal complications, 39.45% are acne sufferers.
Acne vulgaris is a chronic inflammatory disease of sebaceous gland, occurring usually in young age. The sites of predilection are the face, upper chest and back where the sebaceous glands are better developed. Sebaceous glands are entirely controlled by hormones; the male hormones stimulate directly the sebaceous glands to secret sebum. The bacteria free sebum is secreted into the sebaceous gland duct and through the action of bacterial biolytic enzyme free lipid acid is formed and keratin formation is induced, resulting in thrombotic obstruction of the sebaceous gland duct. If the obstruction causes rupture of the follicular wall (濾泡壁), the irritating contents may be expelled into the true skin and cause inflammation and acne formation.
Because hepatophilic virus infection usually occurs in infancy, as the child passes into adolescence, liver dysfunction may accompany the growing of age and symptoms of endocrine disorder may also appear. In acne sufferers, the most common clinical condition is increase of testosterone in the testis and ovary and increase of androstanedione in the adrenal gland, causing endocrine dysfunction and secretion of abundant sebum which liable to form the open mouth comedo (“black head”) and closed mouth comedo; if infected, it forms acne vulgaris. Severe cases may leave pigmentation and scars after healing, which affects cosmetic appearance. If the presence of endocrine dysfunction is, in part, indicated by the formation of acne, then, in cases of hepatophilic virus infection, the number of hypersecretion of male hormone cases is by no means a small one.
Introduction of cases
| Case 6
Huang (code number 304), male, age 32 years. He donated blood 10 years ago and found that he was a type B hepatitis virus carrier with abnormal liver function and increase of transaminase (轉氨酶). He had his first visit in 1995 with the chief complaint of vertigo, palpitation, precordial pain, secondary obesity and hepatic edema. Physical examination revealed a puffy body build, skin somewhat dark in color and hepatomegaly of 3 am. The diagnosis was chronic hepatitis with TCM classification of “wetness-heat vaporization form” and “weakness of liver and kidney form”, complicated with imbalance of auricular fluid. He was treated systematically with TCM drugs in our clinic and obtained clinical cure with disappearance of symptoms. Since cure of the disease, he visited the clinic occasionally to get some TCM drugs for the clearance of wetness-heat and obtained good results. He had a return visit on May 2000, with the complaint of suffering from acne for 2 months associated with long term constipation. Physical examination: multiple acne over face and neck, part of them showing infection and pus points; liver enlarged to 1.5 cm with marked percussion tenderness. This was the first relapse of his liver disease. After 3 parcels of TCM drugs, the liver returned to normal and the acne gradually subsided. Clinical cure was obtained after 4 weeks of TCM treatment and the therapy was then stopped. From that time onwards, no relapse was seen.
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| Case 7
Wu (code number 1977), female, age 35 years. Her first visit was on November 1999 with the chief complaint of suffering from acne for 20 years. She was treated by TCM and WM physicians with no avail, and she was still taking female hormones but the acne did not completely fade away. She had imbalance of auricular fluid and took TCM drugs for 20 days, after which no relapse was seen. She had also insomnia, dreamful sleep, nasal hypersensitivity, occasional headache and vertigo. Physical examination: anemic, lean, geographic tongue, significant tongue coating of yellowish white color, face showing multiple acne, abdomen soft and tympanitic, hypochondriac anomaly, retraction of area of hepatic percussion dullness with the lower margin 3cm above costal margin and with tenderness. The diagnosis was chronic hepatitis with TCM classification of “liver stagnation and lung dryness form” (nasal hypersensitivity, repeated common cold), “wetness-heat vaporization form” (virus gastro-intestinal disease, imbalance of auricular fluid, acne vulgaris induced by wetness-heat of skin) and the “deficiency of qi and blood form” (anxiety, insomnia, endocrine disorder).
After 3 parcels of TCM drugs, the abdominal gaseous retention was relieved and physical examination revealed a hepatomegaly of 1.5 cm. Another 3 parcels were given and the liver returned to normal. In the course of treatment, the acne gradually subsided, and other symptoms also disappeared. A seven week course of therapy was administered and the patient was followed up after cessation of treatment. Repeated common cold symptoms were observed during the course of therapy, and also local tenderness of the costal thoraxie articulations was experienced by the patient; but all these were cured eventually. At the end of TCM drug administration, the acne disappeared completely and the facial skin was smooth.
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By WONG Kwok Hung
published on 30th October 2001
(translated by Professor ZHENG Hua En in 2003)