The 5 Major Causes of Acne in TCM
In Traditional Chinese Medicine (TCM), acne is not only viewed as a surface skin condition, but it is also a reflection of an internal state of imbalance.
In TCM, acne is most often associated with internal Heat and the formation of Dampness. Similar to how heat rises in nature, TCM understands that excess internal Heat and Dampness rise in the body, which is why redness, inflammation, and breakouts commonly appear on the face, neck, and upper back.
Acne is most often associated with internal Heat in TCM. Similar to how heat rises in nature, TCM understands that excess internal heat rises in the body, which is why signs such as redness, inflammation, and breakouts commonly appear on the face, neck, and upper back.
Diet and lifestyle play a major role in the development of internal Heat. The most common contributing factors include:
- Diet: Excessive spicy, fried, oily foods, sugar and alcohol.
- Hormonal Changes: Puberty, menstrual cycle fluctuations, pregnancy, postpartum and menopause.
- External Climate: Hot weather, overuse of saunas or hot yoga/pilates.
- Emotional Stress: Emotions affect the organ systems in TCM and create internal Heat – anger impacts the Liver, worry impacts the Spleen, grief impacts the Lungs, and fear impacts the Kidneys.
Diagnosing Acne from a TCM Practitioner Lens
“Chinese face reading, known as Mian Xiang, divides the face into zones linked to the body’s internal organ systems. While maps vary slightly amongst traditions, the practice is considered an ancient “window” into a person’s overall health and emotional state.”
When performing Mian Xiang, practitioners observe the skin’s colour, texture, signs of pigmentation, the appearance of veins, fine lines and acne eruptions.
The location and characteristics of these signs may indicate patterns of excess, deficiency or stagnation of the body’s fundamental substances of Qi, Blood, Yin and Yang in and in which organ system is afflicted (There are 12-primary meridians that are connected to an internal organ and the addition of the Chong and Ren Mai meridians; in which are highly influential on the reproductive organs and HPO axis); for example redness and acne located on the central cheek area may indicate an internal issue concerning the Stomach and digestive system.
Common Chinese Medicine Causes (Patterns) of Acne
Below are some common diagnostic patterns seen in patients with acne; these patterns can occur alone or in combination. Below are some simple lifestyle changes and dietary strategies that can help support each type of acne pattern.
Lung Heat
This pattern often presents with acne on the forehead and lower cheeks. Because the Lung is associated with the season of Autumn & dryness, pimples may appear red, itchy or inflamed on combination oily/dry skin. Other symptoms may include dry throat, dry nasal passages, hoarse voice, low immunity, constipation or feelings of sadness/grief.
Maximise: A diet rich in cooling and moistening foods that nourish the Lung Qi, such as;
- Pears
- Cucumber
- Mung beans
- Chrysanthemum Tea
- Watercress
Minimise: A lifestyle that exacerbates internal heat and afflicts the Lung Qi, such as;
- Spicy foods
- Excess fried foods
- Overheating (saunas, hot yoga)
- Smoking or vaping (A no-brainer!)
Stomach Heat Acne
This is often the most inflammatory form of acne, commonly linked to a poor diet. These breakouts may appear after periods of indulgence, such as holidays or weekends with excess alcohol or rich foods. Acne typically appears on the digestive and intestinal regions of the face, including the forehead, nose and central face, forming large red pustules. Other associated digestive symptoms may include strong appetite, reflux, nausea, thirst, mouth ulcers or gum issues.
Maximise: A diet that is neutralising and alkalising on the digestive system and Stomach Qi including;
- Steamed leafy greens
- Bitter greens (rocket/arugula, dandelion)
- Aloe vera (small amounts)
- Adequate water intake
Minimise: A rich and overpowering diet of heat and dampness causing foods, including;
- Fried foods
- Dairy (in moderation)
- Alcohol
- Sugar
- Late-night eating (the Stomach Qi is weakest from 7-9pm)
Spleen Weakness & Damp-Heat (Oily or Cystic Acne)
This pattern often develops from long-term digestive weakness. It commonly presents with deep cystic acne, oily skin, and breakouts on the chin, jawline, cheeks and nose. Because the Spleen supports digestion and energy production, patients may also experience bloating, loose stools, fatigue, sluggish digestion and difficulty maintaining a healthy weight. Anxiety, low energy and menstrual irregularities may also occur.
Maximise: A neutral and simple diet with foods that help transform dampness to invigorate the spleen Qi, including;
- Light warm meals such as soups and dahl
- Barley, adzuki beans, lentils
- Bitter melon
- Green tea
- Small amounts of ginger, turmeric and garlic.
- Probiotic-rich foods: kefir, sauerkraut, kimchi, kombucha
Minimise: Heavy, sweet and cold foods that further dampen the Spleen Qi’s ability to transform and transport foods and fluids, including;
- Dairy products (In moderation)
- Nut Butters (Peanut Butter)
- Refined carbohydrates (white bread, pastries)
- Sugary snacks
- Cold or iced drinks and heavy smoothies.
Liver Qi Stagnation (Hormonal or Stress Acne)
The Liver regulates the smooth movement of Qi and Blood, influencing hormonal balance through the reproductive and endocrine systems through the HPO and HPA axis (hypothalamic-pituitary-adrenal axis). This type of acne eruption is due to hormonal changes in the body, whether that be from puberty, cyclical changes throughout a woman’s menstrual cycle, menstrual problems, such as amenorrhea, post- birth-control-acne and peri-menopause. The Liver Qi is also highly related to stress and irritability; thus, high cortisol levels are also associated with this type of acne.
With Liver Qi Stagnation, breakouts commonly occur or worsen before/during ovulation or the menstrual period and usually appear along the jawline, chin and neck and may occur alongside PMS, mood swings or stress.
Maximise: An anti-inflammatory diet and lifestyle that enhances the movement of Liver Qi to support detoxification and emotional calm, including;
- Regular moderate exercise
- Peppermint or chamomile tea
- Dark leafy greens, sprouts & cruciferous vegetables.
- Omega-3 rich foods (fish, chia seeds, seaweed, flaxseed and hemp seeds).
- Adequate sleep (8–10 hours). The Liver undergoes repair at 1-3 am; waking at this time can indicate high emotional stress or Liver Qi disharmony.
Minimise: Behaviours that increase emotional tension and irritability, and foods that afflict the Liver Qi, including;
- Chronic stress
- Irregular sleeping patterns
- Highly processed foods/perfumed cosmetic products, BPA
- Excess caffeine and alcohol
- Overworking
- Emotional suppression
Blood Heat Acne
Blood Heat occurs when internal heat penetrates deeper into the Blood level, leading to pronounced inflammation. This pattern may occur during periods of strong hormonal activity, such as menopause and cyclic changes or in times of hormonal suppression, such as amenorrhea, chronic fatigue and post-viral events. Blood Heat acne lesions and may also present alongside other skin eruptions, including rosacea or hives.
Symptoms may include red, inflamed skin, acne that bleeds easily, flushing, headaches, red eyes, itching, restlessness and feeling overheated. Lesions may also leave darker marks or scarring.
Maximise: Foods & activities that support Blood and Yin production, cool the body and reduce activation of the sympathetic nervous system, including;
- Beetroot
- Goji Berries
- Celery
- Black Sesame
- Mint
- Tremella Mushroom
- Drink adequate fluids to increase the intake of electrolytes (magnesium/coconut water).
- Calm the nervous system (walk at a slow pace, increase quiet time, use magnesium spray, partake in breathwork and meditation).
Minimise: Foods and activities that deplete the Blood and Yin and over-stimulate the Heart-Shen, including;
- Alcohol & Spicy foods
- Emotional Overheating (anger or intense stress)
- Physical overheating (avoid saunas, hot pilates and long, hot showers).
- Excessive high-intensity exercise ie HITT, long/intense running.
- Constant Stimulation (scrolling, TV, writing to-do list and over-scheduling).
Acupuncture Treatments in Clinic
Cosmetic and constitutional acupuncture work together to support acne both externally and internally.
From a cosmetic perspective, techniques such as needling and Gua Sha help to stimulate circulation, support lymphatic drainage, and reduce inflammation, improving redness, healing, and overall skin texture.
At a deeper level, constitutional acupuncture addresses the underlying imbalances – such as Heat, Dampness, and hormonal factors – by supporting the function of key organ systems, including the Spleen (digestion), and the Heart, Liver, and Kidneys (stress and hormonal regulation), while promoting the smooth flow of Qi and Blood. Together, these treatments not only improve the skin’s appearance but also help reduce the frequency and severity of breakouts over time.
Herbal Medicine Support
Chinese herbal medicine is often used alongside acupuncture to address both the root cause and presentation of acne. At The Dao Health, we stock a multi-herb formula called Zilch by Vivian Tam. This formula is designed to target common acne patterns by clearing Heat and inflammation, eliminating Heat toxins, and promoting the movement of Qi and Blood. It is typically prescribed alongside a customised base formula tailored to the individual’s underlying pattern and symptoms. For this reason, it’s important to consult a qualified Chinese Medicine practitioner before using Zilch or other herbal products to ensure it is appropriate for your presentation.
Basic Acne Support Tips
- Prioritise warm, cooked foods.
- Avoid over-cleansing or stripping the skin barrier.
- Aim to sleep between 7–11pm, during the Kidney & San Jiao (Triple Burner) time to support hormonal, emotional and fluid regulation before sleep.
- Maintain regular bowel movements and support the microbiome.
- Manage stress through movement, meditation or hobbies.
