How to Treat Rosacea with Chinese Herbs and Acupuncture
In a previous post we described the different TCM patterns associated with rosacea. This post covers how we treat those patterns with Chinese herbal medicine and acupuncture. Since rosacea is a chronic inflammatory condition, Heat is the most predominant pathogenic factor involved in this skin disease. Acupuncture and herbs are effective at clearing this pathogenic Heat to help reduce the symptoms of erythema (redness), flushing, acne-like blemishes, and to prevent or minimize progression of the condition. If you have rosacea, seek treatment as soon as possible because the earlier you halt the progression of this condition the better (bring a copy of this post in to your practitioner if they are unfamiliar with treating this kind of skin issue). Practitioners should be aware that TCM can be an invaluable help if treatment is persistent. However, reversal of telangiectasia (vasodilation of capillaries) is highly unlikely and any hypertrophy of the nose (rhinophyma) that occurred prior to treatment will be unchanged. (Laser treatment for unsightly capillaries and cosmetic surgery for rhinophyma may be an option).
The initial and most common underlying TCM pattern seen in rosacea is Accumulation of Heat in the Lungs and Stomach. This is when there is much flushing but not yet much telangiectasia and not many papules or pustules. The treatment principal here is to Clear Heat from the Lungs and Stomach. The herbal formula of choice is Pi Pa Qing Fei Yin (with modifications) which should be comprised of the following herbs (though it varies based on the source text):Pi Pa Ye 9g Sang Bai Pi 12g Huang Qin 9g Di Gu Pi 9g Mu Dan Pi 6g Zhi Mu 6g Gan Cao 3g Hong Hua 6g Shi Gao 18g
This herbal formula has several herbs to Clear Heat from the Lungs and the Stomach, as well as herbs to Cool the Blood and Remove Stasis. This is important because if the rosacea is allowed to progress, Heat in the Blood will begin to develop and eventually Blood Stasis will form. By knowing where the disease will go next, we can preempt it and slow or halt its progression. If there is much flushing with the consumption of alcohol (often this can occur moments after taking a sip), add Zhi Zi (6 to 9 grams).
When the flushing becomes more permanent and dilation of capillaries in the face occurs, the pattern of rosacea is Heat in the Blood and the strategy becomes to Clear Heat (from Lungs), Cool Blood and Move Blood. Liang Xue Qing Fei Yin (with modifications) is the herbal formula of choice:Sheng Di Huang 15g Mu Dan Pi 9g Huang Qin 9g Shi Gao 15g Zhi Mu 9g Chi Shao Yao 9g Sang Bai Pi 9g Pi Pa Ye 9g Gan Cao 6g
I am a huge fan of Huai Hua (pagoda flower) and Hong Hua (safflower) for treating the telangiectasia of the face so I always add 6 to 9 grams of each of those two herbs to the above formula as well.
When the rosacea progresses to the pattern of Blood Stasis, the redness of the face is darker, the skin becomes thicker, and there are more pustules. At this phase, treating rosacea is very much like treating cystic acne. We need to Invigorate the Blood and Remove Blood Stasis. A good herbal formula to turn to is Tong Qiao Huo Xue Tang (with modifications):Dang Gui Wei 9g Chi Shao Yao 9g Tao Ren 9g Hong Hua 9g Bai Zhi 6g Chuan Xiong 6g Sheng Di Huang 9g Mu Dan Pi 12g Huai Hua 9g Sheng Ma 3g Da Huang 3g
This formula removes Blood Stasis specifically from the head. I often add Zhi Zi (9g), especially if the patient refuses to stop drinking alcohol. If there are lots of pustules, I also add Kun Bu and Hai Zao (9 to 15 grams each) to the above formula. Note that these two herbs are considered incompatible with Gan Cao. The unmodified formula Tong Qiao Huo Xue Tang is available in patent form from Mayway.
Regardless of the other patterns present, if the patient’s rosacea is worse just prior to or during her period, be sure to also include herbal (and acupuncture) treatment to Regulate the Chong and Ren Mai. This can be done by switching to a different formula in the second half of the menstrual cycle or by adding a few herbs to the base formulas listed above, or by having the patient come for additional acupuncture prior to her period starting.
Topical herbal options can help reduce redness and prevent papules and pustules from forming. Our Zi Zai Dermatology webstore has facial masks currently available and we will soon have a facial toner with herbs that have been found to kill Demodex mites (which have been implicated in rosacea, though not proven to be an actual cause).
Acupuncture can be very helpful in the earlier stages of rosacea to Clear Heat from the Lung and Stomach and to reduce flushing and heat rising to the face. Acupuncture points to choose from include: LI 11, LI 4, LU 5, LU 10, ST 44, ST 36, SP4, SP 6, SP10 to reduce heat rising to the face and to clear organ heat. Some practitioners will needle the face directly and useful points include Yintang, ST 4, LI 20, Bi Tong, DU 25. I will choose points on the face when there is much stagnation in the face, especially around the nose, but I typically stay away from them if there is only mild flushing.
Reducing the causes of pathogenic Heat accumulation in the body is very important to the treatment of rosacea. In our next post we will discuss tips on how to do that so patients can better manage symptoms on their own and improve treatment outcomes.
Publish Date: August 2, 2011 *Articles may include updates since original publishing.