Acne vulgaris - Wokingham, Berkshire

On this page

1. Overview
2. Types and symptoms
3. Causes
4. Acne in Chinese medicine
5. Acupuncture for acne
6. Chinese herbal medicine for acne
7. Cupping therapy for acne
8. Diet and lifestyle
9. Treatment at my clinic
10. Frequently asked questions
11. References

1. Overview

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit — the hair follicle and its associated sebaceous (oil) gland — and is one of the most prevalent skin conditions worldwide. Epidemiological data indicate that acne affects approximately 9.4% of the global population, with a cumulative prevalence approaching 100% among adolescents. It ranks among the top eight most disabling dermatological conditions worldwide, causing not only physical symptoms but significant psychological sequelae including anxiety, depression and social withdrawal. The World Health Organization has endorsed acupuncture as an effective non-pharmacological treatment for acne.

While conventional medicine offers topical treatments, antibiotics, hormonal therapies and isotretinoin (Roaccutane), these carry significant side effect burdens and do not address the underlying physiological drivers of the condition. Traditional Chinese medicine (TCM), through acupuncture and Chinese herbal medicine, addresses acne at its root by correcting the internal imbalances — hormonal, metabolic and constitutional — that drive the skin to produce excess sebum, inflame follicles and develop lesions.

2. Types and symptoms

Acne vulgaris presents across a spectrum of severity and lesion types, from mild comedonal acne to severe nodulocystic disease. Understanding the type of acne is important in tailoring the right TCM treatment approach.

1. Comedones — the most basic acne lesion, formed when a hair follicle becomes clogged with excess sebum and dead skin cells. Open comedones (blackheads) have a dilated pore with an oxidised surface; closed comedones (whiteheads) are covered by a thin layer of skin
2. Papules and pustules — small, raised, red or tender bumps (papules) that may develop a white or yellow pus-filled head (pustules) when the follicle wall ruptures and triggers an inflammatory immune response
3. Nodules and cysts (cystic acne) — larger, deeper, solid and often painful lumps beneath the skin surface, formed when inflammation spreads deeper into the dermis. Cystic acne is the most severe form and the type most likely to leave permanent scarring
4. Hormonal acne — a pattern of acne strongly associated with hormonal fluctuations, typically presenting along the jawline, chin and lower face in adult women, often worsening premenstrually. Particularly common in women with PCOS

Acne lesions most commonly appear on the face, chest and upper back, reflecting in TCM terms the tendency of Heat to rise and accumulate in the upper body.

3. Causes

Acne vulgaris is driven by four key pathophysiological processes: excess sebum production, abnormal follicular keratinisation (hyperkeratosis), overgrowth of Cutibacterium acnes (formerly Propionibacterium acnes) bacteria in the blocked follicle, and inflammation. The factors that trigger or worsen these processes include:

1. Hormonal fluctuations — androgens (particularly testosterone and dihydrotestosterone/DHT) directly stimulate sebaceous glands to produce excess sebum. Hormonal changes during puberty, the menstrual cycle, pregnancy and conditions such as PCOS drive hormonal acne. Elevated luteinising hormone (LH) is particularly associated with the androgen excess underlying acne in women with PCOS
2. Stress — psychological stress increases cortisol and adrenal androgens, which stimulate sebum production and worsen inflammation, directly aggravating acne. Stress-related flares are extremely common
3. Diet — high-glycaemic diets, excessive dairy consumption, spicy food and alcohol all have evidence associating them with acne worsening. High-glycaemic foods spike insulin and insulin-like growth factor 1 (IGF-1), stimulating androgens and sebum production
4. Pharmaceutical drugs — certain medications including anabolic steroids, corticosteroids, lithium and some anticonvulsants can provoke or worsen acne. In TCM terms, many pharmaceutical drugs are “warm” or “hot” in nature, generating the internal Heat that drives acne
5. Genetic factors — a family history of severe acne significantly increases the risk of developing the condition, reflecting constitutional tendencies towards excess sebum production and inflammatory skin responses
6. Poor sleep — inadequate or irregular sleep disrupts cortisol regulation, growth hormone secretion and skin repair processes, all of which can aggravate acne

4. Acne in Chinese medicine

In traditional Chinese medicine, acne is primarily understood as a condition of excess Heat accumulating in the body and rising to the surface. Since Heat by nature rises and ascends, it tends to affect the upper body most severely — explaining why acne predominantly affects the face, chest and upper back. The type and location of lesions, and the accompanying signs and symptoms, indicate which organ system is generating the Heat and what other pathological processes are involved. The main TCM patterns seen in acne are:

1. Lung Heat — the Lung governs the skin and is often implicated in facial acne, particularly across the cheeks and forehead. Lung Heat produces red, inflamed papules and pustules, often accompanied by dry skin, dry stools and a tendency to feel hot. This pattern is commonly seen in teenagers and in acne associated with a hot, dry constitution
2. Stomach and Lung Heat — when excess Heat develops in the Stomach — commonly from a hot, greasy or spicy diet, alcohol and overeating — it combines with Lung Heat to drive more severe facial and body acne. Associated with an oily complexion, strong appetite, bad breath and constipation
3. Heat and Toxin (Blood Heat) — the most intense acne pattern, characterised by deep, painful cystic lesions and nodules, severe inflammation and a tendency to scar. Blood Heat drives aggressive inflammatory acne and is associated with a bright red complexion, intense thirst and a rapid pulse
4. Damp-Heat — when Phlegm-Damp and Heat combine, lesions tend to be larger, slower to resolve, filled with pus and leave post-inflammatory marks. This pattern is frequently seen in patients with oily skin, a rich diet, digestive issues and in women with PCOS. Lesions may be concentrated around the chin and jaw
5. Liver Qi stagnation with Heat — in women whose acne worsens markedly with stress or before menstruation, a pattern of Liver Qi stagnation generating Heat is typically present. This pattern is associated with premenstrual acne flares, breast tenderness, irritability, irregular periods and low mood
6. Kidney Yin deficiency with Empty Heat — in adult women with persistent, low-grade acne, often alongside hormonal irregularity, night sweats and fatigue, a pattern of Kidney Yin deficiency generating rising Empty Heat may be present. Treatment focuses on nourishing Yin and clearing the Deficiency Heat rather than aggressively draining excess Heat

5. Acupuncture for acne

Acupuncture can treat acne by regulating the hormonal environment that drives excess sebum production, reducing systemic and local inflammation, improving skin microcirculation, modulating immune function and addressing the stress and nervous system dysregulation that aggravate acne. These mechanisms are well-supported by research. Specifically, acupuncture has been shown to:

1. Regulate sex hormones including testosterone, reducing androgenic drive on sebaceous glands and directly addressing hormonal acne, particularly in women with PCOS
2. Reduce inflammation through anti-inflammatory neuroimmune mechanisms, including modulation of cytokine release (Kavoussi & Ross, 2007)
3. Enhance immune cell activity including Natural Killer T cells, CD3+ and CD8+ T-cell subsets in acne patients, contributing to lesion resolution
4. Increase local microcirculation in the skin (Komori et al., 2009), supporting the dispersal of inflammation and improving skin repair
5. Modulate the nervous system, reducing the cortisol and adrenal androgen output that worsens stress-related acne flares

Research evidence

A systematic review and meta-analysis by Mansu et al. (2018), published in Evidence-Based Complementary and Alternative Medicine, searched 11 English and Chinese databases and included 12 RCTs on acupuncture for acne vulgaris. The review found that acupuncture and auricular acupressure produced lesion count reductions comparable to pharmacotherapy, with a significantly better adverse event profile — more adverse events were recorded in the control (drug) group than in the acupuncture group. A sham-controlled RCT by Jiao et al. (2022), published in Acupuncture in Medicine, found that acupuncture significantly improved both acne symptoms and quality of life in patients with moderate-to-severe acne vulgaris compared with sham acupuncture. A comprehensive scoping review published in Frontiers in Physiology (2025), covering 114 eligible studies from January 2014 to October 2024, confirmed that acupuncture has established a substantial research base for acne treatment and that the World Health Organization endorses it as an effective non-pharmacological intervention for the condition.

I am a member of the British Acupuncture Council and use acupuncture and moxibustion in the treatment of acne.

6. Chinese herbal medicine for acne

Chinese herbal medicine provides a daily therapeutic stimulus between acupuncture sessions and is particularly effective for moderate-to-severe or persistent acne. Herbal formulas are selected according to the individual’s TCM pattern and adjusted as treatment progresses.

A systematic review by Proença et al. (2022), published in Evidence-Based Complementary and Alternative Medicine, examined 34 clinical trials involving 1,753 participants on herbal medicine for acne vulgaris, confirming that herbal interventions reduced both inflammatory and non-inflammatory lesion counts, sebum production and acne severity scores, and improved quality of life. The four primary targets of acne pathogenesis — sebum excess, hyperkeratosis, Cutibacterium acnes overgrowth and inflammation — all respond to appropriately selected herbal formulas.

Key formulas used in TCM for acne include: Pi Pa Qing Fei Yin (Loquat Leaf Lung-Clearing Decoction) for Lung and Stomach Heat, the most classic formula for common facial acne; Long Dan Xie Gan Tang for Liver Fire and Damp-Heat with severe inflamed cystic lesions, particularly along the jaw and sides of the face; Liang Xue Qing Fei Yin for Blood Heat driving severe inflammatory acne; and Xiao Yao San modifications for Liver Qi stagnation with premenstrual acne worsening. Individual herbs with documented anti-acne activity include Huang Lian (Coptis rhizome, a powerful antibacterial and anti-inflammatory), Huang Bai (Phellodendron), Zhi Mu (Anemarrhena), Dan Shen (Salvia miltiorrhiza) for Blood stasis patterns, and Lian Qiao (Forsythia, excellent for clearing Heat and Toxin from the skin).

I prescribe pharmaceutical-grade Chinese herbal granules from Sun Ten (Taiwan), independently tested for purity and safety. For patients who cannot attend the clinic in person, online Chinese herbal medicine consultations are available with herbs dispensed by post.

7. Cupping therapy for acne

Cupping therapy, particularly bloodletting cupping (pricking a point and applying a cup to draw a small amount of blood), has been used in TCM for acne for centuries. Data mining analysis of dermatological cupping practices has identified acne vulgaris as the single most frequent indication for bloodletting cupping therapy in clinical practice. The mechanism involves the combination of mechanical stimulation, negative pressure and local blood clearing, which enhances local circulation and lymphatic drainage, activates the neuro-endocrine-immune (NEI) network and powerfully clears Blood Heat — the TCM mechanism most directly associated with severe cystic and inflammatory acne. Cupping is typically applied to the upper back and shoulder region and is well-suited to patients with upper body acne involving the chest and back.

8. Diet and lifestyle

Diet and lifestyle have significant impacts on acne through their direct effects on hormones, inflammation and sebum production. The following recommendations are consistent with both research evidence and TCM dietary principles for acne:

1. Reduce high-glycaemic foods — refined carbohydrates, sugar, white bread, pastries and processed foods spike insulin and IGF-1, driving androgen production and sebum output. Replacing these with low-glycaemic whole grains, vegetables and legumes is one of the most evidence-supported dietary changes for acne. See Chinese food therapy for detailed dietary guidance
2. Limit dairy — full-fat cow’s milk in particular has consistent associations with acne worsening in research, partly due to the hormonal content of dairy and its stimulatory effect on IGF-1
3. Reduce alcohol — alcohol generates Heat in the body in TCM terms, directly worsening inflammatory acne. It also raises oestrogen and disrupts hormonal balance
4. Reduce spicy and very hot foods — in TCM, these are “hot” or “warm” in nature and contribute to internal Heat and Stomach Fire, driving sebaceous hyperactivity
5. Increase anti-inflammatory foods — omega-3 rich oily fish, leafy green vegetables, berries and green tea have anti-inflammatory properties and support skin health
6. Manage stress — since stress directly worsens acne through its cortisol and androgen effects, regular stress management — including mindfulness, yoga, adequate sleep and relaxation — is part of an integrated approach
7. Prioritise sleep — sleeping before 10pm and maintaining consistent, adequate sleep supports cortisol regulation, skin repair and hormonal balance, all of which benefit acne

9. Treatment at my clinic

I treat acne vulgaris at my clinics in Wokingham, Berkshire. Online Chinese herbal medicine consultations are also available for patients who cannot attend in person.

Treatment combines acupuncture and Chinese herbal medicine tailored to the individual’s TCM pattern, alongside dietary guidance. Cupping therapy may be added for patients with upper body acne or severe Blood Heat patterns. Most patients see a meaningful improvement in inflammatory lesion count and skin quality within four to eight weeks of weekly treatment, with further improvement over the following months as the underlying hormonal and inflammatory imbalances are corrected. Unlike antibiotics, which suppress acne while taken but do not address the root cause, TCM treatment progressively corrects the internal environment to produce durable improvement. Visit the prices page for treatment costs.

10. Frequently asked questions

Can acupuncture clear acne?

Yes. Acupuncture can significantly reduce acne lesion counts, particularly inflammatory papules and pustules, by regulating hormones, reducing inflammation, improving skin microcirculation and addressing the underlying TCM patterns driving the condition. A systematic review of 12 RCTs found acupuncture produced lesion reductions comparable to pharmacotherapy with a better side-effect profile, and a sham-controlled RCT confirmed it significantly improved both symptoms and quality of life in moderate-to-severe acne vulgaris.

Is acupuncture good for hormonal acne?

Yes — particularly so. Acupuncture has well-documented effects on regulating sex hormones including testosterone, directly targeting the androgen excess that drives hormonal acne. It is especially effective for acne in women with PCOS, premenstrual acne flares and adult hormonal acne along the jaw and chin.

Can Chinese herbal medicine help acne?

Yes. A systematic review of 34 clinical trials involving 1,753 participants confirmed that herbal medicine interventions significantly reduced inflammatory and non-inflammatory lesion counts, sebum production and acne severity. Chinese herbal medicine addresses all four key pathophysiological drivers of acne and provides a daily therapeutic stimulus between acupuncture sessions.

How long does acupuncture take to improve acne?

Most patients notice meaningful improvement in inflammatory lesions within four to eight weeks of weekly acupuncture treatment, particularly when combined with Chinese herbal medicine and dietary changes. Full correction of the underlying TCM pattern — especially hormonal acne or deeply constitutional patterns — may take three to six months. Unlike drug-based approaches, improvements from TCM tend to be sustained rather than reverting when treatment stops.

Can acupuncture help acne scars?

Acupuncture can help reduce post-inflammatory hyperpigmentation (PIH) and support skin healing through its effects on local microcirculation and Blood stasis resolution. Electroacupuncture and dermal needling are the most targeted approaches for acne scarring. Preventing new inflammatory lesions — and thereby preventing further scarring — is the primary goal of treatment.

What is the best acupuncture approach for cystic acne?

Cystic acne reflects a pattern of Blood Heat, Damp-Heat or both in TCM terms. Acupuncture combined with bloodletting cupping therapy is the most powerful approach for cystic and nodulocystic acne, working to aggressively clear Blood Heat and Toxin while reducing deep follicular inflammation. Chinese herbal medicine with formulas targeting Blood Heat and Toxin clearance (such as Liang Xue Qing Fei Yin or Long Dan Xie Gan Tang) completes the internal treatment.

11. References

Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251–257. https://doi.org/10.1177/1534735407305892. PMID: 17761638.

Mansu SSY, Liang H, Parker S, Coyle ME, Zhang AL, Guo X, Xue CC. Acupuncture for acne vulgaris: a systematic review and meta-analysis. 12 RCTs. Evid Based Complement Alternat Med. 2018 Mar 12;2018:4806734. https://doi.org/10.1155/2018/4806734. PMID: 29721027.

Jiao R, Zhai X, Zhang X, Xiong Z, Liu Z. Efficacy of acupuncture in improving symptoms and quality of life of patients with acne vulgaris: a randomized sham acupuncture-controlled trial. Acupunct Med. 2022 Oct;40(5):453–462. https://doi.org/10.1177/09645284221076506. PMID: 35437030.

Proença AC, Luís Â, Duarte AP. The role of herbal medicine in the treatment of acne vulgaris: a systematic review of clinical trials. 34 clinical trials, 1,753 participants. Evid Based Complement Alternat Med. 2022 Jun 15;2022:2011945. https://doi.org/10.1155/2022/2011945. PMID: 35754694.

Rao Q, et al. Current state of research on acupuncture for acne: a scoping review. 114 studies, January 2014–October 2024. Front Physiol. 2025 Sep;16:1661850. https://doi.org/10.3389/fphys.2025.1661850. PMID: 41113620.