Influence of year evolutive phase on the pathogenesis of acne based on the theory of five evolutive phases and six climatic factors

Pu Zhang, Shuo Zhang, Yu-pei Chen, Zhen-lin Chen＊

1 Shaanxi University of Chinese Medicine, Xianyang 712046, Shaanxi Province, China

2 Beijing University of Chinese Medicine, Beijing 100029, China

Funding: General Project of the National Natural Science Foundation of China (No. 81974584)

Abstract According to the theory of traditional Chinese medicine, the occurrence of acne is closely related to the lung, liver, spleen, kidney, and it is mostly caused by the blood heat of lung meridian,excessive heat in stomach and intestine, liver depression transforming into heat and the deficiency of kidney Yin. Doctrine of five evolutive phases and six climatic factors follows the holism of“correspondence between human body and natural environment” as the guiding ideology, analyzes the pathogenic factors in the process of the disease formation and development, and guides the clinical treatment and prevention. Doctrine of five evolutive phases and six climatic factors is used to analyze the cause of acne disease onset. Results show that, when insufficiency of year wood,insufficiency of year earth, insufficiency of year water, insufficiency of year gold, excess of year fire and excess of year gold occur, the incidence of acne disease is increased. When the year is governed by celestial manager qi such as Jueyin wind wood, Yangming dry gold, Taiyin wet earth,the incidence of acne disease will further increase.

Key words: Acne; Five evolutive phases and six climatic factors; Blood-heat; Phlegmatic hygrosis; Blood stasis; Yin deficiency; Year evolutive phase

Introduction

Acne is a chronic inflammatory skin disease that is prevalent at puberty and mainly affects the pilosebaceous unit of face[1]. The main clinical manifestations include the acne, pimples, pustules, nodules in face or chest and back, accompanied with or without different degrees of inflammatory response. Because acne occurs mainly in the patient’s face, it affects the patient’s appearance and poses great impact on mental and physical health of the patients. Modern medicine thinks its pathogenesis factor is pilosebaceous and duct hyperkeratosis,microbial infections, increase of androgen secretion and sebum, secondary inflammation, heredity and other related factors[2]. The main treatments include external antibiotics or combined hormone ointment. For serious acne, the treatment may combine with oral tretinoin or antibiotics to inhibit the inflammatory reaction caused by Propionibacterium acnes and abnormal secretion of sebaceous lipids. Traditional Chinese medicine (TCM)holds that the acne mainly affects lungs, is associated with liver, spleen and stomach, and involves the kidneys after a long term, some lesions are related with syndrome of disharmony between Chong and conception channels. The acne formation is mainly caused by wind-heat or dampheat that attacks epidermis, and lung Qi disharmony[3].The main treatment is to dispel wind, dissolve dampness and clear lung[4]. The doctrine of five evolutive phases and six climatic factors is a theory that studies the effect of climate change on human physiology and pathology under the guidance of the holistic view of “correspondence between human body and natural environment”, referred to as Yun Qi[5]. In Plain Questions · Zhi Zhenyao Dalun,it stresses that “reviewing the pathogenesis should based on the appropriate qi”. This evidence indicates that, in the treatment of disease we should pay attention to the impact of climate change in natural environment on disease[6]. In Plain Questions · Liuyuan Zhengji Dalun,it stresses that, the treatment should not violate the laws of being restrained and revenged in nature, the disorder of internal organs is closely related to the disorder of qi transformation of five evolutive phases and six climatic factors[7]. Acne condition is classified into mild and serious, has long and short courses, the reason is restricted to the external environment and individual constitution difference, so the treatment of acne follows the guidance of “correspondence between human body and natural environment” ideology, initiates from the angle of five evolutive phases and six climatic factors, is guided according to the external environment change and the patient’s constitution, selects medication to formulate prescription, integrates the holism, and optimizes the individual treatment[8].

Understanding of Acne in Traditional Chinese Medicine

In Golden Mirror of Medicine · Essentials of Surgical Techniques · Pulmonary Wind Acne, it states that «acne with pulmonary wind syndrome is caused by blood heat in the lung meridian, occurs on the face and nose, with initial appearance of bumps, millet crumb-like shape, red and swelling pain, and white powder juice after breakage,which becomes white crumbs over time and is shaped like millet white crumbs”. In addition, in “Plain Question· Vitality of Human Communicating and Corresponding to the Universe”, it states that “Sweating and dampness is a sign of acne and sudamen......exposure to the wind after sweating due to overstrain and invasion of pathogenic cold contribute to polyps, which is the acne”. In the theory of traditional Chinese medicine, the etiology and pathogenesis of acne are summarized as follows: (1)Blood heat in lung meridian: first, lung Qi diffusion can play its role of “warming interval between muscles, filling skin, enlarging striate and interstitial space, governing the opening and closure; second, essence of water and grain and fluid can be transported to fur, play its role of nourishing and moisturizing. Lung in the body can be expressed on skin, due to insufficient pulmonary fluid and the dryness caused by consumption of body fluid, the skins loss the nutrition; in the presence of abundant Yang heat,nutrient-blood heat and blood heat obstruction, it runs along the course of meridian and stagnates in the skin,ultimately leading to papule[9]; (2) Gastrointestinal heat accumulation: spleen is responsible for transportation,stomach receives food and drink, the two organs cooperate with each other to complete the formation and distribution of the essence of water and grain, which is the sea of Qi and blood from water and grain. The spleen and stomach pose mutual influence, spleen prefers dryness and abominates dampness. In the presence of abundant dampness or overeating fat and greasy food,the dysfunction of spleen in transportation occurs, the pathogenic dampness accumulates in the gastrointestinal tract, long-term phlegm dampness develop into heat with characteristic of fire being flaring up, which affect the head, face and chest-back, and develop into papules and pustule[10]; (3) Stagnation of liver qi transforms into heat: the liver controls dispersion and modulate qi movement, the liver prefers to be unhindered but dislikes depression. If the melancholy and depression stagnate,the depressed rage impairs the liver, the liver depression transforms to heat, thus damaging the thoroughfare and conception channels, the heat forces blood circulation and is manifested in the head, face, chest and back, developing papules; if the emotional disorder occurs, the liver appears dysfunction of controlling conveyance and dispersion, the Qi and blood circulation disorder occurs, Qi stagnation and blood stasis for a long time will enter the blood,menstrual blood is obstructed, Qi and blood stasis is seen on the skin, manifested as erythema and papules; (4)Deficiency of kidney Yin: the kidney stores essence and is responsible for the growth, development and reproduction of human body, if deficiency of kidney Yin occurs, the imbalance of Yin and Yang, hyperactivity of ministerial fire, excessive prosperity of Tiangui, acne will growth; if you like to stay up all night or long-term mental tension,so that the five emotion will develop into fire, gradually consumption of kidney yin, kidney water deficiency and heart and kidney do not cross, phase fire just move around, will come into being acne[11].

Analysis of Acne Occurrence from the Characteristics of five evolutive phases and six climatic factors research

From the date of birth, five evolutive phases and six climatic factors research will have an impact on the human body. People growing up in different periods, different regions and different environments have different effects on them. Different people get sick for the type of illness,time, simple and serious is differences. Therefore, different Year evolutive phase will lead to different disease, there are excess of Year evolutive phase and insufficiency of year evolutive phase two kinds of pathopoiesia factors.The law of climate change in the year of excess of year evolutive phase is partial prosperity of the Qi of the excess of year evolutive phase. In addition to leading to excess of Qi clash in every direction, but also to stop the excess of Qi appearance injure the Qi of insufficiency. In the same disease, the etiology, pathogenesis and syndromes of different people in different years of year evolutive phase will be different. five evolutive phases and six climatic factors are the conversion of dates by using the theory of“Tiangan Jiyun, Dizhi Jiqi”. We can convert the date of each person’s illness into Ganzhi calendar method, and use Yunqi theory to calculate the characteristics of each person’s Yunqi when he is ill. According to Professor Wang Qi[12]the diagnosis and treatment model of “distinguish of body, distinguish of disease and distinguish of syndrome” is put forward to calculate the characteristics of the patients who are prone to acne, and to provide individualized treatment and prevention for acne patients.

Insufficiency year of Sui wood

In the year of“insufficiency year of Sui wood”, the liver’s function of unhindered is inhibited, the Qi of liver is stagnant, for a long time is developed into fire, and the heat is steamed on the head. If you are coming across the year which Keqi is Jueyin wind wood, this year is the year of flat Qi. The year of year evolutive phase which Yun of wood is insufficiency, be supported by Qi of Sitian,Yunqi has little effect on climate and human body, so the probability of get acne in this year is relatively small.In Plain Questions Qi alternating large theory”, it says“insufficiency year of Sui wood, dryness prevalent”, wood cannot conquer gold, the year of year evolutive phase which Yun of wood is insufficiency, wood Qi already virtual in poor. If encountered the year which Keqi is Yangming dryness of gold, gold injure wood, Qi of dryness of gold are popular, liver wood further with restraint, stasis of liver Qi are more serious, increased the probability of developing the acne. Wood injure soil, insufficiency of wood Yun, wood cannot control soil and soil will harm wood, if meet the year of Taiyin wet soil, the human body’s dampness are more serious, wet Qi go into popular, spleen like dryness and evil dampness, spleen loss transformation,dampness into phlegm, a long time depression change into heat, steam in head, chest back hair for carbuncle.

Insufficiency year of Sui soil

In the year of” insufficiency year of Sui wood”, the deficiency of spleen and stomach Qi, the spleen’s function of transportation and transformation is hinder, water and dampness generate in endogenetic, dampness popular,accumulation into phlegm, phlegm and blood stasis,can be develop into cold ulcers, a long time depression will become into heat, become into carbuncle. If you encounter the year which Keqi is Taiyin wet soil, this year is the year of Tianfu, in the first half of the year the Qi of Sitian of Taiyin wet soil support the insufficiency Qi of Sui soil, Yunqi has little effect on climate and human body,so the probability of acne in the first half of this year is relatively small, in the second half of the year at the affect of Zaiquan of Taiyang cold water, water assimilation with wet, pathogenic factors cold and wet, further damage spleen Yang, hindered spleen and stomach, make the transportation and transformation dysfunction, cold phlegm stagnate in head, thoracic dorsal, become into acne. “Plain Questions · Qi alternating large theory”says “insufficiency year of Sui wood, wind prevalent”,insufficiency year of wood Yun, Qi of spleen and stomach are weakness, if encountered the year which Keqi is Sitian of Jueyin wind wood, liver wood of Sitian injure spleen soil, make the transportation and transformation function of the spleen and stomach weaken further, wet and water’s transportation and transformation are not enough,phlegm and humid generate in endogenetic, hot and humid fumigation, thus disease arises. Sitian of Taiyang cold water, Zaiquan of Taiyin wet soil, is the years of Tong Suihui, soil harm water, insufficiency of soil Yun, the invincible organ of soil Yun will impair it. Therefore, its pathogenesis is as same as Zaiquan of Taiyang cold water.

Insufficiency year of Sui water

In the year of” insufficiency year of Sui wood”, kidney Yin and Yang balance imbalance, kidney yin deficiency,Yin deficiency will change fire, water does not contain wood, liver and kidney Yin deficiency, phase fire just move around, fire of deficiency rise, along the channels steam in the skin for carbuncle; kidney Yang deficiency,Yang deficiency is cold, two veins of Chongren lose the warmth of kidney Yang, blood cannot move, Qi stagnation and blood stasis, depression and become acne[13]. If you encounter the year which Keqi is Sitian of Taiyang cold water, this year is the year of Tianfu, in the first half of the year insufficiency water Yun get support from Sitian of cold water, Yunqi has little impact on the human body. In the second half of this year be impact by Zaiquan of Taiyin wet soil, water cannot conquer soil, moisture popular, spleen be injure, transportation and transformation abnormal,water and wet accumulation, muggy and cold-dampness accumulate in internal to get sick. If you encounter the year which Keqi is Sitian of Taiyin wet soil and Zaiquan of Taiyang cold water, this year is the year of Tong Suihui, in the first half the year of Taiyin wet soil prevailing, moisture epidemic can prone to carbuncle, the second half the year of get the Taiyang cold water’s support, the probability of disease is small. If meet the year of Shaoyang phase fire or Shaoyin monarch fire, insufficiency year of Sui water,kidney water can not restrict the heart fire upward, leading to hyperactive of heart fire, such as ”Plain Questions” says that every carbuncle is belong to heart. Heart fire will lead to carbuncle. Liver and kidney homology, essence and blood mutualization, if the year of Jueyin wind wood,insufficient kidney yin get funding form which liver yin,probability about occur acne is small.

Insufficiency year of Sui gold

In the year of” insufficiency year of Sui wood”, the function of lung rise and fall was dysfunctional, the balance transportion of body fluid be broke, fur was lost in nourishment, external evil was invaded by deficiency,and acne was found on the face[14]. If you are coming across the year of Sitian of Yangming dry gold and Zaiquan of Shaoyin monarch fire, in the first half of the year insufficiency gold Yun get support from Sitian of dry gold, the climate is relatively peaceful, has little impact on the human body, so the probability of acne in the first half of this year is relatively small; in the second half of this year Zaiquan of Shaoyin monarch fire, hot Qi working downward, fire vigorous will injure gold, lung get its persecution, the function of rise and fall disorder, the balance transportation of body fluid be broke, abnormal function of lung lead fur, become into acne, insufficiency of Suijin, fire prevalent”. If you are coming across the year of Sitian of Shaoyang ministerial fire, fire Qi working downward, lung Qi changed into fire, burn body fluid,cause skin loss moist, fire inflammation, obstruction in the face, neck is carbuncle[15]; in the second half of the year, Zaiquan of Jueyin wind wood, wood cannot conquer gold, insufficiency of gold Yun, liver wood back to attack lung gold, lung Qi deficiency, evil of wind wood invading muscle surface, Weiyang be depressed, can also lead to acne[16].

Hyperactivity year of Sui hot

“In hyperactivity year of Sui hot, hot summer prevalent,the lung gold receives evil.” In the , the fire evil is too easy to enter the bloodstream, gathers in the local, burning carrion,produces the carbuncle swelling sore; the fire is the yang evil, towards the top, easily invades the human body upper part, mainly by the head and face redness and swelling heat pain. If meet the year of every Sitian of Shaoyin monarch fire, Shaoyang phase fire, like add firewood in fire, its inflammation is more intense, fire and hot are more flourishing, easy to consume Qi and body fluid, fluid be refined for phlegm, phlegm and Qi mutual assemble and cause blood obstruction, forming blood stasis, phlegm coagulation and blood stasis in the local for carbuncle.At the year of Zaiquan of Shaoyin monarch fire and Shaoyang phase fire, this year is the year of Tong Tianfu,at this time fire assimilation with dryness, heat, its disease characteristics and pathogenesis is as same as the year of Sitian of Shaoyin monarch fire and Shaoyang phase fire.Hyperactivity of fire Yun, lung gold by evil, kidney water for the son of lung gold, Qi of cold water can restrict excess Qi of fire. If you are coming across the year of Sitian of Taiyang cold water, water constraint fire, cold water of Sitian can restrict excess Sui fire, showing a relatively peaceful climate, has little effect on the human body, the incidence of acne is also relatively low.

Hyperactivity year of Sui gold

“In hyperactivity year of Sui gold, Qi of dry prevalent,the liver wood receives evil.” In the , gold constraint wood,hyperactivity of gold Yun , liver wood by evil, liver loss the function of catharsis, Qi stagnation, Qi and blood movement obstacles, Qi stagnation and blood stasis,blocked in the local, become into carbuncle. If you are coming across the year of Sitian of Shaoyin monarch fire, Zaiquan of Yangming dry gold, this year is the year of Tong Tianfu, climate change is particularly severe, In the second half of this year, hyperactivity of Sui gold get support from Yangming dry gold, gold assimilate with dry,lung gold injure liver wood is more serious. Liver wood further be suppressed, incidence of acne disease increased significantly. Hyperactivity of gold Yun, liver wood be restrain, liver be depressed for a long time, at the year of Zaiquan of Jueyin wind wood, Sitian of Shaoyang phase fire, the first half of the year the phase fire exuberant, lead to liver depression cremation heat, internal and external evil interreaction, liver fire refine liquid for phlegm,blocking in the local, come out acne. Liver wood, lung disease is easy to develop, lung Qi’s rise and downward lose towards, and lung lead fur, lung imbalance leads to Yingwei imbalance, sweating cannot unobstructed, come into acne; in the second half of the year Qi of Jueyin wind wood can neutralize the be restrained Qi of liver wood, so the incidence of acne decreased in the second half of the year.

Discussion

Acne is a common disease and frequent disease. At present, modern medicine mainly treats acne with external antibiotics or combined hormone ointment. When acne is more serious, it can be treated with oral isotretinoin drugs or antibiotics. The treatment of acne by TCM is mainly based on syndrome differentiation and treatment.The specific syndromes include: Pulmonary blood hot,Gastrointestinal heat accumulation, Liver depression and to change the heat, kidney yin deficiency and so on, the treatment to clear the lung heat, invigorate spleen and dampness, soothe the liver and clear heat, tonify the liver and kidney. The theory of Yunqi is a theory which study the climate change on human physiology and pathology,can provide new ideas for prevention and treatment of the disease, this paper analyzes the incidence of acne from the perspective of Yunqi, found that the incidence of acne in insufficiency year of Sui wood, insufficiency year of Sui soil, insufficiency year of Sui water, insufficiency year of Sui gold, hyperactivity year of Sui hot, hyperactivity year of Sui gold is higher than that in other years. In addition,if these years encounter some specific Keqi, the probability of acne may be reduced or increased. At this time, we need to combine the actual Yunqi and Keqi specific situation specific analysis. Therefore, we can guide the treatment and prevention of acne through Yunqi theory, and reduce the incidence and probability of acne.