A Medical Case of Acne Vulgaris Treated with Danggui Shaoyao Powder Combined with Sini Powder

Jie REN, Aijuan HE

1. Guizhou University of Chinese Medicine, Guiyang 550002, China; 2. Department of Dermatology, First Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang 550003, China

Abstract Acne vulgaris is a chronic inflammatory skin disease damaging face, and the incidence of acne vulgaris is increasing year by year in China. Acne falls into the category of pimple in traditional Chinese medicine, and there are many dialectical understandings of acne in modern traditional Chinese medicine. Dr. He Aijuan has a unique diagnosis and treatment thinking in treating acne vulgaris (liver stagnation and spleen deficiency type) with traditional Chinese medicine in her clinical work for many years. Her application of Danggui Shaoyao Powder combined with Sini Powder has a remarkable effect in the clinical treatment process, so a clinical medical case is selected for discussion.

Key words Acne, Traditional Chinese medicine, Danggui Shaoyao Powder combined with Sini Powder, Medical cases

1 Introduction

Acne is called Fenci and Mianbao in ancient times, commonly known as "pimple", which is easy to occur on the face and manifested as papules, nodules, cysts and scars[1]. Irregular work and rest in modern life, unclean diet, high work pressure and other reasons cause minor problems to evolve into chronic impairment diseases. Danggui Shaoyao Powder comes fromSynopsisofPrescriptionsoftheGoldenChamber—TreatmentofWomen’sPregnancyDiseasesandPulseSyndromes[2]. The original prescription is used to treat women’s pregnancy diseases, and consists ofA.sinensis,P.lactiflora,P.cocos,A.macrocephalaKoidz,R.Alismatis,L.chuanxiongHort. The basic pathogenesis is deficiency of both liver and spleen, blood deficiency and dampness, soil and wood are at odds with each other. Sini Powder is one of the representative prescriptions inTreatiseonFebrileDiseases, which is used to treat yang stagnation and stagnation of liver-qi[3]. It is composed of four medicines:R.Bupleuri,R.PaeoniaeAlba,F.AurantiiImmaturus, licorice. In the process of clinical diagnosis and treatment of acne vulgaris, Dr. He Aijuan treats acne vulgaris mostly from the liver and spleen. When there is failure of liver to convey and disperse and the spleen-qi does not work well, she uses Danggui Shaoyao Powder combined with Sini Powder to treat acne vulgaris, and has achieved obvious curative effect.

Dr. He Aijuan’s common treatments for acne vulgaris include promoting blood circulation, promoting diuresis, clearing heat, resolving stagnation, warming yang and so on. Heat-clearing drugs commonly used are honeysuckle,F.Forsythiae, dandelion and Chinese violet. Drugs for detumescence and stagnation are oftenG.sinensisand turtle shell, and drugs for promoting blood circulation areA.sinensis,L.chuanxiongHort., red flower and peach kernel. Drugs for inducing diuresis mainly includeP.cocos,R.AlismatisandR.Atractylodis. Yang-warming drugs often includeR.aconitilateralispreparata, prepared liquorice root and so on.

2 Medical case records

Patient Ms. Wang, 22 years old, went to see a doctor on February 9, 2022. The chief complaint was facial papules and herpes for more than three years. Symptoms: scattered red and dark red papules and herpes on the face, dark face, greasy skin, cold extremities, dry mouth and bitter taste, slight rash, less menstruation, blood clots, occasional constipation, urinary incontinence, like to eat sweet food, poor sleep. Physical examination: large tongue red in color, with tooth marks on the edge, white and moist fur, sticky and stringy in pulse. Auxiliary examination: VISIA: red area 2%, porphyrin 23%. Western medicine diagnosis: acne vulgaris; TCM diagnosis: acne, liver stagnation and spleen deficiency, blood stasis and plenty of phlegm.

First diagnosis: TCM diagnosis: acne (liver depression and spleen deficiency, blood stasis and plenty of phlegm); treatment: invigorating spleen and separating the wetness, soothing liver and promoting blood circulation. Prescriptions:B.chinense18 g,F.Aurantii15 g,R.PaeoniaeAlba 15 g,A.sinensis15 g,L.chuanxiongHort. 15 g,P.cocos15 g,R.Alismatis15 g,R.Atractylodis15 g, prepared liquorice root 10 g,S.Gleditsiae15 g, turtle shell 15 g,F.Forsythiae15 g,D.dasycarpusTurcz. 20 g, red flower 6 g. A total of 8 doses, dissolved in water, one dose a day, divided into three parts for taking.

Second diagnosis (February 15, 2022): After taking the first prescription, the dark red papules on the face were mostly changed to red, and the herpes were reduced. The face was gray, cold hands and feet were improved, and there was no complaint of dry mouth and bitter taste. On the basis of the original prescription,F.Forsythiaeand turtle shell were subtracted, and patient continued to takeR.Bupleuri18 g,F.Aurantii15 g,R.PaeoniaeAlba 15 g,A.sinensis15 g,L.chuanxiongHort. 15 g,P.cocos15 g,R.Alismatis15 g,R.Atractylodis15 g, prepared liquorice root 10 g,S.Gleditsiae15 g, red flower 6 g. A total of 8 doses, dissolved in water, one dose a day, divided into three parts for taking. Auxiliary examination: VISIA: red area 7%, porphyrin 28%.

Third diagnosis (February 26, 2022): Patient occasionally had new papules and pimples during taking medicine, which were less than before, and patient did not complain of itching for the rash. On the basis of the original prescription,D.dasycarpusTurcz. was subtracted, and patient continued to takeR.Bupleuri18 g,F.Aurantii15 g,R.PaeoniaeAlba 15 g,A.sinensis15 g,L.chuanxiongHort. 15 g,P.cocos15 g,R.Alismatis15 g,R.Atractylodis15 g, prepared liquorice root 10 g,S.Gleditsiae15 g, red flower 6 g. A total of 8 doses, dissolved in water, one dose a day, divided into three parts for taking. Auxiliary examination: VISIA: red area 18%, porphyrin 34%.

Fourth diagnosis (March 3, 2022): Patient did not complain of new rash after taking the medicine. The face was gray but shiny, and blood clots were reduced during menstruation. On the basis of the original prescription,R.Atractylodiswas changed intoA.macrocephalaKoidz, red flower was subtracted, and patient continued to takeR.Bupleuri18 g,F.Aurantii15 g,R.PaeoniaeAlba 15 g,A.sinensis15 g,L.chuanxiongHort. 15 g,P.cocos15 g,R.Alismatis15 g,R.Atractylodis15 g, prepared liquorice root 10 g,S.Gleditsiae15 g. A total of 8 doses, dissolved in water, one dose a day, divided into three parts for taking. Auxiliary examination: VISIA: red area 31%, porphyrin 42%.

3 Discussion

This patient showed a typical syndrome of liver stagnation and spleen deficiency, blood stasis and plenty of phlegm. There was failure of liver to convey and disperse, the qi activity was damaged, and the spleen suffered from failure in transformation, making acne occur on the head and face.R.BupleuriandP.lactiflorawere used as principal drugs in prescription for relieving liver-qi.P.cocos,R.AlismatisandR.Atractylodiswere used as adjuvant drugs in prescription for strengthening the spleen, invigorating qi and diuresis, andR.Alismatiscould be used to dissipate heat. In the prescription,A.macrocephalaKoidz was changed toR.Atractylodis, which tended to promote diuresis.A.macrocephalaKoidz could be used to invigorate spleen and qi. Supplemented byA.sinensis,L.chuanxiongHort. andF.Aurantii, it could regulate qi and relieve depression, promote blood circulation, and improve blood stasis. Prepared liquorice root could boost the spleen and moderate the property of herbs.R.BupleuriandF.AurantiiImmaturuswere matched, so that the qi and blood ran smoothly, and the limbs were warm. In the prescription, qi circulation was emphasized, and spleen and qi were in transportation and transformation so that liver and spleen were combined, to promote diuresis, strengthen the spleen, remove phlegm. When the wood stagnation was resolved, the blood circulation was smooth, the phlegm stasis was eliminated, and the limbs were warm. The whole prescription could disperse the depressed liver-energy, regulate spleen, improve diuresis, and regulate qi and blood smoothly.

During the treatment, VISIA skin detector showed that both the porphyrin and the value in red area increased, which indicated that porphyrin and facial inflammation were reduced compared with those before treatment. It proved that Danggui Shaoyao Powder combined with Sini Powder was effective in treating acne vulgaris.

Modern pharmacology proves thatP.lactifloracontains total glucosides of paeony and has anti-inflammatory and analgesic effects[4].A.sinensiscontains ferulic acid and angelica polysaccharide, which have the functions of regulating immunity, resisting bacteria and diminishing inflammation[5].P.cocoshas a good inhibitory effect on acute inflammation and chronic inflammation, and has a good anti-inflammatory effect[6]. Saikosaponin is the main active component inR.Bupleurie. Many important biological effects of saikosaponin have been found, such as anti-inflammatory, antibacterial effect[7]and antidepressant effect[8-9]. In traditional Chinese medicine theory, wind-heat in lung meridian, damp-heat in intestines and stomach, phlegm-dampness and blood stasis are the main pathogenesis of acne vulgaris. In the treatment of acne, heat-clearing drugs are used, which are cold in nature and easy to hurt spleenyang. Dr. He Aijuan believes that personalized treatment should be advocated for skin diseases, and soothing the liver and strengthening the spleen, removing blood stasis and promoting diuresis run through the whole treatment process of acne vulgaris (liver stagnation and spleen deficiency type), so that the liver and spleen of patients are compatible, qi-blood stasis can be removed, and facial skin lesions and inflammatory reactions can be significantly reduced. Therefore, in this medical case, acne patients (liver stagnation and spleen deficiency type) were treated with Danggui Shaoyao Powder combined with Sini Powder, which achieved good clinical results.