Hormonal Acne

Many women, especially young women, suffer from what can be termed hormonal acne. Hormonal acne typically, but not exclusively, occurs sometime during the 7 days prior to the onset of bleeding, known as, the pre-menstrual phase of the menstrual cycle.

This is the stage during which both estrogen and progesterone have suddenly, and rather drastically, plummeted. Lutenizing hormone is also at an all-time monthly low, and FSH is slowly climbing out of its monthly trough found around day 21. (Counting begins with the first day of bleed; so day 1 of the menstrual cycle is the first day of bleeding.)

Humans Are Individuals

Despite our ability as scientists to create two dimensional models for physiological processes, it should be noted that the rise and fall of FSH, LH, Estrogen, and Progesterone, that gives birth to a woman’s reproductive life in general and menstrual cycle in particular, is not just a rise and fall of some measurable levels of hormone in the blood, but actually a very complex endocrine interaction between the adrenal glands, ovaries, hypothalamus, pituitary, thyroid, and pineal glands on one hand.

It should then be noted that all of the aforementioned glands, but especially the hypothalamus and adrenals are profoundly affected by what is happening in the nervous system, which is itself affected by a woman’s dietary, lifestyle, and psychological responses to being a living, intelligent, and emotional mammal.

The feelings, or if you want, measurable blood chemistry responses, that we all have to living–happiness, sadness, expectations, disappointments, frustrations, grief, loss, anger, terror, fear–combine with the nervous and endocrine systems to create a more-than-three dimensional multi-valent interaction between phsyiology, psychology, and environment that Body-Mind Medicine observes is utterly unique in each individual woman.

And by that I mean that the very same drop in E2 or Progesterone on day 24 of a 28 day cycle that in plump, naturally cheerful, happy, easy going, lots-of-green vegetable eating Lucila, does nothing unpleasant to, might in wiry, driven, anxious, stressed-beyond-her-coping-skills, iced beverage drinking Henrietta cause serious hormonal acne. And not to be so dramatic, sometimes it is simply too many iced beverages in a non-stressed but poor dieted individual.

The Hypothalamus’ Role

Looking a little bit deeply into even the mechanistic model of bio medicine, we can understand that reproduction and sexuality are a complex function of the interactions within the hypothalamic-pituitary-gonadal axis, and that the hypothalamus links the nervous system to the endocrine system via the pituitary gland.

Really important to understand is that the hypothalamus is affected directly by emotional states and the autonomic nervous system reactions they produce via what is now termed the fight or flight response, by light, smells, pheromones, steroids (both from the ovaries and the adrenals) neural information arising in the stomach, heart, and reproductive tract (again, the fight or flight produces dramatic neural info in the stomach), levels of various chemicals in the blood, such as insulin, glucose, angiotensin, etc., and invading microorganisms; we can see that like some crazy cartoon contraption with a gazillion controls, the smallest malfunction can throw the entire vehicle off its desired course. Add to this, by the way, the disruption of the endocrine system by the chemicals found in plastics and perfumes that has been well-documented of late.

Where I feel bio medicine, due to its received cultural bias towards extrospection and conquering, or ignoring, nature, often goes wrong, is to ignore the role the autonomic inputs and stress hormones play in affecting a wide gamut of diseases, including hormonal acne and gynecological disorders in general.

Because the master gland, the hyothalamus, is so profoundly affected by the corticosteroid stress hormones that are increased by our internally and externally generated stressors, it is painfully simple to understand that developing the skills to bring the body into homeostasis via the relaxation response, and out of the fight or flight stress response, as well as certain deeper philosophical perspectives (e.g. understanding time as circular vs. linear) will be a key piece in hormonal health. This is why there is such a resurgence of interest in eastern wisdom and knowledge in the last half century in the West.

Simply put, we all need to learn how to relax, to take it easy, to enjoy the small and simple things in life, to observe the ways we make small problems larger than they are, etc. etc. Besides restructuring how one lives (taking enough time off from working , for example), on a deeper nervous system level I recommend Mindfulness meditation as a great tool. Even mantra meditation is helpful, but mindfulness is so good because it takes you deep into your inner world and you develop the kind of flexibility that Chinese medicine speaks of as so very desirable, the ability to be “free and easy,” to be a “relaxed wanderer” on the journey of living. One needn’t stop achieving high goals, but it you create illness in the process, maybe re-asses the method. Its all about balance.

Why acupuncture and Chinese medicine are so valuable, is because with acupuncture we can affect the nervous system and hypothalamus directly. We know for scientific fact that acupuncture elevates endorphins and cortisol, we also know for scientific fact that particular locations of the body, when stimulated by acupuncture needles, cause specific, correlating, areas of the brain to “light up” on real time MRI.

Chinese medicine, reflecting some thousands of years of empiricism, notes exactly how our bodies look when we become imbalanced. It describes what can bee seen, touched, listened to, tasted, or smelled. For this it uses images borrowed from nature; the body-mind, when ill, shows signs and symptoms of too much or too little heat, cold, moisture, wind, strength, weakness, flexibility, rigidity. You can sum Chinese medicine up this way, “disease is due to too much of what you don’t want in the wrong place, and/or not enough of what you do want in the right place.

For example: where there is too much heat there will be irritation, as in eczema; irritability, as in PMS or fever; rubor(redness in the skin), as in acne; feeling too hot, as in poison oak, menopausal flushing, fever, infection.

Where there is not enough heat, there will be cold: feeling cold when its not cold; having cold hands and feet; suffering weak digestion (lack of digestive fire) with non-burning diarrhea and poorly digested food; frequent colds or allergies with profuse watery nasal discharge.

Where there is too much water in nature there is flooding. In the body we see excessive moisture/dampness/phlegm in the sinuses or lungs with a cold or other infection; we see discharge as in a yeast infection; we see nausea and/or vomiting as in digestive disorders, emotionally we see a lack of boundaries perhaps, a weak consciousness of where the “I” ends and the “You” begins, on the other hand there may be a sweet,kind,forgiving personality. Really it depends on how the moisture combines with other psychological and energetic/personality factors.

Where there is not enough water we see pathological dryness: dry skin, dry mucus membranes, dry eyes, dry stool, dry emotions even, lack of generosity or sweetness, an inability to share, or simply a brittle hypersensitive nervous system.

Often dampness and heat will accumulate together, as in eczema, as in hormonal acne. It is said that Qi is the locomotive that moves moisture to the correct places in the body. However, when Qi stagnates, when it fails to move adequately, being warm it heats up, and as it is bringing moisture with it, (like the steam that follows the heat waves above a pot of fragrant cooking rice) the result is an accumulation of moisture with heat, termed “damp-heat” in Chinese medicine. Damp heat is at the root of lots more disorders than simply dampness or heat alone.

Hormonal acne is caused by an accumulation of dampness (swelling, pus) with heat (redness, inflammation). Begging the question, though, is, “what causes Qi to stagnate in the first place?”

Affect Damage
or How Chinese Medicine Describes the Role of Emotion in Disease Formation

Qi stagnation is most often, and most powerfully, due to what we call “affect damage.” Chinese medicine describes very accurately and exactly, the many ways our emotions and experiences, when unprocessed, like undigested food, cause the Qi to stagnate or move in the wrong direction.

Grief and sadness, for example, depresses the qi, causing it to move down, rather than up. It especially affects the lung qi. We see this very often with asthma. Of course when we are depressed we usually suffer from fatigue, not to mention a loss of interest and engagement. Our ability to engage the qi of the outer world diminshes.

The thing about Qi is it is mercurial. One minute you get pissed off at the guy who cut you off on the roadway, the next minute your boyfriend makes you laugh. Qi is quick and light, it moves rapidly. That is the trick, to keep Qi moving. For when it does not move, when it stagnates either for long periods, or over and over and over again, it leads to Blood stagnation.

Just like Qi leads moisture through the body, Qi is the “commander” of blood, which is conceived as the denser more concrete physical manifestion of Qi, or, in another way, a warm, nutritive substance that is a more moveable, less dense manifestation of Yin. Yin is the property in the body that, among other things, provides comfort and ease and deep levels of reserve and nourishment.

Blood StasisSo when Qi gets stuck; Blood stasis often accrues. And because women are “beings of blood,” they are more prone to blood stasis early on, than men. And because the heart and uterus are connected by a unique channel (this is how the ancients observed the effects of emotions on fertility and the menstrual cycle) emotive factors can easily cause blood stasis in the uterus and ovaries. The longer the emotional pain lies unresolved, the deeper the blood stasis becomes. Vital it is to treat this, as blood stasis is a key factor in many deeper more debilitating illness, such as endometriosis, cancer, MS., etc.

Blood stasis will create fixed stabbing pains, cramps with bleeding, feeling of sadness accompanied by a sensation of pain or heaviness in the chest/heart area not due to any heart disease. In acne the skin has a kind of darker, purplish, rather than red, cast. Look at the underside of the tongue and you will see thick, engorged, purple veins. This is not good.

Acupuncture Treatment Hormonal Acne

So when I treat hormonal acne with acupuncture, I focus on the period in the menstrual cycle in which the Qi naturally tends to stagnate–the week before bleeding, as the sudden drop of hormone under even the best of circumstances, can be a lot for a woman’s body-mind to integrate. I do find that the emotions that become aggravated during this period are sometimes those emotions that have been successfully repressed, that is , not dealt with, during the rest of the month. In this way, the pre-menstural phase is actually an opportunity; the natural hormonal storm blows to the shore the jetsam and flotsam of the psyche.

If acupuncture is good at anything–and it excels at a great deal–it is good at smoothing transitions, of making movement between things easier and more comfortable, whether we are talking about a natural monthly hormonal shift, adolescence, old age, the change of the seasons, the loss of a loved one, or the stress of trying to earn enough money to buy a new house and being afraid of the future. And it does all this by affecting the nervous and hormonal and neurotransmitter systems, directly.

The second period I focus on is right before ovulation; as this is when the adrenal-ovarian axis is so important. This is when you want to stimulate the ovaries and calm the adrenals for optimal ovarian hormonal production. This is when it is easier to prevent dampness accumulating into phlegm that later erupts in pimples and whiteheads.

For my actual selection of acupuncture locations (I resist the use of the word point, as the spaces in which we place the needles, are always little depressions in the body the Chinese conceptualized as caves or springs, where the Qi meets the surface, they are not, in fact, in any way, points) I look, first and foremost, at where on the face the acne is located. Alongside the temples and outer jaw line leads me to one combination of locations, involving, for point of fact, the Gallbladder and Shao Yang channels) and alongside the mouth in vertical lines to the chin, another set, the Stomach and Chong channels. In the event, I always use the Chong and Ren channels in some way, as these regulate the reproductive system and its hormones.

The other lovely thing about acupuncture, is that it excels at “releasing heat” from the body. So, depending on where I see the acne, I release heat from the corresponding channels. There are ways to move blood stasis with acupuncture as well, though most practitioners will agree herbal medicine is superior in that regard.

Chinese Herbal Medicine Treatment of Hormonal Acne

When I treat hormonal acne with herbal medicine, I choose formulas that regulate the qi, clear heat, dry excess moisture, relax the liver, nourish the blood, and benefit the skin. As the starting point is most often Qi stagnation, I frequently choose from a few formulas that gently unblock Qi stagnation. Then I am concerned with clear the pathological heat which accumulates in the liver energy. I also resolve the moisture issue.

But as women are “beings of blood” in Chinese medicine (men are “being of qi”), one always nourishes and cleanses the blood in this process. And depending on what emotional states are there, we may need to “calm the spirit and nourish the yin.”

Generally speaking hormonal acne is quite easy to treat, depending on how long the person has had it before. Often it improves in one cycle, but it is not unusual to take herbal medicine through three menstrual cycles, during which time one gets two acupuncture treatments per month.

Some of the formulas I use are Xiao Chai Hu Tang, Dan Zhi Xiao Yao Wan, Zhi Bai Di Huang Wan, Wen Dan Tang Jia Wei, and, Long Dan Xie Gan Tang.

Birth Control Drug and Hormonal Acne

Risk Benefit Ratio

There are some women, with terrible periods and horrible acne, who improve dramatically when prescribed the Birth Control Drug. God bless them. I call it drug, not pill, because calling it a pill and not a drug is disingenous marketing on the part of drug companies, with collusion by M.D.’s, it seems, who want to pretend, or have you pretend, that there are no risks.

I have a neurologist M.D. collegue who is strongly opposed to the pill. I asked him why, and he said that every year he sees 1-2 young women who have had a stroke after taking the pill. Goddess in Heaven. That is a pretty serious risk, a great tragedy in fact. How many women given the pill like candy are informed of this risk factor?

But I am no fanatic against drugs, I just want consumers to be informed and doctors to be honest with their patients. And my point is, that those women who cured their terrible periods and acne with birth control, might have done the same with acupuncture and Chinese herbs. Why not have that part of the basket of choices?

On the other hand, I meet lots of women who never had acne before, develop it after taking birth control drugs for contraceptive purposes, or to regulate their cycles. Again, all I am saying is, why not try something without side affects first? Yes it may take more time and effort and even money, but after all, it is your health, so isn’t it worth it?

copyright Eyton J. Shalom, M.S., L.Ac. July 2011 San Diego CA all rights reserved use with permission
Ayurveda, Acupuncture, and Chinese Medicine in San Diego

San Diego Acupuncture

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