Evidence-based Clinical Chinese Medicine

The following sections are included:

• Disclaimer
• Foreword
• Purpose of This Book
• Authors and Contributors
• Members of Advisory Committee and Panel
• Professor Charlie Changli Xue
• Professor Chuanjian Lu
• Acknowledgments
• Contents
• List of Figures
• List of Tables

Acne vulgaris is a chronic skin condition that primarily affects adolescents. Periods of relapse and remission are common, and may extend well into adult life. Acne vulgaris has considerable impact on a patient’s health-related quality of life, and is a significant financial burden. Treatment selection is based on disease severity and patient preference, and includes both topical and systemic options. Early initiation, along with adherence to the induction and maintenance phases of treatment, improves long-term outcomes.

Many terms are used to describe acne vulgaris in Chinese medicine which reflect the pathogenesis of clinical features of the disease. This chapter describes the aetiology, pathogenesis, and syndrome differentiation for acne vulgaris. Chinese herbal medicine and acupuncture treatments which are recommended in key Chinese medicine clinical textbooks and guidelines are described.

Contemporary Chinese medicine practice continues to be guided by the classical literature. This chapter describes the findings from a comprehensive search of the Zhong Hua Yi Dian 中华医典. Seventeen search terms were used to identify instances of acne in classical Chinese medicine texts. Five hundred citations were analysed to identify Chinese herbal medicine formulas used in past eras. Oral and topical Chinese herbal medicine formulas were important interventions to treat acne vulgaris. No acupuncture citations were identified in the included citations, and acupuncture management of acne vulgaris in Chinese medicine history remains uncertain.

This chapter outlines the methods used to identify and evaluate clinical studies of Chinese medicine therapies for acne vulgaris. Comprehensive searches identified studies which were screened against rigorous inclusion criteria. An assessment of the methodological quality of the studies was made using standardised methods. Results from included studies were evaluated to provide an estimate of the treatment effects of a range of Chinese medicine therapies.

Chinese herbal medicine is frequently used to treat acne vulgaris, and has been evaluated in many clinical studies. The findings of 321 studies meeting the inclusion criteria are described in this chapter. The majority of studies evaluated oral Chinese herbal medicine alone or in combination with guideline-recommended treatments for acne. There is promising evidence that Chinese herbal medicine treatment can improve symptoms of acne vulgaris.

The pharmacological actions of ten of the most frequently reported herbs used orally and/or topically in randomised controlled trials were reviewed. Many studies showed antimicrobial and anti-inflammatory actions, which are relevant to the pathogenesis of acne vulgaris.

Acupuncture techniques are another treatment option for skin conditions. This chapter evaluates ten published clinical studies investigating acupuncture and related therapies for acne vulgaris. Five studies were randomised controlled trials and five were non-controlled studies. Acupuncture may have benefits in improving acne grading and overall symptoms. There is limited evidence for other acupuncture therapies.

Combinations of Chinese medicine therapies are an important treatment option for many skin conditions, including acne vulgaris. The evidence from four randomised controlled trials was collated and evaluated. The combination of Chinese herbal medicine with acupuncture therapies may improve clinical outcomes for acne vulgaris, and few adverse events were reported with their use.

Acne vulgaris is a common skin condition in adolescents which may extend to adult life. Chinese medicine has been used for many years for acne vulgaris, and more recently the volume of clinical studies has increased. This chapter provides a ‘whole-evidence’ analysis of Chinese medicine for acne, from classical to contemporary literature, and clinical research. The implications for practice and research are discussed.

The following sections are included:

• Glossary
• Index