Chapter 15
Acne
Summary
Essence: An imbalance of androgen regulation with excess
protein deposited under the epidermis.
Terrain: (1) Luteal insufficiency: Hyper-LH in re-
sponse to insufficient gonadal androgens and/or proges-
terone response, or feedback on pituitary with (2) Adrenal
androgen compensation, (3) ANS: Para≫alpha with (4)
Inflammation: Insulin resistance, ⇓ cortisol, with (5)
Congestion: Liver and colon and thus skin as compensa-
tory emunctory resulting in (6) Skin manifestation: due to
local hypermetabolism of skin.
Treatment goals
Symptomatic: Antimicrobial, anti-inflammatory: topical
most effective
Terrain:
● ANS: ⇓ Para, alpha
● CORTICO: ⇑ Cortisol relative to adrenal androgens
● GONADO: ⇓ LH, if indicated, ⇓ FSH and regulate
progesterone
● SOMATO: ⇓ GH, PL; regulate insulin
● THYRO: adapt TSH, ⇓ Thyroid (where indicated)
● DRAIN: (1) Liver, (2) colon, (3) skin (descending order
of importance)
● DIET: Pancreas sparing
Sample treatment
1. Face mask (c.f. Table 15.5)
2. Cortico-Gonadotropic: Lithospermum officinale MT
60 mL, Alchemilla vulgaris MT 60 mL, Ribes nigrum
GM 60 mL, Fragaria vesca MT 60 mL, Lavandula an-
gustifolia EO 3 mL: 3 mL three times per day
3. Drainage: Viola tricolor MT 120 mL, Arctium lappa
MT 60 mL, Agrimonia eupatoria MT 60 mL: 3 mL BID
Terrain in detail
Precritical terrain
1. Hyperparasympathetic
2. Congested emunctories
a. Liver
The Theory of Endobiogeny. https://doi.org/10.1016/B978-0-12-816965-0.00015-9
© 2020 Elsevier Inc. All rights reserved.
b. Colon
c. Exocrine pancreas
3. Oversolicitation of skin as metabolic organ and com-
pensatory emunctory
Agent
1. Major endocrine transitions: states of increased andro-
gens: birth, puberty, gonadopause
2. Genital recycling: central-peripheral gonadic recalibration
3. Adaptative states: menstruation, emotional stressors,
change of seasons, post-natal
4. Exogenous hormonal therapies (i.e., androgen or pro-
gesterone therapy)
Critical terrain
1. Hyper-LH with insufficient gonadal response → ⇑ an-
drogen receptor expression
a. Relative insufficiency: progesterone and/or gonadal
androgens adequate or excessive, but feedback on
LH impaired
b. Absolute insufficiency: deficient response to LH
demand
2. ⇑ Compensatory adrenal androgen production (not reg-
ulated by LH)
3. Insufficient cortisol relative to adrenal androgens
4. Thyro-somatotropic response alters the quality of acne,
e.g., pustular, pruritic, cystic, etc.
5. Hyperanabolic state focused on skin→keratin and se-
bum production excessive
Mechanism and response
⇑ Sebum production+hyperkeratosis→congestion of hair
follicle. Overgrowth of commensal skin bacteria (from the
lipids in sebum and proteins in keratin) → acne manifestation.
History and BoF findings
Evaluate precritical and critical terrains of acne. Some pos-
sible correlations between history and Biology of Functions
are presented in Table  15.1. The general history includes
the presence of diffuse or localized raised erythematous le-
sions, ± painful papules, pustules, and/or nodules any skin
surface; ± fever, scaring.
123
124  SECTION | C  Assessment and treatment of common disorders

TABLE 15.1  Historical and Biology of Functions correlations.

Subject Finding Terrain BoF
Skin Acne distribution (c.f. physical exam) Various N/A

Pus ⇑ PL ⇑/⇓ Prolactin

Pruritis Alpha, TRH, or, local factors ⇑ Evoked histamine (if global origin)

Inflammation ⇑ TSH, ⇑GH, ⇑ Insulin ⇑ GH growth score, ⇑ Growth index,

⇑/⇓ Insulin, ⇓ serum TSH

Timing Premenstrual Progesterone insufficient ⇑ Progesterone, ⇓ LH

Autumn Insufficient cortisol, relative to ⇑ adrenal ⇓ Cortisol absolute, or, Cortisol/adrenal

androgens (DHEA) cortexratio <2

Gonadopause ⇑ LH, insufficient gonadal androgens ⇓ LH, ⇑ Progesterone, ⇑ DHEA, ⇓

and/or progesterone, DHEA Androgen indexes
compensation

Liver Matinal anorexia Hepatic congestion ⇑/⇓ LMI

Colon Acne: buttocks, constipation Colon congestion ⇓ Pelvic congestion

Physical exam and BoF findings

The acne exam evaluates the specific topography of acne
as an indicator of endocrino-emunctory dysfunction related
to the disorder. The following may be observed on physical
TABLE 15.3  Examination and Biology of Functions
exam with some possible Biology of Functions correlations
correlations.
based on location of acne (Table 15.2) or an evaluation of
global dysfunction of terrain (Table 15.3). Area Finding Terrain BoF
Skin Erythematous Congested ⇑/⇓ LMI,
raised liver, colon ⇓ Pelvic
TABLE 15.2  Acne topography and endocrino-emunctory lesions±pain, Insufficient congestion, ⇓
terrain with Biology of Functions correlations. inflammation cortisol Cortisol

Gonado Excess sebum, ⇑ Adrenal ⇑ DHEA,

Axis Hormone Acne location
long eyelashes, androgens, ⇓ FSH, ⇑
Corticotropic ACTH Forehead colon ⇑ FSH, ⇓ Progesterone
tenderness on progesterone
DHEA Jaw palpation
Buttocks, lateral
Somato Pustular acne ⇑ Prolactin ⇑/⇓ Prolactin
Gonadotropic Gonadal androgens Chin
Pancreas Tender: head Exocrine N/A
Gonadal Chest or general congestion
androgens+hyper para point on
Gonadal Buttocks, midline abdomen
androgens+intestinal Liver Tender, tender Hepatic N/A
congestion medial right congestion
FSH Nasolabial scapula

Somatotropic General Upper arms Colon Tender: Colon over- ⇓ ACTH, ⇓

oversolicitation ACTH-F, TRH, solicited serum TSH,
TSH reflection ⇑ TRH/TSH,
Gonado- General Shoulders points along ⇑/⇓ LMI
somatotropic oversolicitation Upper back colon
 Acne Chapter | 15  125

Treatment 3. Pancreas-sparing diet: basmati rice, sweet potatoes,

yams, leafy green vegetables, 2–3 L of water, tisanes and
Acute relief celery juice for 5 days
For best results, start the following treatments Based on these considerations, the following symptom-
simultaneously: atic tincture can be prepared.
1. Symptomatic: to include drainage, anti-inflammation 4. Acne-drainage: 4 mL twice per day.
and antimicrobial actions (Table 15.4), for example: Viola tricolor MT 60 mL, Agrimonia eupatoria MT
2. Topical face mask (Table 15.5) 60 mL, Salvia sclarea EO 2 mL

TABLE 15.4  Medicinal plants with polyvalent symptomatic actions.

Drainage

Dual Dermal
Plant Skin pancreatrope Liver Colon Inflammation infection Other actions
Viola tricolor • • • • • Dermal depurative, keratolytic,
cicatrizant

Arctium lappa • • • Laxative Immuno-regulatory • ↓ Pus, antihyperglycemant

Agrimonia • • • • ↓ Para
eupatoria

Juglans regia • • • (Intestinal Antihyperglycemant

dysbiosis)

Fragaria vesca • • • Broad endocrine (c.f. below)

Malva sylvestris Laxative Antihypoglycemant

Salvia sclarea • • • Cicatrizing, broad neuro-

endocrine (c.f. below)

TABLE 15.5  Clay mask prescription.

Substance Action Amount and form
Illite green clay Antimicrobial, detoxifier, antipruritic 2–3 tbsp

Yoghurt (unflavored) Humectant, keratolytic 1–2 tbsp

Lavandula angustifolia Antimicrobial, anti-inflammatory 1 drop EO

Salvia sclarea Estrogenic, cortisol-like, anti-inflammatory, antimicrobial 1 drop EO

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Instructions for preparation: (1) mix clay and yoghurt,
(2) add EO’s and mix well, (3) apply to face for 10 min,
wipe off nightly, (4) spray with fine mist of water, if needed,
to keep moist.
Recurrent, chronic acne
In recurrent or chronic cases, treat the global terrain
(Table  15.6), drain-implicated emunctories (Table  15.4)
and, if indicated, add oligoelements (Table  15.7). The
­pancreas-sparing diet should be continued but may be liber-
alized from that noted in acute treatment.
Sample prescriptions in chronic acne
Based on an Endobiogenic approach to acne, the following
can be prescribed.
1. Neuroendocrine regulation: 3 mL three times per day,
or, 4 mL twice per day (Table 15.8).
Lithospermum officinale MT 60 mL, Alchemilla
vulgaris MT 60 mL, Ribes nigrum GM 60 mL,
Fragaria vesca MT 60 mL, Lavandula angustifolia EO
3 mL
2. Drainage: 3 mL three times per day, or, 4 mL twice per
day (Table 15.9).
Viola tricolor MT 120 mL, Arctium lappa MT 60 mL,
Agrimonia eupatoria MT 60 mL

TABLE 15.6  Medicinal plants for neuroendocrine

regulation.
TABLE 15.8  Neuroendocrine prescription.
Terrain Primary Other
Amount Replacements and
⇓ Alpha, para Lavandula Matricaria recutita MT
Herb and form alternatives
angustifolia EO
Lithospermum 60 mL MT Lycopus europaeus MT,
⇓ Gonado LH+FSH: LH: Medicago sativa
officinale Alchemilla vulgaris MT
pituitary Lithospermum MT, Alchemilla vulgaris
officinale MT MT Alchemilla 60 mL MT Achillea millefolium+Lycopus
FSH: Borago officinalis vulgaris europaeus MT
MT
Ribes nigrum 60 mL GM Eleutherococcus senticosus MT.
Insensitive LH Eleutherococcus Fragaria vesca MT
feedback senticosus MT
Fragaria vesca 60 mL MT Lithospermum officinale
⇓ Central Fragaria vesca MT Poterium sanguisorba 25 mL+Prunus amygdalus GM
somato MT 10 mL+Menyanthes trifoliata MT
25 mL
⇑ Progesterone Alchemilla Achillea millefolium MT
vulgaris MT Lavandula 3 mL EO Matricaria recutita EO 1.5 mL or
angustifolia Anthemis nobilis EO 1.5 mL
⇑ Cortisol: Ribes nigrum GM Eleutherococcus
adrenal senticosus MT, Fragaria
androgens vesca MT

TABLE 15.9  Drainage support for acne, dose: 3 mL three

TABLE 15.7  Oligoements for neuroendocrine, times per day.
emunctory regulation. Amount and Replacements and
Aggravating factor(s) Oligoelement Herb form alternatives

Stress Mg Viola tricolor 120 mL MT Arctium lappa MT

80 mL+Ulmus campestre
Hepatic dysfunction Sulfur GM 20 mL+Cedrus libani
Skin-colon Mn-Cu-Co GM 20 mL

Skin-exocrine pancreas Zn-Ni-Co Arctium lappa 60 mL MT Viola tricolor MT

Skin-endocrine pancreas Se+Mg Agrimonia 60 mL MT Arctium lappa MT

eupatoria 30 mL+Juglans regia MT
Skin-estrogens Zn-Cu 30 mL