In Traditional Chinese Medicine, common skin issues like acne, rosacea, and dermatitis are seen as signs of internal imbalance—most often caused by Heat and Dampness. These imbalances show up as redness, inflammation, or congestion, and can often be improved through tailored nutrition and lifestyle changes.

The most common and clearly visible imbalances are acne, rosacea, atopic dermatitis, and perioral dermatitis (POD). What connects these conditions is that, from the perspective of Chinese medicine, they are all influenced by the same pathogen in some form: Heat.

In Chinese medicine, there are five so-called pathogens that are seen as causing illnesses or symptoms— in this case, imbalances on the face. These pathogens are Heat, Cold, Dampness, Dryness, and Wind. In addition to these, facial symptoms often involve stagnation, which is not a pathogen itself, but stagnation can lead to a pathogen or vice versa.

Acne, rosacea, atopy, and POD are all linked to Heat. On the face, Heat is always seen as redness. All red inflammations and sensitivities indicate the presence of Heat. It can also manifest as red eyes and dry skin, since Heat burns up the Body Fluids.

In addition to Heat, another pathogen—Dampness—may also be present. If any of the above-mentioned conditions involve pus-filled pimples or oozing rashes, Dampness is also involved.

Dampness may also appear on its own: whiteheads in acne, blackheads, and oily skin without red sensitivity indicate Dampness.

Dampness can also cause other symptoms, such as eye discharge, puffiness and under-eye bags, as well as dull and yellowish skin tone.

If Heat appears on the face, it is helpful to examine other symptoms. Do symptoms include a feeling of fullness in the upper abdomen, headaches, heartburn, foul-smelling stool, or constipation? These indicate so-called Excess Heat.

If the symptoms include fatigue, exhaustion, melancholy, anxiety, insomnia, night sweats, a feeling of heat at night, heart palpitations, blurry vision, or blurred visual fields, the condition is referred to as Empty Heat.

Heat is caused by:

• Diet: especially grilled or deep-fried, heating ingredients and spices such as onions, chili, ginger, red meat, coffee, and alcohol, as well as ultra-processed foods like pizza, hamburgers, and spicy curry dishes
• Overexertion and insufficient recovery
• Stress (stress causes stagnation, which in turn eventually causes Heat)
• Long-standing repressed anger, rage, and bitterness

Dampness is caused by:

• Diet: especially dairy products, sugar, wheat products such as bread and pasta, pastries, as well as cold and raw vegetables; excessive intake of sweet flavor and cold or cooling foods (including cold drinks!)
• Deficiency of Yang energy and Qi stagnation, or Qi deficiency, which causes Body Fluids to accumulate in the wrong places, potentially leading to bloating, abdominal distension, overweight, or mucous discharges
• Lack of physical activity
• Excessive worrying and thinking, overstudying
• Dampness tends to stagnate easily and can cause a feeling of heaviness

If your face shows signs of Heat or Dampness, try changing your diet for a couple of months. The beauty of Chinese dietary therapy is that it's not about following a strict diet, but rather about using the flavors and energetic temperatures of food to treat the relevant pathogen.

These are not lifelong recommendations but are meant for self-care of the current condition. When followed, these tips often alleviate symptoms enough that medication may not be necessary. That said, if you don’t experience relief, consult a physician. Visible imbalances on the skin can sometimes affect mental well-being and self-esteem so significantly that medication may be the right choice. You should never feel like a failure if you need medical treatment.

The treatment is based on the Five Flavors of food and their energetic temperatures. The Five Flavors are sour, bitter, sweet, pungent, and salty. Each flavor has its own energetic characteristic, based on the direction it guides energy:

• Sour is contracting and draws energy inward
• Bitter is drying, cleansing, and guides energy downward
• Sweet is harmonizing, relaxing, moistening, and warming
• Pungent is expanding, dispersing, and strengthens Qi flow
• Salty is cooling and softening and guides energy downward (inward and down)

Each food also has an energetic temperature, separate from flavor. These are hot, warm, neutral, cool, and cold. Cooking methods significantly affect the food’s energetic temperature:

• Cooling methods: steaming, boiling in plenty of water, and pickling
• Warming methods: oven baking, pan-frying, grilling, and deep-frying
• Spices also influence the temperature

To compare: oven baking is less heating than grilling or deep-frying; steaming is slightly cooler than boiling.

If symptoms include Heat (i.e., red, sensitive acne, rosacea, atopy, or POD), try the following tips:

• Remove Heat: avoid things that increase it and add those that reduce it
• Avoid heating foods: alcohol, coffee, chili, ginger, cinnamon, hot spices, tomato-based sauces and soups, dark chocolate, all onions, and fried, deep-fried, or grilled food
• Avoid ultra-processed and junk food: sugar, pizza, hamburgers, spicy takeout
• Prefer freshly made food from whole ingredients
• Favor foods with neutral and cooling properties: matcha tea, broccoli, zucchini, cauliflower, celery, artichoke, sprouts, mushrooms, berries, cucumber, watermelon, seaweed, lettuce, fresh spinach, kale
• Bitter flavor generally reduces Heat (note: not always, as temperature is separate from flavor! For example, coffee is bitter and directs energy downward, but it is heating)
• Combine red meat with steamed or boiled vegetables and cooling or neutral flavors. A great combination: steamed broccoli and meat.
• Fish and chicken are less heating than red meat
• Avoid cooking by frying and grilling; prefer steaming, boiling, and simmering
• Choose clear-broth soups, since Heat damages Body Fluids. Use high-quality broths. Add ingredients like celery, broccoli, carrots, and your preferred protein source.
• Practice yin yoga and meditation to calm the nervous system

If the condition is Empty Heat, consider the following:

• In Empty Heat, the body has a Yin deficiency, so you need to nourish Yin and avoid things that consume it. Also, reduce Heat (see tips above)
• Iron deficiency and low ferritin are common Western signs—have your levels checked and take supplements if needed, after consulting a doctor
• Ensure regular and sufficient eating: breakfast, lunch, and dinner
• Maintain adequate hydration
• The sweet flavor harmonizes and calms. Choose steamed sweet potato, winter squash, and carrots. Avoid too much bitter flavor as it dries Fluids and can harm Yin (coffee is especially bad)
• Avoid heating foods and excessive pungent flavors
• Maintain a regular daily rhythm and sufficient sleep
• Avoid overexertion and physical strain; focus on recovery
• Minimize stress and emotional overload

If you have acne without redness or sensitivity, or blackheads, whiteheads, and clogged pores, try these tips:

• Remove Dampness and avoid factors that increase it; aim to get Dampness moving
• Avoid dairy, sugar, pastries, pasta, and bread; limit sweet flavors and raw, cold vegetables (e.g., smoothies and cold salads)
• The bitter flavor is drying: increase foods like high-quality matcha tea, broccoli, celery, sprouts, and herbs like dandelion or nettle
• If no Heat is present, a moderate amount of pungent flavor helps break up Dampness—use fresh ginger and turmeric
• Dampness must be moved: EXERCISE
• Engage in aerobic exercise, strength training, and mobility-enhancing activities—sweating is important

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