Uncovering the Root Cause: How Chinese Medicine Identifies Imbalances in Skin Diseases

In the quest for optimal health and well-being, the relationship between ourselves and the environment plays a pivotal role. Our bodies are constantly interacting with external factors, such as weather, pollutants, and stressors, that can influence our physical and emotional well-being. 

Chinese medicine understands this interaction through the concept of the pathogenic influences. These are phemomonon of the natural world, such as heat, cold, wind, damp, and dryness. These factors can invade the body, much like allergens, microscopic  pathogens, and pollution, causings imbalances in the body which develop into disease. 

This is particularly important in skin diseases. In Chinese medicine, we read the skin to understand what imbalances are underlying the condition. The appearance of the skin will reflect the nature of the imbalance leading to the disease.  

In this blog I will explain the concept of health in Chinese medicine and how to understand the 6 pathogenic influences in light of skin diseases. 

The Concept of Balance in TCM:

TCM is rooted in the belief that health is a state of harmony within the body as well as between the body and our evnriornment. This is summed up in the idea of Yin and Yang, opposites that depend on one another and balance each other.  

When we are in harmony within our body and with our surroundings, our bodies are able to protect from the invasion of a pathogenic influences.

Reading the Skin in Chinese Medicine Dermatology

I will look at the skin to understand the nature of the condition. Acne is not just acne and eczema is not just eczema.  The color, texture, and appearance of the skin will provide valuable information about the specific pathogenic factors contributing to the skin condition.For example, intense red skin will shows heat and fire which needs to be treated with cooling herbs. But pale, white, or blue skin may show lack of nourishment from cold. 

From understanding the underlying imbalances I can create a customized herbal formula to treat the condition at the root. For example, if there is heat with wind, we will give herbs that remove both the heat and wind. But if there is heat with dampness, the herbal medicine and treatment will be different. Depending on the strength of each different imbalance present I can personalize the treatment for each individual.  

Pathogenic Influences

The six pathogenic factors—wind, cold, heat, dampness, dryness, and summer heat—represent various environmental forces that can disrupt our internal balance and contribute to illness. When our bodies are imbalanced, either due to emotional stress, poor diet, or other factors, the body’s natural ability to fight off illness becomes damaged and we become more vulnerable to these pathogenic influences.

dandelion blowing in the wind

For example, a person with a weak immune system may be more susceptible to catching a cold during a sudden shift in weather, or someone with a damp constitution might experience sinus headaches when exposed to a damp environment. In these cases, the body’s weakened state allows pathogenic factors to invade and cause illness.

In the clinic, it is rarely ever a single factor. Many components combine to create the pattern of dysharmony. The herbal formula and treatment course will address the imbalances and allowing the body’s natural energies to return. 


Wind is an important pathogenic factor in TCM dermatology because it often leads to the uncomfortable symptom of itching. It is associated with conditions like eczema, urticaria, and pruritus, which may manifest as itching and rashes that move or change quickly. Many herbs which dispel wind are known to reduce itch and lessen the allergic responses. 

Heat or Fire:

Heat and fire are yang pathogenic factors that are associated with fever, inflammation, irritability, and infection. Heat is the root cause of many inflammatory skin conditions like acne, rosacea, psoriasis, and many eczema cases. Redness on the skin is a sign of heat.  The redder the skin the stronger the heat. Inflamed blisters are also can be a sign of strong toxic heat. Herbal medicines that relieve heat have been found to be anti inflammatory and antibacterial.  Cupping can also be used to rapidly reduce intense heat. 

hot desert with small plant

Another type of heat is called vacuity fire. This arises when there is not enough cooling in the body. It will also cause redness on the skin but generally it is duller red and  there may also be dryness without inflammation.  For these cases herbs that nourish the yin and cool the body are used.  


Dampness can accumulate in the body and cause swelling, heaviness, and other symptoms. Dampness is a heavy pathogen causing a feeling of sluggishness. Skin conditions such as seborrheic dermatitis, many types of eczema, and acne have dampness as a factor. Symptoms may include weeping, non-inflammed blisters, or swelling of the skin, often accompanied by a sensation of heaviness. Dampness can also be a cause of itch. Herbs that clear dampness help to reducing inflammation, swelling, and itch.  Some of the strongest anti-itch medicines help by addressing the damp accumulation. 

Sad face in humidity

Damp Heat:

In many inflammatory skin diseases, the dampness will combine with heat to form damp heat. Damp heat is a complex condition that arises when excess heat and dampness accumulate in the body, leading to many skin conditions.  Damp heat can lead to skin issues like eczema, acne, or rashes, often characterized by redness, itching, weeping, oozing, and a sensation of warmth. The inflammation from damp heat often is associated with swelling, inflamed blisters, crusting, and oozing. This is also associated with infection. When treating damp heat, the degree of each component is precisely accessed to tailor the treatment approach.  Herbs that clear damp heat are often antiinflammtory and antibacterial. 


Dryness is a pathogenic factor that can cause dry, flaky, or itchy skin, often seen in conditions like xerosis and aging skin. TCM treatments for dryness-related skin diseases may involve nourishing yin, moisturizing the skin, and promoting fluid balance with acupuncture, herbal medicine, and dietary therapy.


Cold can invade the body and cause a constriction of blood vessels, slowing down blood circulation and leading to pain, stiffness, and other symptoms. Cold is not a major factor in most skin diseases. Cold may show up as blue or pale on the skin.

Other diseases related to cold may be joint pain. Treatment will focus on warming the body, using techniques such as moxibustion, warming herbs, and acupuncture points that promote warmth and circulation.


Summer Heat (暑, shǔ):

Summer heat is a unique TCM concept that refers to the heat and humidity typically experienced during the summer months. It can lead to symptoms like fever, dehydration, dizziness, and fatigue, and is often associated with heat stroke and heat exhaustion. For skin diseases, it is primarily related to sunburns. TCM treatments for summer heat-related skin diseases aim to clear excess heat from the body, reduce inflammation, and promote fluid balance to allow the body to heal. 

Treating the Root Cause

After determining the specific imbalance underlying the condition, I will create a treatment course to address it.  Let’s take eczema for example.  Eczema may be caused by many imbalances, with heat being the most common.  My goal is to determine the type of heat, strength of the imbalance, and the presence of wind or dampness to create the correct treatment. This is done through looking at the skin, taking a medical history, and observing the pulse and tongue. 

For blood heat with wind, I would use herbs that reduce both blood heat and wind such.  But if there is more dampness, we would use herbs for damp heat.  If it is a very strong flare then heat toxicity herbs would need to be used to reduce the heat toxins. Once you remove the toxins the body’s natural healing abilty can return and to return to a state of balance. 


The six pathogenic factors in are important in understanding how we get sick and stay healthy.  By identifying and addressing the specific imbalances causing the skin disease I can customize my treatment to correct the underlying imbalance, leading to long term improvements. 

Feel better, get acupuncture! 

Joseph Alban

Joseph Alban, L.Ac.

Joseph Alban is a Doctor of Acupuncture, New York Licensed Acupuncturist, and NCCAOM Board Certified Herbalist providing the highest quality Acupuncture and Chinese medicine care tailored to your needs.

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