Rosacea — Wokingham, Berkshire

1. Overview

Rosacea is a chronic inflammatory skin condition affecting the central face — primarily the cheeks, nose, chin and forehead — characterised by persistent redness, visible blood vessels, flushing episodes and, in many cases, papules and pustules resembling acne. It affects approximately 10% of the UK population, predominantly fair-skinned women over 30, though it can affect anyone. It is a relapsing-remitting condition: periods of relative calm are interrupted by flares triggered by specific environmental, dietary or emotional factors.

Conventional treatment manages symptoms with topical agents (metronidazole, azelaic acid, ivermectin), oral antibiotics and, for severe cases, laser therapy. These address the surface manifestation without treating the underlying inflammatory tendency. Acupuncture and Chinese herbal medicine treat rosacea from the inside out — clearing the systemic Heat and Blood stasis that drive the vascular reactivity and inflammation at the skin level, producing lasting improvement in redness, flushing frequency and papule formation.

2. Symptoms and subtypes

Rosacea presents across four subtypes that often overlap in the same patient:

Erythematotelangiectatic rosacea (ETR) — the most common subtype; persistent central facial redness, visible dilated capillaries (telangiectasia), episodes of flushing triggered by heat, alcohol, spicy food, exercise or emotional stress, and facial sensitivity; the skin often feels hot, burning or stinging; corresponds most closely to the TCM pattern of Blood Heat and Empty Heat in the skin channels
Papulopustular rosacea — persistent central redness with inflammatory papules (raised bumps) and pustules on the cheeks, chin and nose; resembles acne but without blackheads or whiteheads; most common in middle-aged women; corresponds in TCM to Stomach Heat and Phlegm-Heat accumulating in the skin channels and generating toxin
Phymatous rosacea — thickening and enlargement of the skin, most commonly on the nose (rhinophyma); caused by sebaceous gland hyperplasia and fibrosis; predominantly affects older men; more resistant to treatment than the vascular subtypes
Ocular rosacea — eye involvement with redness, burning, dryness and foreign body sensation; affects approximately 50–58% of rosacea patients; corresponds in TCM to Liver Heat rising to the eyes

3. Causes and triggers

The underlying cause of rosacea involves abnormal innate immune activation, dysregulation of neurovascular responses in the facial skin, and altered skin microbiome. The vascular reactivity and flushing reflect an exaggerated sympathetic nervous system response to stimuli. Known triggers include:

Heat and temperature changes — hot weather, hot baths, saunas, exercise; all generate internal Heat that rises to the face
Alcohol, especially red wine — a potent vasodilator and Heat-generating substance in TCM; red wine is the most common dietary trigger
Spicy foods — chillies, hot spices, ginger in excess and other pungent foods increase Stomach Fire and drive Heat to the face channels
Emotional stress — anxiety, frustration and anger cause Liver Qi stagnation to generate Heat that rises to the face; emotional triggers are particularly relevant in ETR rosacea
Sunlight and UV radiation — UV exposure directly damages the facial capillaries and triggers vascular reactivity
Skin care products — harsh cleansers, exfoliants and products with alcohol, witch hazel or fragrance worsen barrier function and provoke flares
Demodex mite overpopulation — higher densities of Demodex folliculorum mites are consistently found in rosacea skin and may contribute to immune activation; in TCM this corresponds to Damp-Heat promoting the proliferation of pathogenic organisms in the skin

4. Rosacea in Chinese medicine

In traditional Chinese medicine, rosacea falls within the category of Jiu Zha Bi (酒渣鼻) — “wine-blossoming nose” — a classical skin condition characterised by facial redness and vascular proliferation. The facial skin channels are governed primarily by the Lung (which dominates the skin) and Stomach (whose channel runs directly over the cheeks and nose). When Heat accumulates in these organs and rises through their channels to the face, it dilates the superficial vessels, reddens the skin and drives the inflammatory cascade that produces rosacea. The specific TCM patterns are:

Lung and Stomach Heat — the foundational pattern; the Lung governs the skin and the Stomach channel traverses the central face; Heat in both organs rises through their channels to manifest as persistent central facial redness, flushing, dilated capillaries and a burning sensation; exacerbated by spicy food, alcohol and sun; a red tongue tip (Lung) and red tongue centre (Stomach) with a yellow coat, rapid pulse; treatment clears Lung and Stomach Heat, cools the Blood and resolves the facial channels; the classical formula is Pi Pa Qing Fei Yin (Loquat Clear the Lung Decoction), which combines Pipa Ye (Loquat leaf), Sang Bai Pi (Mulberry root bark), Huang Qin, Huang Lian and Zhi Mu to clear Heat from both organs
Blood Heat with Blood stasis — when Heat in the Blood vessels causes them to dilate and proliferate; the persistent redness of ETR rosacea, visible telangiectasia and fixed capillary dilation reflect Blood stasis in the facial skin channels overlaying the Blood Heat; treatment cools the Blood and resolves stasis; Sheng Di Huang, Mu Dan Pi, Chi Shao and Dan Shen are key herbs; Xue Fu Zhu Yu Tang modifications address the stasis component
Stomach Heat with Phlegm-Heat toxin — the pattern in papulopustular rosacea; excess Stomach Fire combines with Phlegm-Damp to generate Phlegm-Heat toxin that rises to the face, producing inflammatory papules and pustules; similar to the Phlegm-Heat pattern of acne but with a predominantly vascular background; treatment clears Stomach Fire, transforms Phlegm and resolves toxin; Huang Lian Jie Du Tang combined with Phlegm-transforming and stasis-resolving herbs
Liver Qi stagnation generating Heat (stress-triggered rosacea) — when emotional stress is the dominant trigger; flushing episodes triggered by anger, frustration or anxiety; Liver Qi stagnates under emotional pressure and rapidly transforms to Fire that rises through the Liver channel to the face; treatment moves Liver Qi, clears Liver Fire and cools the Blood using Long Dan Xie Gan Tang modifications
Yin deficiency with Empty Heat (mature-onset or post-menopausal rosacea) — in perimenopausal and post-menopausal women, declining Yin fails to cool the complexion; the flushing of rosacea combines with hot flushes, night sweats and ageing skin; treatment nourishes Yin and clears Empty Heat using Zhi Bai Di Huang Wan modifications

5. Acupuncture for rosacea

Acupuncture addresses rosacea through three primary mechanisms: it reduces the exaggerated neurovascular response that drives flushing episodes by calming sympathetic nervous system reactivity; it modulates the innate immune activation and inflammatory cytokine production (IL-1, TNF-α) underlying the skin inflammation; and it improves microcirculation — the restoration of normal vascular tone reduces the chronic venous congestion and capillary dilation that produce persistent redness. In TCM terms, needling at distal points clears Heat from the Lung, Stomach and Liver channels and cools the Blood, while local facial points improve the circulation of Qi and Blood in the facial skin channels to resolve stasis. Clinical studies have found acupuncture significantly reduces rosacea severity scores and flushing frequency compared to topical treatment alone. Key points include:

LI 4 (Hegu) and LI 11 (Quchi) — the primary distal points for clearing Heat from the face and skin; LI 11 is the foremost point for clearing Heat from the Blood and skin and is used in virtually all skin conditions with Heat
ST 44 (Neiting) — clears Stomach Fire and Heat from the Stomach channel, which traverses the cheeks and nose directly
LV 2 (Xingjian) — clears Liver Fire and cools the Blood; essential for stress-triggered flushing
SP 10 (Xuehai) — cools the Blood and resolves Blood stasis; the primary Blood-cooling point; used for all Heat-in-Blood patterns producing skin redness
LU 10 (Yuji) — clears Heat from the Lung channel that governs the skin
Local facial points (ST 2 Sibai, ST 3 Juliao, LI 20 Yingxiang) — improve local circulation and resolve stasis in the affected channels

6. Chinese herbal medicine for rosacea

Chinese herbal medicine is the most comprehensive TCM treatment for rosacea, providing systemic Heat-clearing and Blood-cooling treatment daily to address both the acute flushing tendency and the chronic vascular changes. The formula is tailored to the specific TCM pattern. The classical base formula for the Lung-Stomach Heat pattern is Pi Pa Qing Fei Yin (Loquat Leaf Decoction to Clear the Lung) — this is the most commonly used formula for rosacea in Chinese medical practice and combines Pipa Ye (Loquat leaf, clears Lung Heat), Sang Bai Pi (Mulberry root bark, drains Lung Heat), Huang Qin (clears Heat from both Lung and Stomach), Huang Lian (clears Stomach Fire and toxin) and Gan Cao. For Blood Heat and stasis, key individual herbs include Sheng Di Huang (cools Blood Heat), Mu Dan Pi (clears Blood Heat and resolves stasis), Chi Shao (cools Blood and dispels stasis) and Dan Shen (activates Blood). For papulopustular rosacea, Phlegm-resolving herbs such as Zhe Bei Mu and Xuan Shen are added. Herbs are prescribed as pharmaceutical-grade granules from Sun Ten (Taiwan). An online Chinese herbal consultation is available for patients unable to attend in person.

7. Self-care and trigger avoidance

Identify and avoid personal triggers — keep a trigger diary for 4–6 weeks; note flushing episodes and what preceded them (food, drink, activity, emotion, environment); the most common triggers are alcohol (especially red wine), spicy food, sun exposure, hot drinks and emotional stress
Protect from sun year-round — daily mineral SPF 30–50 is essential; choose physical sunscreens with zinc oxide or titanium dioxide rather than chemical filters, which can irritate rosacea skin; wear a wide-brimmed hat in summer
Use a gentle, fragrance-free skincare routine — avoid alcohol-based toners, harsh exfoliants and products containing synthetic fragrance; use a gentle cleanser, hydrating moisturiser and mineral SPF; Cetaphil, La Roche-Posay Toleriane and Avene Cicalfait are commonly tolerated ranges
Cool the face during flares — cool (not cold) water splashed on the face or a cool damp cloth calms flushing; in TCM terms this externally counteracts the rising Fire
Dietary modifications in TCM terms — reduce alcohol, spicy food, hot drinks, coffee and fried/greasy foods that generate Stomach Fire; favour cooling foods (cucumber, watermelon, mint, green tea, pears, live yoghurt); include anti-inflammatory omega-3 rich foods (oily fish, flaxseed)
Manage stress and sleep — emotional tension is a major Liver Fire trigger; regular acupuncture, adequate sleep and stress management significantly reduce flare frequency over time

8. Treatment at my clinic

I treat rosacea at my clinic in Wokingham, Berkshire using acupuncture and Chinese herbal medicine to clear the Lung, Stomach and Liver Heat and cool the Blood driving the condition. Most patients see meaningful improvement in flushing frequency and redness within 6–8 weeks of herbal treatment. Related conditions commonly co-treated include acne, eczema, psoriasis, anxiety and menopausal symptoms.

Visit the prices page for costs or book an online Chinese herbal consultation if you cannot attend in person.

9. Frequently asked questions

Can Chinese herbal medicine treat rosacea?

Yes. Chinese herbal medicine clears the Lung and Stomach Heat driving the facial redness and vascular reactivity of rosacea. The classical formula Pi Pa Qing Fei Yin is the primary formula and has been used for facial Heat conditions for centuries. Treatment typically produces improvement in flushing and redness within 6–8 weeks, with continued improvement over 3–6 months of consistent treatment.

Can acupuncture reduce rosacea redness?

Acupuncture reduces flushing frequency and background redness by calming the sympathetic neurovascular response and cooling Blood Heat in the facial channels. It is most effective combined with Chinese herbal medicine, which provides the daily systemic Heat-clearing effect that acupuncture alone cannot maintain between sessions.

Is rosacea related to diet?

Yes, strongly. Alcohol (especially red wine), spicy food, hot drinks and fatty or fried foods are the most common dietary triggers, all of which generate Stomach Fire in TCM. Eliminating personal triggers, combined with a cooling diet, significantly reduces flare frequency and makes acupuncture and herbal treatment more effective.

How does rosacea differ from acne?

Rosacea produces papules and pustules without blackheads or whiteheads (comedones), with a background of persistent facial redness and flushing — neither of which occurs in acne. The two conditions can coexist and share some TCM overlap (both involve Lung-Stomach Heat) but rosacea has a more pronounced vascular component that requires stronger Blood-cooling treatment. See also: Acne treatment.