Severe acne has long been one of the great challenges in both Western and Chinese medicine. Over the years, I have encountered more than a dozen cases of extremely severe facial acne, most with a disease course of four to five years or longer. The lesions were as hard and knotty as elm wood. Repeated treatments with both Western and Chinese medicine yielded no significant improvement. Medical aesthetics couldn’t solve the problem either. Isotretinoin therapy was relatively painful and its efficacy inconsistent, so most patients eventually gave up. The patients suffered, and I suffered too. I kept searching for better solutions and found many approaches that worked reasonably well for mild to moderate cases — but severe acne remained deeply unsatisfying.
After the Spring Festival this year, a relative of a devoted follower came seeking treatment. I urgently consulted with colleagues, and during our discussion someone mentioned “San Liang San” (Three Two Three). My eyes lit up instantly — this was it.
I first heard the term “San Liang San” during my graduate studies. While studying the Jin Gui Yao Lue (Essentials from the Golden Cabinet), my professor repeatedly mentioned several “San Liang San” formulas circulating at Xiyuan Hospital, all with remarkable clinical efficacy. The core principle is using large doses of the sovereign (jun) herb to exert the primary therapeutic effect, while pairing it with small doses of assistant and envoy (zuo shi) herbs for synergistic enhancement. “San Liang San” is not a fixed prescription but rather a prescribing philosophy — which is why we can find different versions of “San Liang San” treating different conditions.
Among them, the most widely circulated “San Liang San” for sores and ulcers has the following composition:
Raw Astragalus (Sheng Huang Qi) 30g, Honeysuckle (Jin Yin Hua) 30g, Whole Angelica Root (Quan Dang Gui) 30g, Licorice (Gan Cao) 9g, Sichuan Centipede (Chuan Wu Gong) 0.1g (taken separately).
Actions: Nourishes qi and blood, relieves toxicity. Indications: Sores and ulcers, muscular rheumatism, wind-rash, etc. Used for stubborn skin diseases and urticaria that resist prolonged treatment.
Normally, I would not use a formula like this. First, the doses are too large; second, it’s too expensive. Especially for conditions like acne — where patients have typically already taken large quantities of cold-cooling herbs — using such a formula can easily damage the spleen and stomach. Moreover, my teachers all instructed me that acne treatment should primarily focus on dispersion (fa san). One must release the pathogenic factors trapped within the skin in order to truly resolve the problem. They were never fond of the heat-clearing and toxin-resolving approach, because we frequently see cases where the misuse or overuse of such methods causes the lesions to darken and become pitted — making them far harder to treat.
However, since I decided to use this formula, I chose to honor its original intent. After all, from the perspective of herbal compatibility, it may not be as cold-cooling as it first appears. On this foundation, I made additions and subtractions based on the patient’s actual condition, and prescribed an external herbal compress for the face. After nearly a month of treatment, the improvement was dramatic. The patient’s family marveled at the result, calling it “the eighth wonder of the world.”
The success of this treatment was both surprising and, in retrospect, entirely logical. First, I had clearly told the patient from the outset: if the treatment was going to work, there would be visible improvement within two weeks. If there was no significant response after a month, there was no point in continuing to see me. This reflects my fundamental understanding of this disease. Over the years, I’ve treated many acne cases — some waxing and waning repeatedly, some never fully resolving with occasional flare-ups, and others with unbearable itching that drives patients to pick and squeeze. For all these patterns, the application of Chinese herbal medicine typically produces noticeable improvement within 5 to 10 days. With persistence for about a month, the lesions can largely resolve — and if the patient avoids dietary and lifestyle taboos, the probability of a lasting cure is quite high.
Second, I fully expected this formula to cause diarrhea, but it didn’t. Throughout the entire treatment course, the patient’s appetite was not affected in any way, and no adverse reactions occurred. In fact, the patient’s previously loose stools became firmer. This is probably the unique brilliance of “San Liang San.” When I discussed this with colleagues, they shared the same impression. It seems that treating acne from the perspective of the spleen and stomach is more prudent than simply targeting the lung and stomach alone.
Third is the use of insect-based medicines. I had never considered using centipede for acne treatment before — I used to rely frequently on stiff silkworm (Jiang Can). Judging from the results this time, centipede has an excellent ability to attack and disperse severe, nodular acne. This is far more effective than the herbs commonly mentioned in academic papers, such as Dan Shen (Salvia), San Leng (Sparganium), E Zhu (Curcuma), and Zao Jiao Ci (Gleditsia thorn). Of course, from a Western medical perspective, the essence of acne is inflammation within the hair follicle. The anti-inflammatory and swelling-reducing effects of centipede have been verified by modern pharmacology — once you see through this mechanism, it’s hardly surprising.
Fourth is the durability of the results. The patient has now been off medication for nearly a month, and the feedback is that there has been essentially no relapse. It appears that “San Liang San” also has a considerable regulatory effect on the body’s overall physiological state. This formula is truly a blessing for patients with severe acne.
Of course, there are still other questions worth exploring. For example, after the modifications I made, can it still be called “San Liang San”? I believe it can, because the essence of this formula is the “Three Two Three” — if you remove the leading three herbs, the remaining combination would not achieve such remarkable results. Another question: how much of a role did the external application play in this case? I believe it played a very significant role. This type of disease requires simultaneous internal and external treatment. Without the direct action of the external herbal compress, the effects of the internal medicine might have manifested more slowly. I used to frequently prescribe Dian Dao San (Inverted Powder) for acne with good results, but sulfur has become genuinely difficult to purchase recently, so I had to abandon that approach.
中文原文 / Chinese Original
重度痤疮向来是中西医治疗的一大难题，本人碰见了十余例非常严重面部痤疮，大都病程在四五年之上，皮损宛如榆木疙瘩，中西医迭治无明显效果，医美亦不能解决问题，维A酸治疗过程相对痛苦且疗效不稳定，大多数不了了之，病人痛苦，吾亦痛苦，一直在思索良策，得到了不少方法用于轻中度倒是效果不错，但是重度仍然难以令人满意。今年春节后，铁粉一亲戚欲来求治，急与同道商议，一番言语后提到了”三两三”，我瞬时眼前一亮，就它了。
民间秘方”三两三”是我在读研时听到一个词汇，上金匮的时候老师反复提及西苑医院流传的多首”三两三”，效验极佳，其核心要义就是用大剂量的君药发挥主要作用，同时配伍小剂量的佐使药协同增效。”三两三”不是一个固定的方剂，而是一种配伍思想，所以能看到存世有不同的”三两三”治疗不同的疾病。其中，流传甚广的疮疡”三两三”配方如下：
生黄芪30g，金银花30g，全当归30g，甘草9g，川蜈蚣0.1g（分冲）。
功效：养气血，解毒。主治：疮疡，肌肉风湿，风疹等。用于久治不愈的皮肤病、荨麻疹。
这样的组成平时我是不会用的，首先这个量太大，其次是太贵。尤其是对于痤疮这类疾病，通常已经服用过大量寒凉药，在这么用药容易伤脾胃。同时我的老师们都教导我对于痤疮应当以发散为主，必须要把郁在皮内的邪气发散出去才能真正解决问题，他们都不是很喜欢用清热解毒法，因为我们经常见到误用或者滥用清热解毒后痘痘变黑凹陷的情况，那样更难治。
但是既然要用这张方，我任然选择秉承原意，毕竟从配伍的角度讲可能并没有那么的凉，在此基础上又根据患者的实际情况加加减减，并要求外用中药敷脸，经近一个月的治疗后已大为好转，患者家属啧啧称奇，认为这是世界第八大奇迹。
本次诊疗的成功，既让人意外，又在情理之中。首先我已经很明确跟患者交代，如果有效果的话，肯定在两周内就能明显看出来，如果一个月都没啥太大反应就不用找我治了，这是我对这个病的基本认识。这些年治了不少痤疮，有的是反反复复好好坏坏总起，有的是一直没好偶尔加重，有的是麻痒难忍总想去挤，对于这类情况基本上用上中药5-10天就能有明显的改善，坚持个把月基本就能消下去，如果不犯忌讳的话大概率就好了。
第二是我本以为吃这张方会拉肚子，结果并没有，在整个治疗周期中胃口没有受到任何影响，没有出现任何不良反应，大便甚至由稀转干，这大概就是”三两三”的独到之处，跟同道交流起此事大家都有同感。看来从脾胃论治痤疮比单纯地从肺胃入手要更稳妥一些。
其三是虫类药的运用，我治痤疮从来没有想过用蜈蚣，以前倒是经常用僵蚕，从这次的效果看蜈蚣对于这类重度的有明显结节的痤疮具有很好的攻散作用，这可比那些论文里常常提到的丹参三棱莪术皂角刺效果要好的多了。当然，从西医的角度看，痤疮的本质是毛囊内部有炎症，蜈蚣的消炎消肿疗效也是经过现代药理学验证的，点破了自然不足为奇。
其四是效果的持久性，目前已经停药接近一个月了，反馈的情况是基本没有反弹，看来”三两三”对于整体生理状态的调节也具有相当不错的效果，这张方子绝对是重度痤疮患者的福音。
当然，还有一些其他问题值得探讨，比如说，像我这么加减之后，还能叫”三两三”么？我觉得可以，因为这张方子的精髓就是”三两三”，把前面几位药去掉，后面的药物组合不会有如此的疗效。再比如说，本案中使用的外用药究竟发挥了多大的作用？我认为作用是很大的，这种疾病需要内服外用同时进行，如果没有外用药的直接作用，可能内服药的作用显现速度会变慢。我以前经常用颠倒散治疗痤疮，疗效也是很不错，但是最近硫磺实在是不好买了，就此作罢。
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