By Michaela Gorman, Dr.Ac., RMT, DTCM

In Traditional Chinese Medicine (TCM) the skin is more than a barrier protecting the body from the external environment. It is viewed as a vital organ that reflects one’s internal health, emotional well-being, and the balance of life energies. By understanding the role of the skin in TCM, we gain insights into how this ancient healing practice sees the connections between skin, internal organs, and overall wellness.

TCM understands that there are layers to the skin including the epidermis, dermis, and fat layer, but also takes into account the complex mechanisms of the vascular, lymphatic, nervous, and immune systems. This is understood through the role of “Cou Li” which are the pathways through which the blood, body fluids, & Qi flow. They connect the most superficial areas to the internal organ systems. They irrigate, nourish & warm the skin & muscles, control sweat glands, and act as protection from external pathogens. In order for the Cou Li to properly function there needs to be balance in the organ systems, external/internal pathogenic factors, emotions, and environmental factors.

The Lung is a major organ connected to the skin. The lungs are one of the body’s main controllers of “Protective Qi” or “Wei Qi,” which govern the flow of Qi throughout the entire body, onto the surfaces of our skin, and through the Cou Li. If the Lung Qi is weak or blocked it can lead to lack of nourishment and moisture causing dry and dull skin. There can be a lack of circulating Wei Qi which leaves us more prone to external pathogens leading to allergies, bacterial and viral infections internally, as well as on the skin surfaces. Imbalances with the Lung can lead to skin conditions such as Uticaria, Rosacea, Herpes Simplex and Acne. The health of our lung system overall will be displayed in the health and suppleness of our skin.

The Spleen, which is viewed as our digestive system, plays a role in making and providing Qi, Blood, and Body Fluids to nourish our skin. Spleen imbalances are due to improper diets, excessive worrying, and improper eating times. This can lead to Dampness type conditions such as edema, swelling, erosion, weeping, and lesions that are around the mouth, lower body, and in the flexors. The spleen is closely related to conditions such as Perioral Dermatitis, Seborrheic Dermatitis, Atopic Eczema, Acne, Psoriasis, Lichen Planus, and Herpes Zoster or Simplex. The health of our spleen system is displayed in the colour and plumpness of our lips.

The Liver is known for creating a smooth flow of Qi regulating our digestion, emotions, menstrual cycle, and all other functions. The liver also has a key role in “storing” our blood which is nourished through proper sleep. The liver becomes dysregulated from high periods of stress and easily becomes “heated” leading to inflammatory skin conditions such as Psoriasis, Nummular Eczema, Uticaria, Herpes Simplex & Zoster, and Perioral Dermatitis. The health of our liver is displayed in pink, shiny, and strong nails.

The Kidneys are considered the “the root of life” in TCM and are responsible for our overall vitality and moisture in the body. Kidney Qi, or essence, can become damaged from having chronic diseases or overworking and will lead to fatigue, skin dryness, premature aging, and atrophy. This is seen in chronic conditions such as Psoriasis, Atopic Eczema, and Lichen Planus as well as Pigmentation disharmonies like Vitiligo. The vitality of our Kidneys are displayed in the colour of our hair and health of our ears. 

The Heart is what houses our “Shen” or spirit. It’s the place where we get guidance from our soul, as the heart is considered the Emperor over all the organs and our mind in TCM. Physiologically, the heart is responsible for the circulation of blood to the whole body. Like the liver, the heart is easily “heated” which can cause inflammation and sleep disturbances. In TCM Dermatology, the heart is always treated when there is anxiety, sleep disturbances, and heat in the blood. Conditions that are caused by blood heat include Psoriasis, Atopic Dermatitis, Uticaria, Seborrheic Dermatitis, and Rosacea. The health of the heart is displayed in a pink and moist tongue.

Certain pathogenic factors are a product of disharmony in our organ systems and meridians. They are the branch of the disease where the inner organ and meridian imbalances are the root. These include:

• Wind: Itching, fast spreading lesions, scaling, lesions on the top of the body.
• Heat: This is observed to varying degrees of intensity of Redness, Thirst, Bleeding, Feeling hot, Sweating, Pain, Itching, Severity.
• Dampness: Swelling, Sweating, Exudation, Intertriginous areas, Itching, Dryness
• Blood stagnation: Pain, Dryness, Purple lesions, Chronic recalcitrant conditions
• Toxin: Pustules, Increased Severity, Yellow-Brown Crusting, Infection

The main treatment for these dermatological conditions are with Chinese Herbs, and the selection of herbs is different depending on the person, pathological factors, and internal organ imbalances. However, the same will be for everyone which is to first Drain, then Harmonize, then Tonify. Draining herbs is the stage where there are the most dramatic results, because there is a clear reduction in redness, swelling, pain, bleeding, exudation, and itching. You can think of the draining stage as treating the branch. Next is to harmonize, by balancing the organ systems and the Couli, still draining but adding in herbs to nourish underlying deficiencies, treating the root and the branch. The last stage is all about tonifying and maintaining proper function of the organ systems, couli, and skin, treating the root.

Topical herbal agents and emollients are used to reduce the pathogenic factors and repair/protect the skin barrier. Acupuncture is used in dermatology to treat skin diseases and conditions by reducing the pathogenic factors, harmonizing the organ systems, and regulating the flow of Qi, blood, and body fluids through our entire body. Diet Therapy is suggested and changed according to the dermatological condition, pathogenic factors involved, and which organ systems are out of balance. Stress & Lifestyle mitigation plays a huge role in recovering from skin diseases, because these are typically aggravating to our systems leading to more disharmony in organs and increase the likelihood of pathogenic factors.

In TCM, achieving radiant, healthy skin is much more than a cosmetic goal- it is a reflection of inner balance and vitality. By seeing the skin as an interconnected part of the body’s entire system, TCM offers a unique, deeply holistic approach that not only addresses symptoms but also encourages long-term wellness. Whether it’s managing stress to calm the liver, hydrating to support the lung, or eating a balanced diet to maintain spleen health, TCM teaches us that skin health is an ongoing journey toward harmony and balance. With this perspective, TCM offers a refreshing, profound way to view and care for our skin, integrating mind, body, and spirit.