Keloids

Understanding Keloids

The tradition describes a keloid as a local manifestation of deeper disharmony involving the Blood, Spleen and Liver. A healthy body heals a wound cleanly; when internal heat or stasis remains, the scar keeps thickening.

Damp-Heat gives a red raised scar with heat and intense itch, a heavy sluggish body, a sticky taste and poor appetite. Blood Stagnation gives stabbing fixed pain at the scar, worse at night and with pressure, with a hard dark red-purple keloid.

Excess-Heat gives intense local redness and heat with swelling and severe stabbing pain, thirst for cold drinks and restlessness. Toxic-Heat adds pus or oozing exudate from the keloid with throbbing pain, red swollen hot skin and restlessness - that suggests infection.

Qi and Blood deficiency gives a keloid that is less red and less hot, in a person with persistent fatigue, a pale complexion, dizziness and poor appetite. That is the pattern where the scar is a sign of slow, poor healing rather than active heat.

The Chinese name still used for a keloid, xie zu zhong, translates as crab's claw swelling, and it describes the way the tissue creeps outward past the edge of the original wound. Classical writers took that creeping as evidence that the body was already carrying heat, dampness or stagnant blood before the skin was ever broken, so repair ran on and never knew where to stop. The Spleen is the organ that keeps fluids moving, and a diet of greasy, sweet or pungent food weakens it, letting dampness gather and mix with heat inside the Blood. Once a wound exists, that mixture has somewhere to go: it pools at the injury, and the new tissue rises red, hot and maddeningly itchy. People in this state often describe themselves as heavy and foggy, and their tongue coating is greasy.

The Liver governs the smooth movement of Qi and Blood, and its role explains the hard, dark, quiet keloid that aches rather than burns. Frustration, grief or a constitution that holds tension can jam the flow of Qi; when Qi stops, Blood stops behind it, and the scar sets like a knot with a stabbing pain that is always louder at night. A third possibility is heat on its own, arriving after surgery or injury as an angry red and painful lesion with little dampness in the picture. Two further patterns complete the set. Where Qi and Blood are too depleted to finish the job, the scar grows slowly, stays pale and hard, and sits on a person who tires easily. Where toxin has entered the wound, the keloid suppurates, oozes and throbs, and that is the picture that needs the most urgent attention.

How it connects

Keloids and acne frequently appear together because they share a root in Damp-Heat or Blood-Heat. When someone with acne-prone skin develops a keloid, it signals that the internal Heat and Dampness are strong enough to disrupt normal wound healing, and clearing that root calms active acne while helping prevent new keloids forming after breakouts heal. If a keloid becomes infected it can progress to an abscess, which in TCM reflects the pattern deepening from Damp-Heat or Blood Stagnation into Toxic-Heat. Treating the root early with herbs that cool the Blood and resolve Toxins can stop that progression and avoid the need for drainage.

How it is assessed

The practitioner assesses colour, temperature, growth and the constitutional picture.

What a practitioner looks for

• Growth: a keloid that grows beyond the original wound edge is characteristic.
• Colour and heat: red hot itchy scars suggest heat; pale cool scars suggest deficiency.
• Pain: fixed stabbing night pain suggests Blood stagnation.
• Red flags: rapid growth over days or weeks, ulceration, or discharge.

A practitioner reads the scar before asking anything else, noting its colour, its temperature and whether it itches, weeps or simply sits there. A bright red lesion that is hot and tender to touch, on a person who feels heavy and has loose sticky stools, points to Damp-Heat held in the Blood; the coating is yellow and greasy and does not scrape off easily, and the pulse runs slippery and rapid. When the redness is fierce and the pain sharp while the tongue is red and almost bare of coating, with a large flooding pulse, the diagnosis shifts to Excess-Heat burning locally, which often appears suddenly after an operation or an accident.

A dark red-purple nodule that has hardened, with pain that stabs and stays in one place, sends the practitioner looking for Blood Stagnation. The tongue is dusky or spotted with purple, the veins beneath it are swollen and dark, and the pulse is wiry or choppy; the scar itself is not especially hot, which is the clue that old congealed blood, rather than active fire, is keeping it there. If the surface breaks down or begins to discharge pus, the coating thickens and yellows, the pulse becomes slippery and rapid while the pain sharpens, which marks a move into Toxic-Heat and a need for prompt review.

In someone who looks pale and tires quickly, whose scar has formed without much heat and has barely changed in months, the practitioner suspects Qi and Blood Deficiency, and confirms it with a pale tongue, a thin coat and a weak pulse. Red flags are asked about directly: growth over days rather than months, ulceration that will not heal, bleeding that pressure does not stop, or a foul discharge with fever all belong with a dermatologist rather than a herbalist.

TCM patterns in Keloids

Differentiation for keloids turns on three things: how the scar behaves, what the person feels elsewhere, and what tongue and pulse show. Heat with dampness brings redness, swelling, heat and itch, a heavy body, a sticky taste and a greasy yellow coating. Heat without dampness is drier and angrier, with a red tongue that lacks coating and a flooding pulse. Blood that has stopped moving gives a different picture entirely: the scar is hard, dark and purple, the pain is fixed and stabbing and worse at night, and the tongue is dusky with purple spots. Where toxin has entered, the lesion suppurates and throbs. Deficiency is the quietest pattern, with a pale cool scar, fatigue, dizziness and a weak pulse. These are stages of one process, not separate diseases: a scar can begin as Damp-Heat and harden into stasis over a year or two, and the formula changes as the picture shifts.

Treatment approach

How the tradition treats keloids, with the herbs, formulas and points used for it.

Principles

• Move Blood and resolve stasis where the scar is hard, dark and painful.
• Clear heat and resolve toxicity where it is red, hot and itchy, or discharging.
• Support Qi and Blood where healing has been poor and the scar is pale.
• Use conventional scar therapy as the mainstay, since silicone and pressure have the best evidence.
• Every formula choice follows the same logic: treat the branch that is visible, then the root that produced it. Damp-Heat is drained and cooled, stagnant Blood is moved and broken up, toxin is resolved and pus drained, and a deficient constitution is built up so that healing has something to draw on. The internal formula is paired with external work, an ointment, a paste or needling around the scar, because local tissue responds to local treatment even when correcting the root is slow.

Herbs used

Formulas

• Long Dan Xie Gan Tang
• Xue Fu Zhu Yu Tang
• Xian Fang Huo Ming Yin
• Huang Lian Jie Du Tang

Acupoints

• LI-11 (Quchi)
• LI-4 (Hegu)
• SP-10 (Xuehai)
• SP-9 (Yinlingquan)
• LR-3 (Taichong)
• BL-40 (Weizhong)
• ST-36 (Zusanli)
• SP-6 (Sanyinjiao)

What to expect

• Keloids are described as slow and often persistent; the classical literature does not promise flattening.
• Conventional scar treatment remains the primary approach.
• Rapid growth or ulceration needs dermatological review.
• Session frequency matters less than consistency: the plan usually runs to weekly acupuncture, a daily formula and external applications several times a week. Scars that are red and itchy can calm within four to eight weeks, old hard scars take three to six months to soften, and a deficient pattern can need six months or longer. Because the tendency is constitutional, a seasonal course of acupuncture, or a brief run of herbs after any new injury, is often advised to protect the next wound.

Safety and when to get help

For anything severe, sudden or spreading quickly, read when a skin problem needs urgent care.

Cautions

• Avoid unnecessary trauma, piercings and tattoos if you form keloids.
• Do not apply strong topical agents to the scar without advice.
• Sun protection helps scar appearance.

Using this alongside conventional care

• TCM is described as complementary to conventional care: silicone, pressure and steroid injection therapy continue alongside herbs.
• Steroid injections and silicone sheeting can continue while herbs and acupuncture are added, provided the dermatologist and the practitioner both know what the other is doing. Surgery is a different matter: a keloid-prone person may produce a larger scar after excision, so TCM is best started before the operation and continued afterwards. Blood-moving herbs such as Tao Ren and Hong Hua deserve caution alongside warfarin or other anticoagulants, and a complete medication list should be brought to the first consultation.

Diet and lifestyle

• Avoid spicy and greasy food and alcohol while the scar is active.
• The baseline is a diet that does not manufacture dampness or heat: mung bean soup, cucumber and celery on the plate, with bitter greens alongside, and deep-fried food, heavy red meat, alcohol and sweet treats kept rare. Pattern detail then adjusts the emphasis. With Damp-Heat the light cooling foods do most of the work; with Blood Stagnation, turmeric, black fungus, dark greens and a little vinegar are added; with deficiency, bone broth, congee, red dates, goji berries and cooked root vegetables are used instead, so that food rebuilds rather than drains.

If you're pregnant

Several of the herbs used for keloids move Blood strongly and are avoided in pregnancy, among them Hong Hua, Tao Ren and Chuan Xiong, because they can stimulate the uterus. The bitter-cold formulas, Long Dan Xie Gan Tang among them, are set aside as well, since their cold nature is considered harsh for the developing fetus. Acupuncture is the gentler route, though points on the lower abdomen and the lumbosacral area are left alone. Where a deficiency pattern is present, small doses of Dang Gui and Huang Qi may be used to build Qi and Blood. External applications are often preferred, because they keep systemic exposure low.

If you're breastfeeding

Huang Lian and Zhi Zi are bitter and cold, and both can reach a nursing infant through milk, where they may provoke diarrhoea, so they are usually avoided at this stage. For a Damp-Heat picture, milder options such as Fu Ling and Yi Yi Ren clear dampness without the same harsh cold. Blood-moving herbs are used sparingly, since they may reduce milk supply. Acupuncture is a commonly used choice while nursing, although trial evidence is limited, and local needling around the keloid softens the scar without exposing the baby to anything.

If treating a child

In children, a keloid usually appears after a burn, an operation or severe acne, and the two pictures that appear most often are Damp-Heat and Excess-Heat, because a child's Spleen is still developing and generates dampness easily. Herbal doses are reduced to a third or a half of the adult amount, and strong blood-moving herbs are avoided unless there is a clear reason. Children rarely tolerate deep needling, so shallow technique is used instead. External poultices made with Jin Yin Hua or Lian Qiao can work well, and Bai Zhu is often added to protect digestion.

If treating an elderly patient

In older patients a keloid more often reflects Qi and Blood Deficiency: the scar is pale, less inflamed and slow to change. Treatment concentrates on strengthening the Spleen and Stomach so that Qi and Blood are generated, using points such as Sanyinjiao SP-6 and Zusanli ST-36, with herbs such as Huang Qi and Dang Gui. Doses are typically two thirds of the adult amount, and interactions with common prescription medicines are reviewed carefully. Acupuncture is often tolerated better than herbs, and timelines are longer because an older body rebuilds slowly.

Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.

Related conditions

Conditions that often coexist with keloids or share its patterns.

Evidence

Research is limited but encouraging. Small Chinese studies suggest Xue Fu Zhu Yu Tang and Long Dan Xie Gan Tang can reduce keloid size, itching and pain, alone or alongside corticosteroid injection, and acupuncture and moxibustion are reported to soften scar tissue and improve local circulation. Most studies are uncontrolled, small and published only in Chinese, and a proprietary formulation, Xiao Ji Pai Tong San, has only anecdotal reports. Conventional scar therapy remains the mainstay.

What the literature cannot yet show is efficacy in a controlled sense: the reports are small, uncontrolled and published in Chinese, so they establish that the approach is used and tolerated rather than that it outperforms standard scar therapy. That gap is why a practitioner will usually keep silicone, pressure or steroid treatment in place while herbs are trialled.

Studies often cited

PubMed records for the TCM evidence

Real PubMed records for the TCM clinical evidence discussed above, selected by condition name and title relevance. They are references, not proof of benefit.

• Natural products - Dawn of keloid treatment.. Fitoterapia, 2024. PMID: 38554887.
• Fibrosis-associated non-coding RNAs in keloids: Dual roles in pathogenesis and therapy: A review.. International journal of biological macromolecules, 2025. PMID: 40967540.

Classical record