Seborrheic dermatitis

Understanding Seborrheic dermatitis

The tradition describes the condition as a surface sign of a deeper disharmony, primarily involving the Stomach and Spleen.

The Stomach channel runs directly across the face, so internal heat or dampness is said to rise along that pathway and irritate the skin. When digestion is weakened by stress, diet or constitution, fluids are poorly transformed and dampness accumulates.

That produces the characteristic picture: oily red or yellowish patches with greasy scaling, itching when the skin is oily, and digestive signs such as bloating, a sticky taste and incomplete bowel movements.

A dry variant is also described, where the scaling is fine and dry rather than greasy, and the picture is one of Blood deficiency or Empty-Heat from Yin deficiency. The distinction matters because the treatment direction reverses.

A second dry route runs through Stomach Fire. Here the heat is not a lack of moisture but an excess that burns it off, so the face and scalp scale while the person feels hot, wants cold drinks, feels hungry and is constipated. Here the tongue shows a red body beneath a thin yellow coat, with a pulse that runs rapid or wiry. Telling this apart from deficiency dryness matters, because one picture needs cooling and the other needs building, yet on the skin they can look almost the same.

The practical result is that matching patches can call for opposite herbs. A greasy yellow coating with a slippery pulse supports draining and drying, while a narrow dry tongue and a quick pulse support moistening and nourishing. A person may also move from one picture to the other over months, especially after a long course of drying treatment, so the formula and the diet advice are reviewed at follow up rather than fixed for good.

How it connects

Seborrheic dermatitis often appears alongside acne because both share a root in excess Heat and Dampness within the Stomach and Spleen. When rich greasy food overwhelms digestion, Damp-Heat rises to the face, overstimulating oil glands and inflaming the skin, and the same Damp-Heat can clog pores and produce the red inflamed pimples of acne, especially along the chin and jawline where the Stomach channel runs. Eczema also frequently co-occurs where there is an underlying tendency to Dampness and Heat in the skin; both are outward signs of internal disharmony, with seborrheic dermatitis leaning more toward Damp-Heat or Stomach Fire while eczema often mixes Damp-Heat, Blood Heat or Blood deficiency. Treating the shared Damp-Heat often calms both.

How it is assessed

The practitioner distinguishes greasy from dry scaling, and looks for the digestive pattern behind it.

What a practitioner looks for

• Scale quality: greasy yellowish crusts point to Damp-Heat; fine dry scaling points to deficiency.
• Site: the face, scalp, brows and nasolabial folds follow the Stomach channel described in the reference.
• Digestive signs: bloating, sticky taste, loose incomplete stools support Damp-Heat.
• Constitutional signs: night-time heat, dry mouth and heat in palms and soles suggest Empty-Heat.

The consultation usually opens at the surface and works inward. The practitioner asks whether the scaling is greasy or dry, what colour the redness is and where it began, since the brows, nasolabial folds, scalp and chest are the oily areas described. Then come the questions that separate the patterns: appetite, thirst, bowels, sleep, stress and how long the complaint has been present. Oiliness that returns quickly after washing, with a sticky taste in the morning, points one way; a face that feels tight and dry after washing points another.

Four pictures are separated this way. Greasy yellow crusts with bloating, a yellow greasy coating and a slippery rapid pulse indicate Damp-Heat in the Stomach and Spleen. Dry redness with thirst for cold drinks, hunger and constipation, a red tongue with a thin yellow coat and a rapid pulse indicate Stomach Fire. Dull redness with fine bran-like scaling, a pale thin tongue and a thin choppy pulse indicate Blood Deficiency with External Wind. Muted redness with dry mouth at night, five-palm heat and night sweats, a red thin cracked tongue with little coating and a thin rapid pulse indicate Empty-Heat from Yin Deficiency.

TCM patterns in Seborrheic dermatitis

Three patterns are described, and the first question is whether the skin is wet or dry. Wet means oily patches with yellowish greasy crusts, itch that rises when the skin is oily, and a thick yellow tongue coating. Dry means fine white scale without grease, on a red or dull base with a thin dry tongue. The distinction matters because draining herbs that help the first picture leave the second more brittle. Wet skin is read as Damp-Heat in the Stomach and Spleen, confirmed by fullness after eating, a sticky taste and loose stools. Dry skin splits in two. Dull redness with a wandering itch, a pale tongue and a thin pulse is Blood Deficiency with External Wind, while redness that worsens in the evening with dry mouth, night sweats and heat in the palms is Empty-Heat from Yin Deficiency. A greasy flare can also dry out over months, so the tongue and pulse are reviewed at each visit.

Treatment approach

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

Principles

• Drain dampness and clear heat in the greasy pattern, and address digestion as the source.
• Nourish Blood and Yin where the scaling is dry, since drying treatment would worsen it.
• Review diet and stress, which the classical literature names as the common triggers of the Stomach and Spleen pattern.
• Treat the scalp and face gently; harsh degreasing is described as aggravating the cycle.
• The strategy is always two part: clear what has risen to the surface and correct the source that keeps producing it. Bitter cold draining suits the greasy excess, cooling the Stomach while drying the middle. Sweet moistening suits the dry deficiency, rebuilding Blood or Yin so the surface can hold moisture. Because the direction reverses between these pictures, a formula that helped in one phase can aggravate the next, and review matters as much as the first choice.

Herbs used

Formulas

• Wei Ling Tang
• Yin Chen Hao Tang
• Qing Wei San
• Dang Gui Yin Zi
• Er Zhi Wan

Acupoints

• ST-36 (Zusanli)
• SP-9 (Yinlingquan)
• SP-6 (Sanyinjiao)
• LI-4 (Hegu)
• ST-44 (Neiting)
• LI-11 (Quchi)
• PC-6 (Neiguan)
• GB-20 (Fengchi)
• SP-10 (Xuehai)
• KI-3 (Taixi)
• BL-23 (Shenshu)

What to expect

• Itching and greasy scaling are described as improving within weeks of treatment and dietary change.
• Recurrence is common when the digestive pattern is not maintained.
• The dry pattern is expected to respond more slowly.
• Excess pictures usually settle first, with itching and redness easing inside two weeks and oily scaling taking three to six weeks. Blood or Yin deficiency responds more slowly, often over six to twelve weeks, because reserves have to be rebuilt. Flares still happen with stress, diet and weather, so many people keep a maintenance formula or a short course at the first sign rather than expecting a permanent end to the tendency.

Safety and when to get help

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

Cautions

• Do not use strong topical steroids on the face without medical advice.
• Long-term internal herbs should be supervised.
• Persistent scaling that does not respond should be medically reviewed.

Using this alongside conventional care

• TCM is described as complementary to conventional care: antifungal and anti-inflammatory topical treatment can continue alongside herbs and acupuncture.
• Medicated shampoos and topical antifungals can continue while herbs and acupuncture are added, and most practitioners simply space the applications apart. Oral antifungals and isotretinoin need to be declared to both the dermatologist and the TCM practitioner, since several cooling and blood cooling herbs are mildly blood thinning and anticoagulant use deserves a conversation before starting. Nothing prescribed should be stopped suddenly, and a full medication list at the first consultation avoids most of these problems.

Diet and lifestyle

• Reducing greasy, fried and sugary food is described as essential, along with dairy, which is considered damp-forming. Light cooling foods are favoured.
• The general rule is to remove what feeds dampness and heat: fried and greasy food, sugar, rich dairy and alcohol, with late eating and heavy evening meals also worth cutting. Light cooling foods such as leafy greens, cucumber, mung beans, pear and congee suit most pictures. For the greasy pattern, add barley, millet and cooked vegetables and keep meals plain. For dry scaling from Blood deficiency, include warm soups, dark greens, eggs, black sesame and small amounts of red meat. For Empty-Heat, favour pear, honey, tofu and sesame, and avoid chillies, coffee and late nights.

If you're pregnant

The damp heat and Stomach Fire pictures often become more active in pregnancy, because the body runs warmer and holds more fluid. Treatment still has to be gentle so the fetus is protected. Bitter cold herbs of the Huang Lian and Da Huang type are avoided, and milder heat clearing options such as Jin Yin Hua and Yi Yi Ren are preferred. Acupuncture is used cautiously, avoiding lower abdominal points and points known to encourage uterine contractions, including Sanyinjiao SP-6 and Hegu LI-4. Cooling bland foods such as mung bean soup and pear carry much of the work, and a practitioner experienced in pregnancy care should guide the plan.

If you're breastfeeding

Many herbs pass into breast milk, so the same bitter cold group, Huang Lian and Zhi Zi in particular, is avoided because it can loosen an infant's stools. Milder dampness clearing herbs and foods such as Yi Yi Ren and Fu Ling are preferred and also reduce oiliness. A mild Jin Yin Hua wash applied to the scalp or face is low risk, and acupuncture introduces nothing into the milk, with ST-36 Zusanli and SP-9 Yinlingquan, which support the Spleen and dry dampness. Watch the baby's digestion and skin when anything new is started.

If treating a child

In infants it usually shows as cradle cap, a layer of thick yellowish greasy scale on the scalp, which the classical literature reads as damp heat from digestive immaturity or from the mother. Treatment is gentle: a mild wash of Jin Yin Hua and Ju Hua applied to the scalp, and dietary adjustment for a breastfeeding mother. Older children usually show the damp heat or Stomach Fire picture on a diet heavy in greasy and sweet food, and doses run between a third and a half of the adult amount, with formulas such as Wei Ling Tang modified to be milder. The key sign to look for is a red tongue carrying a thick greasy coat.

If treating an elderly patient

In older people the picture drifts towards dryness as Yin and Blood decline, so fine dry scaling replaces heavy greasiness and Empty-Heat or Blood deficiency becomes more likely. The skin has thinned and grown more fragile, which makes harsh drying herbs a poor choice. Formulas such as Er Zhi Wan and Dang Gui Yin Zi, which nourish while gently clearing Wind, fit better, at about two thirds of the adult dose and for longer courses. Polypharmacy needs checking, and gentle acupuncture at points such as KI-3 Taixi and SP-6 Sanyinjiao is often better tolerated than strong decoctions.

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 seborrheic dermatitis or share its patterns.

Evidence

The evidence is moderate and mostly observational or consensus-based. A large case series of 170 patients treated by pattern reported high response rates, an expert consensus standardises three patterns with recommended formulas, and a case report describes resolution with a combined formula. There are few placebo-controlled trials, so the published figures should be read as practice reports rather than proof of efficacy.

The published base is thin and largely observational. The largest report followed 170 people treated by pattern, grouped into damp heat, blood dryness with wind heat, and internal heat from yin deficiency, and recorded a 70.6 percent cure rate and a 100 percent total effective rate over one or two courses of twenty days each, without randomisation or blinding. A 2020 consensus statement from the Chinese Society of Dermatology standardises three patterns and their formulas, and a case report describes clearance with a combined formula. None of this replaces controlled trials, so the figures describe practice rather than proven effect.

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.

• Tanshinone Capsules Combined With Prednisone for Facial Seborrheic Dermatitis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.. Frontiers in medicine, 2022. PMID: 35572959.
• Role of immune cells in seborrheic dermatitis: a two-sample bidirectional Mendelian randomization study.. Archives of dermatological research, 2025. PMID: 39994123.

Classical record