Traditional Chinese Medicine in Acne Treatment: From Classical Formulas to Bioactive Phytoconstituents and Mechanisms.

ETHNOPHARMACOLOGICAL RELEVANCE: Acne vulgaris is a multifactorial inflammatory skin condition that affects over 80% of adolescents worldwide. Conventional monotherapy often fails to address sebaceous hyperplasia, Cutibacterium acnes dysbiosis and epidermal barrier dysfunction concurrently. Traditional Chinese herbal medicine (CHM) has long been used to treat acne patterns such as 'damp-heat' or 'blood-stasis', but the mechanisms underlying its effectiveness require further substantiation within a modern translational framework. AIM OF THE REVIEW: To systematically evaluate the efficacy and safety of Chinese herbal formulas and their bioactive constituents in treating acne and to establish a multi-level framework that bridges classical formulas with active compounds in order to inform multi-target therapeutic strategies. MATERIALS AND METHODS: A systematic search of the CNKI database (2014-2024) was conducted, alongside cross-referencing with prescription databases and a comprehensive review of pharmacological and clinical studies on Chinese herbal formulas for treating acne. RESULTS: Classical and modern compound formulas exert a holistic effect by regulating sebum production, microbial homeostasis and inflammation synergistically. A bibliometric analysis of 1,247 prescriptions identified eight core herbs. The primary bioactive constituents of these herbs, including glycyrrhizin, baicalein, forsythoside A, paeoniflorin, cryptotanshinone and catalpol, modulate key signalling pathways (PI3K/AKT, NF-κB, MAPK and Nrf2/ARE) in order to suppress sebum synthesis, inhibit C. acnes biofilms, reduce inflammation and promote skin barrier repair. CONCLUSIONS: Chinese herbal formulas achieve multi-pathway, multi-target regulation through systematic herb compatibility, while their active constituents target interconnected nodes of acne pathogenesis. By integrating the holistic efficacy of formulas with the mechanistic precision of their components, this review establishes a research paradigm for TCM-based anti-acne therapeutics and provides a theoretical foundation for the development of ethnopharmacology-informed botanical therapies.