Table 2. Integrated Interpretation of Facial Acne Based on Three-zone Mapping

Zone	Face mapping (TCM pattern)	Acne morphology	Associated Symptoms	Pathophysiological mechanisms	Implications
Zone AForehead upper cheek	Heart, Lung(心肺)-心火上炎-肺經風熱	Acute type:papular,comedonal or erythematous papules	InsomniaPalpitationsEmotional stress sleep disturbance	- High sebaceous gland density- HPA axis activation under stress leading to cortisol elevation and sebaceous hyperactivity- Immune hypersensitivity to external irritants- Rich vascularity amplifying erythematous response	Before and during adolescence: reduced immunity, external irritant reactivityAfter adolescence: stress and emotion related inflammation predominates
Zone BNose perioral central cheek	Spleen, Stomach(脾胃)-脾胃濕熱	Seborrheic type:papules, pustules or nodular	Dry mouthThirstBloatingConstipationPerioral drynessOral ulcers	- Highest sebaceous gland activity within the T-zone- Insulin and IGF-1-mediated lipid synthesis enhanced by high-fat and high-glycemic diets- Gut-skin axis involvement through intestinal dysbiosis and H. pylori-associated inflammation- Localized hyperseborrhea in males (O-zone acne)	Predominant in adolescence and males: related to diet, digestive function, and gut microbiome balance
Zone CChin jawline lower cheek	Liver, Kidney(肝腎)-腎陰虛-肝腎不足-沖任失調	Chronic or recurrent type:deep papules, nodules, post-inflammatory hyperpigmentation common	Irregular menstruation premenstrual acneFatigueCold extremitiesEmotional stressDepressive tendency	- Androgen-driven sebaceous gland hypersensitivity- persistent 5α-reductase activation- hormonal fluctuation related to menstrual cycle and polycystic ovary syndrome (PCOS);- interaction between HPA and gonadal axes promoting chronic inflammation- highest lesion distribution in adult females(≥85%)	Predominant in adults: chronic stress or depression- Females : assess hormonal balance, menstrual cycle, and PCOS- Elderly: assess fatigue, cold extremities (aging-hormonal axis)