In a case series published in Frontiers in Medicine, dermatologists at Jiangyin Affiliated Hospital of Nanjing University of Chinese Medicine describe three male patients with hidradenitis suppurativa treated between 2023 and 2024 with individualized combination therapies incorporating Xianfang Huoming Decoction, a twelve-herb formula rooted in the traditional principles of clearing heat, detoxifying, regulating qi, activating blood, and resolving masses. The patients, aged between 12 and 29 years, had disease durations ranging from six months to four years. After just one to five weeks of treatment, their inflammatory lesions and pain symptoms improved substantially, with IHS4 scores—a validated severity measure—decreasing by approximately 71 to 81 percent. Two of the three patients remained recurrence-free during six months of telephone follow-up.

The technical details of the cases reveal the formula’s potential in action. The first patient, a 29-year-old man, arrived in December 2023 with a four-year history of recurrent bilateral axillary lesions—scattered papules, pustules, nodules, and cyst-like lesions that progressively increased in number despite self-medication and multiple treatments at other institutions. Dermatological examination revealed multiple deep-seated tender inflammatory nodules, abscesses, and sinus tracts involving both axillae, qualifying him as Hurley stage II, the moderate tier of the disease’s three-stage classification. His baseline IHS4 score was 14, calculated from four inflammatory nodules, three abscesses, and one draining tunnel, placing him in the severe category. Laboratory workup also uncovered elevated liver enzymes—alanine aminotransferase at 98 U/L, aspartate aminotransferase at 90 U/L, and gamma-glutamyl transferase at 109 U/L—along with hyperglycemia, elevated glycated hemoglobin at 6.8 percent, and hypertriglyceridemia at 4.59 mmol/L, metabolic abnormalities increasingly recognized as systemic components of hidradenitis suppurativa.

According to traditional Chinese medicine syndrome differentiation, the patient’s dark-red nodules and abscesses with sinus formation, heat intolerance, preference for sweet foods, dry stool, light-red tongue with thin yellow coating, and wiry rapid pulse pointed to a heat-toxin accumulation pattern. He received Xianfang Huoming Decoction—prepared by water extraction to approximately 400 mL per dose and administered orally twice daily after meals in a warm state—combined with oral roxithromycin, topical fusidic acid, and two sessions of surgical debridement. One week later, follow-up examination demonstrated marked flattening and darkening of the lesions with resolution of the indurated nodules and abscesses. His IHS4 score plummeted from 14 to 4, a 71 percent reduction, with only the residual draining tunnel accounting for the remaining points. Pain improved, no adverse events were documented, and tolerance was acceptable. Yet the story took a cautionary turn: the patient did not return for scheduled follow-ups, and more than four months later, telephone contact revealed recurrence of new lesions, prompting him to seek general surgery treatment in April 2024.

The second case involved a 12-year-old boy who presented in June 2023 with a two-year history of recurrent painful nodules on the buttocks—multiple deep-seated, tender nodules and abscesses without sinus tract formation, consistent with Hurley stage I disease. His baseline IHS4 score was 11, derived from nine inflammatory nodules and one abscess. Traditional Chinese medicine findings—dry mouth, hyperhidrosis, a habitual preference for cold beverages, a light-red tongue with thin white coating, and a rapid pulse—again classified the condition as heat-toxin accumulation. He received the decoction for three weeks, divided into two portions taken orally after breakfast and dinner, combined with topical fusidic acid and clindamycin gel. At the first follow-up, most lesions had resolved, leaving only post-inflammatory hyperpigmentation, crusting, and one remaining abscess. The IHS4 score fell from 11 to 2, an 81 percent reduction—the largest improvement in the series. During six months of telephone follow-up, no new lesions appeared and no recurrence was observed.

The third patient, a 14-year-old boy, presented in July 2024 with a six-month history of recurrent papules and pustules on the buttocks that persisted despite multiple prior treatments. Notably, he reported a positive family history: his father had experienced recurrent buttock lesions for many years and had undergone surgical treatment eight years previously, underscoring the genetic susceptibility component of the disease. Physical examination revealed multiple deep-seated, tender nodules and abscesses without sinus tracts, and his baseline IHS4 score was 7. Traditional Chinese medicine differentiation—chronic dry mouth, preference for cold beverages, a burning perianal sensation, dark yellow urine, a light-red tongue with thin white greasy coating, and a floating rapid pulse—once more identified heat-toxin accumulation. He received the decoction for five weeks with follow-up every two weeks. Most lesions resolved, leaving residual hyperpigmentation, crusting, and one remaining abscess, and the IHS4 score decreased from 7 to 2, a 71 percent reduction. Six months of telephone follow-up revealed no recurrence.

The formula itself is a pharmacological mosaic. Xianfang Huoming Decoction combines Lonicera japonica Thunb, Paeonia veitchii Lynch, Angelica sinensis, Angelica dahurica, Fritillaria thunbergii, Saposhnikovia divaricata, Gleditsia sinensis, Trichosanthes kirilowii, Boswellia carterii, Commiphora myrrha, Citrus reticulata, and Glycyrrhiza uralensis. In traditional Chinese medicine theory, the formula is traditionally deployed against suppurative inflammatory disorders characterized by swelling, pain, and abscess formation, operating on the principles of clearing heat and detoxifying together with regulating qi, activating blood, and resolving masses. The researchers also reviewed 27 studies on oral herbal treatment of hidradenitis suppurativa published in China, finding that 62.96 percent were single-case reports, that the perianal, anal, and perineal regions were the most frequently affected sites at 55.55 percent, and that dampness was the most common syndrome pattern at 37.04 percent, followed by heat at 33.33 percent. Therapeutically, 74.07 percent of the reviewed studies combined surgery and 62.96 percent combined antibiotics, with only one study using herbal monotherapy.

The scientific context matters here. The pathogenesis of hidradenitis suppurativa is multifactorial, involving genetic susceptibility, immune dysregulation, microbial imbalance, obesity, and smoking, which together drive follicular hyperkeratinization, follicular occlusion, and rupture, followed by persistent perifollicular inflammation and recurrent disease. Recent studies have highlighted the involvement of dysregulated innate and adaptive immune responses, with key inflammatory pathways including the activation of TNF-α, IL-1, IL-17, and IL-23 signaling, which contribute to sustained inflammation, tissue destruction, and disease progression. Systemic inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate have been investigated as potential indicators of disease activity. Current management—topical and intralesional therapies, antibiotics, retinoids, biological agents, corticosteroids, immunosuppressants, physical approaches, and surgery—is limited by insufficient topical efficacy, transient responses to local injections, antibiotic resistance with long-term use, hepatotoxicity and teratogenicity of retinoids, and the high cost of biological agents. Safe, effective, and accessible adjunctive therapies therefore remain an unmet clinical need.

However, the authors are careful to temper enthusiasm with rigorous limitations. Pain improvement was evaluated based on patients’ subjective reports rather than standardized pain assessment tools, introducing potential reporting bias. The first patient’s elevated liver enzymes could not be re-evaluated because he never returned for follow-up, limiting safety assessment of the combined approach. The small sample size, heterogeneous clinical presentations, concomitant conventional treatments, and absence of a control group prevented determination of the independent efficacy and safety of the decoction. The researchers also note that the concentration of active compounds in herbal remedies may vary according to the season of collection, intra-species variation, weather, and growing conditions, posing challenges to consistency and standardization, and that potential interactions between herbal remedies and concomitant medications such as oral antibiotics should be further investigated. Inflammatory biomarkers were not evaluated in the case series, so the biological mechanisms underlying the observed clinical improvement remain speculative.

Still, the findings add to a growing body of evidence that traditional Chinese medicine may help reduce inflammatory activity and promote lesion resolution in hidradenitis suppurativa. The work was supported by the National Natural Science Foundation of China, with ongoing projects investigating the decoction’s therapeutic effects and mechanisms via the Notch signaling pathway and the RAB31/EGF/EGFR signaling pathway—molecular avenues that could eventually explain how a centuries-old formula interacts with modern immunology. The authors conclude that prospective controlled studies using standardized clinical outcomes, safety assessments, and objective inflammatory biomarkers are warranted before the decoction can be recommended as an independent therapy. For now, Xianfang Huoming Decoction stands as a promising adjunctive option in a disease that desperately needs them—a bridge between ancient herbal wisdom and the rigorous clinical trials that will determine whether it truly belongs in the modern therapeutic arsenal.

Subject of Research: Case series evaluating Xianfang Huoming decoction as adjunctive therapy for hidradenitis suppurativa

Article Title: Clinical application of Xianfang Huoming decoction in hidradenitis suppurativa: a three-case series and literature review

Article References: Wang, Z., Wu, X., Zhu, H., Liu, K., Gao, Y., Wei, Y., Mao, Q., & Zhou, L. (2026). Clinical application of Xianfang Huoming decoction in hidradenitis suppurativa: a three-case series and literature review. Frontiers in Medicine, 13, Article 1899685. https://doi.org/10.3389/fmed.2026.1899685

Image Credits: AI Generated

DOI: 10.3389/fmed.2026.1899685

Keywords: hidradenitis suppurativa, Xianfang Huoming decoction, traditional Chinese medicine, herbal medicine, case series, IHS4 score, Hurley stage, inflammation, dermatology, heat-toxin accumulation, Frontiers in Medicine, adjunctive therapy