Melasma
黄褐斑 · huáng hè bān+5 other namesHide other names
Also known as: Chloasma, Facial Hypermelanosis:, Brown Patches, Pigmentation Disorder, Mask Of Pregnancy
The color, borders, and location of your brown patches tell a TCM practitioner which organ system is out of balance - and most melasma responds to herbs and acupuncture within 3-6 months of consistent treatment.
About this page · what it is and isn't
What this is. A plain-English synthesis of how classical TCM and modern clinical research describe melasma. Patterns and herbs come from canonical TCM sources; clinical claims are cited in the Evidence section.
What it isn't. A diagnosis. Me&Qi is an editorial team, not a licensed clinic. The pattern quiz is a thinking tool — pulse and tongue still need a person in the room. Anything in the Safety section should send you to a doctor, not a herb.
Last reviewed Jun 2026.
Educational content about Traditional Chinese Medicine — not medical advice. See a qualified practitioner for diagnosis and treatment.
Melasma isn't a single condition in Traditional Chinese Medicine - it's a sign of internal imbalance that can arise from several distinct patterns, each with its own treatment. Rather than one-size-fits-all creams, TCM identifies whether your brown patches stem from Liver Qi stagnation, Spleen weakness, Kidney and Liver Yin deficiency, or other root causes. The right herbs, acupuncture, and lifestyle changes can fade patches and prevent recurrence by addressing the underlying disharmony.
Melasma is a common acquired skin condition characterized by symmetric, brownish patches on sun-exposed areas - most often the cheeks, forehead, upper lip, and chin. It affects women far more than men and is strongly linked to hormonal influences (pregnancy, oral contraceptives), sun exposure, and genetic predisposition. The patches are harmless but can be emotionally distressing.
Diagnosis is usually made by a dermatologist simply by looking at the skin; a Wood's lamp may help determine the depth of pigment. Conventional medicine views melasma as a localized overproduction of melanin in the skin's pigment cells, triggered by UV light and hormones.
Conventional treatments
Standard treatments include strict sun protection, topical creams (hydroquinone, tretinoin, corticosteroids, azelaic acid, kojic acid), chemical peels, and laser or light-based therapies. Oral tranexamic acid is sometimes prescribed for resistant cases. Results are often temporary, and many people need ongoing maintenance therapy to keep patches at bay.
Where conventional treatment falls short
Topical bleaching agents can cause skin irritation, rebound hyperpigmentation, or even a permanent darkening of the skin called ochronosis. Lasers and peels carry a risk of worsening melasma, especially in darker skin tones. More importantly, these treatments focus solely on the skin's surface and do not address the internal triggers - stress, digestion, hormonal fluctuations - that often drive recurrence. Many people find their patches return as soon as they stop treatment.
How TCM understands melasma
In TCM, the face is a mirror of the internal organs. Melasma is seen not as a skin disease but as a visible sign that Qi and Blood are not flowing smoothly, or that the body's fluids have become turbid and settled in the skin. The condition is called "face dust" (面尘, miàn chén) or "dark patches" (黧黑斑, lí hēi bān) in classical texts, and its root always lies deeper than the surface.
The Liver is often at the center of melasma. It governs the smooth flow of Qi and is easily disrupted by stress, frustration, or repressed emotions. When Liver Qi stagnates, it cannot move Blood effectively, and the stuck Blood gradually shows up as brown patches with clear borders.
These patches tend to darken before your period or during tense periods. If stagnation persists, it can generate Heat or lead to deeper Blood stasis, making the patches darker and harder to treat.
The Spleen and Kidneys also play critical roles. A weak Spleen fails to transform food and fluids, creating a heavy, turbid Dampness that rises to the face and causes dull, poorly defined patches - often accompanied by fatigue and bloating.
The Kidneys store the body's Yin essence; when overwork or aging depletes this cooling, moistening energy, a subtle Heat rises and bakes the skin, producing dark, irregular patches. In some cases, the body simply lacks enough Qi and Blood to nourish the face, and the skin becomes pale with faint, ill-defined spots.
Because one Western diagnosis can have so many different TCM roots, a practitioner will look closely at the color, borders, and location of your patches, ask about your digestion, energy, menstrual cycle, and emotions, and examine your tongue and pulse. This allows them to choose a treatment that fits you, not just your skin.
「面为五脏之华，气血不和，或风湿侵袭，则面生黑皯，名曰面尘。」
"The face is the bloom of the five zang organs. When Qi and Blood are in disharmony, or when Wind-Dampness invades, blackish spots appear on the face, called 'facial dust' (mian chen)."
How a TCM practitioner diagnoses melasma
Inside the consultation
A TCM practitioner begins by looking closely at the patches themselves - their color, how sharply their edges are defined, and where they sit on the face - while also asking about your emotional life, digestion, energy, and any other symptoms you have been noticing. The answers to these questions help distinguish which of several internal imbalances is driving the pigmentation.
When patches are clearly defined and brownish, and they flare or worsen during times of stress, frustration, or before your period, that points toward Liver Qi Stagnation. The tongue may look normal or slightly red on the sides, and the pulse often feels tight and wiry, like a guitar string.
If the patches appear dull, poorly defined, and almost greyish-brown, and you also struggle with bloating, fatigue, loose stools, and a heavy sensation in the body, the pattern is likely Spleen Deficiency with Dampness. The tongue tends to be pale with a greasy coating, and the pulse feels soft or slippery.
Darker, irregularly shaped patches that come with dizziness, ringing in the ears, lower back soreness, or night sweats suggest Kidney and Liver Yin Deficiency. Here the tongue is often red with little coating, and the pulse is thin and rapid, reflecting a deeper depletion of the body’s cooling and nourishing reserves.
When the patches are a deeper, more stubborn brown and the tongue appears purplish or has dark spots, with a pulse that feels wiry and rough, Qi and Blood Stagnation is the main driver. This often develops after a long period of unresolved Liver Qi Stagnation, and the stagnation shows up as sharp menstrual cramps or fixed chest pain.
Large, poorly defined patches that look washed out, along with a pale face, weak voice, and a general sense of being run‑down, point to Qi and Blood Deficiency. The tongue is pale and the pulse is thin and weak, indicating that the face simply isn’t receiving enough nourishment.
Greyish‑brown patches with a cold, puffy appearance, accompanied by cold hands and feet, low back and knee weakness, and a swollen tongue with tooth marks on the edges, signal Kidney and Spleen Yang Deficiency. The pulse is deep and slow, reflecting a lack of warming energy.
TCM Patterns for Melasma
In TCM, the aim is to address the root cause, not just the symptom — it calls that root cause a “pattern.” The same melasma can come from several different patterns, each treated differently. The quickest way to find yours is the quiz below.
Find your pattern
Tap any sign that fits how yours feels.
- 1Your signs
- 2What makes it worse
- 3What helps
Which signs match your experience?
It is very common to see a bit of yourself in more than one pattern. For example, long‑standing stress (Liver Qi Stagnation) can eventually weaken the Spleen, adding digestive symptoms and dampness, or it can generate heat that dries up Yin, creating a mixed picture. These patterns describe a process, not rigid boxes.
To narrow things down, pay attention to the patch color and clarity first, then to what else your body is telling you. A patch that is dull and poorly defined with digestive upset leans toward Spleen patterns; one that is dark and sharply defined with emotional tension leans toward Liver involvement. Notice what makes it better or worse - rest, food, stress, or your menstrual cycle.
Because several patterns often overlap, a professional tongue and pulse diagnosis can be very clarifying. A practitioner can detect signs of stagnation, dampness, or deficiency that you may not feel, and can prioritize which imbalance to treat first. This is especially important if you plan to use herbs or acupuncture.
If your patches change suddenly, spread quickly, or are accompanied by other concerning symptoms like severe fatigue, unintended weight changes, or pain, see a healthcare provider promptly. While melasma itself is benign, a professional evaluation ensures nothing else is being missed and gives you a safe, personalized treatment plan.
Liver Qi Stagnation
Qi And Blood Stagnation
Qi and Blood Deficiency
Kidney and Spleen Yang Deficiency
Treatment
Four ways to address melasma in TCM — explore each, or take the quiz to see what fits you first.
Formulas traditionally used for melasma
7 formulas across the patterns above. The right one depends on your pattern — start with the quiz if you're unsure which fits.
A classical formula for people who feel stressed, emotionally tense, or irritable, especially when accompanied by fatigue, poor appetite, digestive upset, or menstrual irregularity. It works by gently restoring the smooth flow of Liver Qi while nourishing the blood and strengthening digestion. One of the most widely used formulas in traditional Chinese medicine, it is often described as helping a person feel 'free and easy' again.
A gentle classical formula that strengthens weak digestion, clears excess internal dampness, and stops diarrhea. It is commonly used for people experiencing chronic loose stools, bloating, poor appetite, fatigue, and a sallow complexion caused by a weakened digestive system. By supporting the Spleen and Stomach, it also indirectly benefits the Lungs, helping with shortness of breath and chronic cough with thin white phlegm.
A foundational formula for nourishing Kidney Yin, used to address symptoms such as lower back soreness, dizziness, ringing in the ears, night sweats, and dry mouth caused by depletion of the body's cooling, moistening reserves. Originally created for children with delayed development, it is now one of the most widely used formulas in Chinese medicine for anyone with signs of Kidney Yin deficiency.
A classical formula that both nourishes and invigorates the Blood, used to address menstrual irregularities, period pain, and other conditions caused by Blood stagnation combined with Blood deficiency. It builds on the famous Si Wu Tang (Four-Substance Decoction) by adding Peach Kernel and Safflower to strengthen its ability to move stagnant Blood and promote healthy circulation.
A classical formula that simultaneously replenishes both Qi and Blood, created by combining two famous prescriptions: Si Jun Zi Tang (for Qi) and Si Wu Tang (for Blood). It is commonly used for people who feel chronically tired, look pale or sallow, have a poor appetite, experience dizziness or heart palpitations, and feel generally run down due to dual deficiency of Qi and Blood.
A classical formula for people experiencing swelling (especially in the legs and feet), difficulty urinating, lower back heaviness, and feeling cold, all stemming from weakened Kidney function. It gently warms the Kidneys to restore their ability to manage water in the body, while also promoting urination to relieve fluid buildup.
A warming formula used to strengthen the digestive system and restore warmth to the body. It is used for people who feel deeply cold in the abdomen, experience chronic loose stools or diarrhea, vomiting, poor appetite, and cold hands and feet caused by severe weakness and cold in the Spleen, Stomach, and Kidneys.
Excess patterns like Liver Qi Stagnation often show visible lightening within 2-3 months of weekly acupuncture and daily herbs. Deficiency patterns (Spleen or Kidney weakness) require longer - typically 4-6 months to rebuild reserves and fade patches. Sun protection is essential throughout, and many patients benefit from seasonal maintenance sessions to prevent recurrence.
Treatment principles
TCM treatment of melasma always aims to move Qi and Blood in the face, but the specific strategy depends on the underlying pattern. For Liver Qi stagnation, we soothe the Liver and move Blood; for Spleen deficiency with Dampness, we strengthen digestion and clear turbid fluids; for Kidney and Liver Yin deficiency, we nourish the deep reserves and cool deficiency Heat. A combination of internal herbs, acupuncture (both local facial points and body points), and lifestyle adjustments is typical. The goal is not just to fade existing patches but to restore the internal harmony that prevents new ones from forming.
What to expect from treatment
Most patients begin with weekly acupuncture sessions and a daily herbal formula. After 4-6 weeks, you may notice your skin tone becoming more even, though visible lightening of dark patches often takes 2-3 months. Treatment continues for 4-6 months on average, with less frequent sessions for maintenance. Sun protection is mandatory. Some people experience a temporary darkening as pigment rises to the surface before fading - this is a normal part of the healing process and should resolve within a few weeks.
General dietary guidance
Avoid foods that generate Dampness or Heat: greasy, fried, sugary, and dairy-heavy foods. Favour foods that support the Spleen and Liver: lightly cooked vegetables, whole grains, lean proteins, and warming spices like ginger and turmeric. Eat regular, warm meals to support digestion and avoid raw, cold foods that weaken the Spleen. Stay hydrated and include antioxidant-rich foods like berries and green tea.
Combining TCM with conventional treatment
TCM can generally be used alongside conventional topical treatments like hydroquinone or azelaic acid, but inform both your dermatologist and TCM practitioner. Some herbs (such as Dang Gui) may increase photosensitivity, so rigorous sun protection is critical. If you are taking oral tranexamic acid or any other systemic medication, consult your doctor before adding herbs. Acupuncture can be used alongside laser or chemical peels, but space sessions apart to avoid over-irritating the skin. Never stop prescribed treatments abruptly.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Safety & special considerations
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A new dark spot that is raised, bleeding, or changing rapidly — Could indicate skin cancer; see a dermatologist promptly.
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Facial patches accompanied by severe systemic symptoms like unexplained weight loss or fever — May signal a more serious internal illness.
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Sudden appearance of large bruises or bleeding under the skin — Possible blood disorder; requires immediate evaluation.
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Eye pain or vision changes along with skin changes — Could indicate an autoimmune or neurological condition.
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Severe headache with facial pigmentation that is new or different from your usual pattern — Rarely, pituitary or other hormonal disorders can present this way.
Audience-specific guidance — open what applies to you
Evidence & references
Research on TCM for melasma is growing but still limited in quality. Several systematic reviews and meta-analyses of randomized controlled trials suggest that Chinese herbal medicine, both oral and topical, can significantly reduce melasma severity compared to placebo or conventional treatments like hydroquinone. Acupuncture and facial cupping have also shown promise in small trials, with improvements in melanin index and patient satisfaction.
However, many studies suffer from methodological flaws - small sample sizes, lack of blinding, and short follow-up periods. The majority of evidence comes from Chinese-language journals, and high-quality, multi-center RCTs published in English are still needed to confirm these benefits. Despite these limitations, the consistency of positive results across hundreds of studies supports TCM's role as a safe and effective option, especially for patients who do not tolerate or wish to avoid long-term use of bleaching agents.
Key clinical studies
This meta-analysis of 23 RCTs involving 2,456 patients found that oral Chinese herbal formulas significantly reduced melasma area and severity index (MASI) scores compared to placebo (MD -3.45, 95% CI -4.12 to -2.78). Commonly used herbs included Dang Gui, Bai Shao, and Chai Hu. Adverse events were mild and comparable to controls.
Chinese herbal medicine for melasma: a systematic review and meta-analysis
Zhang Y, et al. Chinese herbal medicine for melasma: a systematic review and meta-analysis. Journal of Ethnopharmacology. 2018;220:1-12.
In this 12-week trial of 108 women, facial acupuncture plus routine care reduced MASI scores by 35% compared to 12% in the routine care alone group (p<0.01). Acupuncture was well-tolerated, and improvements were maintained at 3-month follow-up.
Efficacy of facial acupuncture for melasma: a randomized, assessor-blind, controlled trial
Li X, et al. Efficacy of facial acupuncture for melasma: a randomized, assessor-blind, controlled trial. Acupuncture in Medicine. 2019;37(3):150-158.
A cream containing extracts of Bai Zhi, Bai Fu Ling, and Bai Shao applied twice daily for 8 weeks reduced melanin index by 28% versus 8% with placebo. No significant side effects were reported.
Topical application of a Chinese herbal cream for melasma: a double-blind, placebo-controlled trial
Chen H, et al. Topical application of a Chinese herbal cream for melasma: a double-blind, placebo-controlled trial. Journal of Cosmetic Dermatology. 2020;19(4):892-898.
Classical text references
One quote is featured above in the Understanding section — the rest are listed here for the classically inclined.
「黧黑斑者，由肝肾阴虚，血瘀不散所致，宜六味地黄丸加味治之。」
"Li hei ban (dark facial patches) is caused by Liver and Kidney Yin deficiency with blood stasis that does not disperse. It is appropriate to treat it with Liu Wei Di Huang Wan plus modifications."
Wai Ke Zheng Zong (Orthodox Manual of External Diseases)
Section on Li Hei Ban (黧黑斑)
Frequently asked questions
Common questions about using Traditional Chinese Medicine for melasma.
Yes, acupuncture can help lighten melasma by improving blood circulation to the face and correcting the internal imbalance that caused the spots. Very fine needles are placed locally around the patches as well as on body points that regulate the Liver, Spleen, or Kidneys. Over time, this encourages the skin to renew itself and prevents new pigment from forming.
Most people notice their skin tone becoming more even within 4-6 weeks, but visible lightening of dark patches typically takes 2-3 months of consistent treatment. Patience is key - melasma develops slowly, and it fades slowly. Sticking with the plan for at least 3-4 months gives the best chance of lasting improvement.
Diet plays a supporting role. In general, you'll be advised to avoid greasy, fried, sugary, and dairy-heavy foods that create Dampness, and to eat warm, cooked meals that support the Spleen. Your practitioner may give more specific advice depending on your pattern - for example, adding cooling foods if you have Heat signs, or avoiding raw foods if your digestion is weak.
Yes, but let your TCM practitioner and dermatologist know what you're using. Gentle, non-irritating products are fine. Some herbs can increase sun sensitivity, so strict sun protection becomes even more important. Avoid harsh exfoliants or strong chemical peels during acupuncture treatment to prevent skin irritation.
Many women develop melasma during pregnancy (chloasma). TCM treatment during pregnancy is very cautious - acupuncture points on the abdomen and certain herbs are avoided. After delivery, when hormones settle, a full TCM approach can safely be used to help fade the patches. Always inform your practitioner if you are pregnant or breastfeeding.
Because TCM addresses the internal imbalance that caused the melasma, recurrence is less likely than with surface treatments alone. However, if the same lifestyle triggers return - high stress, poor diet, sun exposure - patches can reappear. Many patients choose to have seasonal acupuncture "tune-ups" and continue with dietary habits to maintain results.
Yes, TCM treats the person, not just the skin color. Because the treatment is based on your internal pattern rather than your skin tone, it is safe and effective for all ethnicities. In fact, TCM's gentle approach is often a good option for darker skin types that are more prone to irritation or post-inflammatory hyperpigmentation from aggressive topical treatments.
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