bubble_chart Concept

Skin brown spots refer to the appearance of dot-like or patchy brown spots on the skin, which do not protrude above the epidermis and are not palpable.

This condition is referred to as "chloasma" in Waike Zhengzong; Yizong Jinjian calls it "黧黑皯黯", and later generations have also referred to it as "yellow-brown spots", "liver spots", "pregnancy spots", and "butterfly spots".

Women may also develop brown spots on their faces during pregnancy, which usually fade on their own after childbirth and are not considered pathological.

bubble_chart Pattern Analysis

1. Liver Qi Depression︰The skin exhibits light brown or dark brown speckled or patchy spots with clear boundaries and irregular edges, commonly seen around the face, eyes, and nose. Accompanied by distending pain in the hypochondrium, dysphoria, irritability, belching, poor appetite, thin yellow tongue coating, and wiry-rapid pulse. It is often caused by emotional depression, liver failing to regulate free flow, qi depression transforming into fire, which ascends to attack the head and face, leading to obstruction of nutrient qi and resulting in brown spots. The liver opens into the eyes, hence the spots are more prominent around the eyes, accompanied by symptoms of liver qi stagnation such as hypochondriac pain, dysphoria, belching, and wiry pulse. Treatment should focus on soothing the liver and regulating qi, relieving depression and draining fire. The recommended formulas are Peony and Gardenia Peripatetic Powder or Bupleurum Liver-Soothing Powder. If there is up-flaming of liver fire with darker brown spots, headache, and bitter taste in the mouth, the treatment should aim to clear the liver and drain fire, using Gentian Liver-Draining Decoction with modifications.
2. Dampness-heat︰Brown spots and patches are seen on the forehead, face, lips, and nose, with indistinct boundaries, gradually deepening in color from the edges toward the center. Accompanied by heavy body, chest tightness, thirst without desire to drink, yellow and greasy tongue coating, and slippery and rapid pulse. Often caused by dietary irregularities, excessive consumption of greasy foods, alcohol, and spicy or roasted products, leading to spleen and stomach impairment, dampness-heat obstruction in the middle burner, heat retention due to block of dampness, which fumigates the head and face, resulting in brown spots. Brown spots often spread from the eye area to the lips and nose, gradually deepening in color, and may also appear on the forehead. Treatment should focus on clearing resolving dampness and heat, unblocking qi movement. The recommended formula is Sweet Dew Detoxicating Pill with modifications.
3. Yin Deficiency︰Brown spots are commonly seen on the nose, forehead, and cheeks, appearing as light or dark brown dots or patches of varying sizes. The borders are clear but irregular. Accompanied by dizziness, tinnitus, vexing heat in the chest, palms, and soles, palpitations, insomnia, soreness in the lower back and weak legs, a red tongue with scant coating, and a thin, rapid pulse. These spots often arise from excessive worry, overthinking, or unrestrained sexual activity, leading to heart-kidney yin deficiency and deficiency fire flaming upward, which disturbs the nutrient qi, resulting in brown spots. The spots are typically found on the nose, forehead, and cheeks, with a lighter brown hue. Additional symptoms include soreness in the lower back and weak legs, dizziness, tinnitus, vexing heat in the chest, palms, and soles, a red tongue with scant coating, and a thin, rapid pulse—signs of yin deficiency with effulgent fire. Treatment should focus on nourishing yin and reducing fire. For cases dominated by kidney yin deficiency, the recommended formula is Modified Anemarrhena, Phelloendron and Rehmannia Pill; for cases dominated by heart yin deficiency, Modified Coptis and Ass Hide Glue Decoction is used with adjustments.

The condition of skin brown spots is clinically characterized mainly by heat signs, but there is a distinction between deficiency and excess. Yin deficiency with effulgent fire pertains to deficient fire; liver depression qi stagnation transforming into fire and dampness-heat internal accumulation both pertain to excess fire. Its symptoms and signs are related to the liver, spleen, heart, and kidneys, and careful differentiation is necessary.

bubble_chart Documentation

1. Waike Zhengzong．"Chloasma in Women": "Chloasma is caused by water deficiency failing to control fire, and blood weakness failing to nourish the flesh, leading to fire dryness accumulation forming black spots, with a withered and dull color..."
2. Yizong Jinjian．Face: "This condition is also known as chloasma. Initially, the color is like dust and dirt, over time it becomes as black as coal, withered and dull, varying in size, small ones like foxtail millet grains or red beans, large ones like lotus seeds, or they may be long, slanted, or round, level with the skin. It is caused by worry and depression, blood weakness failing to nourish, and fire dryness accumulation stagnating on the face, commonly seen in women."