When spots, nets, patches, or map-like dark spots appear on the skin, flush with the skin and not raised to the touch, they are collectively referred to as skin dark spots.

This condition is called "miàn gǎn yìng" in Zhubing Yuanhou Lun; Waike Zhengzhi Quanshu refers to it as "miàn chén"; and Waike Dacheng calls it "gǎn 𪒟".

Additionally, "skin brown spots" also involve a change in skin color to a dark brown hue, but "dark spots" are deep and intense in color, while "brown spots" are lighter and more subdued, hence they are described separately.

bubble_chart Pattern Analysis

1. Liver Qi Depression︰Black patches are symmetrically distributed on the face, forehead, and both cheekbones, and may also involve the upper lip. The boundaries are clear, and the color does not fade when pressed. It may be accompanied by symptoms such as hypochondriac region distending pain, dysphoria, and irritability. The tongue is red with a white coating, and the pulse is wiry. The patches are mostly distributed around the eyes and back, and are accompanied by symptoms of liver qi depression, such as hypochondriac pain, dysphoria, and irritability. Treatment should focus on soothing the liver to relieve depression, harmonizing the nutrient qi, and dissipating ecchymosis. The recommended formula is Peripatetic Powder with modifications.
2. Static Blood︰Dark spots often occur unilaterally on the eyelid, cheek, temple, or face. The edges are lighter in color while the center is darker, and may involve the white of the eye; or appear as blue patches on the lower back or buttocks of newborns, usually without subjective symptoms. The tongue coating is thin, or there may be ecchymosis on the sides of the tongue, with a fine and slow pulse. They are mostly distributed unilaterally on the eyelid, cheek, or temple, with lighter edges and a darker center. They may also be seen in infants with insufficient qi and blood or congenital deficiency (blue-black patches on the lower back or buttocks of newborns, which mostly fade as the child grows, though some may persist, generally without affecting health and thus requiring no treatment). Treatment should focus on Orifice-Opening Blood-Activating Decoction with modifications to invigorate blood and resolve stasis, dredge meridians, and activate collaterals.
3. Spleen Deficiency with Impaired Transportation︰Dark spots appear on the cheeks, forehead, behind the ears, and forearms, as well as in the armpits, presenting in patches. Accompanied by anorexia, mental fatigue, abdominal distension and fullness, loose stools, a pale tongue with thin white coating and tooth marks on the edges, and a weak, soggy pulse. Additional symptoms include anorexia, abdominal distension and fullness, and loose stools. Treatment should focus on tonifying the spleen and replenishing qi, nourishing blood, and eliminating spots. The recommended formula is modified Returning to Spleen Decoction.
4. Kidney Yin Deficiency︰Black spots are commonly seen on the cheeks, forehead, neck, back of the hands, forearms, navel, and other areas, ranging from the size of a needle tip to that of a foxtail millet grain. They may be accompanied by symptoms such as soreness and weakness in the lower back and knees, tinnitus, dizziness, vexing heat in the chest, palms, and soles, seminal emission, premature ejaculation, and others. The tongue appears red with scant coating, and the pulse is thin and rapid. Additional manifestations may include dizziness, tinnitus, vexing heat in the chest, palms, and soles, seminal emission, and premature ejaculation. The treatment principle involves enriching yin, tonifying the kidneys, reducing fire, and eliminating spots. The recommended prescription is Modified Anemarrhena, Phelloendron and Rehmannia Pill.

bubble_chart Documentation

1. Lingshu．Five Colors: "Black appears on the forehead, as large as a thumb, and one will die suddenly without being ill."
2. Zhubing Yuanhou Lun．Volume 27: "On a person's face, there may be spots like bird's hemp or sparrow's eggs, which are the color of emetic therapy. This is caused by wind Xieke on the skin, and phlegm-fluid retention soaking in the zang-fu organs, thus causing dark spots."