Facial plaque

Understanding Facial plaque

A name note recorded rather than resolved: 黧黑斑 (lí hēi bān) is also the classical name used on the Melasma page, and this source keeps a separate page for facial plaque. Both are built and both record the overlap.

The tradition describes the face as a mirror of the Liver, Spleen and Kidneys. When they fall out of balance, Qi and Blood fail to rise and nourish the complexion, and stagnation, dampness or heat accumulates as pigment.

Liver Qi stagnation gives brown or dark brown patches on the cheeks and forehead with a diffuse patchy distribution that fluctuates with mood, plus irritability and mood swings. Qi and Blood stagnation gives dark brown, grey-brown or blackish plaques that do not shift, with painful periods with dark clots and fixed lower abdominal pain.

Spleen deficiency with dampness gives dull dusty-brown patches as if dirt is stuck to the face, with fatigue worse after eating, poor appetite, bloating and loose stools. Kidney and Liver Yin deficiency gives dull grey-brown plaques with dizziness, tinnitus, low back and knee soreness and dry eyes with blurred vision.

The Liver is usually the first to falter. Stress, frustration and anger that is never expressed hold Qi back, and Qi that will not move cannot push Blood, so the face is poorly supplied and pigment settles where the flow is slowest. A Spleen too weak to transform fluids sends dampness upward instead, and overwork or ageing drains Kidney Yin, so the deepest reserves of moisture and nourishment run low.

Colour and position carry much of the diagnosis. A practitioner reads the shade of the patch, whether it shifts, and what the tongue, pulse and menstrual history add, then treats the process behind it rather than the patch itself.

How it is assessed

The practitioner checks that the plaque is not suspicious, then assesses the pattern.

What a practitioner looks for

• Movement: plaques that fluctuate with mood suggest Liver Qi stagnation.
• Fixity: dark fixed plaques that do not shift suggest Qi and Blood stagnation.
• Digestion: dusty patches with bloating suggest Spleen deficiency with dampness.
• Red flags: irregular borders, multiple colours, or a lesion that bleeds or itches.

In Liver Qi Stagnation the patches are a brownish bronze haze over cheeks and forehead, spreading or deepening under stress, frustration or before a period. Expect irritability, frequent sighing, breast tenderness and a feeling of bloating. On the tongue, redness shows most clearly at the sides, and the pulse is wiry, like a string pulled tight.

Once the stagnation has moved from Qi into Blood, the plaques darken towards grey-brown or purplish and stop moving. Periods are painful with dark clots, the tongue body is dusky or shows purple spots, and the pulse is choppy or wiry and hesitant, reflecting blood that is stuck rather than merely slow.

Spleen Deficiency with Dampness leaves the face dusty and dull, as though a film of soil had settled on it, with chronic tiredness, a poor appetite and loose stools or bloating after eating. The tongue looks pale and puffy, with scalloped edges, and the pulse feels soft and weak. Where the root is Kidney and Liver Yin Deficiency, the patches are dark and sallow, the whole complexion looks lacklustre and aged, and dizziness, tinnitus, sore lower back and knees, dry eyes and broken sleep come with them; there the tongue is red, thin and cracked with little coating, and the pulse fine, rapid and wiry.

TCM patterns in Facial plaque

Four patterns account for most facial plaques, and the skin gives the first clue. A patch that shifts with mood, one that never moves, a dusty film sitting alongside digestive tiredness, and a dark sallow patch that arrives with backache are four pictures of the same surface. The distinction turns on whether Qi is merely stuck or Blood has congealed, and on whether the deficiency sits in the Spleen or reaches as deep as Kidney and Liver Yin. It matters clinically because the strategies differ: one pattern calls for moving, one for invigorating, one for strengthening and draining, one for enriching deep reserves. Patterns follow each other too, since long-standing Liver Qi stagnation tends to deepen into Blood stasis, and a weak Spleen can let dampness settle while Yin quietly declines. Read the signs dominating now, and let a practitioner confirm their order with tongue and pulse.

Treatment approach

How the tradition treats facial plaque, with the herbs, formulas and points used for it.

Principles

• Have any changing or irregular lesion assessed before treating pigment.
• Move Liver Qi where plaques fluctuate with mood.
• Move Blood where plaques are fixed and dark.
• Strengthen the Spleen or nourish Kidney and Liver Yin according to the deficiency, with sun protection throughout.
• The common thread is to restore the movement of Qi and Blood and to replenish whatever has been depleted, and the method divides by pattern: the Liver is soothed where patches follow stress, Blood is invigorated where they are dark and fixed, the Spleen strengthened and dampness drained where they are dull and dusty, and Kidney and Liver Yin enriched where darkening comes with age and dryness.
• Acupuncture, herbs and diet are combined, so a stress-driven patch may take Xiao Yao San with LR-3 (Taichong), a fixed one Tao Hong Si Wu Tang with SP-10 (Xuehai), and a sallow one Qi Ju Di Huang Wan with KI-3 (Taixi). Sun protection belongs to the treatment in every case.

Herbs used

Formulas

• Xiao Yao San
• Tao Hong Si Wu Tang
• Shen Ling Bai Zhu San
• Qi Ju Di Huang Wan

Acupoints

• LR-3 (Taichong)
• LI-4 (Hegu)
• SP-6 (Sanyinjiao)
• SP-10 (Xuehai)
• ST-36 (Zusanli)
• BL-20 (Pishu)
• KI-3 (Taixi)
• BL-23 (Shenshu)

What to expect

• The tradition describes change over months, not weeks.
• Pigment may lighten rather than clear, and sun protection is essential.
• A lesion that changes needs dermatological review.
• Weekly acupuncture for the first four to eight weeks, then fortnightly or monthly for maintenance, with herbs taken daily as tea or granules, is the usual plan.
• Sleep, mood and digestion often improve before the skin changes, because the skin renews on a four to six week cycle, and lightening usually begins at the edge of a patch and works inward. Topical herbal masks can support that, but the work is internal and change is measured in months.

Safety and when to get help

For anything severe, sudden or spreading quickly, read when a skin problem needs urgent care.

Cautions

• Any changing lesion needs dermatological assessment.
• Sun protection is part of treatment in both frameworks.
• Avoid unregulated lightening products.

Using this alongside conventional care

• TCM is described as complementary to conventional care: prescribed topical treatment and sun protection continue alongside herbs.
• Conventional care continues alongside: topical creams, chemical peels and oral medicines such as tranexamic acid are not disturbed by acupuncture, but both clinicians should know what is being used. Some herbs raise photosensitivity, so sun protection matters more, and Dang Gui has a mild oestrogenic effect worth mentioning in hormone-sensitive conditions. Strong Blood-moving herbs may be paused before a laser or a deep peel because of bruising, and no prescribed medicine should be stopped abruptly.

Diet and lifestyle

• Favour warm nourishing food and avoid greasy and sugary food that is said to create dampness.
• The diet supports the Spleen and avoids adding dampness or stagnation: warm cooked food, soups, congees and steamed vegetables, dark leafy greens, black sesame, goji berries and antioxidant-rich produce, with cold, raw, greasy and very spicy food, dairy, sugar and alcohol kept to a minimum. Warm water or chrysanthemum and rose tea suits most patterns. Add black sesame and goji where Yin is low, ginger and barley where dampness dominates, rose or peppermint tea where Qi is stuck, and small amounts of black fungus, hawthorn and turmeric where Blood is stagnant. Sunscreen is part of the prescription.

If you're pregnant

Facial pigment in pregnancy is common enough to carry its own name, chloasma, the mask of pregnancy. In TCM the pregnancy depletes Kidney and Liver Yin while the growing fetus presses upon the Liver channel and creates Qi stagnation, which is why patches appear. Treatment has to be cautious: Tao Ren, Hong Hua and large doses of Dang Gui move Blood and are avoided because they can threaten the pregnancy. Acupuncture is the safer route, and LR-3 (Taichong) and SP-6 (Sanyinjiao) are used with care or left out in the first trimester. Gentle measures such as rose tea and black sesame, with strict sun protection, carry much of the work.

If you're breastfeeding

Making milk continues to draw on Qi and Blood, which often deepens Spleen deficiency and Kidney Yin deficiency. Many formulas are safe, but strong Blood-moving or heat-clearing ones, Tao Hong Si Wu Tang among them, are used cautiously because their components reach the milk. Xiao Yao San is generally considered gentler, at a reduced dose. Acupuncture passes nothing to the infant and is an excellent choice, and topical masks of pearl powder or licorice can be used alongside.

If treating a child

Facial plaques are rare in children. When they appear they are usually mild and tied to Spleen deficiency with food stagnation from a poor diet or weak digestion, showing as dusty pale patches with a poor appetite, bloating and tiredness. Blood-moving herbs of any strength are never given to children; gentle digestive tonics such as Shen Ling Bai Zhu San in small age-adjusted doses may be considered, and warm cooked food with fewer cold and greasy snacks often resolves both the digestion and the discolouration. Any persistent pigmentation in a child should be seen by a doctor.

If treating an elderly patient

In older adults the patches usually reflect a decline in Kidney and Liver Yin, since reserves fall with age, so they are darker and drier and come with dizziness, tinnitus and lower back weakness. Nourishing Yin and Blood with a formula such as Qi Ju Di Huang Wan is the aim, at about two thirds of the adult dose to protect digestion. Acupuncture is well tolerated and helpful, interactions with other medication need checking, and results take longer than in younger skin.

Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.

Related conditions

Conditions that often coexist with facial plaque or share its patterns.

Evidence

Evidence is growing but mixed. Systematic reviews and meta-analyses of randomised trials suggest acupuncture can significantly reduce melasma area and severity, often outperforming placebo or topical hydroquinone. Chinese herbal formulas, particularly Xiao Yao San and Tao Hong Si Wu Tang, show promising reductions in pigmentation and improved quality of life in Chinese-language studies, though trials are often small and unblinded.

The systematic reviews and meta-analyses of randomised trials report that acupuncture reduces melasma area and severity, often by more than placebo or topical hydroquinone, and Chinese-language studies of Xiao Yao San, and of Tao Hong Si Wu Tang, report lighter patches and better quality of life. Both bodies of work are limited: samples are small, blinding is rare, most trials come from China, and English-language randomised trials are still scarce. The therapies appear safe, particularly when acupuncture and herbs are combined, but standardised protocols are still to be established.

Studies often cited

Classical record