Macules

Understanding Macules

Note the overlap in the source: this page on macules covers flat facial dark spots, and the Melasma page covers the same territory from a different angle. Both are kept because the source treats them separately.

The face is described as a mirror of Qi and Blood. When they flow smoothly the complexion is clear; dark spots arise when Qi stagnates, Blood congeals, or the skin is not being nourished.

Liver Qi stagnation gives light to dark brown patches that worsen with stress, with irritability, chest tightness and sighing. Qi and Blood stagnation gives darker fixed macules with sharp borders and painful periods with clots.

Spleen deficiency with dampness gives macules on the nose, forehead and around the mouth with a pale dusty complexion, bloating and loose stools. Kidney and Liver Yin deficiency gives irregular dark brown macules with night sweats and low back soreness, and Kidney Yang deficiency gives dull dark macules with cold limbs and night urination.

The face is read as a mirror of Qi, Blood and the organs: when flow is smooth and the organs are balanced the complexion stays clear, and dark spots appear when Qi stagnates, Blood congeals or the skin is undernourished. The Liver, Spleen and Kidneys are the systems most involved.

Liver Qi stagnation from stress or held frustration impedes Blood and produces brownish or purplish patches that worsen with emotion, and if it persists it deepens into Qi and Blood stagnation with darker fixed patches. A weak Spleen fails to make clear Qi and Blood and instead generates Dampness that clogs the channels, giving pale dusty spots around the mouth and nose with fatigue and bloating. Kidney Yin deficiency, common with age, overwork or menopause, lets a subtle deficiency heat darken the complexion, while Kidney Yang deficiency leaves a weak warming fire that congeals Blood into dull dark spots with cold limbs.

How it is assessed

The practitioner examines the macules and the constitutional picture behind them.

What a practitioner looks for

• Borders: sharp borders with fixed colour suggest stagnation; soft irregular patches suggest deficiency.
• Stress relation: patches that darken with stress suggest Liver Qi stagnation.
• Digestive signs: bloating and loose stools support Spleen deficiency with dampness.
• Red flags: a spot that changes, bleeds or itches persistently needs dermatological review.

The practitioner first reads the macules themselves, their colour, border and position, then confirms the pattern with the tongue and pulse. Brown patches that flare with stress, especially on the cheeks and forehead, point to Liver Qi stagnation, with a red tongue with a thin coat and a wiry pulse like a guitar string.

Darker, sharply bordered purplish patches point to Qi and Blood stagnation, with a dusky or purplish tongue and a deep thin or wiry pulse, often in someone with a long history of held stress. Pale dusty spots around the nose, mouth and forehead point to Spleen deficiency with Dampness, with a pale tongue with a thin greasy coat, a soft slow pulse, and questions about bloating, loose stools and tiredness after meals.

Irregular dark brown patches with hot flushes, night sweats, dizziness or tinnitus suggest Kidney and Liver Yin deficiency, common around menopause, with a red thin tongue with little coating and a deep thin pulse. Dull dark patches in a person who is always cold, with low back soreness and a pale puffy tongue, point to Kidney Yang deficiency, with a deep weak pulse; this is less common but needs warming and strengthening rather than cooling or moving.

TCM patterns in Macules

Facial macules are treated by pattern, because the same brown patches can come from several different roots. Liver Qi stagnation gives brownish patches that flare with stress and improve when the emotions settle. Qi and Blood stagnation gives darker, sharply bordered patches with fixed stabbing pain and painful periods. Spleen deficiency with Dampness gives pale dusty spots with fatigue, bloating and loose stools. Kidney and Liver Yin deficiency gives irregular patches with night sweats, dizziness and dry eyes, especially around menopause. Kidney Yang deficiency gives dull dark patches with cold limbs and low back weakness. These patterns mix, and one person may carry more than one at once, which is why the tongue and pulse matter as much as the complexion. The self-check above is a way into that differentiation, not a diagnosis.

Treatment approach

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

Principles

• Move Liver Qi where patches darken with stress.
• Move Blood and resolve stasis where macules are dark and border is sharp.
• Strengthen the Spleen and drain dampness where the complexion is sallow and digestion is loose.
• Nourish Yin or warm Yang where the pattern is constitutional, and protect from sun.
• Treatment always harmonises the organs while addressing the face locally. The common thread is to move stagnant Qi and Blood, resolve Dampness or nourish deficiency so that the face receives nourishment and pigment fades naturally, with the emphasis shifting from soothing the Liver and moving Qi, to invigorating Blood, to strengthening the Spleen, to nourishing Yin or warming Yang according to the pattern.

Herbs used

Formulas

• Jia Wei Xiao Yao San
• Xue Fu Zhu Yu Tang
• Shen Ling Bai Zhu San
• Liu Wei Di Huang Wan
• You Gui Wan

Acupoints

• LR-3 (Taichong)
• LI-4 (Hegu)
• SP-6 (Sanyinjiao)
• SP-10 (Xuehai)
• BL-17 (Geshu)
• ST-36 (Zusanli)
• SP-9 (Yinlingquan)
• BL-20 (Pishu)
• KI-3 (Taixi)
• BL-23 (Shenshu)
• DU-4 (Mingmen)
• guanyuan-ren-4

What to expect

• The tradition describes gradual improvement over months.
• Pigment change is slow and may not clear completely.
• A spot that changes, bleeds or itches needs dermatological review first.
• Change is gradual: energy, digestion or mood often improve first, visible lightening of the spots typically follows four to six weeks for excess patterns and eight to twelve weeks for deficiency patterns. Consistency with herbs and sessions matters more than any single week, and the formula is reviewed every two to four weeks as the pattern shifts.

Safety and when to get help

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

Cautions

• Any changing mole needs dermatological assessment before herbal treatment.
• Sun protection is essential during treatment.
• Pregnancy requires practitioner review before internal herbs.

Using this alongside conventional care

• TCM is described as complementary to conventional care: prescribed topical lightening treatment and sun protection continue alongside herbs.
• TCM can complement conventional dermatological treatment. Tell the practitioner about topical hydroquinone or retinoids so herbs that increase photosensitivity or irritation are avoided, and note that oral tranexamic acid combined with Blood-moving herbs such as Dang Gui and Chuan Xiong may add to circulatory effects, so the prescribing doctor should monitor for clotting risk. Both clinicians should know the full list of treatments.

Diet and lifestyle

• Favour cooked whole grains, dark leafy greens and blood-nourishing foods.
• Favour foods that nourish the Spleen and Liver, such as cooked whole grains, dark leafy greens, goji berries, black sesame and mung beans, and reduce greasy, fried and sugary food that creates Dampness and Heat. Spicy food can aggravate Liver Heat and is best minimised, warm water and gentle teas such as chrysanthemum or rose support Qi flow, and sun protection is essential because UV exposure drives melanin production whatever the pattern.

If you're pregnant

Macules often appear or worsen in pregnancy, a condition known as chloasma or the mask of pregnancy, because hormonal shifts increase melanin production and sun exposure darkens it further. The patches usually fade after delivery, so a conservative approach through pregnancy is sensible.

Strong Blood-moving and aggressive pigment-clearing herbs are avoided, and gentle Yin- and Blood-nourishing herbs are used only under professional guidance. Acupuncture, gentle topical care and strict sun protection with a hat and mineral sunscreen are the safer mainstays, and a practitioner experienced in pregnancy care should be consulted before any internal formula.

If you're breastfeeding

After childbirth Blood and Qi are often depleted, which can intensify macules rooted in deficiency patterns. Breastfeeding mothers benefit from gentle nourishing herbs that support Yin and Blood without affecting milk supply or the infant, such as Shu Di Huang, Gou Qi Zi and Shan Zhu Yu, while aggressive Qi-moving or Blood-invigorating herbs are best avoided because they may alter milk quality or quantity.

Acupuncture is commonly used during breastfeeding, although trial evidence is limited, and local facial treatments such as gentle gua sha or herbal masks can support circulation without systemic risk. Any formula should be prescribed by a practitioner who can balance the mother's needs with infant safety.

If treating a child

Macules are uncommon in children, and when they appear they are rarely the hormonally driven melasma seen in adults. A weak Spleen with Dampness or a constitutional Kidney deficiency is more likely, with paler, less defined patches.

Because children's physiology is still developing, treatment relies on gentle dietary adjustment and paediatric tuina rather than strong herbal formulas. Persistent brown patches in a child warrant thorough evaluation to rule out genetic or metabolic conditions.

If treating an elderly patient

In older adults macules almost always reflect deficiency, most often Kidney Yin or Kidney Yang deficiency, and the patches tend to be darker, duller and more stubborn. Treatment must be gentle and sustained, with lower doses around two-thirds of the adult amount and a longer timeline for visible change.

Acupuncture is an excellent choice because it avoids herb-drug interactions with the multiple medicines many older patients take. Sun protection, warm easily digested food and gentle daily movement are especially important to support dwindling reserves.

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 macules or share its patterns.

Evidence

Evidence is growing but dominated by Chinese-language studies. Systematic reviews and meta-analyses of randomised trials found that oral and topical Chinese herbal medicine significantly reduced melasma area and severity compared with placebo or hydroquinone, and acupuncture and facial cupping show promise in small trials with fewer side effects than bleaching agents. Methodological limits are common: small samples, absent blinding and short follow-up.

Studies often cited

Classical record