Hyperpigmentation in Chinese Medicine (TCM Perspective)

Hyperpigementation can look like dark spots, melasma or inflammatory marks.

In Traditional Chinese Medicine (TCM), hyperpigmentation (melasma, dark spots, post-inflammatory marks) is not viewed as a skin-only issue. It reflects an internal imbalance affecting Blood, Qi, and organ systems, especially the Liver, Spleen, and Kidneys.

Pigmentation appears when:

• Blood is not moving properly

• Heat or inflammation lingers in the skin

• Yin deficiency creates dryness and internal heat

• Dampness accumulates and obstructs circulation

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In your clinical world (especially working with hormones and women’s health), hyperpigmentation is often deeply connected to hormonal shifts and Liver constraint.

🌿 Common TCM Patterns Behind Hyperpigmentation

1️⃣ Liver Qi Stagnation → Blood Stasis

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Very common with:

• Hormonal changes (pregnancy, perimenopause, birth control)

• Stress

• PMS

  
  

Why it causes pigmentation:Stagnant Liver Qi slows Blood circulation → Blood pools → dark discoloration forms.

Signs:

• Melasma on cheeks/upper lip

• PMS, breast tenderness

• Wiry pulse

• Slightly purple tongue or sides

  
  

Treatment Strategy:

• Soothe Liver

• Move Qi

• Invigorate Blood

Foods that support the liver are anything green, cruciferous vegetables.

Taking DIM supplement could be an option as well.

Chinese Herbal Medicine: Xiao Yao San (modified)Tao Hong Si Wu Tang (if strong Blood stasis)

2️⃣ Blood Stasis (Post-Inflammatory Pigmentation)

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Common after:

• Acne

• Skin trauma

• Inflammation

  
  

Why it happens:Heat damages vessels → Blood stagnates → residual dark marks.

Signs:

• Fixed, dark, stubborn spots

• History of acne

• Darker/purple tongue body

  
  

Treatment Strategy:

• Break Blood stasis

• Clear residual Heat

• Support new Blood formation

Foods that support blood stasis are things that move blood, think turmeric, garlic, ginger or spices that are very warm in nature. Eggplant and beetroot are great blood movers.

Hong Hua Tea is one of my favourite things to drink for this issue as well.

Herbs:Tao Ren, Hong Hua, Dan Shen, Chi Shao

(Combined carefully depending on constitution), always speak with a trained herbalist or naturopath for herbs + supplements.

3️⃣ Yin Deficiency with Empty Heat

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Common in:

• Perimenopause

• Post-hysterectomy

• Chronic stress

• Overwork

  
  

Why it causes pigmentation:Yin deficiency → Internal heat rises → damages skin fluids → uneven melanin expression.

Signs:

• Dry skin

• Night sweats

• Hot flashes

• Red, peeled tongue

  
  

Treatment Strategy:

• Nourish Liver & Kidney Yin

• Clear deficient heat

• Moisten skin

Foods that support yin are yougurt, celery, watermelon, cucumber, we want things that lubricate and nourish.

Seaweed for topical skin products.

Herbal direction:Liu Wei Di Huang Wan (modified) or Zhi Bai Di Huang Wan (if more heat)

4️⃣ Spleen Qi Deficiency with Dampness

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Common in:

• Digestive weakness

• Damp accumulation

• Postpartum depletion

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Why it causes pigmentation:Poor Spleen transformation → Dampness → obstructed circulation → dull discoloration.

Signs:

• Puffy face

• Fatigue

• Loose stools

• Scalloped tongue

  
  

Treatment Strategy:

• Strengthen Spleen

• Drain Damp

• Support Blood production

Supporting the spleen means WARM foods, no smoothies no ice coffee only warm foods. It needs easy to digest foods like chicken and rice and anything YELLOW or ORANGE will support your spleen!

Herbs: Si Jun Zi Tang baseAdd Chen Pi, Fu Ling and Combine with mild Blood movers

🌿 How I Would Approach It Clinically (Integrative Plan)

Since hyperpigmentation is rarely just “skin deep,” treatment should include:

1️⃣ Regulate Hormones

Support Liver function and progesterone balance if indicated. Acupuncture is great at this.

2️⃣ Move Blood Regularly

Acupuncture 1x weekly for 3 months initially:

• plus gentle movement 3 x per week - yoga, walking, etc.

  
  
  
  

3️⃣ Nourish from Within

• Bone broth

• Goji berries

• Dark leafy greens

• Beetroot (Blood moving) or eggplant

• Avoid excessive alcohol & sugar (creates Damp-Heat)

  
  

4️⃣ Topical + Internal Combo

Internal treatment creates change. Topicals support turnover.

Topically:

Vitamin C serum can be beneficial for pigmentation and anything with seaweed will remineralize the skin especially for yin deficient skin. Book an appointment with Kelsey to support your skin health!

Kelsey Bru is a licensed acupuncturist and TCM Herbalist in the Courtenay, British Columbia. She loves working with women's health, hormones, menopause, fertility, mental health, facial rejuvenation skin care, microneedling and beyond through her online articles and at her clinic, The Remedy Room, on Cliffe Avenue, Courtenay. Call for an appointment at 250-800-7738.