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The Treatment of Chloasma In Traditional Chinese Medicine

Huang Wei Ling

Chloasma is a condition in which dark patches appear on the skin, most commonly on the cheeks, bridge of the nose, forehead, upper lip, and chin – areas of the face that receive the most sun exposure. In Traditional Chinese Medicine (TCM) the causes of the disease could be liver-Qi stagnation, spleendeficiency, kidney-Yin-deficiency and kidney-Yang- insufficiency. Purpose: The purpose of this study is to demonstrate that to successfully treat chloasma you need to look for the roots of the problems, not only the symptom.Over two case reports, the first being a 42-year- old woman who sought Acupuncture treatment for chronic headache and had the doctor notice the skin stains disseminated on her face, especially in the cheeks area. The second case, a 48-year-old man with constant knee pain was on Acupuncture treatment, and at his physical examination, there was found several dark patches on his face. Both patients were diagnosed with energy imbalance (Yin, Yang, Qi and Blood) and were treated with Acupuncture sessions associated with Chinese dietary counseling. Results: Both patients had a significant improvement of the chloasma patches, even thought that wasn’t the main cause of complaint. This overall recovery was achieved with the treatment of the patient in a holistic aspect, because when the energy imbalance that is causing problems is cared for, all the physical and/or emotional symptoms of one or several medical specialties improve at the same time. The treatment of chloasma in TCM has a different point of view from Western medicine, by treating deeply the root cause of the problem in its energy level. Each patient has their own imbalance and the treatment must be individualized to have successful results. Liver-qi stagnation This type of chloasma is mainly caused by dysfunction of the liver, characterized by low emotion, depression and vexation, overabundant liver-fire, and stagnation of qi. The chloasma tends to be brownish or red- brownish in color. The accompanying symptoms are usually distending and painful sensation in the chest and hypochondrium, and irregular menstruation, with the plaque becoming darker before the menstruation. The patient would have white tongue coating, and bitter taste in the mouth. The principle of treatment for this type should be mainly regulating the qi flow, and promoting blood circulation to remove blood stasis. Spleen-deficiency This type of chloasma is mainly due to overwork and irregular food intake leading to deficiency of the spleen and interior retention of water-damp, resulting in obstructed qi flow by dampness, with failure of clear qi in ascending and turbid qi in descending, which goes upward to form the plaque. Usually, this type of chloasma is in a yellow-brownish color, mostly appearing in the zygomatic and forehead areas. The main symptoms would be poor appetite, general weakness, light-colored menses in the late stage of the period, pale tongue with white or sticky coating, and deep-weak pulse. The principle of treatment for this type is mainly reinforcing the function of the spleen to remove dampness. Kidney-yin- deficiency The causative factors for this type of chloasma are mainly overwork, which affects the kidney; or indulgence in sexual activity, which makes consumption of the essential-qi, leading to loss of kidney-yin and upward rising of deficient fire to damage the skin and form chloasma. Usually, this  type of chloasma would have the plaque in strong brownish or dark brownish color, and in butterfly-like shape, thus, is also called butterfly plaque. The patient would often feel soreness and weakness of the waist and knee joints, dizziness and blurred vision, tinnitus and dry eyes, and vexation and dry hotness. Female patients of this type would have preceded menstrual cycle, with dull-red menses; and red tongue with little coating. The principle of treatment for this type should be nourishing yin and lowering down fire, and removing blood stasis to eliminate plaque. Kidney-yang- insufficiency The main causative factor of this type is frequent sexual activity, which injures the kidney, or prolonged illness lack of nourishment and care, which causes consumption and weakness of yang-qi and interior  formation of cold qi, which fails to warm qi and blood resulting in blood stasis and facial pigmentation. This kind of chloasma is often marked by grey-black color, butterfly or map-like pigmentation in the zygomatic or cheek areas. It is often accompanied with soreness and pain in the waist and knee joints; cold hands and feet; profuse clear urine;  delayed menstrual cycle, with dark menses and clots; pale tongue with white coating; and deep-slow pulse. The treating principle for this type should be warming yang to tonify the kidney. For this patient, the chloasma was mainly due to liver stagnation and spleen-deficiency. The liver stagnation caused unsmooth circulation of qi and blood, and the spleen-deficiency caused water-damp not being transported but flowing into the facial part to form chloasma. Her main problem was dysfunction of the liver and spleen, which was manifested by the symptoms of quick temper, abdominal distention and loose stool. I wonder whether my answer can satisfy you or not? If you don’t have any other questions, please tell me your TCM principle of treatment and point selection. Dr. Zhang: Based on the differentiation of dysfunction of the liver and spleen, I think the principle of treatment should be soothing the liver and strengthening the spleen, and promoting the Journal of Traditional Chinese Medicine 2008; 28(4): 305-307 307 circulation of qi and blood. The prescription: Neiguan (PC 6), Shenmen (HT 7), Hegu (LI 4), Xuehai (SP 10), Zusanli (ST 36), Sanyinjiao (SP 6), and Taichong (LR 3). The analysis: Neiguan (PC 6) can soothe the heart and calm the mind, and when combined with Shenmen (HT 7), it can enhance the function of tranquilization. Hegu (LI 4) has the effect of regulating qi and blood, and when combined with Taichong (LR 3), it can regulate the liver-qi and balance yin and yang. Xuehai (SP10) can activate qi flow and promote circulation of blood to remove blood stasis. Zusanli (ST 36) can regulate and tonify the spleen and stomach, and strengthen vital-qi, and when combined with Sanyinjiao (SP 6), it can enhance the function of strengthening the spleen and regulating qi flow. This combination of points may pacify the liver and strengthen the spleen, and regulate qi and blood circulation. Dr. Li: I suggest that auricular points can be added to improve the therapeutic effect. The points can be Liver, Spleen, Kidney, Ear-Shenmen, Subcortex, Endocrine, and Cheek. Dr. Wang: May I ask you Prof. Hu whether we can select facial points for treating chloasma? Prof. Hu: Based on the principle and methods of treatment you give, I’d like to state my views. Dr. Zhang has put forward very good treating principle and point prescription. The auriculo-acupuncture treatment Dr. Li added can enhance the therapeutic effect. I suggest that the auricular point Lung be added to the auricular prescription since the lung dominates the skin and hair. Chloasma is a pathogenic change of the skin, to which the auricular point Lung is indicated. Dr. Wang’s question is very good, which is about how to deal with the local area of chloasma. For this patient, local points on the face can be selected, such as Sibai (ST 2), Quanliao (SI 18), Dicang (ST 4) and Jiache (ST 6). Method of treatment: The transverse penetrating method is used. The filiform needle is used to puncture, with the needle tip and skin surface forming an angle of 15°, along the four margins of the chloasma toward the center of the affected area. TREATMENT AND RESULTS The patient received both body and auricular acupuncture with the above-mentioned method of treatment. For auricular points, they were punctured first, and then embedded with ear seeds. For body acupuncture, the needles were retained for 30 min. But for the first 5