Melasma is a kind of acquired facial pigment metabolism abnormal skin disease, which occurs in young and middle-aged women, manifesting as yellowish brown or light brown skin pigmentation changes on the face, symmetrically distributed on the forehead, eyebrows, cheeks, nose, upper lip, etc., with irregular shape and no conscious symptoms. The clinical treatment mostly starts from the three organs of liver, spleen and kidney, and the mechanism of blood stasis is used throughout the treatment, so as to achieve a harmonious internal yin and yang, and a smooth internal environment for the operation of qi and blood, so that the facial color can be glorious and sallow. Since Chinese medicine requires a long period of internal consumption of Chinese medicine, generally three months is a course of treatment, so it is easier for patients to accept the treatment with cream formula during the treatment period, especially in winter, because the mild character of cream formula takes into account the comprehensive prescription, and it is convenient to take the medicine, so patients can adhere to the medicine and get better results. After analyzing the characteristics of clinical melasma patients and the etiology and pathogenesis of the disease, and summarizing the feedback from the patients with cream prescriptions in recent years, I divided the patients with melasma into 4 categories for evidence-based treatment, and used the corresponding cream formula excipients, and took each material into cream for 90 days. Summarize the experience as follows.
I. Nourishing the liver and kidney as the outline, supplemented with blood invigorating and qi tonifying medicine
The majority of clinical people aged 40 to 50 years old, manifesting as dark brown spots on the face, dry skin, mostly accompanied by poor spirit, dizziness, body win thin, etc. Women mostly see menstrual fluid less dull color, and a small amount of blood clots, light tongue with thin coating and thin pulse.
The main formula is: 600 grams of raw and ripe earth, 450 grams of mulberry, 600 grams of mulberry, 300 grams of shouwu, 400 grams of dry lotus grass, 500 grams of dogwood, 300 grams of walnut, 400 grams of cuscuta, 400 grams of motherwort, 500 grams of angelica, 500 grams of chicken blood vine, 300 grams of live blood vine, 300 grams of dandruff, 600 grams of Chuanxiong, 400 grams of moxibustion astragalus, 200 grams of heliotrope, 400 grams of white atractylodes, 400 grams of white lentil, 200 grams of white lentil, 400 grams of white lentil, 400 grams of white lentil. Atractylodes macrocephala 400 g, white lentil 400 g, tortoise shell gum 100 g, roasted licorice 200 g, etc. In addition to the liver and kidney tonic Radix Rehmanniae Praeparata, Radix et Rhizoma Mulberry, Radix et Rhizoma Shou Wu, Radix et Rhizoma Drynariae, Cornu Cervi Pantotrichum, Walnut, Semen Cuscutae, and Radix et Rhizoma Yi, the formula also includes the blood invigorating and qi tonic Radix Angelicae Sinensis, Radix et Rhizoma Chicken Blood, Radix et Rhizoma Blood, Dang Pi, Rhizoma Chuanxiong, Rhizoma Acanthopanax, and Radix Aconiti, as well as the spleen invigorating and qi tonic Radix Astragali, Rhizoma Atractylodis Macrocephalae, and Radix Glycyrrhiza Uralensis to harmonize the medicines [1]. This formula is used to restore the body’s normal yin and yang harmonizing function. This kind of cream is mostly made with honey.
According to the different symptoms of each individual and the deficiency of yin and yang, the prescription is adjusted appropriately, such as adding Chai Hu, Yu Jin, and Chen Pi for liver depression, and adding Nightshade, Sour Jujube or Cypress Seed for poor sleep.
In connection with modern medical research, this type of patients should pay attention to whether they have tuberculosis, thyroid disease, etc. Women in the treatment process, the patient’s gynecological conditions need to do the necessary inquiries and examinations, appropriate with the appropriate drug regimen.
Second, to clear the liver and depression as the main method, discretionary use of qi-transferring and blood-activating drugs.
Patients aged 30~45 years old are the majority of the patients, and their manifestations are mostly dark black spots on the face with a large area. Patients are usually short-tempered, with chest distension and pain, women have breast distension and pain during menstruation, and they prefer to switch to a variety of powder-covered cosmetics, male patients are alcoholics, etc. The patient’s tongue is red or dark, with a thin yellow coating and a stringent pulse.
Most of these patients are suffering from irregular life, stressful work, worries and irritations, and unrestrained emotions, so that the liver is out of control, the qi and blood are stagnant, and the skin of the face loses the normal glory and moistening needed and becomes dark spots. Therefore, we propose to de-stress the liver and activate blood circulation to remove blood stasis. The main formula is as follows: Chai Hu 900g, Huang Cen 500g, Yu Jin 400g, Xiang Shen 250g, Citrus aurantium 300g, Rose Flower 200g, Chicken Blood Vine 400g, Blood Vine 500g, Angelica Sinensis 500g, Chuanxiong 500g, Shou Wu Vine 500g, Danshen 450g, Xia Ku Cao 500g, Yi Mu Cao 500g, Atractylodes Macrocephalae 300g, Poria 400g, White Lentil 400 grams, etc. The formula is based on Chai Hu, Huang Cen, Yu Jin, Xiang Shen, Citrus aurantium, and Rose Flower to clear liver stagnation, and is complemented by the blood activating and stagnation dispersing herbs Chicken Blood Vine, Blood Vine, Angelica sinensis, Chuanxiong, Shou Wu Vine, Dan Shen, Xia Ku Cao, and Motherwort, and focuses on regulating the spleen and stomach with Bai Zhu, Fu Ling, and Bai Ban Dou [1]. The combination of all the medicines makes the stagnant qi flow smoothly, so that qi and blood can moisten the skin around the body, and the dark spots on the face of Lai gradually recede. This type of formula is mostly used to collect the paste with icing sugar.
According to each person’s condition, it is appropriate to add cooked rhubarb for constipation, and a small amount of raw rhubarb for severe cases. For those who have poor sleep, add ling magnet, nightshade, sour date, etc.
For this type of common pathogenic factors, patients should pay attention to regulate their own life patterns, with a positive attitude to face life, learning and family social problems, correct some bad habits in life, to achieve health from the mood, life habits, in order to achieve the purpose of regulating themselves at all times. Long-term use of contraceptives may also lead to disease, so give appropriate guidance to change the best way to contraception.
Third, the main medicine is to strengthen the spleen and remove dampness, supplemented by qi-boosting medicine.
Patients of this type are of all ages and show light facial pigmentation with a large and diffuse area, sometimes light and sometimes heavy. The patient is weak with little food, often has loose stools, has a pale complexion, is late in menstruation or has a small amount of pale color, is cold and uncomfortable at the end of the extremities in winter, has a light, fatty tongue with white greasy coating and a moist pulse.
Due to the patient’s poor endowment, poor diet, fatigue, cold and dampness, the spleen Yang, which presides over the back of the day, is fragile and not well cared for, so that the spleen’s lifting and clearing functions are dysfunctional and dampness stagnates, blocking the meridians and causing the normal operation of Qi and blood, and the face is not moistened and spotted. Therefore, the main treatment is to strengthen the spleen, relieve dampness and revitalize the spleen and Yang by removing stagnation. The medicine used is as follows: 600 grams of prince’s ginseng, 500 grams of party ginseng, 600 grams of atractylodes, 500 grams of white lentils, 500 grams of poria, 500 grams of moxibustion astragalus, 600 grams of lotus seeds, 250 grams of angelica, 600 grams of chuanxiong, 500 grams of chicken blood vine, 400 grams of live blood vine, 300 grams of rose, 300 grams of peony, 250 grams of sand, 200 grams of thick park, 500 grams of taro meat, 600 grams of cinnamon , 200 grams of cinnamon, 200 grams of roasted grass, etc. The formula is given on the basis of strengthening the spleen and nourishing the qi, prince ginseng, dang ginseng, atractylodes, white lentils, poria, moxibustion astragalus, lotus seeds, supplemented with the qi-boosting and invigorating spleen and yang-supplementing medicine sandy nuts, thick park, cinnamon branch, yam meat, cinnamon to inspire the right qi, supplemented with blood invigorating and nourishing medicine angelica, Chuanxiong, chicken blood vine, live blood vine, rose hips, white peony to harmonize the qi and blood in time [1], and roasted herbs to harmonize the medicines, so that the qi restores its main stimulus to regulate the physiological functions of the internal organs. Physiological functions, clear qi upward, dispel turbidity and glory face. This kind of paste is mostly collected with syrup.
Patients who sleep poorly, can be appropriate to add Wu Wei Zi, nightshade, Fu Shen, etc., such as liver depression, as appropriate, add Chai Hu, Yu Jin, Chen Pi, etc., female patients if the menstrual period when the abdomen cold pain, can be appropriate to give with the heavenly snow lotus plus paste formula used.
For patients with spleen deficiency causing chloasma, they should pay attention to regular life, eat less cold food in summer and avoid cold and dampness in winter, and dietary supplements are the best way to maintain health for these patients. The best dietary supplements are red dates, lentils, poria, coix seed rice, ginger and so on.
Fourth, the first step is to eliminate blood stasis with the camp, and to regulate the beginning and end with qi and blood medicines.
Patients with this type are between 35 and 45 years old and are closely related to sunlight exposure and irregular life. Patients show dark facial pigmentation, female patients usually have blood clots in menstruation, dysmenorrhea is obvious, the tongue is dark and even has purple spots and purple spots, the lips are purple and dark, the moss is thin and the pulse is stringent. According to Chinese medicine, patients usually work under the sun and the sun causes fire and dryness to stagnate on the face and cannot be dissipated in time, or overwork or blood weakness makes blood stasis and water deficiency and kidney color exposed to the outside of the disease. Blood stasis is the most obvious symptom of blood stasis in the treatment of melasma, so the treatment should be based on the medicine of harmonizing the camp and dispelling blood stasis, moving Qi and activating Blood. The medicine used is as follows: Radix Angelicae Sinensis 500g, Peach kernel 500g, Safflower 300g, Red spoon 400g, Rhizoma Chuanxiong 800g, Radix Chrysanthemum 400g, Motherwort 500g, Rose bush 300g, Zeilan 200g, Ground turtle worm 200g, Roasted Astragalus 400g, Prince’s ginseng 500g, Mulberry 300g, Cuscuta 300g, Dulcus 300g, Lady’s chasteberry 300g, Dry lotus grass 300g, Radix Rehmanniae 300g. 300 grams, rehmanniae 300 grams, etc. The formula uses a large number of blood nourishing and invigorating herbs angelica, peach kernel, safflower, red spoon, Chuanxiong, henbane, motherwort, rosebuds, zelenium and blood-breaking herbs ground turtle worms, etc., so that there is timely replenishment of new life in the removal of blood stasis, so that the stasis does not go to blood loss, loss and more stasis; roasted astragalus and prince’s ginseng are used to nourish qi and strengthen the spleen and stomach, and under the internal environment of qi and blood reconciliation, mulberry seeds, codonopsis, duzhong, lady’s mantle, dry lotus grass and rehmannia [1] are added By nourishing Yin and tonifying the kidneys, the face will be better cared for, and it is better to collect the paste with syrup.
Patients of this type should pay particular attention to the regularity of life in the usual regimen due to the obvious symptoms of blood stasis, do more aerobic exercises appropriately, and pay attention to avoid strong sunlight exposure at work. If female patients have cold pain during menstruation in the lower abdomen, they can add appropriate amount of heavenly snow lotus. Those who have poor sleep can add appropriate amount of sour date palm, nightshade vine and acacia flower.
Experience: Chinese medicine treatment for chloasma focuses on regulating the internal environment and removing dark spots by removing blood stasis, tonifying deficiency and regulating qi, and if clinical evidence can be well identified and guidance on prevention and emphasis on precautions can be achieved.
Modern medicine has done a lot of work in understanding the relationship between female hormones and melasma, the effect of sunlight on facial pigmentation, oxygen free radicals and the connection between genetics and cosmetics and melasma, which is also of great help to the treatment of Chinese medicine in this area. A lot of clinical as well as laboratory studies have also been done in recent years on TCM evidence-based treatment of melasma. Some research articles have explored the relationship between female melasma and superoxide dismutase (SOD), malondialdehyde (MDA), a product of lipid peroxidation, and the sex hormones estradiol (E2), follicular estrogen (FSH), luteinizing hormone (LH), gaudone (T), and progesterone (P), and then observed their relationship with melasma The correlation between them and different TCM clinical typologies was observed, and the efficacy of TCM herbs was confirmed. For the pharmacological study of single herbal medicine to remove pigmentation, it has been reported that peony bark increases tyrosinase activity, poring decreases tyrosinase activity, and Chinese herbal medicine such as Atractylodes macrocephala decreases tyrosine.
At present, more and more treatment methods combining Chinese and Western medicine give good results to most patients. In the treatment of TCM, we must put prevention and regulation in an important position so as to achieve the best near and long term results.