Dermatology
Dermatology
Melasma (chloasma in older literature) and post-inflammatory hyperpigmentation are persistent darkening of the face and neck. Conventional dermatology attributes melasma to melanin overproduction triggered by sun exposure, hormonal changes (pregnancy, oral contraceptives, HRT), and genetic predisposition—and then offers hydroquinone, tretinoin, lasers, and sunscreen as frontline therapy. Those approaches suppress melanin chemistry or ablate skin layers but do not address why your Liver and constitutional terrain invited the pigment to deposit in the first place.
In classical Chinese medicine, melasma is a surface manifestation of Liver Qi stagnation converting to Liver Fire, with Fire damaging the Connecting Vessels (络脉, luò mài) that govern facial color and pigmentation. Blood stasis in the skin surface traps melanin locally. Kidney deficiency (肾虚, shèn xū)—especially Kidney Yin exhaustion—forms the constitutional soil. Sun exposure is the trigger, not the cause; your constitutional predisposition and Liver disharmony are why exposure darkens your skin instead of giving you an even tan.
Classical Chinese medicine recognizes melasma as a Liver-Kidney-Blood pattern:
Hydroquinone and tretinoin force melanin suppression from outside, but they leave the Liver-Kidney imbalance intact. Lasers ablate the pigmented skin, but if your constitutional Fire and stasis remain unresolved, melasma returns—often within 12–24 months. You end up on a treadmill of repeated treatments.
Classical Chinese medicine moves the Liver, clears the Fire, moves the Blood, and restores Kidney Yin—so melasma fades from the inside out and stays gone.
A custom formula for melasma typically follows this strategy:
You will typically take a warm herbal decoction twice daily. Formulas are adjusted every 2–4 weeks based on how your patches respond, your energy, digestion, mood, and sleep. Most patients see visible fading after 8–12 weeks of consistent treatment, with continued improvement over 6 months. Because we are restoring your constitution, not suppressing pigment chemistry, results tend to be durable.
First 2–4 weeks: You may notice improved mood, digestion, and energy as Liver Qi begins to move. Sleep quality often improves. Melasma patches may still be dark, but you may feel them softening or becoming slightly lighter at the edges—a sign Blood is beginning to circulate.
Weeks 4–8: Patches typically begin visible fading, often starting at the edges and working inward. This is Blood stasis clearing. Some patients notice the patches feel less thick or raised. Others observe a subtle shift in color tone—the brown becoming less intense or more translucent.
Weeks 8–16: Continued steady fading. Edges typically clear first; central patches take longer. Your skin texture often improves—less dryness, more radiance. Energy and resilience remain stable or improve further.
Months 4–6: Many patients reach their plateau of improvement. Fine-tuning of the formula may speed final clearing or maintain stability.
Sun protection remains essential—not because the formula stops working in sun, but because UV exposure is a co-trigger. SPF 30+ daily and reapplication every 2 hours during peak sun are standard care. The difference is that with your Liver and Blood restored, your skin now has the resilience to resist re-pigmentation even with modest sun exposure.
Michael Woodworth has 25+ years of clinical experience managing persistent skin conditions including melasma, post-inflammatory hyperpigmentation, and rosacea. Over that span he has observed that classical patterns—Liver stagnation, Blood stasis, Kidney deficiency—predict treatment response better than melanin levels alone. His approach combines careful constitutional assessment with targeted herbal strategy, adjusting formulas month by month to match your healing arc. Many of his melasma patients are women who have already tried hydroquinone, tretinoin, or lasers without lasting relief—or who want to avoid those routes entirely and address the root cause.
Rootworth provides the custom herbal formulas. If you need hands-on assessment (palpation of the abdomen, tongue diagnosis, comprehensive intake), or if you are interested in pairing herbal treatment with additional modalities, visit Makari Wellness for in-person care with Michael.
If you have tried conventional treatments and found they fade or relapse, or if you prefer to address your Liver-Kidney constitution rather than suppress melanin from outside, Rootworth custom formulas offer a different path. Your formula is designed specifically for your pattern—not a one-size-fits-all protocol. We adjust every 4 weeks as you heal, and you remain in direct contact with Michael throughout. Most melasma patients see meaningful fading within 8–12 weeks and can reduce or discontinue other treatments.
A note on these statements.
Rootworth herbal preparations are dietary supplements. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Classical Chinese medicine pattern assessment is distinct from the diagnosis and treatment of disease as defined under United States federal law. Individual results vary.