Face Turning Black Around the Mouth? Doctor Luo Tianyi’s Sheng Yang Shun Qi Tang (Yang-Raising Qi-Smoothing Decoction) for Melasma and a Dull Complexion

Opening scene: the root cause, written down first — unremitting worry

💬 Note from Doctor Luo: Today’s case has to do with women’s beauty — and it is a fascinating one.

The patient was a woman in her early thirties, and Doctor Luo Tianyi states the cause right at the top of the case record: unremitting worry — emotional trouble (constrained liver qi, worry injuring the spleen).

💬 Note from Doctor Luo: In the Jin-Yuan period, doctors already wrote the background of the illness into their case records (Doctor Zhu Danxi did the same) — this is what traditional Chinese medicine is about: to treat an illness, you must find the root. Emotion comes first, and then irregular eating (poor diet, disordered rhythm), and the result is injury to the spleen and stomach.

The causes are all linked together: worry injures the spleen (emotion damages the spleen and stomach) + constrained liver qi running sideways to attack the spleen earth + emotion disrupting the rhythm of eating (after a breakup some people binge on snacks, others can’t eat at all) → the spleen and stomach are wounded. An experienced old doctor is like a detective — the moment he sees one clue, he reasons out the whole chain — this is what a high level of diagnostic skill looks like.

The symptoms: a blackened face, with the ring around the lips darkest of all

• Dark, lusterless complexion — the face was blackish and without sheen (a healthy face should show a faint ruddy-yellow glow, radiant and full of life)
• Lips darkest of all — the ring around the lips was especially dark (a particularly telling sign)
• A hollow, hungry feeling at the heart — the heart felt suspended and empty, as if starving, and yet she was hungry without appetite (starving, but no desire for food)
• Short, rapid breathing — qi deficiency (the injured spleen and stomach → insufficient upright qi → shortness of breath and rapid breathing)

💬 Note from Doctor Luo: Let me tell you a story about the great inspection diagnostician Master Wang Hongbo. I was seeing a child once, and Master Wang happened to be present, so I asked him to take a look. He swept his eyes over the child and said at once: “This child has spleen deficiency and heavy dampness.” I asked how he could tell at a single glance. He said: “Look at the face in three sections — upper court, middle court, lower court. In this child the color of the lower section doesn’t match the upper — the dampness moves downward, settles below, and that is why the lower part is dark.” That left a deep impression on me — there is real method behind it. This woman had the ring around her lips, the darkest circle of all — the same principle.

The differentiation: why does the face turn dark?

Doctor Luo Tianyi’s analysis is exceptionally thorough — let’s enjoy it:

💬 Note from Doctor Luo: The heart and lungs dwell above — they drive the ying qi and wei qi (ying = the nourishing substances within the vessels; wei = the protective qi outside the vessels) throughout the body, and their luster shines outward (the lungs are white, the heart is red; the skin should show a red-tinted whiteness revealed at the surface). The liver and kidneys dwell below — they nourish the sinews and bones and strengthen the interior, and should remain hidden, not leaked out (the green-black colors should be stored within and never surface — a greenish or bluish face is definitely a sign of illness). The spleen and stomach dwell in the middle — they govern the transformation and distribution of refined essences, irrigating the four organs (like the earth nourishing all directions; they are the core — the spleen rises, the stomach descends, connecting above and below, like the axle of a wheel).

When the qi of the spleen and stomach is injured, the four organs lose their support — once the spleen and stomach are damaged there is no source of nourishment, and every other organ weakens — injury to the spleen and stomach strikes at the very foundation of life! This is why the School of Tonifying Earth (bu tu pai) made such a point of the spleen and stomach — when the spleen and stomach are injured, a hundred diseases grow from it.

For this woman: worry congeals the qi (worry injures the spleen, cutting off the spleen-stomach qi, disturbing the ascent and descent) + irregular eating (qi consumed and left insufficient) → the spleen and stomach are wounded → the ascending-descending function weakens → clear qi cannot rise, turbid qi cannot descend → yin qi stagnates upward in the yang position (yin has slipped into the yang’s territory) → blackness settles into the face (the face turns dark).

Why is the ring around the mouth especially dark? The Neijing says “the qi of the spleen connects to the mouth” — the mouth is linked to the spleen. The spleen belongs to earth and controls water; now water insults earth instead (water turns around and bullies earth) — the spleen’s territory is flooded with water, so the color around the lips is especially deep — a disease of yin and yang turned on their backs.

The Neijing also says: “When the yangming vessel declines above, the face begins to wither” — the foot yangming stomach channel runs across the face, so the face has a great deal to do with the stomach. Regulating the spleen and stomach is the core principle for treating the face: for melasma (brown patches) or a poor complexion, you can soothe the liver (for constrained liver qi) and tonify qi and blood — but the core must always be regulating the spleen and stomach — the spleen and stomach are the source of nourishment; if they break down and qi and blood run short, of course the face has no color — withered and blackened. Once the spleen and stomach are well regulated, melasma can disperse and the complexion can turn rosy again. Women who care about beauty must get the spleen and stomach in good order!

The prescription: Sheng Yang Shun Qi Tang (Yang-Raising Qi-Smoothing Decoction) — helping the yangming’s generative qi rise

Having completed his analysis, Doctor Luo Tianyi concluded: “The qi of the yangming is insufficient” — so he used Sheng Yang Shun Qi Tang — to aid the generative qi of the yangming (the stomach channel, spleen and stomach) to rise, and thereby restore the complexion.

The basis for the formula: the Neijing’s “when the qi above is insufficient, push it upward and nourish it” — when the qi in the upper part of the body is lacking, you must push the qi movement upward.

💬 Note from Doctor Luo: Look at this — there are herbs to tonify the middle qi, herbs to raise things upward, herbs to scatter wind and free the channels, herbs to remove dampness, and bai shao to restrain the liver and soften the wood — a fairly complete plan.

Let me highlight a few points:

• The real core of the formula is tonifying the spleen and stomach — even though sheng ma and ge gen are the sovereign herbs, if you don’t fill the middle burner’s spleen and stomach first, raising qi upward on an empty foundation just leaves it hollow. Only when the upright qi of the spleen and stomach is sufficient will the upward-rising herbs do their work — that is the true core of this formula!
• Sheng jiang and da zao are not simple at all: we usually say they just harmonize the spleen and stomach and leave it at that, but Doctor Luo Tianyi quotes the Neijing — “pungent-sweet disperses and emerges as yang” — ginger’s pungent heat combined with dates’ sweet warmth opens the interstices, brings forth fluids, and restores yang qi. The man was a true scholar — even his ginger and dates come with classical citations.
• The ren shen–huang qi–gan cao combination (very commonly used across the formulas I’ve been discussing lately) is the core for tonifying the upright qi of the spleen and stomach. In the Jin dynasty they hadn’t yet summarized the use of shan yao (Chinese yam) and lian zi (lotus seeds) — those came later, and it was Doctor Zhang Xichun who excelled at huai shan yao (Chinese yam from Huaiqing); ren shen and huang qi work even better when paired with huai shan yao.

Administration (very particular about timing): grind the ingredients into powder for one dose; take two cups of water, three slices of ginger, and two jujubes, decoct down to one cup, strain and take warm. It must be taken after breakfast and before noon — at about nine or ten o’clock in the morning!

💬 Note from Doctor Luo: Why at that time? It is the hour when the weather’s qi is rising — in the morning the qi movement ascends, so taking the medicine then lets the yang qi of the body rise and spread easily. This is also an important tip: take Bu Zhong Yi Qi Wan (Tonify-the-Middle and Augment-the-Qi Pill) at this same time — after breakfast and before noon (around nine or ten), when yang qi is rising, is the best moment. If you take it before breakfast, the food presses it down into the lower burner. This formula is taken only once a day.

The result: recovered after several doses — after taking a few doses, the blackness of the face receded, the color around the lips lightened, and the other symptoms disappeared as well.

Lesson one: how the School of Tonifying Earth regulates the body

💬 Note from Doctor Luo: This case is a classic — we see how this school tonifies the spleen and stomach, moves the qi upward, and removes dampness to clear away the body’s “yin haze” and restore it to normal.

Lesson two: for beauty, regulate the spleen and stomach first — don’t get the cart before the horse

💬 Note from Doctor Luo: When people meet, the first thing they see is the face — which is why cosmetics sell so well (a single livestream can move hundreds of millions). But I think that is putting the cart before the horse:

• When your upright qi is sufficient and your qi and blood flourish, your face looks good naturally (a face like a peach blossom)
• When your spleen and stomach are a mess and qi and blood can’t reach the surface, your face turns sallow — do you really solve that by piling on foundation until it looks peach-blossom pink? It’s like a houseplant with yellowing leaves: you wouldn’t paint the leaves green with enamel at night — wouldn’t that be absurd?

A woman’s beauty must be built from inside the body — when the internal beauty is set right, the face will truly be beautiful. Cosmetics are only the icing on the cake — don’t overuse them: they are all chemical products, and every ingredient list reads like a chemistry textbook. Are they truly good for people? We should keep our eyes open.

The approach to beauty through body regulation (what today’s case teaches us):

1. Tonify the spleen and stomach — the core! When the qi of the spleen and stomach is sufficient, dampness can be removed and the channels and collaterals can run free
2. Use herbs that rise upward — once qi and blood are replenished, they rise and shine on the face from above
3. Use some wind herbs to free the channels and collaterals — open up whatever is blocked (today we have more options; you can add some blood-activating, stasis-resolving herbs)
4. Soften, restrain, and soothe the liver — keep the liver in check (the liver is tied to emotion and to qi-blood stagnation): bai shao, mei gui hua (rose buds), chen pi (tangerine peel), and qing pi (green tangerine peel) all work
5. Add some blood-nourishing herbs

Master these ideas and you will have a much deeper understanding of beauty — beauty starts with the spleen and stomach, and the stomach channel runs across the face. The next time you think about beauty care, you’ll have the right orientation from Chinese medicine.

The original case record comes from Wei Sheng Bao Jian (Precious Mirror of Health) by Doctor Luo Tianyi; the commentary is adapted from the public lectures of Doctor Luo Dalun (Ph.D. in TCM Diagnostics, Beijing University of Chinese Medicine).