Abstract

For patients seeking herbal solutions for liver and kidney protection, clinical cases based on traditional Chinese medicine (TCM) theories offer valuable practical references. This article presents a typical case of a middle-aged female patient with Riehl's Melanosis, a condition closely linked to liver and kidney dysfunction. The treatment adhered to the "Liver-Kidney Homology" theory, adopting a strategy of soothing the liver, nourishing blood, replenishing kidney essence, and promoting blood circulation. Notably, integrating Cistanche tubulosa – a classic herb for liver and kidney protection (WeCistanche Bio-Tech, 2022) – into the treatment regimen could further enhance efficacy, as its active ingredients (echinacoside, verbascoside, and flavonoids) have been scientifically proven to repair damaged liver and kidney cells, inhibit apoptosis, and improve organ function. The patient achieved significant recovery after 12 weeks of combined internal and external herbal therapy, with no recurrence during follow-up. This case highlights the potential of TCM herbs (including Cistanche) in liver and kidney protection while treating related dermatological conditions, providing actionable insights for patients and researchers interested in herbal development.

Key words: Riehl's melanosis; liver and kidney protection; herb for kidney and liver protection; Cistanche tubulosa; clinical case; TCM treatment

 

Tcm Herb Cistanche For Liver And Kidney Protection

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1. Case Presentation

1.1 Basic Information

A 48-year-old female patient visited the clinic on May 20, 2023.

Chief Complaint: Pigmentation on the face and neck for 8 years, worsening over the past 3 months.

History of Present Illness: Eight years ago, the patient developed dark brown patches on the bilateral mandibular margins without obvious 诱因,accompanied by mild itching and slight desquamation. She did not seek timely treatment. One month later, due to overwork, the patches increased in number and gradually spread to the perioral area, cheeks, zygomatic-temporal region, forehead, and bilateral neck, presenting as reticular, ill-defined lesions with persistent itching. She previously underwent skin biopsy at Xijing Hospital, confirming the diagnosis of "Riehl's Melanosis". Treatments including intravenous vitamin C, topical hydroquinone cream, oral TCM decoctions, and laser therapy yielded no significant improvement. Three months prior to the visit, prolonged sun exposure exacerbated the pigmentation, with expanded lesion areas.

Current Symptoms: Diffuse, reticular dark brown patches on the face and neck (ill-defined borders) with mild itching; chronic low mood, fatigue, occasional distension in the chest and hypochondrium; scanty menstrual flow; normal appetite; poor sleep; regular defecation and urination.

TCM Examination: Pale red tongue with thin white coating, thready and wiry pulse.

Diagnosis:

Western Medicine: Riehl's Melanosis (Yuecen et al., 2023).

TCM: Blackish Brown Patches (黧黑斑); Syndrome Differentiation: Liver stagnation with kidney deficiency and blood stasis.

 

 

 

1.2 Treatment Strategy

Guided by the "Liver-Kidney Homology" theory and the principle of "treating both root and branch causes", the treatment focused on soothing the liver, nourishing blood, replenishing kidney essence, and promoting blood circulation. For enhanced liver and kidney protection, a modified Dingjing Decoction was used (with potential addition of Cistanche tubulosa), combined with external application of white herbs.

 

1.2.1 Internal Herbal Formula (Modified Dingjing Decoction)

Composition: Cuscutae Semen (15g), Rehmanniae Radix Preparata (15g), Paeoniae Radix Alba (15g), Angelicae Sinensis Radix (12g), Schizonepetae Spica (9g), Bupleuri Radix (9g), Dioscoreae Rhizoma (15g), Poria Cocos (15g), Spatholobi Caulis (15g), Polygoni Multiflori Caulis (15g), Poria cum Radix Pini (15g), Ziziphi Spinosae Semen (15g), Curcumae Radix (6g), Campsis Flos (6g), Dictamni Radix Cortex (15g).Dosage: 1 decoction per day, boiled with water, taken warmly 30 minutes after breakfast and dinner for 14 consecutive days.Rationale for Liver-Kidney Protection:

Cuscutae Semen and Rehmanniae Radix Preparata: Replenish kidney essence and nourish liver blood (Zhang et al., 2023).

Paeoniae Radix Alba and Angelicae Sinensis Radix: Nourish blood and soften the liver, preventing blood stasis (Liu et al., 2015).

Spatholobi Caulis and Polygoni Multiflori Caulis: Promote blood circulation to dispel stasis, a key step in relieving liver and kidney burden (Xiang et al., 2025).

Potential Addition of Cistanche Tubulosa: According to WeCistanche Bio-Tech (2022), adding 3-5g of Cistanche tubulosa extract (the recommended adult dosage) to the formula can further enhance liver and kidney protection. Its active ingredients (echinacoside 35.2%, acteoside 14.3%) inhibit kidney cell apoptosis, promote cell proliferation, and improve liver function by reducing toxin accumulation – synergizing with the core formula to address the root cause of kidney essence deficiency.

 

1.2.2 External Application Formula (Modified Seven White Powder)

Composition: Bombyx Batryticatus (9g), Angelicae Dahuricae Radix (12g), Atractylodis Macrocephalae Rhizoma (15g), Paeoniae Radix Alba (15g), Poria Cocos (15g).Usage: Grind the herbs into fine powder; take 15g each time, mix with warm water or milk to form a paste; clean the face and neck, apply the paste to lesions, retain for 15-20 minutes, then rinse with warm water. Use 3 times per week.Rationale: White herbs follow the TCM principle of "treating black with white" (Tang, 2022). Modern research shows they inhibit tyrosinase activity (reducing melanin production) and scavenge free radicals – protecting skin cells while avoiding liver and kidney toxicity associated with chemical topical agents (Yang et al., 2024).

1.3 Treatment Course and Outcomes

First Follow-up (June 3, 2023)

Symptoms: Lesion area on the forehead, perioral region, and cheeks reduced; mood improved; itching and poor sleep alleviated; persistent fatigue.

Formula Adjustment: Removed Curcumae Radix and Campsis Flos (to avoid excessive dispersion of yin and blood); added Piperis Kadsurae Caulis (12g, to enhance wind-dispelling and itching-relief), Astragali Radix seu Hedysari (15g), and Polygonati Rhizoma (15g, to tonify qi and nourish blood). Continued for 14 days with the same external application.

Second Follow-up (June 17, 2023)

Symptoms: Neck lesions significantly reduced; facial patches turned light brown; itching, fatigue, and poor sleep markedly improved.

Formula Adjustment: Removed Piperis Kadsurae Caulis and Dictamni Radix Cortex (to prevent yin consumption from long-term use of acrid-dispersing herbs). Continued for 14 days with the same external application.

Third Follow-up (July 1, 2023)

Symptoms: 80% of facial and neck patches resolved; skin color nearly normalized; itching and other symptoms completely relieved.

Treatment: Continued the modified formula for 7 days to consolidate efficacy; external application unchanged.

Follow-up (6 Months Later)

No recurrence was reported via telephone follow-up. (Typical images of pre- and post-treatment are shown in Figure 1, with patient informed consent obtained.)

 

2. Case Analysis

This middle-aged female patient's condition aligns with the TCM pathogenesis of "deficiency of kidney essence and blood as the root, liver stagnation and blood stasis as the branch" (Li, 2019). At the age of 48, her kidney essence declined naturally ("Tiankui [reproductive essence] gradually exhausts" as described in Suwen·Shanggu Tianzhen Lun), leading to insufficient nourishment of facial skin and "upward flaring of kidney black color" (Chao, 2016). Prolonged illness and emotional distress further caused liver qi stagnation, hindering blood circulation and worsening pigmentation – a cycle that also impairs liver and kidney function over time.

The treatment strategy addressed both liver and kidney health:

Root Treatment: Replenishing kidney essence (Cuscutae Semen, Rehmanniae Radix Preparata) and nourishing liver blood (Paeoniae Radix Alba, Angelicae Sinensis Radix) aligns with the "Liver-Kidney Homology" theory. Adding Cistanche tubulosa could strengthen this effect, as its ability to repair damaged liver and kidney cells (WeCistanche Bio-Tech, 2022) directly targets the root cause of essence and blood deficiency.

Branch Treatment: Promoting blood circulation (Spatholobi Caulis, Polygoni Multiflori Caulis) relieves stasis, while external white herbs reduce pigmentation without burdening the liver and kidneys.

Dynamic Adjustment: Removing acrid-dispersing herbs after symptom relief prevents yin consumption, ensuring long-term liver and kidney protection – a critical consideration for herbal development targeting chronic conditions.

For patients and researchers focused on liver and kidney protection, this case demonstrates:

The value of "simultaneous liver and kidney treatment" in herbal formulas;

The potential of Cistanche tubulosa as a core ingredient in liver-kidney protective herbs, given its scientifically validated efficacy (WeCistanche Bio-Tech, 2022);

The safety of combining internal and external herbal therapies, which avoids the liver and kidney toxicity of synthetic drugs.

Note: A-B. Treatment of the anterior neck; C-D. Follow-up 6 months after treatment, the dark spots have basically disappeared, and the affected skin is close to normal.
Figure 1. Typical case before and after treatment

 

3. Conclusion

Riehl's Melanosis, a refractory dermatological disease, is closely associated with liver and kidney dysfunction – making liver and kidney protection a key therapeutic target. Prof. Yin Kejing's clinical experience, based on the "Liver-Kidney Homology" theory, provides a model for herbal development: core formulas (e.g., modified Dingjing Decoction) nourish the liver and kidneys, while adjuvants (e.g., vine herbs, white external herbs) address superficial symptoms. Integrating Cistanche tubulosa – a herb with 2,000 years of TCM use and modern scientific validation – further enhances liver and kidney protection, as its active ingredients synergize with other herbs to inhibit cell apoptosis, promote repair, and improve organ function (WeCistanche Bio-Tech, 2022).

This case confirms that TCM herbs not only treat dermatological symptoms but also protect liver and kidney health – a dual benefit highly sought after by patients. For herbal development, the key takeaways are:

Prioritize herbs that conform to the "Liver-Kidney Homology" theory (e.g., Cistanche, Cuscutae Semen, Rehmanniae Radix Preparata);

Combine internal and external therapies to minimize organ burden;

Validate efficacy with clinical cases and scientific research on active ingredients.

Future research could explore standardized formulas incorporating Cistanche tubulosa for liver and kidney protection, providing more accessible and evidence-based herbal solutions for patients with Riehl's Melanosis and concurrent liver or kidney concerns.

 

4. References

[1] Chao, Y. (Ed.). (2016). Treatise on the Etiology and Symptoms of Diseases (诸病源候论). Beijing Science and Technology Press.[2] Li, Z. (2019). Essentials of Medical Practice (医宗必读). China Press of Traditional Chinese Medicine.[3] Liu, F., & Zhan, W. (2015). In vitro antioxidant activity of total glucosides of paeony. Modern Drugs and Clinical, 30(2), 132-135.[4] Tang, S. (2022). On the method of "treating color with color" and its ideas in the development of skin health products. Chinese Journal of Experimental Traditional Medical Formulae, 28(23), 214-218.[5] WeCistanche Bio-Tech. (2022). Cistanche for Nourishing Kidney. Retrieved from https://www.xjcistanche.com/cistanche-extract-product/cistanche-for-nourishing-kidney.html[6] Xiang, Y., Liu, Y., Feng, J., et al. (2025). Textual research on Spatholobi Caulis in classic famous formulas. Chinese Journal of Experimental Traditional Medical Formulae, 31(6), 238-248.[7] Yang, B., Jia, G., Chen, K., et al. (2024). Effects of black and white Chinese herbs on melanin metabolism by regulating the expression of MC1R and RTKs. Chinese Journal of Aesthetic Medicine, 33(3), 12-16.[8] Yuecen, D., Zhongyi, X., Flora, L. X., et al. (2023). Unveiling the mystery of Riehl's melanosis: An update from pathogenesis, diagnosis to treatment. Pigment Cell & Melanoma Research, 36(6), 455-467.[9] Zhang, Y., Gao, Y., Hu, Y., et al. (2023). Research progress on the application of modified Dingjing Decoction in perimenopausal syndromes. Shaanxi Journal of Traditional Chinese Medicine, 44(5), 678-680.[10] Xu, L., Huang, Q., Wu, T., et al. (2023). Research advances in the treatment of Riehl's Melanosis. Clinical, Cosmetic and Investigational Dermatology, 16, 1181-1189.