Hair Loss and Traditional Chinese Medicine

Listen to the podcast

Article originally published February, 2024
Excerpted and translated from Dr. Chui’s series of articles by Yvonne Lau

Since time immemorial and across cultures, lustrous, abundant hair has been seen as a sign of radiant health, as well as fertility and virility. This is also true in traditional Chinese medicine (TCM), as the quantity and quality of hair is understood to reflect the state of the Zang Fu organs and physical condition. These internal organs are closely related and affect each other, so to avoid premature greying, dryness, and general loss and thinning of hair, it is vital to balance each of the Zang Fu.

The relationship between hair and the five internal Organs

Kidney

According to TCM concepts, the foundation of the physical substance that allows hair to grow is the pre- and post-natal Essence stored in the Kidney. It is said that hair is the “abundance of Blood” and “Kidney governs bones and generates marrow, and its magnificence is hair". This means that the growth of hair relies on Blood, which relies on marrow, which relies on Kidney Essence. As such, Kidney deficiency can lead to dryness, premature graying and excessive shedding of the hair.

Liver

The Huangdi Neijing states that the Liver stores Blood and governs the Sea of Blood. As such, hair growth is closely related to Blood nourishment. Li Zhen of the Ming Dynasty said in his introduction to medicine: “If the Blood is strong, the hair will be moist, and if the Blood is weak, the hair will be weak.” The Liver also regulates the circulation of Qi and Blood throughout the body. The Liver meridian and Governor meridian meet at the top of the head, so enriched Liver Blood keeps hair nourished and moisturized.

Lungs

The Huangdi Neijing states that “the beauty of the Lung is in the hair” and “the skin of the Lung is also the hair”. As such, traditional Chinese medicine asserts that the external manifestations of Lung Qi is found in head and body hair, and so when Lung Qi is strong, the hair is nourished and vibrant.

Spleen

According to traditional Chinese medicine, the Spleen is the foundation of acquired diseases and the source of Qi and Blood. One of the main physiological functions of the Spleen is to transport and transform water and Grain/Post-natal Essence, which is equivalent to absorbing and transporting water, electrolytes and nutrients throughout the body. Because the normal growth and development of hair depends on water and Grain Essence and the nourishment of Qi and Blood, when the Spleen's transportation and transformation functions are normal, hair will receive sufficient supply of Qi, Blood and nutrients, making it healthy, moist, and shiny. Contrarily, if the Spleen cannot properly perform its function, hair withers and falls.

Another physiological function of the Spleen is to transport and transform water and dampness, that is, it participates in the metabolism of water and liquid in the body. If the Spleen Qi is deficient, this will affect its function of transporting and transforming water and dampness, resulting in Dampness stagnation according to TCM principles. Long standing stagnation of Damp will then turn into Heat, which can lead to a pattern of internal Damp Heat, often resulting in diseases such as alopecia areata, folliculitis, and seborrheic alopecia.

Heart

Traditional Chinese medicine believes that one of the main physiological functions of the Heart is to control blood vessels, including controlling blood and main vessels. The Huangdi Neijing says: "All Blood belongs to the Heart." Simply put, the Heart, meridians and blood circulation constitute a relatively independent functional system. The push of Heart Qi (i.e. heartbeat) allows Qi and Blood to reach all parts of the body (including hair) through the vessels and Channels, so that the various organs and tissues of the body receive a normal supply of Qi and Blood and can perform their normal functions. If Heart Qi is strong, the meridians are unobstructed, making Qi and Blood abundant and leading to vigorous hair. However, if Heart Qi is deficient and the Channels are blocked, Qi and Blood flow to the head are deficient and hair growth and vigor will be restricted.

Healthy Hair Strategies

The coordination and nourishment of Qi and Blood rely on the meridians, and the head is the meeting place of all Yang meridians. As such, physical stimulation can be beneficial. All Qi and Blood flows to the head, so combing your hair stimulates the meridians, increases blood flow to hair roots, dispels Wind, and improves eyesight. It also enhances the activity of melanocytes and hair follicle cells, keeping hair strong and shiny with less gray. The correct way to comb your hair is generally considered to be from front to back, then from back to front; then from left to right, and finally from right to left. Repeat dozens of times as your time allows. As for the comb used, it is best to use a wooden or ox bone comb rather than one made from nylon, rubber, or metal as these will cause static electricity to build up, irritating the scalp and potentially leading to hair loss. The Huangdi Neijing points out: "The twelve meridians are all part of the skin. Therefore, the onset of all diseases must precede the skin." The so-called skin part is the reflection of the functional activities of the twelve main meridians on the body. The surface area is also the place where the twelve main meridians are spread. According to traditional Chinese medicine, external evils can pass through the skin and penetrate deep into the meridians. Lesions on the internal organs can also manifest on the skin through the meridians. Stimulation from tapping or tapping the skin with plum blossom needles can regulate the functions of the internal organs and meridians, thereby preventing and treating disease. If plum blossom needles are used to directly stimulate the scalp, it can also improve the blood flow supply of the head skin and stimulate the growth of hair follicles.

Herbs taken internally

In addition to the physical stimulation of hair follicles to promote hair growth, Chinese herbs can also help. Using TCM diagnostic principles, accessing the root cause and type of hair loss is important in determining the appropriate treatment strategy and formula. Decoctions formulated according to the constitution of the patient is best, and most likely will be based on Blood and Kidney tonics and moving Qi but may also be one designed to clear Wind or Cool Blood, so it is extremely important to properly diagnose the patient.

Commonly used herbs include Dang gui/Angelicae sinensis, He shou wu/Polygonum multiflorum, Ce bai ye/Platycladus orientalis, Han lian cao/Eclipta prostata, Sang ye/Morus alba, Huang qi/Astragalus membranaceus, Ren shen/Panax ginseng, Chuan xiong/Ligusticum chuanxiong, Hong hua/Carthamus tinctorius, Gu sui bu/Drynaria fortunei, Bu gu zhi/Psoralea corylifolia, Da huang/Rheum palmatum, Ku shen/Sophora flavescens, Bai zhi/Angelica dahurica, and Bai xian pi/Dictamnus dasycarpus, among others.

External applications

TCM water or wine decoctions can be used externally to wash hair and for application to the scalp, allowing the medicinal ingredients to act directly on the skin tissue and hair follicles. These can produce medicinal or chemical stimulation, including moisturizing, beautifying and preventing hair loss. The herbs mentioned above can also be utilized externally.

Chinese medicinal herbal wines are easy to make and good for long-term hair care. The use of He shou wu, Dang gui, and Sang shen zi would be beneficial to nourish Blood, Liver, and Kidneys. Combine with Kidney tonics Bu gu zhi and Gu sui bu. As "Qi is the leader of Blood", Ren shen to replenish vitality and Tian qi to move Blood and dispel stasis can be added to improve local Blood circulation. The above herbs should be soaked together in pure alcohol to extract the active ingredients and massaged into the scalp so that the effective ingredients can directly penetrate hair follicles. This combination tonifies the Kidneys and Qi, and tonifies and moves Blood.

Studies have shown that some plants of the Apiaceae family such as Dang gui/Angelicae sinensis, Chuan xiong/Ligusticum chuanxiong, and Bai zhi/Angelica dahurica contain some active ingredients that can increase the sensitivity of skin or hair to ultraviolet rays, enhance the activity of tyrosinase through ultraviolet rays, stimulate melanocytes, and increase melanin, thereby darkening the skin or hair. There have been studies on the use of Bai zhi/Angelica dahurica (its active ingredient being total coumarin) to treat vitiligo. When combined with sunlight exposure, normal pigmentation can often return.

The Whys of Hair Loss

Hair loss, including physiological and pathological hair loss, is a distressing problem. The causes of pathological hair loss are multifaceted with internal and external factors.

Internal Factors

Genetics

Hair loss is mainly associated with genetics and this is known as androgenic alopecia. Studies have found that having more affected family members will increase the chances for this to occur. If the father has alopecia, the chances of his son developing alopecia is higher than those of men whose fathers do not have this condition. Other studies have found that women with pathological alopecia carry more susceptible genes than men with pathological alopecia.

Endocrine disorders

Endocrine disorders and excessive or insufficient secretion of certain hormones can also lead to hair loss, the most important of which are male hormones and estrogen. The main male hormone that causes hair loss is dihydrotestosterone (DHT), a metabolite of testosterone. Research shows that in people with genetic susceptibility, the hair loss areas on their foreheads are particularly sensitive to the stimulation of DHT and this makes these areas more susceptible to hair loss. Hair follicles can also enter the resting phase prematurely and cause hair loss. In addition to DHT, excessive dehydroepiandrosterone (DHEA) or plasma sex hormones binding globulin (SHBG) that is too low will affect the normal growth of hair and lead to hair loss.

Insufficient estrogen in women (especially postpartum and menopausal women) can also easily cause hair loss. When a woman is pregnant, the level of estrogen in her body is high, which causes some hair that should enter the resting phase and fall out to remain in the growth phase without falling off, so the hair becomes more and more abundant. After childbirth, estrogen levels drop, causing more hair to enter the resting phase and fall out one after another in the next few months, resulting in massive hair loss. When hormone levels are readjusted, the body's internal environment is relatively balanced, and hair will grow normally again. Studies have found that patients with hair loss generally experience a decrease in estrogen, an increase in androgen, or a relatively low ratio of the two (female and male).

Autoimmune diseases

Hair loss may be an autoimmune disease. The so-called autoimmune diseases are a group of diseases caused by inflammation and tissue damage caused by the body's own antibodies, such as systemic lupus erythematosus, rheumatoid arthritis, glomerulonephritis, certain thyroid dysfunctions, scleroderma, malignant Anemia etc. Studies have found that the serum of some patients with alopecia areata and alopecia totalis contains higher levels of antibodies related to immune responses, suggesting that hair loss may be related to autoimmune responses. The reason why the body loses its ability to distinguish between "self" and "non-self" substances is not yet fully understood.

Mental stress

Severe or prolonged depression, excessive mental stress, fright or over stimulation can all lead to hair loss. Mental stress, especially of the sudden sort experienced by fright, can cause the body's arrector pili muscles to contract, making the hair stand upright. Stress can also constrict the capillaries flowing through the hair follicles, affecting the transport of nutrients. As a result, the hair does not receive adequate nutritional supply and the hair is in a state of nutritional decline leading to it falling out easily.

Malnutrition

Malnutrition including vitamin deficiency or excess, lack of trace elements or protein can lead to hair loss. Especially important are vitamins A, B2 and folic acid. Vitamin A is an essential nutrient for the formation of hair cuticles. Long-term deficiency can cause thinning of hair and hair, but long-term overdose of vitamin A can also cause hair loss. Lack or imbalance of trace elements in the body, especially zinc, copper, iron, selenium, etc., will lead to hair loss while a lack of protein can make hair dry and brittle, making it prone to falling out.

Metabolic disorders

Diabetes mellitus and excess sugar intake can cause hair loss. Excessive sugar in the body will affect the absorption and metabolism of vitamin B, disrupt the normal growth of hair and pigment metabolism, and may also be converted into excess fat and induce seborrheic dermatitis, leading to hair loss.

External factors

Chemical

Chemical factors mainly include drugs, hair dyes, shampoos and perms. Many drugs can cause varying degrees of hair loss. Common ones include anti-cancer drugs (chemotherapy drugs), colchicine to treat gout, certain anticoagulants such as heparin and aspirin, hyperthyroidism, and birth control pills.

The heavy metal powder sometimes contained in hair dyes will combine with the pigment in the inner layer of the hair to change its structure and color. However, long-term or abnormal use of hair dyes can easily cause the hair to lose moisture and cause bifurcation, dryness, brittleness and erosion, leading hair to easily fall out. Generally, shampoo contains many different chemicals, which can easily cause damage to the hair, especially if the hair is not rinsed enough after washing. Chemical substances remaining in the hair will continue to irritate the scalp and cause hair loss. Perming agents are strong alkaline solutions that can easily damage the structure of part of the hair, causing the hair to lose its normal elasticity and traction. In addition, high-temperature perms can easily damage the scalp and hair.

Physical

There are mainly mechanical, radioactive, ultraviolet and high temperature exposure during blow drying among other factors. Most basically, frequent pulling of the hair, such as braiding or wrapping the hair too tightly for too long with accessories, or strong local friction on the scalp, such as using rough pillows, can easily lead to mechanical hair loss.

The material of the comb is also very important. Using a rubber or a metal comb can easily generate static electricity, which can damage hair. It will cause adverse stimulation to the skin and increase the pulling force and friction on the hair. Especially for dry hair, it is best to use a wooden or ox bone comb.

Radiation of any intensity can directly damage hair follicles and cause hair loss. Direct exposure to UV light can break the keratin in hair, making it brittle. Blow-drying your hair with hot air will reduce the moisture content and damage hair.

When age or other reasons causes hair to prematurely go gray/white and soft, it also makes it more susceptible to dryness, brittleness and breakage.

Infection

Infections including from viruses such as HIV, varicella/zoster virus, Epstein-Barr, bacterial infections such as Mycobacterium tuberculosis and Staphylococcus aureus fungi (tinea capitis, Treponema pallidum) can cause temporary cystic hair loss or permanent scarring alopecia.

Sources

• 崔紹漢教授Professor Chui Shao Han, 中醫學對頭髮的認識（1） “Traditional Chinese Medicine’s Understanding of Hair (part 1)” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 80, January 2016 pgs. 108-109.
• 崔紹漢教授Professor Chui Shao Han, 中醫學對頭髮的認識（2） “Traditional Chinese Medicine’s Understanding of Hair (part 2)” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 81, February 2016 pgs. 98-99.
• 崔紹漢教授Professor Chui Shao Han, 中醫學對頭髮的認識（3） “Traditional Chinese Medicine’s Understanding of Hair (part 3)” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 82, March 2016 pgs. 98-99.
• 崔紹漢教授Professor Chui Shao Han, 從現代醫學看脫髮的原因pt. 1 “Causes of hair loss from a modern medicine perspective 2” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 84, May 2016 pgs. 80-81.
• 崔紹漢教授Professor Chui Shao Han, 從現代醫學看脫髮的原因pt. 2 “Causes of hair loss from a modern medicine perspective 2” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 85, June2016 pgs. 96-97.
• 崔紹漢教授Professor Chui Shao Han, 從現代醫學看脫髮的原因pt. 3 “Causes of hair loss from a modern medicine perspective 2” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 86, July 2016 pgs. 96-97.
• 崔紹漢教授Professor Chui Shao Han, 中醫美髮秘笈1 “Traditional Chinese Medicine Hair Tips pt. 1” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 87, August 2016 pgs. 96-97.
• 崔紹漢教授Professor Chui Shao Han, 中醫美髮秘笈3 “Traditional Chinese Medicine Hair Tips pt. 3” 中藥醫緣 Health & Wellness magazine, pub. By Ming Moon Tong, Issue 89, October 2016 pgs. 94-95.