TREATMENT OF ALOPECIA

WITH CHINESE HERBS
by Subhuti Dharmananda, Ph.D., Director, Institute for
Traditional Medicine, Portland, Oregon

Alopecia may arise from numerous causes, including
stress reactions, hypothyroidism, exposure of the hair
follicles to topically-applied chemicals, therapies used for
cancer, and genetic male-pattern balding. The disorder is
often classified by its specific manifestation, such as patchy
balding (alopecia areata), total loss of head hair (alopecia
totalis), or total loss of body hair (alopecia universalis).
Alopecia areata and alopecia totalis frequently affect women,
and the disorder may persist for several months to about a
year, sometimes longer.
Generally, alopecia is interpreted by Chinese doctors as
the result of a deficiency syndrome, specifically involving
blood deficiency, with generation of internal wind or invasion
of external wind that affects the head; the situation is
sometimes complicated by blood stasis and/or blood heat.
The belief that there is an influence of wind in the etiology of
the hair loss is reflected in the Chinese name for the
disease, which is youfeng, literally oil-wind. The reference to
oil, which can also mean glossy, is an expression
characterizing the smooth, shiny scalp appearance where
the hair has been lost. The Chinese name has led to some
humorous translations; in the package insert for Alopecia
Areata Pills, the primary indication is for "grease hair
dropping."
The underlying pathological processes cause the hair
follicles to be undernourished. Blood deficiency can arise
from poor diet, excessive use of drugs, the aging process,
stress reaction (worry, anxiety, depression, which impairs
spleen function and thereby reduces nurturing of blood), and

" in this case it is invading the channels that traverse the scalp. and tough hairs depends on the sufficient supply of nourishment from ying and blood. In patients with chronic diseases and exhaustion of essence and blood. like other sudden health changes. and the excessive heat in the blood may produce wind and cause loss of hairs due to reduced nutrition supply. In patients with their diseases wrongly treated or refractory to any treatment. pliable. According to the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine (2). Nervousness. The hair pores are open when the hair is poorly nourished. If the supply of nutrients is reduced. and such patients may show clinical manifestations of wind syndrome owing to blood stagnation. and such patients may show clinical manifestation of wind syndrome due to blood heat. Sudden hair loss. the wind may be produced in the body to cause loss of hairs. and mental instability may cause production of internal heat. depression. the fresh blood can not be produced to nourish the hairs because of the stagnation of blood and obstruction of meridians. is interpreted as a consequence of "wind. and such patients may show the clinical manifestation of wind syndrome due to deficiency of blood. the deficiency of blood may also produce wind to cause loss of hairs. and the normal growth and development of long.debilitating diseases. A typical description of the cause of alopecia is presented in Practical Traditional Chinese Dermatology (1): The hairs are the extension of blood. Alopecia is mostly caused by deficiency of liver and kidney with subsequent failure of [blood to go up and nourish] the hair. and wind invades the .

causing blood-dryness and malnutrition of the hair. hence. tails cooked Moutan Tang-kuei Red peony Scrophularia Peony Cnidium Biota leaf Cnidium Persica Morus leaf Lycium Carthamus . pathogenic wind intrudes from outside. RECOMMENDED PRESCRIPTIONS In Practical Traditional Chinese Dermatology. while the kidneys produce bone marrow which is also responsible for the growth of hair. However. hence the occurrence of the disease. The same encyclopedia has an elaboration of the etiology of alopecia in the volume of dermatology (16): This disease is often caused by deficiency of blood. because the liver stores the blood whose state can be manifested by the hair. Therefore.pores on the occasion. which fails to cooperate with qi in nourishing the skin. deficiency of the liver qi and kidney qi may also cause this disease. stagnation of liver qi and impaired qi mechanism will also result in hair loss because of the malnutrition of hair due to stagnation of qi and stasis of blood. and the opening of the sweat glands is loose. Tang-kuei. three basic formulas are recommended: Wind Due to Blood Heat Wind Due to Wind Due to Blood Deficiency Blood Stagnation Rehmannia. and overwork may impair the heart qi and cause stagnation of qi and blood stasis so that qi and blood cannot nourish the hair. deficient blood with wind [invasion] leads to hair loss. The striae of skin and muscles in turn become loose. the mood of depression. raw Rehmannia. stagnation of liver qi. Besides.

Anemarrhena Vitex Tang-kuei Morus fruit Dictamnus Ligustrum Cuscuta Eclipta Ho-shou-wu Astragalus Citrus Biota leaf Angelica Green onion Ginger. baked Again. raw Ligustrum Morus fruit Moutan Red peony Deficiency Deficiency Deficiency Deficiency Blood of Yin and of Yin and of Qi and of Qi and Stasis Blood Blood Blood Blood (Decoction) (Pill) (Decoction) (Powder) Tang-kuei Ho-shou-wu Tang-kuei Tang-kuei Red peony Red peony Peony Cnidium Rehmannia Hoelen Rehmannia Achyranthes Peony Tang-kuei Codonopsis Lycium Atractylodes Cornus Salvia Cuscuta Scrophularia Ho-shou-wu Psoralea Sesame. the first three for "blood-deficiency and wind- . the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine offers yet another group of formulas. Musk baked Ho-shou-wu Rehmannia Soja Schizandra Cnidium Hoelen Typhonium Polygala Licorice. fresh Ligustrum Licorice. black Cuscuta Hematite Fu-shen Tang-kuei Morinda Cistanche Ligustrum Morus fruit Chiang-huo Schizonepeta Peony Cnidium Citrus Persica Astragalus Carthamus Cinnamon Bakeri bark Astragalus Ginseng Jujube Hoelen Atractylodes Ginger. fresh Jujube A slightly different presentation of patterns and formulas is offered in the book Manual of Dermatology in Chinese Medicine (3) Blood Heat Giving Rise to Wind Rehmannia.

By that time. One can see that in virtually all formulations (the exception being the last two presented above). Wan Dan Modified Tang-kuei Peony Cnidium Rehmannia Tongqiao Huoxue Tang. but it was recorded by Wang An.D.dryness" and the latter two for "activating blood flow to remove blood stasis:" Shenying Yangxue Qibao Yangzhen Shengfa Meiran g Dan. Ginseng Nutritive Combination (Renshen Yang Rong Tang). similar to the decoction for qi ." The prescription is attributed to a master herbalist of the Ming Dynasty. This Chinese name of this formula is translated in Formulas and Strategies (17) as "Seven-Treasure Special Pill for Beautiful Whiskers. but there are distinctly different groups of ingredients that are relied upon for different syndromes and by different authorities. Qibao Meiran Dan is the same as the Pill for Deficiency of Yin and Blood mentioned above. Shao Yingjie. in his book Yifang Jijie during the early Qing Dynasty (1682 A. the formula had become quite popular. fresh Green onion Huoxue Quyu Pian Tang-kuei Red peony Persica Carthamus Pangolin Artemisia (liujinu) Gleditsia Pyrolusite (zhiwu) Saussurea Clove Rhubarb Eupolyphaga In this last group. Tang-kuei Persica raw Ho-shouLycium Carthamus wu Carthamus Cuscuta Sparganium Ligustrum Cuscuta Ligustrum Cuscuta Chiang-huo Gastrodia Eclipta Salvia Soja Ho-shou-wu Psoralea Zedoaria Bupleurum Curcuma Turmeric Ginger.). tonification therapy is important. Modified Carthamus Tang-kuei Ho-shou-wu Tang-kuei Peony Hoelen Red peony Cnidium Achyranthes Cnidium Rehmannia.

and blood deficiency related above. morus leaf. schizonepeta. An examination of the herb formulas reveals very few ingredients in each formula for dispelling wind (sometimes none) and no ingredients specific to calming internal wind other than the single mention each of gastrodia and hematite (this may have been included mainly as a blood nourishing agent). Chinese chive) mentioned in the above formulas. cnidium. that formula has been recommended by Japanese doctors for treating alopecia (4). is a well-known traditional prescription given for general weakness and nutritional deficiency. cnidium. ligustrum. morus fruit. and biota leaf. typhonium. vitex. and carthamus are the most frequently used. peony. Although mentioned only once among the ingredients for the above formulas. Cuscuta is mainly used for tonifying the kidney. as well as herbs that are characteristically recommended for preventing graying of hair (a condition also thought to be due to blood deficiency syndrome). comprised of tang-kuei. chianghuo. as described below. with dictamnus. and green onion (congbai. eclipta is also used for preventing greying of hair and is included in some of the formulas used in clinical trials. and rehmannia). red peony. and psoralea are examples. For blood stasis. persica. The emphasis on wind in the etiology of alopecia as described in modern texts appears to be more of an academic nod to the ancient name of the disease than to a persisting belief that wind is an important factor in the . Wind-dispelling herbs are broadly selected from the range of available items. notably ho-shou-wu. black soy beans (soja). a principle of therapy not much relied upon other than through inclusion of cooked rehmannia as part of the blood nourishing strategy. Some herbs that have black color (the color of Chinese hair) are used: black sesame seeds. While there are no individual herbs that stand out as being essential to the treatment of alopecia. there is obvious reliance on the ingredients of Siwu Tang (Tang-kuei Four Combination.

was made as large honey pills. The pills. cuscuta.. made by adding Erzhi Wan (a formula comprised of just ligustrum plus eclipta). It is considered safe and relatively mild. which provided about 20 grams of herbs in powder form and 10 grams of honey as binder. The complete formula. the condition that is the subject of the clinical evaluations. especially herbs that nourish the blood. Shengfa Wan (literally.disease. are relied upon. lycium. can spontaneously resolve. containing ho-shou-wu. psoralea. ligustrum. which means that one can not separate out cases of improvements due to herb therapy from spontaneous remission. and hoelen. 10 grams each. those prescriptions subjected to clinical trials rarely include winddispelling or wind-settling ingredients. An examination of formula ingredients reveals that tonic therapies. . pill to generate hair). improved. is a modification of Qibao Meiran Dan. tang-kuei.Erzhi Wan is considered by some to be superior in treating premature graying or loss of hair. Therefore. CLINICAL EVALUATIONS OF INTERNAL THERAPIES Alopecia areata. it is difficult to know the effectiveness of treatment in the absence of a carefully controlled study. It is often compared to Liuwei Dihuang Wan [Rehmannia Six Formula]. at least. the majority of cases treated are resolved or.. were administered before meals. According toFormulas and Strategies: This formula [Erzhi Wan] is widely used in China. achyranthes. As with the formulas recommended above. According to the reported results (summarized briefly below). The reports in the medical literature generally involve uncontrolled studies.. both by itself and as an additive to other formulas when the liver and kidney yin need to be tonified. and administered three times daily (5). with a treatment time of 1-3 months duration (though sometimes longer). eclipta.

all of 50 cases of alopecia areata treated could be cured within 9 weeks with daily ingestion of a decoction of ho-shou-wu. and the remaining 12 by 9 weeks. salvia. According to another report. rehmannia. included ligustrum. tangkuei. It was stated that of 21 cases treated. A follow-up after . in which case the pill was given after meals instead. and eclipta. Shengfa Yin. astragalus. 2 cases were cured. was given along with topical application of the drug minoxidil. cnidium. a decoction comprised of ho-shou-wu. Cystine is important to protein structure and was given to promote good hair formation. carthamus. may have been due to use of a higher dosage form of administration and longer therapy (duration not specified in the report). with 117 of 146 cases cured. rehmannia. treatment time was 2-12 months. and 3 significantly improved (with 8 cases not improved). compared to the report on Shengfa Wan. was reported to cure 30 of 36 persons affected by alopecia areata. ho-shouwu. schizandra. gelatin. atractylodes. tang-kuei. the role of cystine is questionable. morus fruit. schizandra. 8 markedly improved. soja. biota twig. The high rate of success might have been due to the combination of using a decoction plus applying a topical preparation. black sesame. taken along with cystine (100 mg. the internal treatment for alopecia. Treatment time was 1-3 months. biota seed. and chiang-huo. Specifically. According to the report. and jujube. A similar formula. and 11 cases improved. In a large-scale study (8). longan. three times daily). and it is not included in the other trials. ligustrum. with 4 others improved (6). it is an oxidized form of the common amino acid cysteine. another 32 cases after 6 weeks. and topically applying concentrated decoction of morus bark (7). peony. Tuofa Zaisheng San. The obviously better results.unless digestive disturbance occurred. 6 cases were resolved after three weeks.

was quite a bit lower than most Westerners. at the time this package insert was written. The package insert proclaims "satisfactory results" were attained with over 1. one or two [additional] courses of treatment is necessary to ensure efficacy. newly grown. light color. which was developed during the 1970's and has been marketed worldwide since the 1980's. According to the package labeling. Alopecia that occurs in the elderly is responsive to treatment.000 trial cases and that: After treatment for a period of time.5 grams). according to one report (9).one year showed that there was relapse in only 10 cases. the formula is: Ho-shou-wu Rehmannia (raw and cooked) Tang-kuei Salvia Peony Schizandra Codonopsis Chaenomeles Chiang-huo 20% 20% 10% 10% 10% 10% 10% 5% 5% The herbs are extracted. formed into small pills (250 mg each). three times daily (daily dose of the extract is 4. In order to reduce the recurrence. 6 bottles of the product. and recommended to be taken 6 pills each time. A double-blind placebo-controlled study of an anti-aging mixture . the dosage should probably be increased by as much as 50%. soft hair gradually becomes darker and black. But in a few occasions the patients have recurrence of baldness. This formula is very similar to the patent remedy called Alopecia Areata Pills (Trichogen). for a course of treatment of 600 pills (if taken continuously. over a period of 33 days). Since the body weight of the Chinese.

such as hot pepper or ginger. with nearly 35% of the control group showing some improvements in both subjective and objective measures. to try and restore the scalp circulation. morus fruit. nourish the blood. including a reduction in alopecia during a 3 month trial. 3. salvia. TOPICAL TREATMENTS Alopecia often occurs in individuals who are relatively healthy. However. since the hair follicles are just below the skin surface. Employ herbs with a reputation for benefiting the hair. The power of the placebo and the rate of spontaneous remission was here demonstrated. 2. such as those used in internal therapies. to promote microcirculation. In such cases. including astragalus. and overcome disorders such as blood stasis. was conducted with 507 subjects. because of the localization of the symptom. Use strong circulatory stimulants. or ligustrum. such as ho-shou-wu. The diversity of recommended topical treatments. which includes some that are not easy to explain by the usual . Use blood-vitalizing herbs. the herb treatment group had nearly 77% of patients showing improvements. There are three major approaches to topical treatment with herbs: 1. topical treatments are deemed especially appropriate. Also. but the most evident symptom-or the symptom of greatest immediate concern to them-is the alopecia. 287 receiving the herbs.named Huolisu. and ho-shouwu. they may suffer from substantial emotional stress and poor nutrition. topical treatment is deemed a means of rectifying the problem even if an internal therapy is also needed to improve the function of the internal organs.

and applied to the affected area twice daily. and pinellia is made as a decoction and mixed with fresh ginger root juice. biota leaf.interpretations of herb actions. and musk.  Fresh slices of ginger are rubbed onto the bald area to produce a hot feeling. and most Westerners are not well disposed to making these unusual preparations and using them regularly. these are suggested: .  In Manual of Dermatology in Chinese Medicine. 16: Dermatology. make a decoction (musk is added separately) and wash the head with it. siler.   In the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine. makes it difficult to select one that would be workable. three times daily. and repeat.  A mixture of artemisia. let it set in the head for 5 minutes. zanthoxylum. Brassica is powdered. kao-pen. vitex. In Practical Traditional Chinese Dermatology. so only brief mention will be made here. Cordyceps tincture is applied to the affected area 3-5 times daily. chrysanthemum. and angelica is made as a tincture and applied once or twice a day. mixed with oil to form an ointment. ginger. mentha. three topical treatments are described:  A mixture of dictamnus. then rinse with warm water. these topicals are mentioned:  A mixture of biota leaf. schizonepeta. vol. crataegus. and applied to the affected area once daily. Powder of chuanwu (a type of aconite) is mixed with vinegar or ginger juice and applied once a day to the bald area.

carthamus. alopecia totalis. and some undisclosed ingredients. tang-kuei. so is difficult to obtain other than in this prepared form.1% respectively. . the herb swertia is "80% effective in treating all cases of hair loss. The largest clinical evaluation of a topical treatment for alopecia involved over 8.300 patients (11). This herb has been extracted in an essential oil base (geraniol) in the hair tonic product Gentax that is produced and widely used in Japan and is now available in the U.4%. The liquid was applied 2-3 times per day. in Torrance. (via Kenshin Trading Company.S. applied three times daily. Less than 6% of those treated in each category failed to respond to the treatment. and 62. like that of ginger and zanthoxylum.7%. The action of capsicum. for 2-3 months. A popular Chinese "hair growth" tincture-Lily Brand Hair Tonic-is made with extract of capsicum (and other undisclosed ingredients). astragalus. known as "101 Hair Regenerating Alcohol" (which has been made available in Chinese shops in the U. According to the book Oriental Materia Medica (10). and alopecia universalis were 91.) contains ginger. persica. is to promote local circulation via "counterirritant" action (spicy components cause the vessels to dilate). It was claimed in the report that the "cure" rates for alopecia areata.S." Research in Japan has shown that an extract of swertia (a relative of gentiana that is used frequently in the treatment of hepatitis) dramatically enhances the circulation to the skin when applied topically. 83. salvia.  Fresh ginger roots slice: rub the affected part rapidly. ginseng. this is similar to the home remedy made by the Chinese with red chilies soaked in wine. California). Psoralea tincture (Bugu Zhiding). cnidium. The liquid. The crude herb swertia is rarely exported from the Orient.

In another large-scale clinical evaluation. resorcinol. The effective rate for that treatment was only 48%. The liquid extract of biota twig. the herbs that accomplish this. ginseng leaf. glycerin. biota twig. Cancer Treatment with Fu Zheng Pei Ben Principle (14) and Treatment of Toxic Side Effects Resulting from Radiation and Chemotherapy (15)) there is no mention of alopecia. and salvia (see: Millettia (Jixueteng))may also promote . only 48 patients (less than 6%) showed no response. which is difficult to prevent while the drug is being used. One of the proposed mechanisms involved in overcoming leukopenia is promoting microcirculation in the bone marrow. 822 patients suffering from alopecia areata or alopecia totalis were treated with the topical formula. Yet another topical treatment that was evaluated is Jumei Renshen Shengfalu (13). Suxiao Ketuling Shengfa Jing (12). drynaria. drynaria. with improvement in 52 cases. Nonetheless. According to the report. HAIR LOSS ASSOCIATED WITH CHEMOTHERAPY Chemotherapy for cancer and certain other drug treatments may cause alopecia. The ingredients.g. include capsicum. and carbolic acid. ITM received reports of some cases of patients undergoing chemotherapy that did not result in hair loss or resulted in less hair loss than was expected (these cases were unexplained by Western doctors in the U. and cnidium. ginseng. extracted in alcohol. A control group was treated with a "Western" style topical liquid containing salicylic acid.. the patients were using Chinese herb tonic formulas to help prevent leukopenia. hu-chang.S. In books about treating side effects of cancer therapy (e. 630 patients were cured and others had partial regrowth of hair. and melia was applied topically for 88 cases of alopecia areata resulting in improvement in 71 of those cases. and 74 cases of alopecia seborrheica. ho-shou-wu. carthamus. such as millettia.). Both the herb and drug liquids were applied twice daily for 2-3 months. eclipta.

3. vol. WA. Lu Jingbin. So. 1990 Higher Education Press. Practical Traditional Chinese Dermatology. 5. Treatment of alopecia areata mainly with Chinese herbs. Long Beach. Lan Ke and Chen Huiren. as well as theoretical basis. Manual of Dermatology in Chinese Medicine. Shen De-Hui. Hubei Journal of Traditional Chinese Medicine 1988. to expect that this type of alopecia might be prevented by early intervention with Chinese herbs. 3(3): 55.). Treatment of 21 cases of alopecia with Shengfa Wan. help alleviate alopecia. et al. Sichuan Journal of Traditional Chinese Medicine 1987. Jiang Haiyan. REFERENCES 1. 1995 Eastland Press. the combination of tonic herbs and topical application of circulation-promoting agents may help to more quickly restore hair growth in those who begin the herb treatment after hair loss has already occurred. there is some preliminary and circumstantial evidence. Hunan Journal of Traditional Chinese Medicine 1987. 2. Li Lin. CA. Otsuka K. and Nissi Wang. The English-Chinese Encyclopedia of Practical Traditional Chinese Medicine. Xu Xiangcai (Chief ed. Wu Xiu-Fen. Journal . Natural Healing with Chinese Herbs. 5(4): 47-48.microcirculation in the skin and. 7. Tang Bingguang. 61. 1982 Oriental Healing Arts Institute. Treatment of 146 cases of hair loss with Tuofa Zaisheng San and Shengfa Shui. Seattle. 6: Therapeutics of Acupuncture and Moxibustion.. Treatment of 36 cases of alopecia areata with Shengfa Yin. When the drug therapy or radiation is stopped. 6: 19. Hong Kong. 4. 8. 1995 Hai Feng Publishing Company. Beijing. thereby. 6.

Treatment of alopecia with Jumei Renshen Shengfalu. Zhao Zhangguang. double-blind study of 507 subjects of middle and old age. 29(9): 693-694. and Harrison H (compilers). Chinese Herbal Medicine: Formulas and Strategies. 16. 9.. 9(1): 39. Xu Xiangcai (Chief ed. Treatment of 822 patients with alopecia areata with Suxiao Ketuling Shengfajing. Pan Mingji. 15. Beijing. Hubei Journal of Traditional Chinese Medicine 1991. Long Beach. vol. et al. 17. 1992 Fujian Science and Technology Publishing House. The EnglishChinese Encyclopedia of Practical Traditional Chinese Medicine. Treatment of 8324 cases of alopecia with 101 Hair Regenerating Alcohol. Seattle. Oriental Materia Medica: A Concise Guide. 6(5): 271274. 1990 rev. CA. 16: Dermatology. 13. . Hong-Yen Hsu. et al. Chinese Journal of Integrated Traditional and Western Medicine 1986. 10.. 7(7): 438-439. Du Xin. 12. 14. Kaw UA. 1980 Traditional Chinese Medical Publisher. Xiang Xirui and Xue Changhua. Cancer Treatment with Fu Zheng Pei Ben Principle. Fujian. Treatment of Toxic Side Effects Resulting from Radiation and Chemotherapy by Traditional Chinese Medicine. CA. Cheung CS. 11. Journal of Traditional Chinese Medicine 1988.. ed. 1986 Oriental Healing Arts Institute.of Integrated Traditional and Western Medicine 1987. Eastland Press. 1990 Higher Education Press. Bensky D and Barolet R. WA. San Francisco.). Zhang Zhongxing. Chinese Journal of Integrated Traditional and Western Medicine 1989. 13(6): 9-10. Antiaging effect of Huolisu-A controlled.

June 1999 .