TCM Herbal Formulas for Patchy Baldness

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Treatment for patchy baldness, also known as Alopecia Areata (AA)

Patchy baldness, also known as Alopecia areata (AA), is a fairly uncommon but troubling type of inflammatory hair loss. The condition is estimated to affect 0.1 – 0.2% of those in the population who are largely between the ages of 15 and 30, although it can occur at any age. Modern medicine views AA as an autoimmune process, but offers little effective treatment.

Traditional Chinese Medicine (TCM), on the other hand, does very well in the treatment of this condition, but as with all inflammatory or autoimmune diseases it is much easier and faster to treat in the early stages. Interestingly, however, even when the condition is quite advanced with many bald patches covering a wide area, hope is not lost, as hair follicles are not dead but retain a lifelong possibility for regrowth.

The TCM approach requires a series of assessments to ascertain the severity and level of activity of the alopecia:
– if hair is lost only in small round patches on the scalp, this is simple alopecia areata;
– if the whole scalp is affected, this is alopecia totalis;
– if the entire body loses hair, it is alopecia universalis.

In addition, the level of activity or quiescence of the condition can be gauged by assessing the hair on the margins of the bald spots: when they are too easily pulled out, when they have a wider base than top, or when the follicles appear as black dots, it means the condition is active and more hair loss will follow. All of these signs, together with the severity and duration of the hair loss and any accompanying systemic symptoms, will point to the correct TCM diagnosis and appropriate herbal composition.

TCM views hair as the ‘Surplus of Blood.’ That is to say, only by having strong, rich, nourishing Blood, which is circulating well and freely, can we have luxuriant and normal hair. According to TCM, several things can affect the Blood and give rise to AA.


This is the most common presentation of active alopecia, especially in young people. The TCM term ‘heat’ is roughly akin to the Western term ‘inflammation.’ Heat can be generated by stress and anxiety, or by heating substances such as alcohol, spicy foods and smoking. This heat can scorch and dry the Blood, which will no longer be able to nourish the hair, or for that matter, the skin. This may lead to the co-occurrence of eczema, with dry, red, itchy skin, or slight redness and itching of the bald spots on the head. The tongue will be red, at least at the tip.

A three-pronged treatment is needed in order to: 1) clear heat from the blood with cooling herbs; 2) supplement the blood with dark, rich nourishing herbs; and 3) ‘lift’ the circulation of this new Blood to the scalp and follicles. Rhemannia root, Angelica Dong gui, black sesame seeds, goji berries and mulberries can do the cooling and enriching. If you think of the deep purple of juicy mulberries, the richness of black sesame, and the blood-red of goji berries, you can instantly visualize their tonic effect on the blood. Herbs such as vitex seeds and tribulus fruit provide the light lifting action which pulls all of this rich blood up to the head. If the patient suffers from considerable anxiety, whether as a cause or an effect of the alopecia, we address that also, with calming and settling substances such as pearl shell or abalone shell.


In this version of the disease, the blood may not be dry and scorched by heat, but rather circulating very poorly, stagnating and clumping. This often appears in long-term cases, or in people who have suffered severe stress over a long period of time. The chronically pent-up emotions that can result in such situations will stagnate the movement of energy and blood throughout the body, and there may be other signs of this, such as clotty painful periods, stabbing headaches, chest pain, depression, spider veins, congested veins on the underside of the tongue, and a purple tongue.

Treating this presentation is entirely different, as the sticky, rich herbs used in the previous pattern would simply make this condition worse. Instead, in this instance, we need to circulate the energy and blood, disperse emotional depression, and restore proper flow in the meridians. Herbs such as red salvia, curcuma root, cyperus root and peach pit are very adept at freeing the flow of energy and blood in the entire body. Not only will this help the hair, but also the mental and emotional health of the patient. This is a reflection of the most important adage of Traditional Chinese Medicine: where there is free flow, there is no disease.


This version of the disease occurs in older or debilitated patients, very long-term cases, or postpartum women where much blood has been lost. This is also the least common presentation. The blood of these patients is thin and weak because their ability to assimilate and transform food is also weak, or they may have mistakenly taken up a restrictive diet, such as veganism, or a raw food diet. (Traditional Chinese Medicine views vegan diets as less nourishing to the body’s Qi and Blood, this being especially true in older or weaker people, in menstruating women, or in people with long-term illness. Raw food diets are cold in energy and they cool the digestive fire, reducing absorbtion of nutrients. Over time, the body is simply not able to produce sufficient blood. The person may have a diagnosis of anemia, or their blood tests may be normal. Still, they can suffer from fatigue and feeling cold, pale pallor, brittle nails, or dry skin. In addition, the tongue is often pale.

This presentation needs Qi (energy) tonics, in addition to the Blood enriching herbs discussed earlier. Astragalus, Chinese ginseng, Atractylodis, and Poria mushrooms are good examples of such strengthening herbs.


Alopecia areata is very gratifying to treat, as it is easily cured in the early stages and can, at the very least, be vastly improved – even in severe cases. The appearance of new hair growth, typically with fine, downy hairs like peach fuzz, is an unmistakable sign that we are on the right track. Over a few weeks, these fine hairs become thicker, longer, and darker, until the patchy bald spot is gone.

The duration of treatment varies in proportion to the severity and duration of the hair loss, but results are seen anywhere between three and nine months on average. Three months is a good measure because it is considered one course of treatment for any blood related pathology in TCM, as it takes that long to produce new blood. Alopecia may require one to several such courses of treatment.

Finally, it is well known that 35 – 45 % of cases of alopecia areata actually resolve spontaneously within a year. Some people wonder therefore whether it is worth treating right away, or if they should wait and see if will go away on its own. The reality is that it’s very common for AA to recur without treatment, and 25% of patients will then progress to either alopecia totalis or alopecia universalis, both of which are much harder to treat. In my opinion, it is best to treat alopecia areata right away, as the body is sending a message that all is not quite right with the Blood, and one ounce of prevention really is worth a pound of cure.

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