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Common clinical patterns
1. Blood heat generates wind
2. Stagnation of liver qi with stasis of blood in the hair orifices
3. Exhausted qi and blood
4. Kidney and liver xu
Which pattern?
Typically seen as an initial attack in the young, characterised by rapid loss of hair with quick progress. Small coin shaped patches, or more widespread hair loss. Usually confined to the scalp, but may spread to the eyebrows and beard area. Itching or erythema of scalp occasional, but usually no subjective symptoms (hair loss discovered by accident). Anxiety and irritability common.
T: red body, sides or tip
P: thready and rapid
Blood heat generates wind
Sudden hair loss of the scalp or other body parts, or persistent and repeated bouts of hair loss and re-growth. Stabbing pain of the scalp, paresthesia, or no subjective sensation. PMS, irregular menstruation, depression, oppression of chest, etc.
T: purple, or with purple patches. Dark with congested sublingual veins
P: deep, choppy or slippery
Stagnation of liver qi with stasis of blood in the hair orifices
Seen in longer term alopecia, post-partum alopecia, or alopecia after a long and debilitating illness. Gradual and insidious hair loss is typical along with s/sx including pallor, weak nails, palpitation, insomnia, low vitality and stamina, shortness of breath on exertion.
T: pale, teeth marked. Thin coating
P: thready, xu
Exhaused qi and blood
Usually seen in older patients, patients with a family history of alopecia, in reoccurring alopecia, or in chronic and widespread hair loss (totalis, universalis). Hx of greying hair or withered, weak, and brittle hair. Nail involvement common. Back px, weak knees, dizziness, tinnitus etc. If yin more affected: warm chest, night sweats, restlessness, etc. If yang more affected: cold sensations, cold limbs, impotence, etc.
T: red or pale, fissured. Dry patchy coating
P: Xu pulse. Thready and deep
Kidney and liver xu
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