BLOOD DEFICIENCY
Hair loss may be accompanied by dryness, fatigue, pallor, dizziness, and brittle nails. Women may have scanty menstruation. The tongue tends to be pale (Blood not rich enough to colour it a healthy pink.) The diet may be deficient in Blood nourishing foods, i.e. red meats or vegetarian substitutes. The prescribed herbal formula will be composed of herbs that boost and tonify Blood, such as Dong Gui and He Shou Wu, both of which are specifically indicated for hair. If there are signs of digestive deficiency and therefore poor assimilation of nutrients, one would add digestive herbs such as Bai Zhu and dried ginger root. If there is a mental emotional component with insomnia, anxiety and disquiet, calming herbs such as dried longan fruit are included.

BLOOD STASIS
Another obstructive pattern, this is the most difficult to treat. Usually the hair loss is severe and very long standing, with a strong component of emotional frustration, tension, resentment, and hopelessness. Extreme emotional states over many years cause Blood Stagnation. Emotion is energy, when emotion doesn’t move, energy doesn’t move. When energy stagnates, it cannot move Blood. Evidence of poor Blood circulation may be seen in a purplish tinge or purple patches on the tongue, very clotted menstrual blood or fibroids. The skin may be very dry and withered, and in extreme cases the body will be thin and emaciated. Treatment uses herbs to assist Blood circulation, as well as tonify Blood and settle the mind with soothing, calcium rich substances such as oyster shell. With lots of persistence, it is possible to bring about an improvement.

DAMPNESS OBSTRUCTING
Unlike the previous two, this is an example of an obstructive pattern. This means the Blood may be relatively adequate, but it is prevented from sufficiently reaching the hair roots, in this case by Dampness. This usually manifests as excess sebum in the scalp and face. Patients report that their hair becomes oily very quickly, and there may be some dandruff or crust on the scalp. Here, the treatment is quite different. Herbs which dry Dampness and reduce sebum production are the primary ingredients of the herbal formula. Barley and Tribulus figure prominently.

If one were to give Blood tonics in these cases, it would make the problem worse, as Blood tonics are themselves rich and oily in nature. This is an example of why TCM works so well: alopecia by any other name is not necessarily still a rose, i.e. every patient is different and TCM pays attention to those differences.

FOR BLOOD AND KIDNEY DEFICIENCY
This pattern is very similar to the one above, but either of longer duration, or with a strong hereditary component of Kidney weakness. This would cause accompanying symptoms of premature graying of hair, low back pain, sore knees and ear ringing. In TCM, the Kidney system is considered the foundation of the body’s energy. If contains Kidney Essence, which is the genetic raw material out of which Blood, Yin and Yang energy are all formed. Unfortunately, we are not all born with the same strength of Essence. If there is a strong family history of premature hairloss, or if the patient has depleted their existing store of Essence through overwork and hard living, herbs must be given to supplement this precious material. He Shou Wu does this very well, as does Lycium and Cuscuta seed.