Treatment of Alopecia Areata (Patchy Hair Loss) with Chinese Herbal Medicine: A Case Report

Last updated: 6 Aug 2025 | 147 Views |

Treatment of Alopecia Areata with Chinese Herbal Medicine: A Case Report
Initial Visit: October 5, 2024
Patient: Female, 30 years old

Vital Signs:
Body temperature: Normal
Pulse: 88/min
Blood pressure: 112/73 mmHg
Weight: 42.9 kg

Chief Complaint:
The patient presented with patchy hair loss for over 4 months, worsening in the past month.

History of Present Illness:
Four months prior, the patient noticed localized hair loss. She sought treatment with a modern medicine physician and received two monthly intralesional corticosteroid injections at the affected areas, along with topical steroid (Dermovate). Additionally, she received two intramuscular corticosteroid injections (once per month).
After treatment, some regrowth was noted in previously affected areas. However, within the past month, new bald patches of varying sizes appeared at the nape of the neck. The lesions were not itchy, but mild itching occurred due to topical application.

Sleep pattern: Goes to bed around 11 PM – 4 AM, often wakes 1–2 hours earlier than planned.
Other symptoms: Chest tightness and panic in crowded places.
Appetite, digestion, and bowel movements: Normal
Menstruation: Regular cycle, but this cycle had reduced volume, dark color; occasional lower back pain during menstruation and headaches prior to onset.
Work schedule: Includes occasional night shifts.

Physical Examination:
Multiple bald patches, mainly at the nape and behind both ears. Some areas show fine hair regrowth. Scalp shows mild redness and small red papules in certain areas.

Tongue and Pulse:
Tongue: Slightly enlarged, reddish, with thin white coating; red tip; scalloped edges
Pulse: Thin and wiry

Diagnosis (TCM):
Patchy hair loss (斑秃, Bān Tū)

Treatment:
Customized decoction based on Gui Pi Tang (归脾汤) and Liu Wei Di Huang Tang (六味地黄汤), with modifications.

Follow-Up Visits:
2nd Visit – October 12, 2024
No discomfort after taking the first decoction. Mild itching along the front hairline; used topical steroid once. No new lesions. Fine hair observed in original lesions. Appetite and bowel movement normal. Sleep remained light with early waking. Menses began on October 8 with normal volume. Hair shedding still excessive but no new bald patches. Washing hair every 2 days.

3rd Visit – October 26, 2024
Patient noted reduced hair loss. Menses lasted 8 days, with heavy flow for 5 days. Topical steroids discontinued due to scalp itching. Two weeks prior, patient used DPCP topically but developed red rash and intense itching, so it was stopped. Washing hair daily. Normal appetite and digestion. Sleep improved—although interrupted, she could fall back asleep.

4th Visit – November 9, 2024
Bald patches showed longer hair regrowth, some with white hair. No new lesions, no itching. Improved sleep; occasionally wakes early but returns to sleep. Menses began on November 4, with normal volume. Experienced headache before menstruation. Mild dry cough with scant phlegm two weeks ago. Washing hair every 2 days.

Patient discontinued all modern medical treatments.

5th Visit – November 23, 2024
Between November 14–16, slight brownish vaginal spotting occurred, followed by heavy menstruation from Nov 19–23. One day of fatigue. Patient paused Chinese herbs for a week and noticed slight increase in hair loss. Headache occurred before menstruation. Previous cough fully resolved. Appetite and digestion normal.

6th Visit – November 30, 2024
Menstruation ended one day after resuming Chinese herbal decoction. Slight hair loss persisted within normal limits. No fatigue. Bowel and sleep patterns normal. Small area of white hair at nape. New hair growth at frontal and lateral hairline areas.

7th Visit – December 21, 2024
Hair in bald areas continued to grow longer. Some regions still showed short or white hair. Menses began on December 18, with normal volume. Mild lower abdominal and lower back pain during menstruation. No premenstrual headaches. Normal bowel movements. No abnormal hair loss. Sleeps well but still wakes earlier than usual.

8th Visit – January 4, 2025
Vital Signs:
Pulse: 63/min
Blood pressure: 114/99 mmHg

Hair loss within normal limits. Washing hair every 2–3 days. Menses lasted 6 days. Sleep improved, though patient still wakes early. Bowel movements normal.

9th Visit – January 18, 2025
Condition stable for past two weeks. No abnormal hair loss. Menses on January 14, normal volume. Mild menstrual abdominal and back pain. No premenstrual headache. Normal digestion and sleep, though patient still wakes early. Occasional mild fatigue.

Treatment: Switched to pre-made herbal pills and capsules.

10th Visit – February 1, 2025
Condition remained stable. No abnormal hair loss. Continued herbal granules to maintain stability. Patient advised to stop herbs after completing this course.

Post-Treatment Follow-Up (Early March 2025)
Approximately 2 weeks after finishing herbal pills, two small new bald patches appeared. Patient resumed herbal decoction (at a reduced dose). After resumption, improvement was observed. No new lesions. Existing patches showed gradual hair regrowth.

Conclusion and Analysis
The patient had alopecia areata for 4 months and was previously treated with topical and injectable corticosteroids, with partial improvement. However, new lesions continued to appear. The patient also had irregular menstruation with scanty, dark flow, premenstrual headaches, and sleep disturbances.

From a Traditional Chinese Medicine (TCM) perspective, hair health is closely related to the condition of blood, the liver, and the kidneys. In this case, the patient was diagnosed with deficiency of Qi and blood, combined with liver and kidney deficiency. Emotional stress, irregular sleep due to shift work, and poor rest aggravated the liver’s function, disrupted blood circulation, and impaired nourishment of hair roots. Long-term steroid use may have also affected hormonal balance and the menstrual cycle.

After taking Chinese herbal decoctions aimed at nourishing blood and Qi, and tonifying the liver and kidney Yin, the patient showed improvement by the third visit: hair loss decreased, sleep improved, and menstrual irregularities subsided. Residual symptoms included early waking and occasional headaches.

With continued treatment, hair regrowth resumed and stabilized. When switching to herbal pills, mild recurrence occurred, indicating decoctions were more effective. After maintaining a stable condition for 3–6 months, medication may be discontinued.

This case demonstrates that Traditional Chinese Medicine can effectively treat alopecia areata by addressing root causes, such as blood and Qi deficiency and organ imbalance. However, lifestyle modifications must accompany treatment to ensure long-term results.

Treatment Photos
October 5, 2024

October 26, 2024

November 9, 2024

November 23, 2024

December 21, 2024

January 18, 2025