Theories in early Chinese history on the causes and treatment of alopecia areata

Alopecia areata (AA) is a condition characterized by unpredictable hair loss, often occurring in patches. While current science has offered us some insights into the etiology of this condition, it’s fascinating to look back at the theories of early history. The study of AA in ancient times was more focused on treatment rather than understanding the cause, which mirrored the overall approach to medical conditions in those eras.

One of the earliest documented attempts to explain the pathogenesis, or origin, of AA comes from Chao Yuanfang, a renowned physician from the Sui Dynasty era in China (581–618 CE). In the seventh of his fifty volumes of work, “Theories of various diseases,” Yuanfang associated AA with the invasion of ‘evil wind spirits’ in the head. Yuanfang suggested that a deficiency caused by these spirits would lead to hair loss and muscle death. He described the hair loss patches as coin-sized or finger-shaped, which were long-lasting and non-itchy. This condition was referred to as a “ghost’s lick,” reflecting the supernatural beliefs of the time and how they might cause hair loss.

Fast forward to the Ming Dynasty, (1555−1636), another influential Chinese physician, proposed a more physiological theory. In his text “Surgical Authentic” (1617), Shi Gong posited that AA resulted from blood asthenia, a term used to describe a lack of energy. According to Shi Gong, this energy deficiency prevented the vital force, or “Qi” (pronounced “chi”), from supporting and nourishing the skin, leading to hair loss. Shi Gong also suggested that an attack of ‘Hot Wind’ when the body was weak could cause AA. His descriptions of the skin being smooth, shiny, and itchy suggest a more detailed observation of the condition’s physical characteristics.

As medical knowledge evolved, especially with the advent of modern medicine in the 19th Century, the focus shifted towards understanding the underlying causes of diseases, including AA. Despite this shift, treatment was still a high priority. Ancient Chinese medical treatments for alopecia areata focused on traditional Chinese medicine (TCM) using herbs and acupuncture.

Various herbal remedies have been used in TCM to address alopecia areata. For instance, He Shou Wu (also known as Fo-Ti or Polygonum multiflorum) is a common herb used for hair growth and coloring the hair. Other herbs traditionally used for AA include ginseng, astragalus, dong quai, and rehmannia. These herbs are often used in combinations in the form of teas, decoctions, or pills. Some traditional Chinese treatments involve the application of herbal mixtures directly to the scalp. Ingredients in these mixtures may include herbs known for promoting circulation or reducing inflammation.

Acupuncture is a unique effective traditional therapeutics with a history of at least three thousand years. It involves inserting thin needles into specific points on the body to stimulate energy flow (Qi). According to TCM principles, this can help harmonize the body’s systems and promote healing. Some TCM practitioners may still use acupuncture for treating alopecia areata, though the scientific evidence supporting its effectiveness specifically for this condition is limited.

Dietary and Lifestyle Changes: TCM also emphasizes the role of diet and lifestyle in maintaining balance in the body. For hair health, a diet rich in nourishing foods, such as black beans, sesame seeds, and various types of seafood, has been suggested in books stretching back to the Ming Dynasty and Chen Shi Gong. Physical exercises and practices like Tai Chi or Qi Gong, aimed at promoting the flow of Qi, have also been advised in TCM.

It’s important to note that these early theories of AA disease and treatments for it were based on the cultural and scientific understanding of the time. They reflected a blend of spiritual, environmental, and physiological elements, which is characteristic of ancient Chinese medicine. While these theories may seem far removed from our current understanding of AA, they were the stepping stones that eventually led us to our current knowledge.

Today, alopecia areata is understood as an autoimmune disease, wherein the body’s immune system mistakenly attacks the hair follicles, leading to hair loss. Despite the leaps we have made in understanding this condition, there is still much to learn. Reflecting on these historical perspectives serves as a reminder of how our understanding of diseases evolves over time and underscores the continuous nature of medical discovery.


Chao Y. Zhu bing yuan hou lun. Zhong yi gu ji chu ban she; 2005. book.
Broadley D, McElwee KJ. A “hair-raising” history of alopecia areata. Exp Dermatol. 2020 Mar;29(3):208–22.