Definition
Western
Alopecia is the loss of hair [1] from any causes and can occur at any site on the body, such as fine hair lining the eyes or lips [2-3]. One common type of alopecia is androgenetic alopecia, which affects many men and a similar proportion of postmenopausal women [4]. Individuals with this type of alopecia usually have balding appearance concentrated at the temple and/or top of the head [5].
Traditional Chinese Medicine (TCM)
Balding is defined as the thinning or incidental loss of hair on the skin [6-8]. Healthy individuals usually have thick, smooth and silky hair. Common causes of balding include weak body state due to aging, fatigue or poor digestive functions. Emotional distress will also deplete the Liver and Kidney systems of essential fluids required to secure strong crown of hair.
Classifications and Symptoms Displayed in TCM Context
Poor blood circulation
Blood flow is impeded; blood fails to reach the scalp to facilitate the growth of hair. Alopecia of this type is relatively persistent. There may be accompanying chest pain [7-8, 11].
Malnutrition
Scalp is undernourished in such cases. In addition to alopecia, individuals may also experience heart palpitations and insomnia[7, 11].
Weak body type
Weak digestive system may result in poor absorption of nutrients, which can ultimately affect normal hair growth. Additional symptoms typical to this category include dizziness, tinnitus and fatigue[7-8,11].
Causes
Emotional distress, such as anxiety, can lead to hair loss. According to TCM theories, one’s outward appearance is usually inter-related to one’s inner body conditions. As such, internal diseases can have impact on one’s hair growth. Likewise diets can affect the conditions of one’s hair. Over-consumption of oily foods can also lead to greasy scalp which may result in hair loss while under-absorption of essential nutrients can lead to malnourished scalp, that becomes too weak to support the growth of hair [6-8,11].
Risk Factors
· Alopecia areata, a reversible, initially patchy hair loss most commonly involving the scalp, and is more common in patients with Down’s syndrome. This correlation may be due to genetic factors [4].
· Males are more prone to androgenetic alopecia [4] due to the presence of male sex hormones and their related physiological functions [5].
· Inheritance: Individuals whose family members are bald are at higher risk. Studies on both alopecia areata and androgenetic alopecia suggested that there is higher incidence of balding in genetically related individuals [5,10].
Treatments
Herbal prescriptions: Commonly used herbs include:
1. He Shou Wu – 何首乌
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English/ Common name
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Turmeric [8]
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Latin species
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Curcuma longa [8]
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Park of plant used
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Rhizomes [8]
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Action/s
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Helps to reduce joint inflammations and other joint discomforts [9-10].
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Precaution/s
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May cause stomach upset, especially in high doses or if given over a long period of time [8]. Anaemic and pregnant patients should be cautious when using [23].
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2. Wu Jia Pi – 五加皮
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English/ Common name
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Wu Jia Pi [23]
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Latin species
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Acanthopanax gracilistylus W.W.Smith [23]
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Park of plant used
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Dried bark of roots [23]
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Action/s
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Helps to modulate the immune system in the body [17].
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Precaution/s
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Self-made wines made of unknown dosages of acanthopanax can cause blindness, numbness in limbs, dizziness, and headache [2]. Please contact professional advice before use.
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3. Gui Pi – 桂皮
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English/ Common name
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Cinnamon [18]
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Latin species
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Cinnamomum cassia Presl [23]
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Park of plant used
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Tree bark [23]
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Action/s
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Found to inhibit the formation of 5-lipoxgenase, which catalyses the formation of leukotriene, a compound involved in inflammatory and allergic reactions [19].
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Precaution/s
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Safe when consumed in amounts commonly found in foods and in medicinal doses. However, when used in large amounts for a long period, cinnamon may affect blood sugar levels and harm the liver. Hence, caution should be exercised for patients with diabetes or liver diseases when using this herb [18].
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4. Sang Zhi – 桑枝
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English/ Common name
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White Mulberry [20]
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Latin species
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Morus alba L. [23]
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Park of plant used
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Twigs [23]
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Action/s
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Helps to suppress inflammations by inhibiting iNOS activity [21].
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Precaution/s
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No significant adverse side effects have been reported. Diabetic patients should use this herb with caution as this herb may lower blood sugar levels [20].
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5. Hu Zhang – 虎杖
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English/ Common name
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Hu Zhang [23]
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Latin species
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Polygonum cuspidatum Sieb. Et Zucc. [23]
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Park of plant used
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Rhizomes [23]
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Action/s
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Found to be have anti-inflammatory effects when applied topically [16].
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Precaution/s
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Some side effects include diarrhoea, dizziness, vomiting, paralysis, breathing difficulty and coma [22]. Should not be used in pregnancy [23].
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Other treatments which are also used in treating RA include taichi [13], acupuncture [14] and massage [15].
Tests & Diagnosis
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Physical examination
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For the affected joint, the patient will be assessed in terms of the ability to walk, bend or carry out daily activities by a qualified practitioner.
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Laboratory tests
Positive blood tests may be carried out for certain antibodies, such as rheumatoid factor (RF) and antibodies. Other tests for white blood cell count, anaemia blood tests, erythrocyte sedimentation rate and C-reactive protein may also be acquired.
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X-Rays
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Often used to determine the degree of joint destruction. However, they may not useful in the early stages of rheumatoid arthritis as visual bone damage is not significant.
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Home Remedies
Cinnamon tea
a) Mix cinnamon powder and honey
b) Stir the mixture in warm water.
c) Drink it once every morning before breakfast
References
1. National centre for complementary and alternative medicine. Rheumatoid Arthritis and CAM. [Cited June 2010; Available from: http://nccam.nih.gov/health/RA/].
2. The Side Effects of Acanthopanax spinosus. [Cited July 2010; Available from: http://www.zhion.com/Ch_Med/Acanthopanax_spinosus.html].
3. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Handout on health: Rheumatoid arthritis. [Cited June 2010; Available from: http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp].
4. Oliver, J.E. and A.J. Silman, Why are women predisposed to autoimmune rheumatic diseases? Arthritis Research & Therapy, 2009. 11(5): p. 9.
5. Kumar, P.J., Clinical medicine 7th ed. ed. 2009: Saunders Elsevier. 1,343 p.
6. Baka, Z., E. Buzas, and G. Nagy, Rheumatoid arthritis and smoking: putting the pieces together. Arthritis Research & Therapy, 2009. 11(4): p. 13.
7. Costenbader, K.H., et al., Smoking intensity, duration, and cessation, and the risk of rheumatoid arthritis in women. American Journal of Medicine, 2006. 119(6): p. 503-511.
8. Medline Plus Supplements. Turmeric (Curcuma longa Linn.) and Curcumin. [Cited June 2010; Available from: http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-turmeric.html].
9. Funk, J.L., et al., Efficacy and mechanism of action of turmeric supplements in the treatment of experimental arthritis. Arthritis and Rheumatism, 2006. 54(11): p. 3452-3464.
10. Funk, J.L., et al., Turmeric extracts containing curcuminoids prevent experimental rheumatoid arthritis. Journal of Natural Products, 2006. 69(3): p. 351-355.
11. Tao, X.L., et al., Benefit of an extract of Tripterygium wilfordii Hook F in patients with rheumatoid arthritis - A double-blind, placebo-controlled study. Arthritis and Rheumatism, 2002. 46(7): p. 1735-1743.
12. Canter, P.H., H.S. Lee, and E. Ernst, A systematic review of randomised clinical trials of Tripterygium wilfordii for rheumatoid arthritis. Phytomedicine, 2006. 13(5): p. 371-377.
13. Lee, M.S., M.H. Pittler, and E. Ernst, Tai chi for rheumatoid arthritis: Systematic review. Rheumatology, 2007. 46(11): p. 1648-1651.
14. Sato, M., et al., Therapeutic effects of acupuncture in patients with rheumatoid arthritis: a prospective study using F-18-FDG-PET. Annals of Nuclear Medicine, 2009. 23(3): p. 311-316.
15. Arthritis Foundation. Common Therapies to Consider. [Cited June 2010; Available from: http://www.arthritis.org/common-therapies-to-consider.php].
16. Bralley, E.E., et al., Topical anti-inflammatory activity of Polygonum cuspidatum extract in the TPA model of mouse ear inflammation. Journal of Inflammation-London, 2008. 5.
17. Shan, B.E., et al., Suppressive effect of Chinese medicinal herb, Acanthopanax gracilistylus, extract on human lymphocytes in vitro. Clinical and Experimental Immunology, 1999. 118(1): p. 41-48.
18. WebMD. Cassia Cinnamon: Uses, Side effects, Interactions and Warnings. [Cited July 2010; Available from: http://www.webmd.com/vitamins-supplements/ingredientmono-1002-CASSIA+CINNAMON.aspx?activeIngredientId=1002&activeIngredientName=CASSIA+CINNAMON].
19. Prasad, N.S., et al., Spice phenolics inhibit human PMNL 5-lipoxygenase. Prostaglandins Leukotrienes and Essential Fatty Acids, 2004. 70(6): p. 521-528.
20. WebMD. White Mulberry: Uses, Side Effects, Interactions and Warnings. [Cited July 2010; Available from: http://www.webmd.com/vitamins-supplements/ingredientmono-1250-WHITE+MULBERRY.aspx?activeIngredientId=1250&activeIngredientName=WHITE+MULBERRY&source=2].
21. Hong, C.H., et al., Evaluation of natural products on inhibition of inducible cyclooxygenase (COX-2) and nitric oxide synthase (iNOS) in cultured mouse macrophage cells. Journal of Ethnopharmacology, 2002. 83(1-2): p. 153-159.
22. WebMD. Hu Zhang (Polygonum Cuspidatum): Uses, Side Effects, Interactions and Warnings. [Cited July 2010; Available from: http://www.webmd.com/vitamins-supplements/ingredientmono-910-HU+ZHANG+Polygonum+Cuspidatum.aspx?activeIngredientId=910&activeIngredientName=HU+ZHANG+(Polygonum+Cuspidatum)&source=3].
23. Gao, X.M., 中药学. 1st Ed. 2002: 中国中医药出版社.
24. Zhou, Z.Y., 中医内科学. 2 ed. 痹证. 2007: 中国中医药出版社. 521.