by Eric Brand

A few days ago, we had a little speculation about TCM patterns and genetics in the comments thread of one of our blogs. Specifically, we were pondering whether there was any clinical significance to constitutional variations that seem to be more prevalent in different ethnic groups. I used myself as an example, since I tend to sweat much more than most locals if I am in a hot place like Southern China. I mean, people are regularly alarmed, strangers handing me tissues, the difference is that obvious… Clearly, my constitution is wired to sweat more vigorously, but whether such a trait could be linked with ethnicity, I am not sure. I am similarly unsure if this constitutional tendency reflects healthy variation or if it reflects pathology from a TCM perspective.

Given that I have virtually never seen anyone in China sweat to the degree that I do everyday, I have to wonder what an ancient Chinese doctor would have thought if I walked into his office. Would he have thought that I had great heat or some other cause of pathological sweating? Or maybe he would have just said, “this strange white guy from a distant land sweats like a pig, but he seems otherwise healthy…”

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I’m quite interested in this type of question, but I’ve never seen much discussion of it in Chinese medicine. I also do not really know if there is a strong genetic component to sweating, though there seems to be. However, I do know of one topic that seems to be clearly linked to a genetic trait that is markedly less common among people of Chinese descent than it is amongst gringos like myself: balding. Finally, a topic that I'm truly qualified for!

What does Chinese medicine make of male pattern baldness? In a sense, it is a new phenomenon for Chinese medicine to encounter pattern baldness on such a massive scale, since it is comparatively rare or less severe in the Chinese population.

Many Chinese medicine textbooks state that baldness in the absence of other pathology is not considered to be pathological. That said, I have seen any number of herbalists who have tried to sell me on hair tonics. I started losing my hair at age 18, so I had plenty of time to get used to the idea and I was never bothered by it in the least. I’ve been happily bald for virtually my entire adult life. However, many Chinese friends have told me that having my degree of baldness would be devastating to most young Chinese men. Thus, it is possible that people try to sell me hair tonics out of sympathy or out of the belief that it must be secretly traumatic to me.

Given that baldness in my case is clearly a genetic trait, would a hair tonic do any good? The typical supplementing medicinals such as He Shou Wu and formulas such as Qi Bao Mei Xu Dan are often used for cases when yin, blood, or essence vacuity causes baldness. Is there any link between pattern baldness and any of these TCM patterns? It appears that the standard modern TCM answer is, no, not necessarily. Sudden hair loss or hair loss that is associated with illness is definitely treated with Chinese medicine, in both men and women (in fact, it seems to be more commonly seen in women). But whether pattern baldness is of diagnostic significance, and whether it can respond to therapy, is a different story.

Interestingly, if you really look at it, very few medicinals are actually said to promote the growth of head hair. Most items are ascribed an action of blackening the hair and beard, or nourishing the whiskers. Whiskers in men are different than head hair, both in terms of Chinese medicine and biomedicine. In Chinese medicine, the head hair is associated with the blood and kidney essence in general; by contrast, the whiskers are often associated with the chong mai (penetrating vessel). The growth of facial hair is often compared to menstruation; menstruation is a sloughing of blood that is associated with the chong mai in women, and facial hair is thought to be associated with sloughing of blood (blood and hair share a similar nature in Chinese medicine) and the chong mai in men. Unlike pattern baldness, which appears rather rarely in Chinese culture, the growth of whiskers has been an important topic for centuries.

People often suggest that the medicinal He Shou Wu (Polygoni Multiflori Radix) will generally stimulate hair production. Several authors, including Subhuti Dharmananda, have written about this rather extensively on the web. However, to my knowledge male pattern baldness has never been successfully treated with Chinese medicine alone.

Likewise, I am not aware of anything that suggests that patients with pattern baldness are more prone to experiencing clinical symptoms of blood vacuity or essence vacuity. The fact that supplementing blood or essence seems unable to treat the hair loss makes me wonder if there is any strong link between these TCM patterns and pattern baldness. I go along with the conventional TCM theories about treating hair loss in general, but I am not sure that any conventional theory exists for treating genetic cases of hair loss.

Naturally, the way to solve this problem would be to have tens of thousands of digital patient files that could be sorted based on any given research question. Digitized medical records (such as those used in Chinese medicine hospitals in Taiwan) have detailed information on patients, including their TCM diseases, patterns, and therapy. It would be interesting to see the statistics on balding and TCM pattern tendencies in general, as well as the response to therapy.

However, the Taiwanese records are unlikely to hold any clues about pattern baldness, because there are so few cases of it in the local population. Thus, we would need to have digital files from Western patients, or scientific research that assesses the prevalence of TCM patterns in patients with pattern baldness compared to matched controls. Naturally, there would need to be some method of ensuring diagnostic accuracy and consistency, such as the diagnostic rating scales used in TCM research in China (see some of our previous EBM blogs at Blue Poppy for more details). The field in the West is a long way from having such data, research funds, or even diagnostic consistency, so any scientific assessment of pattern baldness and TCM may take a long time to emerge.

As always, if anyone has read any primary resources on this topic or any others that we discuss, I’d love to hear more about it.