Taming Hair Loss and Premature Graying - Master Zhang Zhiyuan’s “Mei Tou Jian” (Beautiful Head Decoction)
18. Taming Hair Loss and Premature Graying - Master Zhang Zhiyuan’s “Mei Tou Jian” (Beautiful Head Decoction)
Master Zhang Zhiyuan, a National Master of Traditional Chinese Medicine. Mei Tou Jian is his empirical formula for clinically treating hair loss and premature graying of hair and beard.
Pathogenesis
The pathogenesis of hair loss and premature graying can be summarized as follows: Liver-Kidney Yin deficiency with insufficiency of Jing and Blood, causing the hair to lose its nourishment, constitutes the root of the disease; Yin and Blood deficiency leads to internal generation of deficient heat, which rises upward to scorch the hair follicles, accelerating hair loss and graying; as the disease course extends, Qi and Blood circulation becomes sluggish, and stasis obstructs the scalp collaterals, so the follicles fail to receive nutrient supply, further aggravating hair loss. The three factors are mutually causative; simple tonification often fails to produce results, requiring the combined use of tonifying, clearing, and unblocking methods.
Formula Composition
Composition: Gardenia Fruit 20g, Eclipta 20g, Raw Rehmannia 15g, Prepared Rehmannia 15g, Angelica 10g, Salvia 10g, Safflower 6g, Chuanxiong 6g, Chinese Ararot Bark 10g
Efficacy: Regulates and tonifies Liver and Kidney, nourishes Blood and invigorates it, cools Blood and clears Heat
Indications: Hair loss, premature graying of hair and beard (Liver-Kidney Yin deficiency with Blood-heat and stasis obstruction pattern)
The formula adapts Er Zhi Wan (Gardenia Fruit, Eclipta) combined with the Four Substances Decoction (Si Wu Tang) concept, with modifications. Gardenia Fruit and Eclipta tonify Liver and Kidney, cool Blood, and blacken hair as sovereign herbs, used in the heaviest doses at 20g each. Prepared Rehmannia tonifies the Kidney and fills Jing; Raw Rehmannia nourishes Yin, cools Blood, and is cool while the other is warm, tonifying without being drying. Angelica nourishes Blood and harmonizes it; Salvia, Safflower, and Chuanxiong invigorate Blood and resolve stasis, opening scalp collaterals so that Jing and Blood can reach the hair roots. Chinese Ararot Bark cools Blood, stops bleeding, clears Heat, stops itching, and specifically clears stagnant heat from the scalp.
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Tonify Liver and Kidney | Gardenia Fruit 20g, Eclipta 20g, Prepared Rehmannia 15g | Er Zhi Wan tonifies Liver and Kidney, cools Blood, and blackens hair; Prepared Rehmannia fills Jing and essence, together consolidating the root of hair |
| Nourish Blood, Invigorate Blood | Angelica 10g, Salvia 10g, Safflower 6g, Chuanxiong 6g | Angelica tonifies Blood and harmonizes it; Salvia, Safflower, and Chuanxiong invigorate Blood, resolve stasis, open collaterals, guide Jing and Blood upward to the scalp, and improve follicle blood supply |
| Cool Blood, Clear Heat | Raw Rehmannia 15g, Chinese Ararot Bark 10g | Raw Rehmannia nourishes Yin, cools Blood, and clears deficient heat; Chinese Ararot Bark cools Blood, stops itching, clears scalp stagnant heat, and protects and consolidates the follicles |
Pattern-Based Modifications
| Coexisting Pattern | Modified Herbs | Therapeutic Rationale |
|---|---|---|
| Severe Liver-Kidney deficiency | Add Processed Fleeceflower 15g, Wolfberry 12g | Enhance tonifying Liver and Kidney and supplementing Jing and Blood, assisting in blackening hair |
| Blood-heat predominant | Add Moutan Bark 10g, Red Peony 10g | Strengthen cooling Blood and clearing Heat, clearing scalp stagnant heat |
| Oily, itchy scalp | Add Sophora 10g, Dictamnus Bark 15g | Clear Heat, dry Dampness, stop itching, improve scalp environment |
| Obvious blood stasis | Add Peach Pit 10g, Red Peony 10g | Enhance invigorating Blood, resolving stasis, and opening collaterals |
| Insomnia with many dreams | Add Jujube Seed 15g, Polygonum Multiflorum Vine 20g | Nourish the Heart and calm the Spirit, improve sleep to aid recovery of Jing and Blood |
| Qi deficiency with fatigue | Add Astragalus 15g, Codonopsis 12g | Boost Qi to generate Blood; when Qi moves, Blood moves |
Modifications should always follow the principle of not obstructing pathogen with tonification, not harming righteous Qi with clearing Heat, and not depleting Blood with blood invigoration. In clinical practice, for pure deficiency patterns, additional tonifying herbs may be used; when stasis signs are not obvious, Safflower can be reduced; when Damp-Heat predominates, appropriate additions of herbs that clear Heat and dry Dampness may be made.
Summary
Mei Tou Jian uses Er Zhi Wan to tonify Liver and Kidney and the Four Substances Decoction concept to nourish Blood and invigorate it, combined with Chinese Ararot Bark to cool Blood and clear Heat, integrating tonifying, nourishing, unblocking, and clearing into one formula, targeting the “deficiency, heat, and stasis” of hair loss and premature graying. The nature of the herbs is mild, suitable for long-term use; clinically it has shown good results for alopecia areata, androgenetic alopecia, and complex premature graying.
References:
[1] Zhang Zhiyuan. Zhang Zhiyuan’s Seventy Years of Clinical Practice: Glimpses of Gold [M]. Beijing: People’s Medical Publishing House, 2014.
[2] Zhang Zhiyuan. Casual Notes from Clinical Rest [M]. Beijing: China Traditional Chinese Medicine Press, 2013.
[3] State Administration of Traditional Chinese Medicine, Terminology Standardization Project. Zhang Zhiyuan Entry [EB/OL]. Dazhong Medical Web.
[4] Introduction to National Master Zhang Zhiyuan’s Inheritance Studio [EB/OL]. Official Website of Shandong University of Traditional Chinese Medicine.
18. 脫髮、頭髮早白剋星，國醫大師張志遠“美頭煎”
張志遠， 國醫大師，美頭煎是其臨床調治脫髮、鬚髮早白的經驗效方。
病機
脫髮與鬚髮早白的病機可歸納為：肝腎陰虛，精血不足，毛髮失於濡養為發病之本；陰血虧虛則內生虛熱，血熱上擾灼傷毛囊，加速脫落與變白；病程日久，氣血運行不暢，瘀血阻滯頭皮絡脈，毛囊得不到營養供應，進一步加重脫髮。三者互為因果，單純補益往往不能取效，需補、清、通並用。
方藥組成
組成：女貞子 20g、旱蓮草 20g、生地黃 15g、熟地黃 15g、當歸 10g、丹參 10g、紅花 6g、川芎 6g、側柏葉 10g
功效：調補肝腎，養血活血，涼血清熱
主治：脫髮、鬚髮早白（證屬肝腎陰虛、血熱瘀阻）
方以二至丸（女貞子、旱蓮草）合四物湯意加減化裁。女貞子、旱蓮草滋補肝腎、涼血烏髮為君，用量最重，各20g。熟地黃補腎填精，生地黃滋陰涼血，一溫一涼，補而不燥。當歸養血和血，丹參、紅花、川芎活血化瘀，疏通頭皮絡脈，使精血能上達毛根。側柏葉涼血止血、清熱止癢，專清頭皮鬱熱。
| 藥組 | 藥物劑量 | 功用 |
|---|---|---|
| 補肝腎 | 女貞子 20g、旱蓮草 20g、熟地黃 15g | 二至丸滋補肝腎、涼血烏髮，熟地黃填精益髓，共固毛髮之根本 |
| 養血活血 | 當歸 10g、丹參 10g、紅花 6g、川芎 6g | 當歸補血和血，丹參、紅花、川芎活血化瘀通絡，引精血上達頭皮，改善毛囊供血 |
| 涼血清熱 | 生地黃 15g、側柏葉 10g | 生地黃滋陰涼血清虛熱，側柏葉涼血止癢、清頭皮鬱熱，護固毛囊 |
隨證加減
| 兼證 | 加減藥物 | 立法用意 |
|---|---|---|
| 肝腎虧虛甚 | 加制何首烏 15g、枸杞子 12g | 增強補肝腎、益精血之力，助烏髮 |
| 血熱偏重 | 加牡丹皮 10g、赤芍 10g | 加強涼血清熱之力，清頭皮鬱熱 |
| 頭皮油膩瘙癢 | 加苦參 10g、白鮮皮 15g | 清熱燥溼止癢，改善頭皮環境 |
| 瘀血明顯 | 加桃仁 10g、赤芍 10g | 增強活血化瘀通絡之力 |
| 失眠多夢 | 加酸棗仁 15g、夜交藤 20g | 養心安神，改善睡眠以助精血恢復 |
| 氣虛乏力 | 加黃芪 15g、黨參 12g | 益氣生血，氣行則血行 |
加減總以補虛不礙邪、清熱不傷正、活血不耗血為度。臨床見單純虛證者可加用補益藥，瘀象不顯著者可減紅花，溼熱偏重者酌加清熱燥溼之品。
小結
美頭煎以二至丸補肝腎、四物湯意養血活血，配側柏葉涼血清熱，融補、養、通、清於一爐，針對脫髮與鬚髮早白”虛、熱、瘀”。藥性平和，適合較長時期服用，臨床對斑禿、雄激素性脫髮及複合型早白均有較好效果。
參考文獻：
[1] 張志遠. 張志遠臨證七十年碎金錄[M]. 北京: 人民衛生出版社, 2014.
[2] 張志遠. 診餘偶及[M]. 北京: 中國中醫藥出版社, 2013.
[3] 國家中醫藥管理局名詞術語規範推廣項目. 張志遠詞條[EB/OL]. 大眾醫學網.
[4] 國醫大師張志遠傳承工作室簡介[EB/OL]. 山東中醫藥大學官網.