| Study background:Seborrheic alopecia is often referred to as male pattern alopecia or androgenetic alopecia in Western medical literature. In traditional Chinese medicine, it was first described in the Qing text "Waike Quansheng Ji (Life-saving Manual of Diagnosis and Treatment of External Diseases)" as "fazhu hair-loss" or "zhufa tinea". Western medicine recognizes the incidence of androgenetic alopecia to be related to genetic inheritance, imbalances in androgen hormone, and abnormal sebaceous activity. Traditional Chinese medicine, on the other hand, believes that hair-loss is mainly due to deficiency of the kidney essence, which is the basis for the generation of blood that is indispensable for healthy hair growth. Thus, the health of the hair is intimately related to the health of the viscera. In clinical terms, hair-loss is often caused by "liver wind, phlegm dampness, fire heat, or blood stasis"Androgenetic alopecia is one of the most common, and yet hard to treat, chronic dermatological disorders that typically affects young males20-30years of age. However, there has been a trend of increasing incidence in young females in recent years. Clinical representations of patients suffering from androgenetic alopecia include gradual receding hair line starting from the temples (alopecia triangularis) and hair-loss in the vertex of the head. Course of the disease is often slow, chronic, and progressive. Often light and fragile lanugo hairs are seen in place of normal healthy hair prior to complete hair-loss. Hair in the temporal and parietal areas is typically not affected. Most patients do not complain of symptoms other than hair-loss, though some patients complain of slight itching or numbness on the affected scalp. Androgenetic alopecia is often accompanied with excessive sebaceous secretions and inflammation, and there is often a family history of hair-loss. In recent years, due to the changes in life-style, there has been an increasing incidence of androgenetic alopecia in the younger generations. Since alopecia affects physical appearance; it can severely depress a patient's self-esteem. Treatment for this disorder is typically long term, and currently there are no treatments proven to be effective in curing androgenetic alopecia. For these reasons, research into the pathogenesis of the disorder, as well as the availability of treatment options are direly needed.Objective:This study compares the treatment effect of triple needle therapy, application of Chinese medical hair regrown spray, and the combination of the two therapies in patients suffering from seborrheic alopecia. Specific focuses of the study include:(1) Statistically analyze and compare the differences in response between the three treatment groups.(2) Investigate the pathogenesis and mechanism of seborrheic alopecia(3) Investigate the effectiveness of triple needle therapy and the application of Chinese medical hair regrown spray on the treatment of seborrheic alopecia.(4) Investigate the current state of patients suffering from seborrheic alopecia in the Vancouver Canada region, as well as performing a systematic and initial conclusive clinical analysis of the data collected.(5) Attempt to further the understanding of the pathogenesis and mechanism of seborrheic alopecia in traditional Chinese medicine, and to provide a basis for the usage of triple needle therapy and the application of Chinese medical hair regrown spray in the treatment of seborrehic alopecia, with the goal of enhancing treatment benefits and reduce potential recurrence of the disease.This study focused on Vancouver Canada patients as subjects in the systematic and clinical study on the treatment effect of triple needle therapy and the application of Chinese medical hair regrown spray. This study has found that regardless of the treatment options, both the triple needle therapy and the application of Chinese medical hair regrown spray have produced good results for patients suffering from seborrheic alopecia. This study has made up for the lack of study and Chinese medical treatment of seborrheic alopecia on patient groups based in Canada, and is innovative in this regard.Methods:Patient information:Through the patient base in Tian You Acupuncture Clinic,90patients suffering from seborrheic alopecia have volunteered to participate in this study.80patients successfully completed the treatment program. Nine patients did not complete the study due to the length of time required by the treatment program, and1patient stopped treatment due to a geographical move. Patients in the study were asked to complete a clinical observation form, and were randomly selected into one of the three groups:26patients in the triple needle therapy group,30patients in the application of Chinese medical hair regrown spray group, and24patients in the combination of triple needle therapy and application of the Chinese medical hair regrown spray group.Diagnostic criteria of the study:Clinical standard of the diagnostic criteria of seborrheic alopecia were outlined in the Western dermatology medical text "Hair and Hair Diseases" by C. E. Orfanos and R. Happle in1990:(1) Patient hair-loss pattern should exhibit the clinical male and female modeling pattern.(For male and female hair-loss pattern, please see Figure图2and图3, respectively).(2) Gradual time course of hair-loss and progressive transformation of terminal hairs into intermediate, vellus, and finally lanugo hairs.(3) Hereditary predisposition in the family with simultaneous presence of other symtoms of SAHA syndrome (seborrhea, acne, hirsutism, alopecia) in women.Traditional Chinese medical standard of diagnostic criteria for seborrheic alopecia were referenced from Chinese medical text "Surgery of Traditional Chinese Medicine" by People's Medical Publishing House. Clinical features include a slowly receding hair line starting from the temples. Hair in affected areas gradually becomes thinner, softer, sparse, and eventually fall out. After about10years, the frontal and top portion of the hair can completely fall out. Scalp of the bald areas appears shiny, smooth, and the pores are small. Some lanugo hair may remain in the affected area. Hair in other parts of the scalp is typically not affected. Three treatment groups used in the study:(1) Triple needle therapy group:An Chi handy acupuncture needles were used on selected local meridians. Manufacturer address for An Chi is4F, No.570, Sec.7, Zhongxiaodong road, Taipei, Taiwan. Model of acupuncture needle used: single handy acupuncture needle,30G X1.0-1.5.Allow the patient to sit comfortably, then select and sterilize the selected meridian points. Insert An Chi handy acupuncture needles at the selected points. Needling manipulation techniques used include needling direction of pulling and pushing, and needling direction of arriving and departing.Select the acupuncture points by judging the size of the balding patch, then insert needle and perform the three needle technique on the average points of the balding area. Needle should be inserted under the scalp in a30°angle. When the point of the needle has reached the subgaleal layer, your finger should feel lesser resistance coming from the needle. At this point, position the needle parallel to the scalp and continue to insert the needle, until the patient reports sensations of numbness and distention.The needle point should face the flow of the meridian points at a parallel angle. Since the area of hair-loss is unique to each patient, select the meridian points that cover the area of hair-loss. According to the area of hair-loss, you may wish to select meridian points on the bladder meridians, du meridians, or gall bladder meridians. For large areas of hair-loss, all these meridian points could be used. First insert a needle following the flow of the meridian points parallel to the scalp, and then insert another two needles beside the first insertion point. These two needles may point toward the same or opposite direction to the first needle inserted. A characteristic feature of traditional Chinese medicine is to tailor the treatment to the unique clinical presentation and constitution of each patient. There are four types of patient constitution that should be considered when selecting the meridian points for treatment of seborrheic alopecia:For patients that fall into the dampness-heat constitution type, meridian points LI4, ST40, ST36, SP9, SI3, SI4…should be selected. These points allow for tonification of spleen and lessening of dampness, as well as to cool down heat and fire.For patients that fall into the blood-heat and wind-dryness or blood-deficiency and wind-dryness constitution type, meridian points LI4, LIU, SP1O, LR3, SI4, ST36… should be selected, these points allow for dispersion of wind and cooling of heat, as well as to nourish blood and moisten dryness.For patients that fall into the liver and kidney insufficiency or liver and kidney yin deficiency constitution type, meridian points KI3, KI6, LR3, ST36, SP6, LI4… should be selected, these points allow for tonification of spleen and stomach, as well as liver and kidneys.For patients that fall into the blood-stasis constitution type, meridian points LI4, DU14, ST36, SP10, LR3, SP6, DU2O, DU21, BL7-should be selected, these points allow for dispersion of local circulation, as well as to activate blood and resolve stasis.After qi has been obtained in these meridian points, you may stop further needling. Acupuncture should be performed once every two days, each time for60minutes. One course of treatment consists of20days, which includes10acupuncture sessions. Observe the patients for a total of three courses of treatment.(2) Application of Chinese medical hair regrown spray group:These steps should be performed by the patient in the comfort of their own homes:first thoroughly wash the affected area with shampoo or other cleaning agents of choice, then sit in a comfortable position and fully moisten the affected areas with the Chinese medical hair regrown spray and massage until the area feels warm to the touch. This allow for better absorption of the medicinal ingredients into the affected scalp. Components of the Chinese medical hair regrown spray include herbs such as oriental arborvitae leafytwigs (cacumen platycladi orientalis), drynaria fortunei (fortune's drynaria rhizome), polygoni multiflori (polygonatum)… etc.(3) Combination of triple needle and Chinese medical hair regrown spray group:This group will receive a combination of the above two therapies. Patients will receive triple needle therapy prior to the application of the Chinese medical hair regrown spray. Triple needle therapy is done once every two days, while the spray is applied three times per day. A course of treatment lasts20days, and the study lasts three courses.Observational scale used:Prior to the beginning and at the end of the study, record the number of hair that is lost, and rate the degree of greasiness, itching, and amount of dandruff per day. These observations will be rated on a scale and used as a basis to evaluate the effectiveness of treatments.For hair-loss:Record0for no hair loss,2for less than30strands of hair loss per day,4for betrween30to60strands of hair loss per day,6for between61and100strands of hair loss per day, and8for greater than100strands of hair loss per day.Degree of itching:record0for no itching,2for mild itching,4for moderate itching, and6for severe itching.Degree of greasiness:record0if there is no excessive greasiness,2for mild greasiness (hair appears greasy if not washed in two days),4for moderate greasiness (hair appears greasy if not washed in one day), and6for severe greasiness (hair always appears greasy and shiny).Amount of dandruff:record0for no dandruff,2for light amount of dandruff,4for moderate amount of dandruff, and6for heavy amount of dandruff. Note:formula used: Standard for treatment evaluation:Standard was referenced from "Clinical Teaching Standards in the Study of New Traditional Chinese Medical Drugs" third edition by the Ministry of Health of the People's Republic of China.Cured:Hair-loss has ceased, and new hair has grown in bald areas. Hair density, thickness and color of the newly grown hair are the same as the healthy hair in other unaffected parts of the scalp. Sebaceous secretion has returned to normal, or the symptoms and the total score have decreased95%or more.Highly effective:hair-loss has ceased, and new hair has grown to about70%in the bald areas. Hair density, thickness and color of the new grown hair are close to the healthy hair in other unaffected parts of the scalp. Sebaceous secretion has significantly lessened, or the symptoms and the total score have decreased70%of more but less than95%.Effective:hair-loss has ceased, and new hair has grown to about30%in the bald areas, including lanugo and light colored hair. Symptoms and total score have decreased35%or more, but less than70%.Not effective:hair-loss continues, and new hair has grown in less than30%in the bald areas. The above mentioned symptoms have not improved, and total score has decreased by less than35%. Statistical methods used in the study:All scores were entered and organized using SPSS17.0in Microsoft Office Excel2010. Chi test (x2test) was used to statistically analyze the data, and the results were represented as the average plus or minus standard deviation (x±S). Differences among the three groups were evaluated using the F test, and comparisons of groups before and after treatments were evaluated using the T test. Data that represent standard probability distribution was examined using the Q test, and data that does not represent such distribution was examined using rank sum test. Data with P<0.05are deemed statistically meaningful, and data with P<0.01are deemed statistically significant.Results:(1) Incidence of seborrheic alopecia occurs in males and females in a9:1ratio. Most patients affected are between18to30years of age, which nicely corresponds with traditional notion that seborrheic alopecia typically affects young males. Most patients affected belonged to the white collar group that required heavy thinking on their jobs.(2) Seborrheic alopecia is chronic and difficult to treat. Length of the disorder typically ranges from less than one year to more than5years.(3) Seborrheic alopecia typically affects males with dampness-heat constitution.(4) The incidence of seborrheic alopecia is closely correlated to daily habits, diet, smoking, and alcohol consumption.(5) The incidence of seborrehic alopecia is closely correlated to the frequency of intake of dairy, deep fried, barbequed foods, and Western breads, desserts, and fast foods.(6) There is not a close correlation of dimethicone in the shampoo and the incidence of seborrheic alopecia(7) The incidence of seborrheic alopecia is closely correlated with staying up past11pm.(8) After the first course of treatment, effectiveness of treatment was rated at61.5%for the triple needle therapy group, followed by61.3%in the combination of the triple needle therapy and the application of Chinese medical hair regrown spray group, and56.7%in the application of Chinese medical hair regrown spray group.(9) After2courses of treatment, effectiveness of treatment was rated at91.7%for the combination of the triple needle therapy and the application of Chinese medical hair regrown spray group, followed by84.6%in the triple needle therapy group, then76.7%for the application of Chinese medical hair regrown spray group. Average effectiveness in all three groups was83.8%.(10)After3courses of treatment, effectiveness of treatment was rated100%for the combination of the triple needle therapy and the application of Chinese medical hair regrown spray group,96.7%for the application of Chinese medical hair regrown spray group, and96.2%in the triple needle therapy group. Average effectiveness in all three groups was97.5%.(11)During the course of treatment for seborrheic alopecia, the combination of triple needle therapy and the application of Chinese medical hair regrown spray produce the best treatment responses. After three courses of treatment, effectiveness of the combination of the triple needle therapy and the application of Chinese medical hair regrown spray group is better than that of triple needle therapy or the application of Chinese medical hair regrown spray group.(12)Triple needle therapy, application of Chinese medical hair regrown spray, or the combination of the two therapies all produces positive treatment responses.(13)There is no difference in the effectiveness of the triple needle therapy and the application of Chinese medical hair regrown spray in the treatment of seborrheic alopecia.(14)Triple needle therapy, application of the Chinese medical hair regrown spray, or a combination of the two treatments all produce positive response in the treatment of alopecia, regardless of the length of the disease.(15)There is no negative side effect observed in triple needle therapy, application of the Chinese medical hair regrown spray, or combination of the two therapies in the treatment of seborrheic alopecia.Conclusion:According the relevant information collected from Canadian patients in the Vancouver area, incidence of seborrheic alopecia is closely related to frequency of eating a local diet that includes a high proportion of dairy, deep-fried, barbequed foods, as well as Western breads, desserts, and other fast foods.Triple needle therapy, application of the Chinese medical hair regrown spray, or a combination of the two therapies have been shown to be highly effective in the treatment of seborrheic alopecia, regardless of the length of the disease. No undesirable side effects on these treatments have been noted, which is characteristic of traditional Chinese medical treatments. For these reasons, triple needle therapy and the Chinese medical hair regrown spray are highly recommended as treatment options for seborrheic alopecia.
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