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Alopecia areata, commonly known as ghost shaving head, is referred to as "hair loss" in the Neijing. The Zhubing Yuanhou Lun categorizes it into two conditions based on clinical manifestations: beard and hair loss condition and ghost licking head condition. It also lists alopecia areata caused by red baldness and white baldness for differentiation. Physicians in the Ming and Qing dynasties referred to patchy alopecia areata as "alopecia areata" and provided specialized discussions, offering valuable experience for the prevention and treatment of this condition in later generations.

Clinical observations show that alopecia areata can be seen in various diseases. This article focuses on discussing cases where alopecia areata is the main symptom, and does not discuss alopecia areata caused by other diseases.

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1. Wind Generation Due to Blood Heat︰Sudden patchy hair loss with shiny scalp and mild local itching, usually without systemic symptoms, or accompanied by restlessness, thirst, constipation, dark urine, red tongue with thin yellow coating, and wiry, slippery, rapid pulse. This condition is often caused by emotional stress, mental agitation, exuberance of heart fire, blood heat generating wind, and wind movement leading to hair loss. The key diagnostic points are: sudden onset, round or oval patches of hair loss, shiny scalp without subjective symptoms, along with red tongue and wiry, slippery pulse. Treatment focuses on cooling blood and clearing heat to dispel wind. The recommended formula is Wu Fa Wan (Black Hair Pill), or optionally adding unprocessed Rehmannia Root and Moutan Bark, prepared as a decoction for oral administration.
2. Yin and Blood Deficiency︰The hair is oily and shiny with excessive dandruff, frequently falls out, and over time, the top of the head or both temples gradually become sparse. There is scalp itching, possibly accompanied by tinnitus, soreness in the waist, and limb fatigue. The tongue is red with scant coating, and the pulse is thin and rapid. This is often due to liver and kidney deficiency, resulting in insufficient yin and blood. Hair is the surplus of blood, and blood deficiency fails to nourish the hair, leading to hair loss. Alternatively, it may be caused by loose skin striae and interstices, sweating in the wind, allowing wind pathogens to invade the body. Excessive wind and blood dryness deprive the hair of nourishment, causing it to fall out. Zhubing Yuanhou Lun states: "When a person has wind pathogens in the head and a localized deficiency, the hair will fall out in patches." Based on clinical manifestations:
   1. The hair is fine and weak, excessively oily and shiny, with no signs of breakage.
   2. Alopecia areata often occurs on the top of the head or both temples, with excessive scalp oil or dandruff and itching.
   3. The onset is slow, the course is prolonged, and it is commonly seen in middle-aged adults. Frequent alopecia areata gradually leads to baldness.
   4. Scalp itching is often present.
   Symptoms such as dizziness, tinnitus, soreness in the waist, limb fatigue, a red tongue with little coating, and a thin, rapid pulse indicate liver and kidney deficiency and depletion of yin and blood. The treatment principle focuses on nourishing water to moisten wood, nourishing blood, and dispelling wind. The recommended formula is Shen Ying Yang Zhen Dan with modifications.
3. Deficiency of Both Qi and Blood︰The hair is thin, soft, dry, and lacks luster, with uniform hair loss and gradual thinning. There is a shortage of qi and lack of strength, faint and low voice, pale complexion, palpitation or severe palpitation, numbness in the limbs, a pale tongue texture with scant coating, and a thin, weak pulse. Due to prolonged illness or postpartum conditions, qi and blood gradually become deficient, failing to nourish and moisten, leading to hair loss. Clinically, the manifestations include:
   1. The hair is fine and weak, dry and dull, often with broken strands remaining.
   2. In cases of alopecia areata, the hair is sparse and scattered across the entire scalp, with noticeable hair loss in frequently rubbed areas such as the occipital region.
   3. The onset is slow, and the course is prolonged. It can occur at any age, often starting after a prolonged illness or postpartum, with hair gradually thinning.
   4. There are no subjective symptoms.
   The complexion is pale, with palpitation and shortness of breath. A pale tongue with scant coating and a thin, weak pulse indicate deficiency of both qi and blood. Treatment should focus on greatly tonifying qi and blood, with appropriate selection of Ginseng Nourishing Pill, Ten Complete Major Tonifying Pill , Tonifying Middle and Replenishing Qi Pill, Eight Precious Ingredients Motherwort Pill, etc.
4. Static Blood︰Partial or complete hair loss, or loss of beard and eyebrows, with no regrowth over time, often accompanied by headache, thirst with a desire to drink but not swallow, dull complexion, purplish-red lips, dark tongue texture with ecchymosis, and thin, choppy pulse. This is due to static blood not being cleared, preventing the generation of new blood, leading to alopecia areata as the hair is not nourished by blood. Yilin Gaicuo states: "Blood stasis between the skin and muscles blocks the blood pathways, preventing new blood from nourishing the hair, hence hair loss." Clinically, the diagnosis is primarily based on the following three points:
   1. If a dull complexion, purplish-red lips, thirst with a desire to drink but not swallow, a dark tongue with ecchymosis, and a thin, choppy pulse are observed, it can be confirmed as a static blood syndrome.
   2. According to Wang Qing-ren's theory that "alopecia areata without apparent illness is also due to blood stasis," any case without obvious disease cause, and not caused by blood heat, yin deficiency, or qi-blood deficiency, should be diagnosed as alopecia areata due to static blood obstruction.
   3. For alopecia areata that persists over time and does not respond to various treatments, it can be treated as static blood syndrome.
   Treatment should follow the principle of "blood-excess syndrome should be treated by removing therapy," adopting methods to invigorate blood and resolve stasis, with the prescription selected from Orifice-Openning Blood-Activating Decoction with modifications.

Yinxue deficiency and Qi-blood deficiency alopecia areata both belong to deficiency pattern, with commonalities: (1) the hair characteristics are both fine and weak; (2) both have a slow onset and a prolonged course. Some patients may also present with various accompanying symptoms, which can aid in pattern identification.