"I've been losing a lot of hair — a handful every time I wash it." It is a sentence that comes up often.

This article does not recommend products, and does not tell you what to take to grow it back. It is about what a practitioner asks, and when to see a dermatologist first, set out as 5 things.

I. First: the pattern matters more than the amount

It is easy to describe hair loss by quantity alone. A practitioner is more interested in distribution and form — these distinctions mainly help decide whether a dermatologist should come first; TCM assessment still rests on the whole picture:

• Thinning overall, or noticeably worse in particular areas
• A receding hairline, or thinning through the crown
• Round, distinct bald patches — this one needs a doctor first
• Along with flaking, redness, itching or soreness — this one too
• Whole hairs with the root, or hairs breaking mid-shaft

How TCM understands the relationship between hair and the overall state belongs to the theoretical framework of the organ systems and qi — a different kind of explanation from a dermatological account of the follicle cycle. The two should not be conflated.

II. The 5 things a practitioner asks about

• When it started and how it changed — when you noticed, sudden or gradual, whether it is worsening.
• Distribution and form — the questions in the section above.
• What else happened around that time — illness, fever, surgery, childbirth, marked weight change, a period of severe stress.
• The condition of the scalp — oiliness, flaking, itching, redness, spots or sores.
• Existing diagnoses and medication — what you take, supplements, thyroid or anaemia results, whether anyone in the family has something similar.

The third is the easiest to skip and it is critical — a practitioner asks about the months before as well, not only the last few days.

III. How to describe it usefully

This table deliberately does not say what any answer means. TCM is not a self-assessment quiz — and some of these need a dermatologist's examination to establish at all.

IV. See a dermatologist or doctor first in these situations

• Round, well-defined bald patches
• A scalp that is red, swollen, weeping, crusted or clearly painful — if it comes with a high fever, facial swelling or feeling unwell in yourself, call 999 now, or go to the nearest hospital emergency department
• Sudden heavy loss over a short period
• Marked weight change, heat or cold intolerance, or palpitations alongside it — thyroid testing may be needed
• In women, alongside changes to periods or body hair
• During or just after particular treatments (chemotherapy, for instance) — follow your treating doctor's plan
• Hair loss that began after starting a new medication — tell your doctor, and never stop it on your own
• An ulcer or new growth on the scalp that does not heal

These need a doctor's examination — including blood tests or scalp examination where indicated — to establish the cause, and a TCM consultation does not substitute for them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

V. Fitting it into life in Malaysia

• Heat, sweat, washing daily. Very common here — say honestly how often and what you use.
• Commuting in a helmet. Heat, friction and sweat; how many hours a day is worth a sentence.
• Colouring and perming. How often, when the last time was, and whether it started after.
• Hair loss after childbirth. Always mention that timing. On postnatal consultations: confinement.
• Photograph it. Same angle, same light, taken again after an interval. More useful than any description.

On preparing: what to prepare before an online consultation.

In closing

✅ Worth remembering:

1. Distribution and form matter more than how much is falling out.
2. A practitioner asks about onset, pattern, what else happened at the time, the scalp, and existing diagnoses and medication.
3. Asking back three or four months is standard, not a detour.
4. Round bald patches, a red or weeping scalp, sudden heavy loss — see a dermatologist first.
5. If it began after a new medication, tell your doctor and do not stop it on your own.

❌ Better not to:

1. Buy products before establishing which situation this is.
2. Use hair-growth products of unclear composition or origin.
3. Rely on TCM care alone when the scalp is red, weeping or painful.

👉 If you would like to set the whole picture out for a practitioner, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in section IV applies, see a dermatologist or doctor first.

Reviewed by Ms. Koo Shuang, a TCM practitioner registered with Malaysia's Traditional and Complementary Medicine Council under the T&CM Act 2016, practising in gastroenterology, dermatology, respiratory and women's health.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

「医师，我最近掉头发掉得很凶，洗头一抓一把。」这是不少读者常说的一句话。

这篇不推荐产品，也不告诉您「吃什么会长回来」。这篇讲的是医师在问诊时会了解哪些事，以及什么情况该先看皮肤科，整理成 5 件事。

一、先分清楚：掉发的「样子」比「量」更关键

描述掉发时，很容易只讲量。医师更在意的是分布与形态——以下这些区分，主要用来判断是否需要先看皮肤科；中医的辨证仍以整体情况为依据：

• 整体变稀，还是某几个区域特别明显
• 发际线后退，还是头顶中间变稀
• 一块一块的圆形空白——这一种需要先就医
• 连着头皮屑、红、痒、疼——这一种也需要先就医
• 掉的是整根带毛囊，还是断在中间

至于中医怎么理解头发与整体状态的关系，属于脏腑与气血的理论框架，与现代皮肤科对毛囊周期的解释不是同一回事，两者不应混为一谈。

二、医师会了解的 5 件事

• 开始的时间与变化：什么时候发现、是突然的还是慢慢的、有没有加重。
• 分布与形态：上一节的那几个问题。
• 同一时期发生的事：生病、发烧、手术、产后、体重明显变化、极大的压力。
• 头皮的状况：出油、头皮屑、痒、红、有没有痘或疮。
• 已有的诊断与用药：正在服用的药物、补充品、甲状腺或贫血的检验结果、家族中有没有类似情况。

第三项最容易被略过，但它非常关键——医师会连同前几个月发生的事一起问，而不是只看最近这几天。

三、一张表看懂：怎么描述才有用

这张表刻意不写「哪一种代表什么」。中医不做自我对号入座——分辨是医师问诊后的判断，而其中有些情况需要皮肤科的检查才能确认。

四、这些情况请先看皮肤科或医生

• 一块一块的圆形空白，边缘清楚
• 头皮红肿、化脓、结痂、明显疼痛——若同时有高烧、脸部肿胀或整个人明显不适，请立刻拨打 999，或前往最近的医院急诊部
• 突然在短时间内大量掉发
• 同时有明显体重变化、怕冷或怕热、心悸——可能需要甲状腺相关检验
• 女性伴随月经改变、体毛变化
• 正在或刚结束特定治疗（例如化疗）——请以主治医生的安排为主
• 服用新药之后开始掉发——请让医生知道，切勿自行停药
• 头皮出现不会好的溃疡或新长的东西

这些需要医生的检查（必要时包括验血或头皮检查）才能确认原因，中医问诊不能取代这些检查。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

五、大马生活里怎么安排

• 天气热、出汗多、每天洗头：这是本地很普遍的情况，问诊时如实说明频率与用的洗发水。
• 戴头盔通勤：闷、摩擦、汗——骑摩托的时间长度值得提一句。
• 染发与烫发：多久一次、最近一次什么时候、有没有在那之后开始。
• 产后掉发：这是问诊时务必说明的时间点。相关的产后问诊内容，可参考：坐月子。
• 拍照记录：同一角度、同样光线，隔一段时间再拍一次。这比任何形容都有用。

关于问诊前的准备，可参考：线上问诊前该准备什么。

结语

✅ 记住这几点：

1. 掉发的分布与形态，比「掉多少」更关键。
2. 医师会了解开始时间、分布形态、同期发生的事、头皮状况、已有诊断与用药。
3. 往回问三四个月是这类问诊的固定动作，不是离题。
4. 圆形空白、头皮红肿化脓、短时间大量掉发——先看皮肤科。
5. 服用新药后开始掉发，请让医生知道，切勿自行停药。

❌ 不要这样做：

1. 不要先买产品再找答案——先确认是哪一种情况。
2. 不要使用成分与来源不明的生发产品。
3. 不要在头皮有红肿、化脓或疼痛时还只靠调理。

👉 如果您想把掉发的情况完整说给医师听，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有第四节列出的情况，请先看皮肤科或医生。

本文由 邱双 医师 撰稿审阅。邱双 医师依 2016 年 T&CM 法令于马来西亚传统与辅助医药理事会注册执业，专长为肠胃科、皮肤科、呼吸科与妇科。

无论身在何处，与持证中医师对坐。

汉方现代中医