Hair Fall medically known as alopecia, refers to excessive shedding or loss of hair from the scalp or other body parts. It can be temporary or permanent and affects both men and women.

I)Normal hair shedding vs. Excessive hair fall:

The human scalp contains approximately 100,000-150,000 hair follicles.
It is normal to lose 50-100 hairs per day as part of the natural hair growth cycle.
When hair loss exceeds this normal range or leads to visible thinning, it is considered excessive hair fall and requires intervention.

Hair growth Cycle:

Hair growth occurs in four distinct phases:

a)Anagen phase(Growth phase):

Here the hair follicles produce new hair.
Duration is about 2-7 years(it can vary according to individuals and their genetics).

b)Catagen Phase(Transition phase):

Duration is about 2-3 weeks.
In this phase hair growth slows down.

c)Telogen phase(Resting phase):

It lasts about 3-4 months.
Here the follicle remains inactive, and the club hair stays in place.

d)Exogen Phase(Shedding phase):

It lasts only a few days to weeks.
Here old hair sheds, and starts the new cycle again.
Seasonal shedding may also occur at a specific time of the year.

Losing 50-100 strands per day is considered normal. However, excessive shedding indicates an underlying issue.

In Ayurveda, this condition can be correlated to ‘Khalitya’ a type of Shiro Roga, primarily referring to hair fall and baldness. It is considered a Tridosha Vyadhi, that involves an imbalance of all three doshas-Vata, Pitta, and Kapha. However, Pitta plays a major role in hair loss.

SAMPRAPTI(PATHOGENESIS) OF KHALITYA:

In the initial state, it begins with Vata-Pitta Dushti: Increased pitta leads to weak hair roots and dries them up, causing brittleness and premature hair fall.
This is followed by Raktha dushti(blood vitiation stage): Pitta and Vata lead to blood vitiation, which leads to improper nourishment of hair follicles. In this stage, scalp dryness, dandruff, and inflammation occur.
Then comes the kapha dushti(blockage stage): Increased kapha blocks the hair follicle, which prevents new hair growth. The scalp turns oily, making the hair thinner and miniaturization.
The final stage is Srotorodha(follicle destruction stage-Baldness): Here there is the destruction of hair follicles, resulting in irreversible baldness.

CAUSES OF HAIRFALL:

Hair fall is a multifactorial issue, influenced by genetics, health conditions, diet, lifestyle, and environmental factors.

1.Genetic Factors(Androgenetic Alopecia):

Male pattern Baldness(MPB): Here the hair loss happens in a certain pattern(crown thinning, diminishing of hairline).
Female Pattern Baldness(FPB): Here thinning occurs on the crown and top portion of the scalp, which normally happens due to hormonal imbalances.
This condition usually happens when the individual is sensitive to Dihydrotestosterone(DHT), which impacts the hair growth cycle.

2. Hormone Balance issues:

Thyroid problems: Hypothyroidism and hyperthyroidism can lead to hair thinning.
PCOS(Polycystic Ovary Syndrome): Higher androgen levels can cause an increment in hair loss.
Pregnancy and postpartum hair loss: Since estrogen fluctuation happens during this phase, severe hair loss is common after delivery.
Menopause: Low levels of estrogen and progesterone during this phase cause hair loss.

3. Nutritional Deficiencies:

a)Protein deficiency:

Keratin is the major protein in hair; so protein deficiency weakens the hair’s strength.

b)Iron deficiency(Anemia):

Iron deficiency also reduces the oxygen supply to the hair, leading to hair fall.

c)Vitamin Deficiencies:

Vitamin D: It reinforces follicle growth.
Biotin(Vitamin B7): It is necessary for the production of keratin.
Zinc and Selenium: Deficiencies can lead to brittle hair and shedding of hair.
Vitamin B12:It increases red blood cell production and oxygen supply to the hair follicle.

4. Scalp infections and Diseases:

Dandruff(Seborrheic Dermatitis):
Increased dandruff can lead to follicle inflammation and hair fall.
Fungal infections(Tinea Capitis): A scalp infection(contagious type)that further leads to hair fall in patches.
Psoriasis and Eczema: It is an autoimmune condition that leads to inflammation of the scalp and hair thinning.

5. Stress and Psychological Factors:

Telogen Effluvium: Due to severe stress, that makes hair follicles in the resting stage, it leads to excessive shedding.
Trichotillomania: The individuals compulsively pull out the hair, as a part of psychological issues.
Poor sleeping habits: It leads to disruption of hair growth cycles.

6. Autoimmune Disease:

Alopecia Areata: The hair loss is patch-like since the immune system attacks the hair follicles.
Lupus: It is an autoimmune condition where thinning of hair and inflammation occurs.

7. Medical Conditions and Treatments:

Diabetes: This leads to poor circulation and increased blood sugar that damages the hair follicle.
Chronic illness: Eg; kidney diseases, liver disorders, and heart diseases can weaken hair.
Chemotherapy and radiation: Since rapid cell division occurs in this, it also leads to the division of hair follicles.
Few medications like antidepressants,beta-blockers(for blood pressure), anticoagulants(blood thinners), or birth control pills, etc.

8. Lack of hair care:

Due to frequent heat styling.
Usage of harsh chemicals.
Some kind of tight hair styling(traction alopecia).
Repeated hair wash using harsh shampoos.

9. Environmental and lifestyle factors:

Pollution.
Hard water.
Uv radiation.
Smoking and alcohol consumption.

Exposure to these factors can lead to hair breakage and hair fall at a faster rate.

10. Aging:

Due to aging, the hair naturally thins.

Ayurvedic Perspective of Hair Fall:

Ayurveda states that an imbalance in the three doshas—Vata, Pitta, and Kapha—is the main cause of hair loss.

Vata imbalance: Dryness and brittle hair, which is brought on by inadequate nutrition.
Pitta imbalance: Hair thinning, which is frequently associated with stress-related hair loss, is caused by an excess of heat in the body.
Kapha imbalance: Too much oil production can block follicles and result in hair loss from dandruff.

Ayurvedic causes of hair fall:

Weak agni, or poor digestion.
Overindulgence in salty, oily, and spicy foods.
Excessive stress and sleep deprivation.
Use of shampoos with chemical bases rather than natural ones.
Excessive exposure to pollution and the sun.

DIAGNOSIS OF HAIRFALL:

The diagnosis of hair fall requires a comprehensive evaluation through history, clinical examination, trichoscopy, and laboratory tests. A correct diagnosis helps in giving the most effective treatments.

1. Medical History and patient consultation:

Ask the patient about:

Hair Fall duration.
Hair loss pattern.
Family history.
Dietary habits: Like any nutritional deficiencies of iron, protein, vitamins.
Lifestyle factors: Hair care routine, sleep habits, stress, etc.
Illness or infections: Like surgeries, chronic disease(diabetes, thyroid issues), fever, etc.
Medications and treatments: Use of drugs(like chemotherapy, and hormonal pills).

2.Physical Examination(Scalp and Hair Analysis):

Hair density and distribution: Check for thinning or localized bald patches.
Condition of the scalp: Analyze the presence of dandruff, fungal infections, redness, scaling, or scarring.
Abnormalities of hair shaft: Observe to identify breakage, texture changes, or miniaturization of hair.

3. Diagnostic Tests for Hair Fall:

a)Hair pull test:

Pull a small section of hair(about 50-60 strands).
Hair shedding can be suspected if 5-6 hairs come out.

b)Hair Tug Test:

This is used to identify hair fragility and structural abnormalities.
Easy breakage of hair indicates shaft disorders or damage due to hair styling using chemicals.

c)Trichoscopy(Scalp Dermoscopy):

Using a dermatoscope, assess follicle health, inflammation, miniaturization, and density of hair.
Helps in differentiating androgenetic alopecia, alopecia areata, or scalp infections.

d)Trichogram and Phototrichogram:

It is a microscopic study of hair roots to analyze the proportion of hairs in anagen, catagen, telogen and exogen phases.
Phototrichogram: It is a computerized version that shows elaborate scalp and follicle analysis.

4. Laboratory Test for Hair fall:

Blood tests usually suggested are:

a)Hormonal tests:

Thyroid function tests(T3, T4, TSH): Hyperthyroidism and hypothyroidism both can cause hair fall.
Androgen(DHT, Testosterone, DHEAS): Elevated levels can indicate androgenetic alopecia or PCOS-related hair loss.
Cortisol levels: To check for stress-related hair fall.

b)Nutritional tests:

Serum Ferritin and Iron levels: Low levels can cause thinning of the hair.
Vitamin D, Vitamin B12, Zinc, and Biotin: All these deficiencies can lead to diminished hair growth.

c)Autoimmune and Inflammatory Markers:

ANA(Antinuclear Antibody Test): For the diagnosis of Lupus or other autoimmune disorders.
CRP and ESR(Inflammation Markers): It help to identify any chronic inflammation affecting the hair follicles.

5. Scalp Biopsy:

Not a mandatory test, but helps to diagnose scarring alopecia, alopecia areata, Lichen Planopilaris, or fungal infections.
Microscopic examination of scalp tissue is done here.

6. Fungal and Bacterial culture:

A scalp swab can be made to test for fungal(tinea capitis) or bacterial infections.

TREATMENT OF HAIR FALL IN MAURYA AYURVEDA HOSPITAL:

Ayurveda offers a holistic approach to hair fall with effective internal and external treatments, addressing the root cause naturally.

INTERNAL MEDICINES

Mahatiktaka ghrita.
Draksharishtam.
Bhringraj capsules.
Ashwagandha Capsules.
Brahmi capsules.
Triphala choornam.
Yashtimadhu churna.
Amalaki Rasayana.

HAIR OILS FOR EXTERNAL APPLICATION:

Mahabhringaraja Taila.
Neeli bhringyadi Taila.
Durdurapatradi kera Taila.
Chemparuthyadi Kera Taila.
Kesharaja Taila.
Malatyadi kera Taila.
Psora oil.

Along with this, CHAMPA ORGANICS-HAIR OIL, SHAMPOO, AND HAIR SERUM, are the exclusive formulations of our hospital, which are clinically tested and commonly recommended for our patients.

EXTERNAL TREATMENTS BEST FOR HAIR FALL IN AYURVEDA:

SHIRO ABHYANGA:

Shiro Abhyanga is a traditional ayurvedic head massage that involves the application of medicated oils to the scalp and is followed by gentle massage techniques. For massage, we gently warm the oil and do the massage. The massage is done for about 20 minutes. A few techniques like circular motion, zig-zag movements, and gentle pressure along with the nape of the neck(relieves stress). The oil is chosen based on dosha and the complaints involved.

Benefits of Shiro Abhyanga in hair fall:

It nourishes the scalp and hair follicles.
It improves blood circulation.
It reduces stress and anxiety.
It controls dandruff and scalp infections.
It strengthens the hair shaft and reduces breakage.
It enhances sleep quality.

SHIRODHARA:

Shirodhara involves a continuous and gentle stream of warm medicated oil poured over the forehead. Normally this is given to the patients, who have hair fall due to stress. Since it is a well-known therapy in Ayurveda for promoting mental relaxation, nervous system rejuvenation, and scalp nourishment. Normally Ksheerabala Taila and Valiya Chandanadi are used. Here the patient is made to lie down on a Droni, with a towel or cotton band placed over the eyes. Shirodhara pot is kept 4-6 inches above the forehead. The procedure is usually done about 30-60 minutes. The same oil is used for massage of the hair for better absorption. Usually advised for 7/14/21 days based on the condition.

Benefits of Shirodhara in hairfall:

It improves blood circulation to the scalp.
It balances Vata and Pitta dosha.
It reduces stress and anxiety.
It helps in removing scalp impurities.

RAKTAMOKSHANA:

Raktamokshana is included in panchakarma therapy in Ayurveda. It is mainly indicated for diseases caused by Vitiated Pitta and Rakta. The major treatment suggested for Khalitya(hair fall) is Raktamokshana, which is often associated with vitiated pitta and toxins in the blood.

Raktamokshana is normally performed in different methods. For this condition mainly Prachana and leech therapy is done.

The procedure of Raktamokshana is mainly done in three stages:

Purva Karma(Pre procedure):

These steps are done before bloodletting.

Assess the patient’s condition for his constitution(Prakrthi), dosha imbalance(Vikruthi), Bala(strength), etc.

A few things to be monitored before bloodletting:

BT-CT(Bleeding and Clotting Time): To assess the coagulation capacity.
Hemoglobin(Hb) level ensures the patient is not anemic.
Platelet count, for ruling out any sort of bleeding disorders. Also, make sure the patient doesn’t have any history of bleeding disorders.
Blood pressure: To prevent complications during bloodletting.
Ensure that the patient does not use anticoagulants(since it can increase the chances of bleeding).
Make sure the patient is hydrated well to prevent dizziness or hypotension post-procedure.

Pradhana Karma(Main Procedure):

a) Jalukavacharana(Leech Therapy):

It gives the best result in hair fall due to Pitta-Raktha dushti and inflammation in the scalp.
On certain points in the scalp or back of the neck, live medicinal leeches are placed for sucking the blood.
The leeches suck out the impure blood, which removes the toxins.

b) Prachanna(Multiple puncture Therapy):

For localized hair fall and dandruff.
Using sterile needles or scalpels multiple tiny pricks are made. As the bleeding occurs it leads to detoxification.

Paschat Karma(Post Procedure):

After the procedure the patient is advised to take rest and a light diet has to be followed.
Avoid spicy, oily, and heavy food items.

Benefits of Raktamokshana in Hair Fall:

It detoxifies the blood.
It balances the pitta dosha, the primary cause of hair thinning and premature hair graying.
It improves blood circulation to the scalp, which promotes hair growth.
It reduces dandruff, scalp infections(like seborrheic dermatitis), fungal infections, etc.
It strengthens hair follicles by removing heat and inflammation.

VIRECHANA:

Virechana also comes under panchakarma therapies in Ayurveda, primarily used for clearing out pitta dosha and detoxification of the body through controlled purgation.

Virechana Procedure:

It mainly involves three stages:

Poorva Karma(Preparatory phase):
Pradhana Karma(Main procedure):
Paschat Karma(Post therapeutic care):

a)Poorva Karma(Preparatory Phase):

Deepana and Pachana(Digestive stimulation): Panchakola Choornam and Ashta Choornam can be used for this purpose.
Snehapana(Internal Oleation): It is done using the intake of various Ghrita(ghee) like Mahatikthaka Ghritha, and Triphala Ghrita for about 3-7 days according to the patient’s condition.
Abhyanga(External Oleation) and Swedana(Sudation): It aids in loosening up of toxins.

b)Pradhana Karma(Main Procedure):

Analyze Patient strength and administer medicine for Purgation.

The common medicines used are:

Sukumara Eranda Taila.
Gandharvahasthadi Eranda Taila.
Rasna Eranda Taila.
Avipathi Choornam.
Thrivruth Lehyam.
Manibadra Gulam.

Then after the intake of these medicines, the patient experiences multiple bowel movements that release toxins from the body.

c)Paschat Karma(Post-Therapeutic Care):

After the patient is done with bowel movements, the patient is asked to rest.
The patient has to take light food for a few days until the digestion reaches a normal level.
Also, the patient has to avoid excessive exertion, sun exposure, and heavy foods.

Benefits of Virechana in hair fall:

It helps in detoxifying blood(Raktha and Pitta Dosha).
It improves digestion and nutrient absorption.
It strengthens hair follicles.
It balances stress and hormonal issues.
It also prevents premature graying.

NASYAM:

Nasyam is a panchakarma procedure that involves the administration of herbal oils or powders through the nose.It can be considered a powerful detoxification procedure that clears toxins from head and neck regions, balances doshas, and nourishes the scalp and hair roots.

The procedure of Nasya:

The patient can be given mild abhyanga(oil massage) and Swedana(steam therapy) are done on the face, neck, and scalp to open the channels(srotas). After tilting the head slightly backward the patient is made to lie comfortably.

The medicated oil is administered to each nostril. Again a gentle massage is given on the forehead, nose, and scalp to aid absorption. The patient is asked to breathe deeply and rest for a few minutes. If the patient feels medicines or phlegm coming out it can spit out. The patient can also rest for about 15-30 minutes. Wind, cold, exposure to sun, or strong smells should be avoided. And a light diet should be followed.

Normally two types of Nasya are done.

Prati Marsha Nasya: Here it is a daily type of Nasya, where 2 drops of medicinal oil are administered to each nostril on a routine basis. Anutaila can be used as a daily preventive form of medicinal oil for Nasya.
Marsha Nasya: Here the medicines are administered in maximum dosage(2-10 drops). Ksheerabala Taila is commonly used.

Benefits of Nasya in hair fall:

It prevents premature hair graying.
It reduces hair fall by balancing Vata and Pitta doshas.
It reduces excess hair fall.
It promotes hair growth.
It is good for dandruff and scalp infections.
It detoxifies and clears sinus blockages.
It reduces stress and anxiety.

MESOTHERAPY:

Mesotherapy is a technique which is performed in both modern medicine and Ayurveda. Where in Ayurveda, Mesotherapy is done using natural and herbal formulations. It aims mainly for rejuvenation, nourishment, and detoxification.

For hair conditions like alopecia, dandruff, scalp infections, and premature graying, Mesotherapy is done.

Method for Ayurvedic Mesotherapy:

a)Pre Treatment assessment:

Assess the hair type and skin type.
Check for the medical history.
Analyze the presence of toxins, excess heat(pitta dosha), or poor circulation(stagnation of Kapha dosha).

b)Preparation Phase:

Detoxification of the body: If the patient has enough strength, detoxification methods like Virechana,Nasya karma, and Raktamokshana can be performed(not a mandatory phase).

c) Microneedling or injections(Prachanna):

In our hospital, initially, the scalp is applied with any numbing cream(like lidocaine, epinephrine, or prilocaine).
Leave it for about 45 minutes and wipe it off with Triphala kashaya.
This is followed by microneedling using a sterile derma roller(do it evenly to a particular direction).
Again after cleansing the scalp with Triphala Kashayam, we apply our special serum, Champa Hair Serum, followed by a gentle massage and put on a hair cap.Hair wash can be done only after 24 hours.
The treatment is done once every week. The number of sessions varies for each patient. After two or three sittings normally we can see the hair growth in patients.

Benefits of Mesotherapy:

It is a comparatively safe and non-invasive method.
It has long-lasting results.
It detoxifies and rejuvenates the scalp.
It reduces hair fall and premature graying.
It controls dandruff and scalp infections.
It strengthens hair follicles.
It stimulates hair growth.

ROLE OF ACUPUNCTURE IN STRESS-RELATED HAIR FALL:

Acupuncture is a natural, holistic treatment for hair fall that addresses circulation, stress, toxins, and hormonal balance.

Needling in Acupuncture:

It uses thin, sterile needles inserted at specific angles(perpendicular/oblique) based on meridian pathways. The sterile needles are normally retained for 15-30 minutes. So, Acupuncture is normally given for stress-related hair loss.

So key points in needling for Hair growth are:

Baihui(GV20): This is on the top of the head; which increases circulation to the scalp.
Sanyinjiao(SP6): It is beneficial in hair loss due to PCOS or stress by regulating hormones.
Zusanil(ST36): It boosts all energy, improves digestion, and impacts hair growth.
Shenmen(HT7): It reduces stress, calms the mind, and prevents stress-induced hair fall.
Liver3(LR3): It helps maintain liver energy as it is closely associated with hair health.

Benefits of Acupuncture in Hair Fall:

It helps to improve immunity and reduces autoimmune hair loss.
It strengthens hair follicles and regenerates growth.
It reduces stress and balances the hormones.
It improves circulation to the scalp.

DIETARY GUIDELINES SUGGESTED FOR HAIR FALL:

a)Consume more of pitta pacifying food items. Since pitta is the primary cause of hair loss.

Hydrate your body: Drink coconut and tender coconut water, aloe vera juice , cucumber juice, water melon juice etc.
Increase the intake of nutrient-rich food items like: Amla(Indian gooseberry), dates and figs, sesame seeds, pumpkin seeds, flax seeds, and nuts(almonds, walnuts, cashews, etc).
Ingest more iron-rich foods. Eg: Sprouted legumes, green gram, red lentils, pigeon peas, cotton cheese, etc.

b)Avoid Pitta aggravating food:

Few food items increase heat in the body ; like

Pickles, vinegar, curd.
Excessive spicy food items.
Caffeine and alcohol.
Processed and junk foods.

LIFESTYLE HABITS FOR HAIR CARE:

Eat at regular times.
Avoid eating late at night.
Try to stay hydrated.
Practice mindful eating.
Get enough sleep.

DISCLAIMER: The information provided in this article is intended solely for educational purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

Maurya Ayurveda Hospital,opposite to Sabine Hospital,Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

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