Traditional Chinese medicine approaches in treating alopecia:mechanisms,evidence,and future directionsOA

Alopecia is a highly prevalent dermatological disorder characterized by dysregulation of hair follicle cycling,stem cell exhaustion,inflammatory activation,and hormonal imbalance.Currently approved pharmacotherapies provide limited efficacy and are often associated with adverse effects,highlighting an unmet need for multi-targeted and biologically integrative treatment strategies.Traditional Chinese Medicine(TCM),with its long-standing clinical use and multi-component,multi-target characteristics,has emerged as a promising complementary approach for hair loss management.In this review,we integrate hair follicle biology with classical TCM theory to elucidate the mechanistic basis of TCM interventions in alopecia.We summarize key molecules and cellular processes underlying hair loss,including hair follicle stem cell dysfunction,androgen-androgen receptor signaling,oxidative stress-induced aging,immune dysregulation,and impaired angiogenesis.Frequently prescribed TCM herbs and representative formulas,such as Polygonum multiflorum,Platycladus orientalis,Angelica sinensis,and Shi-Bi-Man,are discussed with respect to their bioactive constituents and experimental effects on dermal papilla cells,stem cell activation,inflammatory pathways,and follicular microcirculation.Although some pharmacological and preliminary clinical evidence support the therapeutic potential of TCM for treating alopecia,substantial challenges remain,including insufficient standardization of herbal preparations,limited mechanistic validation,and a lack of high-quality randomized controlled trials.Future integration of systems pharmacology,multi-omics technologies,and advanced drug-delivery platforms may facilitate the translation of TCM from empirical practice to evidence-based therapy for hair loss.