The head is the region where all yang meridians converge. Besides, the conception vessel, thoroughfare vessel and many branches or collaterals of the yin meridians extend to the head. Therefore, essences of all viscera come up to nourish the head. Inside the head stores the brains (cerebral marrow) and marrow, which is governed by the kidney. The kidney also governs bones. The development of the skull and brains all depend on kidney essence to nourish. The hair is the extending part of blood and the external manifestation of the kidney. The spleen and the stomach are the sources of qi and blood. Therefore, inspection of head and hair is helpful for understanding the conditions of the kidney, spleen and stomach as well as qi and blood.

1. Inspection of head
Inspection of head means to examine the external shape and movement of the head.

Shape of head:
Bigger head with smaller face, downward looking of the eyes and low intelligence in children is usually caused by insufficiency of kidney essence and retention of fluid, often seen in children with fluid retention in the brain. Smaller head with round top, earlier closure of fontanel and low intelligence in children is frequently caused by insufficiency of kidney essence and maldevelopment of the brain. Protrusion of forehead and temporal regions with flat top of head in children often results from congenital insufficiency of kidney essence, or postnatal improper regulation of the spleen and stomach and maldevelopment of the skull, usually seen in rickets.

Fontanel:
Inspection of fontanel must be done in examining the infants under the age of 1 year and a half. Sunken fontanel indicates asthenia syndrome, usually caused by excessive vomiting which impairs body fluid, or by weakness of the spleen and stomach and prolapse of the gastrosplenic qi, or by congenital insufficiency and malnutrition of the brains. Protrusion of fontanel indicates sthenia syndrome, usually caused by virulent heat in exogenous febrile disease attacking the upper part of the body, or by fluid retention and blood stasis in the skull. Retard closure of fontanel and non-closure of the bone fissure is frequently caused by congenital insufficiency of kidney essence, or by chronic disease and malnutrition after birth.

Shaking:
Involuntary shaking or tremor in both children and adults means internal disturbance of liver wind.

2. Inspection of hair
The inspection of head and hair mainly examines the luster, shape, growth and loss of hair.

Luster and shape:
In the yellow race, black, dense and lustrous hair is the sign of sufficient kidney essence and exuberance of qi and blood. Yellowish, dry, thin, soft and brittle hair is the sign of insufficiency of kidney essence and asthenia of qi and blood which fail to nourish hair. White hair in young people without pathological changes is usually related to congenital constitution and is not a morbid condition. If white hair is accompanied by aching and weak loins and knees, tinnitus and amnesia, it is caused by asthenia of liver and kidney yin and lack of essence. If white hair is accompanied by insomnia and poor appetite, it is caused by overstrain of the heart and spleen as well as deficiency of qi and blood. Appearance of infantile hair like tassels with yellowish lusterless dryness is usually seen in malnutrition due to impairment of the spleen and stomach by improper feeding.

Loss of hair:
Sparse, yellow and dry hair is caused by insufficient kidney essence, asthenia of qi and blood which fail to nourish hair, usually seen in patients after serious illness and chronic disease. Sparse hair in young people often results from blood heat or consumption of kidney essence. Greasy hair with obvious loss of hair at the top of the head accompanied by pruritus and desquamation is usually caused by internal accumulation of damp heat. Sudden patch loss of hair with round or elliptic exposed head scalp is known as alopecia areata due to blood asthenia and wind attack, or caused by anxiety and nervousness which lead to qi stagnation and fire depression as well as blood heat generating wind.