The effectiveness of the drugs, the doctors' sense of responsibility and the close co-operation between doctors and the patients are three basic elements for the cure of a disease. The close co-operation between patients and the doctor can increase the therapeutic effects of the medicine and shorten the treatment course.

1. Relief of psychological pressure and modification of the psychological state
It is not ease to completely eliminate the psychological pressure at a time of frustration and suffering. To achieve this, the joint endeavors from the patients, the families and the society are needed. A cordial atmosphere should be maintained at home, and whenever a patient is in a bad mood and unhappy the family members should persuade and comfort the patient, but should never irritate the patients by putting fuel on the flame. The patients should be assisted to establish a firm confidence in the fighting of the disease and have ease of mind. The colleagues should show delicacy in showing their concern and help to the patients' condition. The patients should not be disturbed by unnecessary and repeated questions and inquiries. Talking about a patient's condition with other people will also hurt his self-respect and should be discouraged. The disease is not infectious and can not be transmitted to other people through contact. There is therefore no need to avoid or discriminate against these patients. It is important for the patient to maintain a healthy psychological state, to self-adjust and alleviate psychological pressure. According to the clinical observations patients with cheerful disposition have better therapeutic results than those in a depressive mental state. Also men and children have better therapeutic results than women and adults, respectively. These indicated that the therapeutic outcome of a patient has psychological implications. During the course of the treatment the patients should have ease of mind, be positive about life, but not be vexed or angry. They should make effort to alleviate worries and sadness. According to one's interest, the patient may choose some recreational activities to adjust his psychological state, such as sports or music, etc. Taiji shadow boxing and Taiji swordsmanship are healthy exercise that associates activity and inertia, can regulate the qi and blood, nourish the heart and tranquilize the soul, balance the yin and yang. It is easy to learn and to do, suitable to men and women, young and old. Best results can be expected if the exercise is done in the morning under the instruction of the teacher. During the period of the illness the patients should have a properly balanced diet, work and rest as well as adequate sleep.
2. Careful observation of the doctors orders
1) Regular visits and reporting of the conditions to the doctor
The patients should pay the doctor a visit once every 1 ~ 2 months if convenient. The doctor can correctly grasp the patients' condition and make the necessary treatment plans through direct discussion and consultation with the patients. If direct visit to the hospital is not always possible, the patients should inform the doctor of their conditions via phone, E-mail, letters and through photos. The incorrect belief that "one drug and one treatment is used for the disease from beginning to the end" should be abandoned. Even if the effects of the initial therapy are significant, regular visits to the hospital are also required for the doctor to assess the patients' condition and make the necessary adjustments to achieve the best therapeutic effects. The patients should thoroughly understand the importance of these regular visits.
2) Treatment by strictly following the doctor's orders
During the treatment the doctors' orders should be carefully followed, the intake and topical application of the drugs should be done according to schedule. The patients should co-operate in autologous epidermal grafting when necessary. Some patients regard epidermal grafting as a type of skin grafting, and this procedure direct the treatment toward the surface but not the internal cause. Those patients with such a view do not understand the principle of autologous epidermal grafting. Skin grafting is a surgical or a plastic surgical operation to replace a skin defect. It removes a full-thickness graft from the donor site to a defected skin area. But an autologous epidermal grafting is the grafting of the epidermis to the white patch (without damage to the skin). Seven days after the operation the epidermal sheet will fall off and the pigment cells will be left behind to proliferate and accelerate the healing of the white patches. Whether the grafted melanocytes will survive is dependent on the effects of drug therapy. The relation between drug therapy and epidermal grafting is like farming. The farmers should first loosen the soil, apply fertilizers and irrigate the land (which is equivalent to drug therapy). When the land is ready, the seed can be sowed (which is like epidermal grafting) and the seedlings can then be exuberant. Although such an analogy is not entirely appropriate, it may help in the understanding of the procedures. Drug therapy may be used to adjust the overall state of the body (be it endocrine or immunological) while the epidermal grafting may replace the depleted local pigment cells. We believe that epidermal grafting should not be used indiscriminately irrespective of the patients' condition, but should be used selectively at the best operative times based on the conditions to increase the survival rate of the grafts. Otherwise the treatment failure might increase the patients' psychological burden. The procedure is non-traumatic, painless, without any sequelae or serious side-effects. It is well tolerated in children and old patients alike. The youngest patient grafted in our hospital is a 3 year old patient. He was grafted twice with a total of 16 blisters. The child was quite co-operative. Therefore, it is not necessary to have any fear for the procedure.
3. Avoidance during therapy
The Chinese Medicine maintains that during the therapy of skin diseases certain foods should be avoided, such as fish, shrimp, beef and lamb as well as hot spices. We believe that it is not necessary to avoid all kinds of foods indiscriminately. Our hospital advice the patients to avoid two types of food: smoking, alcoholic drinking and children's snacks and drinks. Based on our observations they will have adverse effects on the progress of the disease and will influence the therapy. Besides, it has no beneficial effects on the human body as a whole. Therefore, after the onset of the disease, these should be avoided whether there is a therapy or not; spices such as chili pepper, spring onions, ginger and garlic as spices can be used by vitiligo patients if used normally with cooking. Based on our long-term clinical observation, fish, shrimp, beef and lamb have no obvious effects on the patients' condition and should not necessarily be avoided. However, the proportion of these foods in the diet should be adjusted. Long-term avoidance of these or any other food will have adverse effects on the development of the body and lead to deficiency of nutrients, esp. for children and young adults. But for those children whose diet contains large quantities of meat, fish and eggs but not vegetables the dietary bias should be corrected by temporary restriction on these kinds of food. Our clinical observations showed that many vitiligo children who eat a lot of roasted chicken skeletons for a long time are overweight. This might be related to the residual growth hormones in the chicken skeletons. Children with vitiligo should therefore eat less chicken. For those children with apparent history of rapid development of vitiligo after intake of fish and shrimp, etc. or history of atopy to foreign proteins, avoidance to such food should be carried out accordingly. Fruit and vegetables should not be avoided even if oranges and tomatoes are rich in vitamin C. Theoretically, the over ingestion of vitamin C may block the absorption of copper and zinc ions through the intestine and copper and zinc deficiency may cause dysfunction of melanin synthesis by melanocytes. But vitamin over-dose will not occur through taking food rich in the vitamin and it will not affect the treatment. Various kinds of vitamins are essential nutrients participating in the physiological function of the organism and their deficiency may lead to many kinds of diseases such as vitamin C deficiency → pernicious anemia, vitamin B1 deficiency → beriberi, vitamin B2 deficiency → mucosal disease, vitamin B6, B12, folic acid deficiency → anemia. But long-term intake of vitamin C pills may result in over-dose that may interfere with the normal physiological function and impaired function of melanocytes. Such vitamin use should be avoided in vitiligo.

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