Vitiligo
Overview
Vitiligo is a chronic acquired condition in which pigment-producing cells are lost, causing well-defined milky-white patches on the skin, sometimes with whitening of hair; it is not contagious, and course and response to treatment vary greatly between individuals. Chinese medicine names it 'bai bo feng' and relates it mainly to liver qi stagnation with blood stasis and external wind, or to liver-kidney insufficiency with deficient blood failing to nourish the skin. Treatment generally requires patience and dermatological supervision; Chinese approaches are adjunctive and outcomes are not guaranteed.
TCM disease & pathogenesis
TCM calls this bai bo feng or bai dian, characterized by milky-white, sharply demarcated patches of variable shape. The site is the skin interstices and pores, related to liver, kidney, spleen, qi, and blood. Emotional injury constrains liver qi; external wind then attacks the exterior so qi and blood lose harmony and blood fails to moisten the skin. Alternatively, weak constitutional endowment or prolonged illness leaves liver-kidney deficiency with insufficient essence-blood and insecure defense, allowing wind to linger in the interstices so the skin loses warm nourishment and turns white. Early cases show liver qi stagnation with qi-blood disharmony; chronic cases show liver-kidney insufficiency with static blood in the collaterals. Treatment harmonizes qi and blood, soothes the liver, and expels wind, while supplementing liver-kidney and quickening blood. The course is long; TCM is adjunctive to dermatological care and results vary.
Pattern differentiation (clinical patterns)
Liver Stagnation with Qi Stasis
Pale-red patches that spread with emotional fluctuation, hypochondriac fullness, vexation and poor sleep, pale-red tongue with thin coating, wiry pulse.
Soothe the liver and regulate qi; quicken blood and expel wind.
Liver-Kidney Insufficiency
Long-standing milky or porcelain-white well-defined patches with whitened hair within them, sore weak lower back and knees, dizziness, pale tongue with scant coating, fine weak pulse.
Nourish liver and kidney; nourish blood and expel wind.
Connections
Daily care & prevention
Protect affected skin from sunburn with clothing and broad-spectrum sunscreen (depigmented skin burns easily); avoid injury and friction that may trigger new patches, manage stress, and keep follow-up with dermatology; do not use unregulated 'cure' products. Press Xuehai (SP10), Sanyinjiao (SP6), Zusanli (ST36), Quchi (LI11), Ganshu (BL18), and Shenshu (BL23). Rapid widespread spread or involvement of the eyes or mucous membranes warrants evaluation.
When to seek medical care
Seek medical care for rapid generalized spread, involvement of the eyes or extensive mucosal surfaces, new patches with significant inflammation, or significant emotional distress; vitiligo may coexist with autoimmune thyroid disease, so screening can be considered.