Objective: To evaluate the clinical efficacy of TCM Buwu decoction combined with phototherapy in the treatment of advanced vitiligo, and to detect the changes of heme oxygenase-1（ HO-1） level, T cell subpopulation, nuclear factor E2-related transcription factor 2（Nrf2） and dead bone tablet 1（p62） mRNA in peripheral blood of patients before and after treatment, so as to explore the preliminary mechanism of action. Methods: According to the inclusion criteria of advanced vitiligo patients, sixty patients were selected and randomly divided into obesevation group （30 cases） and control group（30 cases）. Both groups were treated with 308 excimer light, and the observation group was treated with Buwu decoction on the basis of phototherapy. The clinical efficacy of the two groups was evaluated, and the level of HO-1 in serum was detected by ELISA; T cell subsets of peripheral blood lymphocytes were detected by flow cytometry; the expressions of Nrf2 and p62 mRNA in PBMC were detected by RT-qPCR. Results: There was significant difference in clinical efficacy between the two groups（ Z=0.019, P<0.05）. The level of HO-1 in peripheral blood of 2 groups after treatment was significantly higher than that before treatment （P<0.01）. After treatment, the proportion of peripheral blood lymphocytes CD3+CD8+T cells was lower than before treatment, and the proportion of CD4+/CD8+ was significantly higher than before treatment （P< 0.01）. The relative expression levels of Nrf2 and p62 mRNA in peripheral blood lymphocytes of two groups were higher after treatment than before treatment （P<0.01）. Conclusion: TCM combined with 308 excimer light can effectively treat advanced vitiligo, and can up-regulate Nrf2 and p62 mRNA to promote the expression of HO-1 in its downstream, thus playing antioxidant, anti-inflammatory and immune regulation roles, and reduce the proportion of CD3+CD8+T cells in peripheral blood, whose effect is better than that of simple light therapy group. [ABSTRACT FROM AUTHOR]