Wang Lijun1 Min Zhongsheng2 Wang Zixiong1 Abstract: Thirty guinea pigs were randomly divided into model group, NB-UVB group and NB-UVB combined with Bai Biao Wan and Bai Pu Wan group (combined group). The guinea pigs in each group were decolorized with H2O2 daily, and the model group was not treated; the guinea pigs in the NB-UVB group were treated with phototherapy 5 times/week; the combined group was treated with Bai Biao Wan and Bai Pu Wan daily except for phototherapy as in the NB-UVB group. At the end of the experiment, the color changes of the target lesions were compared, and the most obviously depigmented parts of the target lesions were stained with ferrous sulfate Lillie method to observe and calculate the number of melanin follicles in them. Results: There was significant depigmentation in the model group compared with the NB-UVB group and the combined group, while there was no significant difference between the NB-UVB group and the combined group; the number of melanin follicles in the target lesions of the NB-UVB group and the combined group were significantly less than that of the model group, but there was no significant difference between them. Wang Lijun, Department of Dermatology, Wuxi Hospital of Traditional Chinese Medicine The treatment of vitiligo is tricky, and different methods of combined treatment are often used clinically. Narrow-spectrum medium-wave ultraviolet light (NB-UVB) has been used in the treatment of vitiligo and has achieved more satisfactory efficacy, but it is not known whether there is a synergistic effect between its combined application with Chinese medicine. We have done an experimental study and the results are reported below. 1. Materials and methods: 1.1 Subject animals 30 normal grade healthy black or brown guinea pigs were randomly divided into 9 cases in the model group, 11 cases in the NB-UVB group and 10 cases in the NB-UVB combined with Bai Biao Wan and Bai Pu Wan group (combined group) according to sex, weight and color of the target lesions. 1.2 Drugs, reagents and instruments: Bai Biao Pill (Zi Cao, Cyperus, Cao He Che, Bai Yao Zi, Bai Wei, Peach Blossom, Red Flower, Atractylodes, Gentiana, Sea Bladder Sheath, Glycyrrhiza, Radix et Rhizoma, Tribulus terrestris Batch No.: 031021), Bai Pu Pill (Tribulus terrestris, Purple-backed Faustus, Cyperus, White Polygonum, Batch No.: 031028) were provided by the preparation room of Jiangsu Provincial Hospital of Traditional Chinese Medicine; 3% H2O2 was provided by Nanjing Xinglan Arrow Technology Co. (batch number: 03.09.1-1); UV236 B phototherapy instrument (produced by Warman, Germany, wavelength 310-315nm, peak 311nm). NB-UVB group guinea pigs were treated with phototherapy 5 times/week with a starting dose of 0.3 J/cm², increasing by 0.1 J/M² until 1.0 J/M², then increasing by 0.2 J/cm² until 2.0 J/M², and then irradiated with 3.0 J/M² until the end of the experiment. to the end of the experiment. The combined group was given 4 times the adult dose of Bai Biao Pill and Bai Pu Wan (Bai Biao Pill 0.70g/kg.d and Bai Pu Wan 0.70g/kg.d) daily except for the NB-UVB group. The color changes of the target lesions were compared before and after the experiment, and after the experiment, 1×1M2 sized lesions were fixed with neutral formaldehyde and embedded in paraffin, —————————————————– Author Affiliation: 1: Wuxi Hospital, Nanjing University of Traditional Chinese Medicine, Wuxi, China 214001 2: Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine Sections were stained for melanin by ferrous sulfate lillie method1 and the number of melanin follicles was observed and counted. (Pathological sections were completed with the assistance of the Department of Pathology, Jiangsu Provincial Hospital of Traditional Chinese Medicine) 1. 4 Observation indexes 1.4.1 Visual observation indexes and points: no change in the color of the target lesion (0 points); 2 small patches of hypopigmentation in the target lesion (1 point); 3 more hypopigmentation in the target lesion (2 points); 4 small patches of depigmentation or a small amount of hair whitening in the target lesion (3 points); 5 large patches of depigmentation or more hair whitening in the target lesion (4 points). 1.4.2 Histopathological index: 20 hair follicles were observed sequentially, and the number of melanin follicles was counted. 2. Experimental results After 30 times of phototherapy, the cumulative dose of irradiation for each group of guinea pigs reached 64.2 J/each, and the pigmentation in the target lesion area of both NB-UVB group and combined group could be seen to be significantly deepened, but at the same time, some guinea pigs could still be seen to have hypopigmentation, depigmentation and some hairs turning white in the target lesion area. In the model group, there was more significant hypopigmentation, depigmentation and some hair whitening in the target lesion area. After the experiment, the target skin lesion depigmentation scores of each group were as follows: model group 3.333±0.816; NB-UVB group 1.000±1.500; combined group 1.125±1.555. Table 1 Comparison of target skin lesion depigmentation scores between groups Two mean differences q value P=0.05 Model group and combined group 2.333 3.727 3.580 * The mean number of melanin follicles in the target lesions was 8.500±3.082 in the model group, 14.444±3.395 in the NB-UVB group, and 15.375±2.648 in the combined group. group 15.375±2.615. The comparison of the number of target lesions with melanin follicles in each group is shown in Table 2 Table 2: Comparison of the number of target lesions with melanin follicles in each group. The results showed that both the color change situation of target lesions and the number of melanin follicles suggest that NB-UVB and NB-UVB combined with Chinese herbal medicine Bai Biao Wan and Bai Pu Wan have some inhibitory effect on the decolorization of H2O2, but there is no significant difference in the inhibitory effect of both on the decolorization of H2O2. The mechanism of NB-UVB treatment for vitiligo is not clear yet, but it may be mainly due to two factors: 1, NB-UVB irradiation of skin stimulates epidermal cells to secrete various cytokines including IL-1, tumor necrosis factor-α, leukotriene, etc. to stimulate the proliferation of dopamine-negative non-pigmented melanocytes in the hair root sheath outside the hair follicle, produce melanin and migrate to the depigmented area to restore pigmentation. The immunosuppressive effect of NB-UVB prevents the migration and proliferation of melanocytes from being destroyed. The Chinese medicine “Bai Biao Pill” (Zi Cao, Shen Xiang, Cao He Che, Bai Yao Zi, Bai Wei, Tao Ren, Hong Hua, Cang Zhu, Gentian Cao, Sea Bladder Sheath, Licorice, Sheng Shou Wu, Tribulus terrestris) and “Bai Pu Pill” (Tribulus terrestris, Purple Back Puffball, Cang Er Zi, White Polygonum) are mainly for dispersing wind with blood. The two drugs are synergistic to treat vitiligo in Jiangsu Province Chinese Hospital for nearly 20 years and have achieved more satisfactory results. Although NB-UVB treatment for vitiligo has been more and more widely used because of its better efficacy and less and mild side effects, the overall efficacy still needs to be further improved. Long Zijiang et al3 used H2O2 topically to depigment the black skin of guinea pigs to establish an animal model of vitiligo, and the results showed that the black skin of guinea pigs became pale with the naked eye after the use of H2O2, and with the prolongation of the drug, some white spots appeared, and even the original black hair grew out of white hair. The pathological section of the skin showed a reduction of melanin in the spinous layer and hair follicles. In our experiments the groups also showed similar changes to different degrees, and the depigmentation in the model group was significantly stronger than that in the NB-UVB group and the combined group, with statistically significant differences, while there was no significant difference between the latter two. The experimental results showed that NB-UVB phototherapy alone and NB-UVB phototherapy combined with Chinese herbal medicine Bai Biao Wan, and Bai Pu Wan taken internally could significantly inhibit the depigmentation effect of H2O2, but there was no significant difference in the degree between the two. Nevertheless, in order to further improve the efficacy in the future will still have to try the combined application of various different methods. References 1. Gong Zhijin, Zhan Rongzhou Pathological tissue production and staining techniques, Shanghai: Shanghai Science and Technology Press, 1994: 184 2. Long Zijiang, Bai Mei, Fan Yan. Preparation of animal models of vitiligo by chemical decolorization method, Journal of Anhui College of Traditional Chinese Medicine, 1997, 16(6): 60-61.