Abstract： Objective： To observe the clinical effect of Xuanbai Chengqi tang combined with ambroxol and Xuebijing injection for severe pneumonia complicated with acute respiratory distress syndrome and its effect on serum related factors. Methods：A total of 60 cases of patients with severe pneumonia complicated with acute respiratory distress syndrome were selected as the study subjects and divided into the study group and the control group according to the random number table method，with 30 cases in each group. The control group was treated with ambroxol combined with Xuebijing injection，and the study group was additionally treated with Xuanbai Chengqi tang based on the treatment of the control group. The Chinese medicine syndrome scores，procalcitonin(PCT)，interleukin-6(IL-6)，C-reactive protein(CRP)，forced expiratory volumes in one second(FEV1)，forced vital capacities(FVC)，peak expiratory flows(PEF)，oxygen saturations(SaO2)，partial pressures of blood oxygen(PaO2) and oxygenation values(PaO2/FiO2) before and after treatment as well as the clinical effects in the two groups were compared. Results：The total effective rate was 93.33% in the study group，higher than that of 73.33% in the control group(P＜0.05). After treatment， the Chinese medicine syndrome scores， PCT， IL- 6 and CRP levels in the two groups were decreased when compared with those before treatment(P＜0.05)，and FEV1，FVC，PEF，SaO2，PaO2 and PaO2/ FiO2 were increased(P＜0.05)；the Chinese medicine syndrome score，PCT，IL-6 and CRP levels in the study group were lower than those in the control group(P＜0.05)，and FEV1，FVC，PEF，SaO2，PaO2 and PaO2/FiO2 were higher(P＜0.05). The incidence of adverse reactions was 23.33% in the study group， lower than that of 43.33% in the control group(P＜0.05). Conclusion：Xuanbai Chengqi tang combined with ambroxol and Xuebijing injection can effectively treat patients with severe pneumonia complicated with acute respiratory distress syndrome， improve their lung function and respiratory status， and reduce the risk of inflammatory responses and adverse reactions，with a good curative effect and high safety.