Abstract：Objective：To observe the clinical effect of Xingnaojing injection for acute severe brain injury on improving brain edema and cerebral hypoxia. Methods：A total of 96 cases of patients with acute severe brain injury were randomly divided into the control group and the observation group， with 48 cases in each group. The control group was treated with large decompressive craniectomy， and the observation group was additionally treated with Xingnaojing injection based on the treatment of the control group. The changes of brain edema areas，states of brain hypoxia，coma degrees and inflammatory factor levels before and after treatment and the clinical effects in the two groups were observed. Results：The total effective rate was 91.67% in the observation group，higher than that of 72.92% in the control group(P＜0.05). After treatment，the brain edema areas in the two groups were decreased when compared with those before treatment(P＜0.05)， oxygen desaturation values，serum interleukin- 2(IL- 2) and tumor necrosis factor- α(TNF- α) levels were decreased(P＜0.05)，and Glasgow Coma Scale(GCS) scores， low oxygen saturations and serum interleukin- 4(IL- 4) levels were increased(P＜0.05). After treatment，the brain edema area in the observation group was smaller than that in the control group(P＜0.05)，oxygen desaturation value，serum IL-2 and TNF-α level were lower(P＜0.05)，and GCS score，low oxygen saturation and serum IL-4 level were higher(P＜0.05). Conclusion： Xingnaojing injection for acute severe brain injury has a significant curative effect， which can reduce the brain edema area， correct the state of brain hypoxia， improve coma degree， and reduce the inflammatory responses.