Abstract： Objective： To observe the anticoagulant effect of Fuyuan Huoxue Gushen Prescription combined with routine western medicine for recurrent spontaneous abortion with antiphospholipid syndrome and expressions of myeloid differentiation factor 88 (MyD88) and toll-like receptor 4 (TLR- 4) in peripheral blood. Methods： A total of 100 cases of patients with recurrent spontaneous abortion with antiphospholipid syndrome were selected and divided into the control group and the observation group according to the random number table method，with 50 cases in each group. The control group was given routine treatment， and the observation group was additionally treated with Fuyuan Huoxue Gushen Prescription based on the treatment of the control group. Before treatment and at 10 weeks of pregnancy， the levels of intercellular adhesion molecule- 1 (ICAM- 1)，vascular cell adhesion molecule- 1 (VCAM- 1)， interleukin- 35 (IL-35)，vascular endothelial growth factor (VEGF)，anti-β2-glycoprotein I (anti- β2-GPI)， and TLR4/MyD88 mRNA expression in the two groups were compared； the levels of T lymphocytes including CD4+ and CD8+ ，immunoglobulin M (IgM)，and activated partial thromboplastin time (APTT)，and platelet aggregation rates were detected；the pulsatility index (PI)，systolic/diastolic end flow ratio (S/D)， resistance index (RI) in uterine artery were tested. The spontaneous abortion rates and successful delivery rates were recorded in the two groups. Results： At 10 weeks of pregnancy， the mRNA expressions of MyD88 and TLR- 4 in the two groups were decreased when compared with those before treatment (P＜ 0.05)，and the mRNA expressions of MyD88 and TLR-4 in the observation group were lower than those in the control group (P＜0.05). At 10 weeks of pregnancy，ICAM- 1，VCAM- 1，IgM，CD4+，anti- β2-GPI and platelet aggregation rates in the two groups were decreased when compared with those before treatment (P＜0.05)，and ICAM-1，VCAM-1，IgM，CD4+，anti-β2-GPI and platelet aggregation rate in the observation group were lower than those in the control group (P＜0.05)； the contents of IL- 35， VEGF，APTT，and CD8 + in the two groups were increased when compared with those before treatment (P＜0.05)，and the contents of IL-35，VEGF，APTT，and CD8+ in the observation group were higher than those in the control group (P＜0.05). At 10 weeks of pregnancy， the PI， RI， and S/D in the two groups were decreased when compared with those before treatment (P＜0.05)，and the PI，RI，and S/D in the observation group were lower than those in the control group (P＜0.05). The successful delivery rate was 96.00% in the observation group， higher than that of 78.00% in the control group (P＜0.05)， and the spontaneous abortion rate was 4.00% in the observation group，lower than that of 22.00% in the control group (P＜0.05). Conclusion：Fuyuan Huoxue Gushen Prescription for patients with recurrent spontaneous abortion with antiphospholipid syndrome can regulate their TLR- 4/MyD88 signal pathway， inhibit inflammatory reactions， reduce vascular endothelial damage， enhance anticoagulation， and improve immune responses，uterine artery blood flow and pregnancy outcome.