Abstract：Objective：To observe the clinical effect of the therapy of Modified Maxing Shigan Decoction combined with Azithromycin on mycoplasmal pneumonia (MPP) of phlegm-heat obstructing the lung type in children. Methods： A total of 90 cases of MPP children of phlegm- heat obstructing the lung type were selected and divided into the western medicine group， the Chinese medicine group and the combination group， with 30 cases in each group. The three groups were given routine symptomatic treatment，based on which the western medicine group was given Azithromycin for treatment，the Chinese medicine group was given Modified Maxing Shigan Decoction for treatment，and the combination group was treated with Modified Maxing Shigan Decoction combined with Azithromycin. The three groups were treated for 10 days. The clinical effects，the levels of serum NOD-like receptor pyrin domain 3 (NLRP3) mRNA，interleukin-1β (IL-1β) and interleukin-18 (IL-18) before and after treatment，and the incidence of adverse reactions were compared between the three groups. Results：After treatment，the total effective rate was 93.33% in the combination group，higher than that of 70.00% in the western medicine group and 66.67% in the Chinese medicine group (P＜0.05). The levels of serum NLRP3 mRNA，IL-18 and IL-1β in the three groups were decreased when compared with those before treatment (P＜0.05)， and the above 3 levels in the combination group were lower than those in the western medicine group and the Chinese medicine group (P＜0.05). During treatment，the total incidence of adverse reactions was 16.67% in the western medicine group， 16.67% in the Chinese medicine group and 13.33% in the combination group， there being no significance in the difference between the three groups (P＞0.05). Conclusion： The therapy of Modified Maxing Shigan Decoction combined with Azithromycin can enhance the clinical effect on MPP children of phlegm- heat obstructing the lung type， decrease the NLRP3 mRNA expression， and inhibit the inflammatory responses with good safety.