Objective：To observe the clinical effect of modified Xiangsha Liujunzi Decoction in the treatment of reflux esophagitis （RE） with the syndrome of middle-energizer deficiency and qi counterflow. Methods： A total of 72 cases of RE patients with the syndrome of middle-energizer deficiency and qi counterflow admitted to Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine from November 2021 to October 2023 were selected and divided into the trial group and the control group according to the random number table method， with 36 cases in each group. Both groups received conventional western medicine treatment， and the trial group was additionally treated with modified Xiangsha Liujunzi Decoction. After eight weeks of continuous treatment，the clinical effects in the two groups were observed； the changes in traditional Chinese medicine syndrome scores and the Reflux Disease Questionnaire （RDQ） scores before and after treatment were compared between the two groups； adverse reactions were recorded. Results：After treatment，the total effective rate was 88.89%（32/36） in the trial group and 66.67%（24/36） in the control group，the difference being significant （P＜0.05）. After treatment，the scores of various syndromes and signs such as acid reflux，belching or reflux，epigastric dull pain，gastric distension and fullness，loss of appetite，fatigue and lack of strength，and thin，unformed stool，as well as the total scores in the two groups were declined when compared with those before treatment （P＜0.05），and the above scores （excepr for epigastric dull pain） in the trial group were lower than those in the control group （P＜0.05）. After treatment，the RDQ scores in both groups were dropped when compared with those before treatment （P＜0.05），and the RDQ score in the trial group was lower than that in the control group （P＜0.05）. Both groups did not experience any adverse reactions during the treatment process. Conclusion： The application of modified Xiangsha Liujunzi Decoction in the treatment of RE with the syndrome of middle-energizer deficiency and qi counterflow has a clear therapeutic effect and good safety and can significantly improve the traditional Chinese medicine syndomes and reflux of patients.