Abstract： Objective： To evaluate the clinical efficacy of Xinma Granules combined with non-invasive mechanical ventilation （NIV） in treating acute exacerbation of chronic pulmonary heart disease （AECPHD） with phlegm-dampness obstructing lung syndrome in Guandong Second Traditional Chinese Medicine Hospital from October 2023 to September 2024. Methods： A total of 72 hospitalized AECPHD patients with phlegm-dampness obstructing lung syndrome were randomly divided into the observation group and the control group using the random number table method， with 36 cases in each group. Both groups received standard symptomatic treatment. The control group received additional NIV， while the observation group received Xinma Granules combined with NIV. Clinical efficacy was assessed by comparing traditional Chinese medicine（TCM）syndrome scores， arterial blood gas analysis [partial pressure of oxygen （PaO2）， partial pressure of carbon dioxide （PaCO2）]， pulmonary function [percentage of forced expiratory volume in the first second relative to predicted value （FEV1pre%） and percentage of one-second rate （FEV1/ FVC）]，and cardiac function [pulmonary artery systolic pressure （PASP），and right ventricular Tei index] before and after treatment. Results：The total effective rate was significantly higher in the observation group （80.6%，29/36） than in the control group （58.3%， 21/36） （P＜0.05）. Both groups showed reduced TCM syndrome scores after treatment （P＜0.05）， with lower scores in the observation group （P＜0.05）. PaO2， FEV1pre% ， and FEV1/FVC increased in both groups （P＜0.05）， with higher indexes in the observation group （P＜0.05）. PaCO2， PASP， and right ventricular Tei index decreased in both groups （P＜0.05）， with more significant reduction in the observation group （P＜0.05）. Conclusion： Xinma Granules combined with NIV effectively alleviates clinical symptoms in AECPHD patients with phlegm-dampness obstructing lung syndrome， improves hypoxemia and carbon dioxide retention，and enhances cardiopulmonary function，demonstrating good efficacy and safety.