Abstract：Objective：To observe the clinical effect of Zhenwu Decoction combined with moxibustion on chronic heart failure （CHF） and its effects on myocardial energy expenditure （MEE） and neurohormone levels. Methods：A total of 86 cases of CHF patients treated at Wenzhou TCM Hospital of Zhejiang Chinese Medical University from May 2021 to May 2024 were selected as the study subjects. They were divided into the observation group and the control group according to the random number table method， with 43 cases in each group. The control group was treated with Spironolactone，Digoxin Tablets，and Metoprolol Succinate Sustained-Release Tablets，and the observation group was treated with Zhenwu Decoction combined with moxibustion. Clinical effects， traditional Chinese medicine（TCM） syndrome scores，heart function [left ventricular ejection fraction （LVEF），left ventricular mass index （LVMI）， left ventricular end-diastolic diameter （LVEDD），MEE]，neurohormone levels [serum renin activity （PRA），angiotensin Ⅱ（Ang Ⅱ）， aldosterone （ALD）]， and six-minute walking distance （6MWD） were observed in the two groups. Results：The total effective rate was 97.67%（ 42/43） in the observation group，higher than that of 81.40%（ 35/43） in the control group，the difference being significant （P＜0.05）. After treatment，TCM syndrome scores for palpitations， shortness of breath， oliguria， and spontaneous sweating in the two groups were decreased when compared with those before treatment （P＜0.05），and the scores in the observation group were lower than those in the control group （P＜ 0.05）. After treatment，LVEF levels in the two groups were increased when compared with those before treatment （P＜ 0.05），and the levels of LVMI，LVEDD，and MEE were reduced when compared with those before treatment （P＜ 0.05）. The LVEF level in the observation group was higher than that in the control group （P＜0.05）； the levels of LVMI， LVEDD， and MEE in the observation group were lower than those in the control group （P＜0.05）. After treatment，the levels of PRA，AngⅡ，and ALD in the two groups were decreased when compared with those before treatment （P＜0.05）， and the three levels in the observation group were lower than those in the control group （P＜ 0.05）. After treatment， 6MWD in the two groups were increased when compared with those before treatment （P＜ 0.05）， and the observation group had greater 6MWD than the control group （P＜0.05）. Conclusion： Zhenwu Decoction combined with moxibustion for CHF can enhance the clinical effect，effectively improve TCM syndromes and heart function，and optimize MEE and neurohormone levels.