Abstract： Objective： To observe the clinical efficacy of Jideshu Pills combined with Sanfu Paste in treating ankylosing spondylitis （AS） with kidney deficiency and Du cold syndrome， and to investigate its effects on bone metabolism and inflammatory factors. Methods： A total of 108 AS patients with kidney deficiency and Du cold syndrome treated at Henan Province Hospital of Traditional Chinese Medicine from June 2021 to June 2023 were selected and divided into the study group and the control group by the random number table method，with 54 cases in each group. Both groups received conventional western medicine treatment. The control group received additional Jideshu Pills， while the study group received Jideshu Pills combined with Sanfu Paste. Clinical efficacy， bone metabolism markers， inflammatory factors， acute-phase reactants， traditional Chinese medicine（TCM） syndrome scores，Bath Ankylosing Spondylitis Disease Activity Index （BASDAI） scores，Visual Analogue Scale （VAS） scores for lumbosacral pain，and the incidence of adverse reactions were compared between the two groups. Results：After treatment，the total effective rate in the study group was 96.23%（ 51/53），significantly higher than 82.35%（ 42/51） in the control group （P＜0.05）. Serum levels of bone-specific alkaline phosphatase （BALP）， osteocalcin （OC）， procollagen type Ⅰ C-terminal propeptide （P Ⅰ CP）， and procollagen type Ⅰ N-terminal propeptide （P Ⅰ NP） increased in both groups compared to pretreatment （P＜0.05）， with the study group showing higher levels than the control group （P＜0.05）. No significant differences were observed in serum 25-hydroxyvitamin D [25（OH）D] and parathyroid hormone （PTH） levels between the two groups （P＞0.05）. Serum levels of interleukin-6 （IL-6）， interleukin-17 （IL-17），interleukin-23 （IL-23），tumor necrosis factor-α （TNF-α），C-reactive protein （CRP）， and erythrocyte sedimentation rate （ESR） decreased in both groups compared to pretreatment （P＜0.05）， with the study group showing lower levels than the control group （P＜0.05）. Scores for lumbosacral pain，confinement of lumbar mobility，soreness and weakness of waist and knees，preference for warmth and aversion to cold，fatigue，and total TCM syndrome scores decreased in both groups compared to pretreatment （P＜0.05）， with the study group showing lower scores than the control group （P＜0.05）. BASDAI and VAS scores decreased in both groups compared to pretreatment（ P＜0.05），with the study group showing lower scores than the control group（ P＜0.05）. The incidence of adverse reactions was 13.21% （7/53） in the study group and 11.76% （6/51） in the control group，with no significant difference （P＞0.05）. Conclusion：Jideshu Pills combined with Sanfu Paste can effectively improve bone metabolism， reduce inflammation responses，alleviate symptoms，and demonstrate good clinical efficacy in treating AS with kidney deficiency and Du cold syndrome.