Abstract： Objective： To observe the clinical efficacy of modified Xinglou Chengqi Decoction combined with Edaravone in the treatment of elderly acute cerebral infarction （ACI） with phlegm-heat and fu-organs excess syndrome. Methods：A total of 120 elderly ACI patients with phlegm-heat and fu-organs excess syndrome，admitted to Kaifeng Hospital of Traditional Chinese Medicine between May 2021 and January 2024， were enrolled and divided into the Edaravone group and the Xinglou Chengqi Decoction group by the random number table method，with 60 cases in each group. Both groups received conventional therapy. The Edaravone group received additional Edaravone treatment，while the Xinglou Chengqi Decoction group received Xinglou Chengqi Decoction in addition to the treatment of the Edaravone group. The course of treatment for both groups was two weeks. The following indicators were compared：clinical efficacy， changes in neurological function [National Institutes of Health Stroke Scale （NIHSS） scores]，activities of daily living [Activity of Daily Living Scale （ADL）scores]， oxidative stress markers [malondialdehyde （MDA）， superoxide dismutase （SOD）] levels，and neural function proteins [ubiquitin C-terminal hydrolase-L1 （UCH-L1），visinin-like protein-1 （VILIP-1）] before and after treatment，and incidence of adverse reactions between the two groups. Results： After treatment， the total effective rate in the Xinglou Chengqi Decoction group was 96.67% （58/60）， significantly higher than that of 81.67% （49/60） in the Edaravone group （P＜0.05）. ADL scores and SOD levels increased in both groups compared with those before treatment （P＜0.05），and were higher in the Xinglou Chengqi Decoction group than those in the Edaravone group （P＜0.05）. NIHSS scores and levels of MDA，UCH-L1，and VILIP-1 decreased in both groups compared with those before treatment （P＜0.05），and were lower in the Xinglou Chengqi Decoction group than those in the Edaravone group （P＜0.05）. The incidence of adverse reactions was 10.00%（ 6/60） in the Xinglou Chengqi Decoction group and 8.33%（5/60） in the Edaravone group， with no statistically significant difference （P＞0.05）. Conclusion： Modified Xinglou Chengqi Decoction combined with Edaravone exerts certain efficacy and safety in the treatment of elderly ACI with phlegm-heat and fu-organs excess syndrome. It effectively improves neurological function and activities of daily living of patients.