Abstract： Objective： To observe the clinical efficacy of modified Huoluo Xiaoling Dan medicinal mud compression therapy combined with extracorporeal shock wave therapy （ESWT） in the treatment of rotator cuff injury of qi deficiency and blood stasis type in elderly. Methods： A total of 98 elderly patients with rotator cuff injury of qi deficiency and blood stasis type who received conservative treatment at Hangzhou Linping First People's Hospital from January 2024 to January 2025 were enrolled and divided into the control group and the trial group using the random number table method， with 49 cases in each group. The control group received ESWT alone， while the trial group received modified Huoluo Xiaoling Dan medicinal mud compression therapy combined with ESWT. After six weeks of treatment， the clinical efficacy， shoulder joint function [Constant-Murley Score （CMS）]， shoulder pain severity [Visual Analogue Scale （VAS）]，range of motion，pain mediator levels [substance P （SP），prostaglandin E2（ PGE2）]， and inflammatory factor levels [interleukin-6 （IL-6），tumor necrosis factor-α （TNF-α），high-sensitivity C-reactive protein （hs-CRP）] were compared between the two groups. Results： After treatment， the total effective rate was 91.84%（ 45/49） in the trial group and 73.47%（ 36/49） in the control group，with significant difference between the two groups （P＜0.05）. After treatment，the CMS scores increased in both groups compared to before treatment （P＜0.05）， and the trial group showed higher CMS scores than the control group （P＜0.05）； the VAS scores decreased in both groups compared to before treatment （P＜0.05）， and the trial group showed lower VAS scores than the control group （P＜0.05）. After treatment， the angles of external rotation， forward flexion， and abduction increased in both groups compared to before treatment （P＜0.05），and the trial group showed greater improvement in these angles than the control group （P＜0.05）. After treatment，the levels of SP and PGE2 decreased in both groups compared to before treatment （P＜0.05），and the trial group showed lower levels than the control group （P＜0.05）. After treatment，the levels of IL-6，TNF-α，and hs-CRP decreased in both groups compared to before treatment （P＜0.05），and the trial group showed lower levels than the control group （P＜0.05）. Conclusion： Modified Huoluo Xiaoling Dan medicinal mud compression therapy combined with ESWT can improve the clinical efficacy，reduce the levels of pain mediators and inflammatory factors， alleviate pain， and promote the recovery of shoulder joint function in elderly patients with rotator cuff injury of qi deficiency and blood stasis type.