Abstract： Objective： To observe the efficacy of modified Shaofu Zhuyu Decoction combined with warm needle moxibustion in treating adenomyosis （AM）. Methods： A total of 82 AM patients admitted to Kaifeng Hospital of Traditional Chinese Medicine from May 2021 to May 2024 were randomly divided into the treatment group and the control group using the random number table method，with 41 cases in each group. Both groups received conventional western medicine therapy；the control group was treated with warm needle moxibustion，and the treatment group was treated with modified Shaofu Zhuyu Decoction based on the treatment of the control group. Clinical efficacy，incidence of adverse reactions，as well as changes in traditional Chinese medicine syndrome scores，menstrual conditions [Visual Analogue Scale （VAS） for pain，Pictorial Blood Loss Assessment Chart （PBAC） score]，serum carbohydrate antigen 125 （CA125） levels， and uterine parameters before and after treatment were compared between the two groups. Results： After treatment， the total effective rate was 90.24% （37/41） in the treatment group， significantly higher than that of 73.17% （30/41） in the control group （P＜0.05）. After treatment，traditional Chinese medicine syndrome scores decreased in both groups （P＜0.05），with lower scores in the treatment group （P＜0.05）. After treatment，VAS and PBAC scores decreased in both groups （P＜0.05），with greater reductions in the treatment group （P＜0.05）. After treatment， serum CA125 levels decreased in both groups （P＜0.05）， with lower levels in the treatment group （P＜ 0.05）. After treatment， endometrial thickness decreased and uterine volume reduced in both groups （P＜0.05）. The endometrial thickness and uterine volume in the treatment group was less than that in the control group，respectively， differences being significant （P＜0.05）. No significant difference in the incidence of adverse reactions between the two groups （P＞0.05）. Conclusion： Modified Shaofu Zhuyu Decoction combined with warm needle moxibustion shows favorable therapeutic efficacy in the treatment of AM. It can improve uterine conditions， reduce menstrual pain and bleeding，and demonstrate high safety.