Abstract：Objective：To observe the clinical efficacy of Shexiang Tongxin Dropping Pills combined with western medicine in the treatment of heart failure with reduced ejection fraction （HFrEF） of qi deficiency and blood stasis syndrome. Methods： A total of 80 patients with HFrEF of qi deficiency and blood stasis syndrome admitted to Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine from March 2023 to January 2025 were selected and divided into the treatment group and the control group using the random number table method， with 40 cases in each group. The control group was treated with western medicine，while the treatment group was treated with western medicine combined with Shexiang Tongxin Dropping Pills. Both groups were treated for eight weeks. The clinical efficacy was compared between the two groups. Changes in cardiac function [N-terminal pro-B-type natriuretic peptide （NT-proBNP）， left ventricular end-systolic volume （LVESV）， 6-minute walk test （6MWT）]， traditional Chinese medicine syndrome scores， and levels of transforming growth factor-β1 （TGF-β1）， small mother against decapentaplegic 3 （Smad3），and nuclear factor-κB （NF-κB） before and after treatment were compared between the two groups. Results：The total clinical effective rate was 92.50% （37/40） in the treatment group and 72.50% （29/40） in the control group （P＜0.05）. After treatment， NT-proBNP， LVESV， and traditional Chinese medicine syndrome scores decreased in both groups compared with those before treatment （P＜0.05）， while the 6MWT values increased （P＜0.05）. The treatment group had lower NT-proBNP， LVESV， and traditional Chinese medicine syndrome scores than the control group （P＜0.05），and a longer 6MWT value than the control group （P＜0.05）. After treatment， levels of TGF- β1， Smad3， and NF- κB decreased in both groups compared with those before treatment （P＜0.05）， and the treatment group had lower levels of these three indicators than the control group （P＜ 0.05）. Conclusion：Shexiang Tongxin Dropping Pills combined with western medicine demonstrate good efficacy in the treatment of HFrEF of qi deficiency and blood stasis syndrome， can alleviate symptoms， improve cardiac function， and downregulate the levels of TGF-β1，Smad3，and NF-κB.