Abstract：Objective：To observe the clinical efficacy of modified Xiaoqinglong Decoction combined with western medicine in the treatment of refractory mycoplasma pneumoniae pneumonia （RMPP） in children. Methods： A prospective controlled study was conducted. A total of 208 children with RMPP admitted to Jiaozuo Maternal and Child Health Hospital from January 2023 to December 2024 were selected and randomly divided into the control group and the treatment group，with 104 cases in each group. Finally，98 cases in the control group and 100 cases in the treatment group completed the study. The control group was treated with low-dose methylprednisolone combined with doxycycline， while the treatment group received modified Xiaoqinglong Decoction in addition to the control group's regimen. Both groups were treated for two weeks continuously. The clinical efficacy and the time for symptoms and signs to disappear were compared between the two groups. Changes in the traditional Chinese medicine syndrome score for wind-cold obstructing lung syndrome，lung function indices [forced vital capacity （FVC），peak expiratory flow （PEF），forced expiratory volume in the first second （FEV1）]， and inflammatory markers [erythrocyte sedimentation rate （ESR）， high-sensitivity C-reactive protein （hs-CRP），interleukin-6 （IL-6），tumor necrosis factor-α （TNF-α）] before and after treatment were also compared. Results： After two weeks of treatment， the total clinical effective rate was 94.00% （94/100） in the treatment group and 84.69% （83/98） in the control group，showing a statistically significant difference （P＜0.05）. After treatment，the scores for primary symptoms，secondary symptoms，and the total score of wind-cold obstructing lung syndrome decreased in both groups compared to before treatment （P＜0.05）. The three scores mentioned above in the treatment group were lower than those in the control group （P＜0.05）. The disappearance times for cough，fever，wheezing，and pulmonary wet rales in the treatment group were all shorter than those in the control group， with statistically significant differences （P＜0.05）. After treatment， the levels of FVC， PEF， and FEV1 increased in both groups compared to before treatment （P＜0.05）， and the levels of these three indices were higher in the treatment group than in the control group（ P＜0.05）. After treatment，the levels of ESR，IL-6，hs-CRP， and TNF-α decreased in both groups compared to before treatment （P＜0.05），and the levels of these four indices were lower in the treatment group than in the control group （P＜0.05）. Conclusion： Modified Xiaoqinglong Decoction combined with western medicine is effective in the treatment of RMPP in children. It can reduce systemic inflammatory responses，alleviate symptoms，shorten the time to symptom and sign relief，and improve lung function.