Abstract： Objective： To observe the clinical efficacy of Qishen Decoction in the treatment of patients with metabolic dysfunction-associated steatohepatitis （MASH） with syndrome of qi deficiency， blood stasis， and phlegm retention，and to evaluate its effect on the levels of peripheral blood T helper 17 （Th17） cells and regulatory T （Treg） cells. Methods： A total of 60 MASH patients treated in the outpatient and inpatient departments of the Second Department of Gastroenterology and Hepatology at the Heilongjiang Academy of Chinese Medicine Sciences from January to May 2025 were selected. They were randomly divided into the treatment group and the control group using the random number table method in a 1∶ 1 ratio， with 30 cases in each group. The treatment group received Qishen Decoction， while the control group received Vitamin E Soft Capsules. Changes in the following parameters were observed before and after treatment in both groups： blood lipids [triglycerides （TG）， total cholesterol （TC）， lowdensity lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）]， liver function [alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， gamma-glutamyl transferase （GGT）]， controlled attenuation parameter（ CAP），inflammatory factors [interleukin（ IL）-17，IL-22，IL-10，transforming growth factor- β （TGF-β）]，and Th17/Treg levels. Results：The total effective rate was 86.7% （26/30） in the treatment group and 60.0% （18/30） in the control group，with a statistically significant difference between the two groups （P＜0.05）. After treatment，traditional Chinese medicine syndrome scores decreased in both groups compared to before treatment （P＜ 0.05），and the score in the treatment group was lower than that in the control group （P＜0.05）. After treatment，levels of ALT， AST， and GGT decreased in both groups compared to before treatment （P＜0.05）， and the levels in the treatment group were lower than those in the control group （P＜0.05）. After treatment，levels of TC，TG，and LDL-C in the treatment group were significantly reduced compared to before treatment and were lower than those in the control group （P＜0.05）；HDL-C levels were significantly increased compared to before treatment （P＜0.05） and were higher than those in the control group （P＜0.05）. In the control group，TC and TG levels were significantly reduced compared to before treatment （P＜0.05）； however， there were no statistically significant differences in HDL-C and LDL-C levels before and after treatment （P＞0.05）. After treatment， CAP values decreased significantly in both groups compared to before treatment （P＜0.05），and the CAP value in the treatment group was lower than that in the control group（ P＜0.05）. After treatment，levels of IL-17 and IL-22 in the treatment group were decreased compared to before treatment （P＜0.05） and lower than those in the control group （P＜0.05）；levels of IL-10 and TGF-β were increased compared to before treatment （P＜0.05） and higher than those in the control group （P＜0.05）. In the control group， levels of IL-17 and IL-22 were decreased compared to before treatment （P＜0.05），but the differences in IL-10 and TGF-β levels before and after treatment were not statistically significant （P＞0.05）. After treatment，Th17 levels and the Th17/Treg ratio decreased in both groups compared to before treatment （P＜0.05）， and both were lower in the treatment group than in the control group （P＜0.05）； Treg levels increased in both groups compared to before treatment （P＜0.05）， and were higher in the treatment group than in the control group （P＜0.05）. Conclusion： Qishen Decoction can achieve therapeutic effects in MASH by regulating the Th17/Treg balance， thereby improving liver function， lipid metabolism， immune function， and systemic inflammatory response， and reducing liver fat content of patients.