Abstract：Objective：To observe the clinical efficacy of Huayin Zhiqiu Decoction in treating moderate to severe allergic rhinitis （AR）.Methods： A total of 60 patients with moderate to severe AR admitted to Yuyao Hospital of Traditional Chinese Medicine from January to December 2024 were selected and randomly divided into a control group and a combination group according to a random number table method，with 30 cases in each group. The control group received conventional western medication， while the combination group received additional Huayin Zhiqiu Decoction based on the control group's treatment. Clinical efficacy， traditional Chinese medicine syndrome scores， Total Nasal Symptom Score （TNSS）， interleukin-18 （IL-18）， interleukin-1β （IL-1β）， mucin-5AC （MUC5AC） levels， and adverse reactions were compared between the two groups. Results： After treatment， the total effective rate was 96.67% （29/30） in the combination group and 70.00% （21/30） in the control group， with the difference being significant （P＜0.05）. The scores for primary and secondary symptoms of traditional Chinese medicine syndrome decreased in both groups compared to before treatment （P＜0.05），and the combination group had lower scores than the control group （P＜0.05）. The scores for nasal congestion， nasal itching， sneezing， and rhinorrhea in the TNSS decreased in both groups compared to before treatment （P＜0.05），and the combination group had lower scores for all four symptoms than the control group （P＜0.05）. Serum levels of IL-18， IL-1β， and MUC5AC decreased in both groups compared to before treatment （P＜0.05），and the combination group had lower levels of these markers than the control group （P＜0.05）. During treatment， no adverse reactions such as skin allergies or liver/kidney function impairment were observed in either group. Conclusion：Huayin Zhiqiu Decoction combined with conventional western medication demonstrates definite efficacy in treating moderate to severe AR. It significantly alleviates nasal symptoms， improves traditional Chinese medicine syndromes， reduces nasal mucosal inflammatory responses， and enhances patients' quality of life.