Abstract： Objective： To observe the clinical efficacy of Qingre Lishi Chubi Decoction combined with warm acupuncture in treating rheumatoid arthritis （RA） of damp-heat obstruction type and its effects on serum granulocytemacrophage colony-stimulating factor （GM-CSF） and immune function. Methods：A total of 135 RA patients treated in Hebi Hospital of Chinese Medicine from January 2023 to February 2024 were enrolled and randomly divided into the warm acupuncture group， the Chinese medicine group， and the acupuncture-medicine combination group by the random number table method，with 45 cases in each group. After exclusions，44 cases in the warm acupuncture group， 43 cases in the Chinese medicine group， and 43 cases in the acupuncture-medicine combination group were finally included. The warm acupuncture group received warm acupuncture；the Chinese medicine group received Qingre Lishi Chubi Decoction；and the acupuncture-medicine combination group received both warm acupuncture and Qingre Lishi Chubi Decoction. All groups were treated for 12 weeks. The clinical efficacy， incidence of adverse reactions， traditional Chinese medicine （TCM） syndrome scores， ultrasonographic finding scores， 6-point Behavioral Rating Scale（ BRS-6） scores，28-joint Disease Activity Score（ DAS-28） scores，CD4+ T cell and CD8+ T cell levels，T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibitory motif （ITIM） domains （TIGIT） expression， and serum levels of tumor necrosis factor-α （TNF-α）， GM-CSF， and reactive oxygen species （ROS） were compared among the three groups. Results：After treatment，the total effective rate was 97.67% （42/43） in the acupuncture-medicine combination group，88.37% （38/43） in the Chinese medicine group，and 84.09% （37/44） in the warm acupuncture group，the difference being significant among the three groups （P＜0.05）. After treatment，the TCM syndrome scores （joint swelling and pain，joint fever，thirst，morning stiffness，fever，limited joint flexion and extension， sweating） in all three groups were decreased when compared with those before treatment （P＜0.05）； comparison of all scores among the three groups showed statistically significant differences （P＜0.05）. with the scores in the acupuncture-medicine combination group being lower than those in the Chinese medicine group and the warm acupuncture group （P＜0.05）， and the scores in the Chinese medicine group being lower than those in the warm acupuncture group （P＜0.05）. After treatment，the ultrasonographic finding，DAS-28，and BRS-6 scores in all three groups were decreased when compared with those before treatment （P＜0.05）；comparison of ultrasound findings scores DAS-28 scores，and BRS-6 scores among the three groups showed statistically significant differences （P＜0.05），with the three scores in the acupuncture-medicine combination group being lower than those in the warm acupuncture group and the Chinese medicine group （P＜0.05），and the three scores in the Chinese medicine group being lower than those in the warm acupuncture group （P＜0.05）. After treatment， the levels of CD4+ T cells and TIGIT in all three groups were decreased when compared with those before treatment （P＜0.05）， while the levels of CD8+ T cells were increased （P＜0.05）. The levels of CD4+ T cells and TIGIT in the acupuncture-medicine combination group were lower than those in the warm acupuncture group and the Chinese medicine group （P＜0.05），while the CD8+ T cell level was higher （P＜0.05）. The levels of CD4+ T cells and TIGIT in the Chinese medicine group were lower than those in the warm acupuncture group （P＜0.05），while the CD8+ T cell level was higher （P＜0.05）. After treatment，the levels of TNF-α，GM-CSF，and ROS in all three groups were decreased when compared with those before treatment （P＜ 0.05）； the three indicators in the acupuncture-medicine combination group were lower than those in the warm acupuncture group and the Chinese medicine group （P＜0.05）， and those in the Chinese medicine group were lower than those in the warm acupuncture group （P＜0.05）. The incidence of adverse reactions was 16.28% （7/43） in the acupuncture-medicine combination group，11.36% （5/44） in the warm acupuncture group，and 9.30% （4/43） in the Chinese medicine group，there being no significant difference among the three groups （P＞0.05）. During treatment，no significant abnormalities were observed in liver and kidney function， blood routine， or urine routine tests across the three groups. Conclusion： Qingre Lishi Chubi Decoction combined with warm acupuncture can effectively regulate immune responses， inhibit inflammatory reactions and reactive oxygen species levels， improve ultrasonographic findings， and alleviate joint symptoms in RA patients of damp-heat obstruction type， with superior effect to either Qingre Lishi Chubi Decoction or warm acupuncture alone.