Abstract：Objective：To observe the clinical effect of modified Xuanbai Chengqi tang combined with methylprednisolone sodium succinate for acute respiratory distress syndrome (ARDS) with fluid retention with heat syndrome. Methods：A total of 63 cases of ARDS patients with fluid retention with heat syndrome were selected and divided into the treatment group and the control group according to the random number table method，with 33 and 30 cases in each group respectively. The control group was treated with methylprednisolone sodium succinate for injection，and the treatment group was additionally treated with modified Xuanbai Chengqi tang based on the treatment of the control group. Both groups were treated for seven days. Clinical effects was compared between the two groups. Before and after treatment， Chinese medicine syndrome scores， inflammatory factors and blood gas analysis indexes were compared between the two groups. Results：The total effective rate was 84.85% in the treatment group，higher than that of 60.00% in the control group(P＜0.05). After treatment，Chinese medicine syndrome scores were decreased when compared with those 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 C- reactive protein(CRP) and interleukin-6 (IL-6) in the two groups were decreased when compared with those before treatment(P＜0.05)，and the above two levels in the treatment groups were lower than those in the control group(P＜0.05). After treatment， arterial partial pressure of oxygen(PaO2) and oxygenation index(PaO2/FiO2) in the two groups were increased when compared with those before treatment(P＜0.05)，and the above two indexes in the treatment group were higher than those in the control group(P＜ 0.05)；arterial partial pressure of carbon dioxide(PaCO2) in the two groups were decreased when compared with those before treatment(P＜0.05)， and PaCO2 in the treatment group was lower than that in the control group(P＜0.05). Conclusion： Modified Xuanbai Chengqi tang combined with methylprednisolone sodium succinate for ARDS with fluid retention with heat syndrome can effectively relieve clinical symptoms and inflammatory responses， and improve blood gas analysis indexes.