To evaluate the effect of Xinglou Chengqi Decoction（星蒌承气汤）in improving the intestinal microecology of acute cerebral infarction patients with phlegm-heat in Fu-organs syndrome.

A total of 60 acute cerebral infarction patients with phlegm-heat in Fu-organs syndrome who received the corresponding treatment in the hospital during May 2020 to June 2023 were selected as the subjects of this experiment，and were randomly divided into two groups.Both groups were treated with conventional western medicine，including lowering blood lipids，blood pressure and blood sugar，controlling underlying diseases，antiplatelet aggregation and neuroprotection.On this basis，the control group（30 cases）used aspirin enteric-coated tablets once a day and atorvastatin once a day orally.On the basis of conventional Western medicine treatment，the observation group（30 cases）was treated with Xingpu Chengqi Decoction，1 dose a day，taking twice in the morning and evening after decocting.Two groups were treated continuously for 14 days.The treatment efficacy of two groups was compared，and the improvement time of clinical symptoms such as limb weakness，aphasia，slurred speech and limb dysfunction before and after treatment was compared between two groups.Venous blood was collected on an empty stomach before and after treatment，and the levels of 5-hydroxytryptamine（5-HT），norepinephrine（NE），glutamicacid（Glu），doparnine（DA），brain-derived neurotrophic factor（BDNF）andγ-aminobutyric acid（GABA），the National Institutes of Health Stroke Scale（NIHSS）score，Barthel index score and modified Rankin score were compared between two groups before and after treatment.The numbers of bifidobacteria，lactobacillus，enterococci and yeast were compared between two groups before and after treatment.

Dopamine，neurotransmitters norepinephrine，epinephrine，5-hydroxytryptamine The total effective rate in the control group（63.33%，19/30）was significantly lower than that（86.67%，26/30）in the observation group.The improvement time of clinical symptoms such as limb weakness，aphasia，slurred speech and limb dysfunction in the observation group was shorter than that in the control group（P<0.05）.The levels of DA，NE，adrenaline，5-HT after treatment in two groups were decreased and the decrease in the observation group was higher than that of the control group（P<0.05）.The modified Rankin score and NIHSSscore in two groups were lower than those before treatment.Barthel index scores in two groups after treatment were higher than those before treatment.The improvement of the observation group was better than that of the control group（P<0.05），and the levels of bifidobacteria，lactobacillus and enterococci in two groups increased compared with those before treatment，and the levels of yeast decreased compared with those before treatment，and the improvement in the observation group was better than that of the control（P<0.05）.

Xinglou Chengqi Decoction can improve the nervous function of acute cerebral infarction patients with phlegm-heat in Fuorgans syndrome，reduce the clinical symptoms and improve the therapeutic effect.Its mechanism of action may be related to regulating the secretion of neurotransmitters and maintaining the balance of brain-gut axis.