To observe the curative effect of Xiaoxuming Decoction（小续命汤）on acute cerebral infarction（ACI）complicated with stroke associated related pneumonia（SAP）syndrome of wind-phlegm blocking collateral and its effect on Toll-like receptor 4（TLR4）/nuclear factor kappa-B（NF-κB）signaling pathway.

A total of 90 patients with ACI combined with SAP treated in Changzhou Hospital of Traditional Chinese Medicine from January 2023 to June 2024 were selected and divided into control group（45 cases）and study group（45 cases）by random number table method. The control group was given the conventional Western medicine treatment，and the study group was given the oral treatment of Xiaoxuming Decoction on the basis of the conventional group. The clinical efficacy，TCM syndrome scores，stroke scale and cognitive function score，laboratory indexes and adverse reactions were observed in two groups.

The total effective rate of treatment in the study group was higher than that in the conventional group（P<0.05）. After treatment，National Institutes of Health Stroke Scale（NIHSS）and Modified Rankin scale（mRS）scores，levels of serum tumor necrosis factor（TNF-α），pigment-derived factor（PEDF），proad-renomedullin（pro-ADM）and C-reactive protein（CRP），the expressions of TLR4 and NF-κB in the study group were lower than those of the control group（P<0.05）. After treatment，the scores of Mini-Mental State Examination（MMSE）and Montreal Cognitive Assessment（MoCA）in the study group were higher than those in the control group（P<0.05）. There was no significant difference in the total incidence of adverse reactions between the two groups（P>0.05）.

In the treatment of acute cerebral infarction complicated with SAP wind-phlegm blocking collateral syndrome，Xiaoxuming Decoction can effectively relieve the clinical symptoms，improve the cognitive function and inflammatory response，and protect the neurological function of patients by regulating TLR4/NF-κB signaling pathway，with high safety.