Shengma Biejia Decoction（升麻鳖甲汤），recorded in the Synopsis of Prescriptions of Golden Chamber，consists of a combination of Shengma（Cimicifugae Rhizoma），Biejia（Trionycis Carapax），Danggui（Angelicae Sinensis Radix），Gancao（Glycyrrhizae Radix et Rhizoma），Shujiao（Zanthoxyli Pericarpium）and Xionghuang（Realgar），and can be used to treat Yang toxin. On the basis of this prescriptions，Shujiao（Zanthoxyli Pericarpium）and Xionghuang（Realgar）are subtracted to treat Yin toxin. Physicians in past dynasties held varying perspectives on the drug addition and subtraction of Shengma Biejia Decoction. The toxicity of Xionghuang（Realgar）in Shengma Biejia Decoction restricts its clinical applications. Physicians hold discrepant perspectives on the interpretation of“Yin-Yang”of the Yin-Yang toxin，with some linking it to the cold and heat nature of diseases and others connecting it to the differentiation between exterior and interior diseases，causing debate over drug addition and subtraction of Shengma Biejia Decoction. Ancient physicians thought that Yin-Yang toxin was exogenous diseases such as typhoid fever and epidemic disease，and treated it with Shengma Biejia Decoction. In modern clinic，Shengma Biejia Decoction is widely used to treat dermatological diseases，ophthalmological and otolaryngological diseases and internal diseases including hematological diseases and immunological diseases，and its pharmacodynamic mechanism is related to regulating immunity and inhibiting tumor cell viability. Most physicians believe that the usage of Xionghuang（Realgar）in this prescription should be taken with water in low doses for a short duration. Shengma Biejia Decoction with Xionghuang（Realgar）is commonly used for dermatological diseases，hematological diseases and immunological diseases，particularly for treating urticaria，leukemia and systemic lupus erythematosus. This paper addressed the problems of drug addition and subtraction of Shengma Biejia Decoction，reviewed the advancements in clinical application and pharmacodynamic mechanism of Shengma Biejia Decoction，and conducted statistical analysis on the clinical utilization of Shengma Biejia Decoction with Xionghuang（Realgar）. This review aimed to offer guidance for the clinical application of Shengma Biejia Decoction and inform future basic and theoretical research in this area.