Objective: To investigate the clinical efficacy of Qianjin Weijing Decoction combined with acupuncture in treating elderly patients with aspiration pneumonia presenting with the phlegm-heat obstructing the lung syndrome, and to evaluate its impact on inflammatory indicators and prognosis. Methods: A total of 105 elderly patients with aspiration pneumonia admitted to our hospital between April 2022 and June 2023 were selected and randomly assigned to a control group (n=52) and a combination group (n=53). Both groups received conventional treatments, including fiberoptic bronchoscopic lavage and sputum suction, prevention and management of gastroesophageal reflux, oral care, and nutritional support. The control group received additional treatment with intravenous ceftazidime. The combination group received Qianjin Weijing Decoction and acupuncture in addition to the treatments administered to the control group. The therapeutic efficacy, levels of C-reactive protein (CRP) and procalcitonin (PCT), blood gas parameters, APACHE II scores, Clinical Pulmonary Infection Score (CPIS), number of recurrences within one year, time to disappearance of pulmonary rales, duration of cough, and results of blood and sputum cultures were compared between the two groups. Results: After treatment, the total effective rate was significantly higher in the combination group than in the control group (χ2=11.165, P<0.05). Post-treatment, the combination group exhibited significantly lower levels of CRP, PCT, arterial partial pressure of carbon dioxide (PaCO₂), APACHE II scores, and CPIS scores, and a significantly higher arterial partial pressure of oxygen (PaO₂) compared to the control group (P<0.05). Furthermore, the number of recurrences within one year, the time to disappearance of pulmonary rales, and the duration of cough were significantly lower in the combination group than in the control group (P<0.05). The total number of bacterial strains identified in blood and sputum cultures post-treatment was also significantly lower in the combination group (χ²=9.535, P<0.05). Conclusion: For elderly patients with aspiration pneumonia, the addition of Qianjin Weijing Decoction and acupuncture to standard antibiotic therapy can more effectively improve oxygenation, alleviate the inflammatory response, relieve clinical symptoms, and reduce the recurrence rate.