Objective To investigate the effect of Pei's Xuanzhe Peiqi decoction on enhancing efficacy and reducing toxicity of radiotherapy in patients with esophageal cancer of intermingled phlegm and blood stasis pattern. Methods A total of 80 patients with esophageal cancer of intermingled phlegm and blood stasis pattern were enrolled and assigned to an observation group or a control group by the random number table method, with 40 cases in each group. The control group received radiotherapy alone, while the observation group received additional Pei's Xuanzhe Peiqi decoction on the basis of radiotherapy. Both groups were treated continuously for 6 weeks. After 6 weeks of treatment, the following parameters were compared between the two groups: clinical efficacy (objective response rate and disease control rate), serum levels of tumor markers (cytokeratin 19 fragment [CYFRA21-1], carcinoembryonic antigen [CEA], carbohydrate antigen 19-9 [CA19-9], and squamous cell carcinoma antigen [SCCA]), physical status (Karnofsky performance status [KPS] score), quality of life (World Health Organization Quality of Life-100 assessment instrument [WHOQOL-100] score), total traditional Chinese medicine syndrome score, immune function (proportions of peripheral blood T-lymphocyte subsets [CD3+, CD4+, and CD8+ T cells]), and the incidence of radiotherapy-related adverse reactions (radiation pneumonitis, radiation skin reaction, radiation esophagitis, and myelosuppression). Results After 6 weeks of treatment, the observation group showed lower serum levels of CYFRA21-1, CEA, CA19-9, and SCCA, a lower total traditional Chinese medicine syndrome score, and a lower proportion of peripheral blood CD8+ T cells than the control group (all P<0.05); the KPS score, WHOQOL-100 score, proportions of peripheral blood CD3+ and CD4+ T cells, objective response rate, and disease control rate in the observation group were higher than those in the control group (all P<0.05); the incidence rates of radiation pneumonitis, skin reaction, and esophagitis, as well as myelosuppression, in the observation group were lower than those in the control group (all P<0.05). Conclusion Pei's Xuanzhe Peiqi decoction combined with radiotherapy can improve short-term efficacy, alleviate clinical symptoms, enhance quality of life, and reduce the incidence of radiotherapy-related adverse reactions in patients with esophageal cancer of intermingled phlegm and blood stasis pattern, thus demonstrating both efficacy-enhancing and toxicity‑reducing effects. 

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