〔Abstract〕 Objective To observe the clinical efficacy of modified Simiao powder on acute gouty arthritis, and to explore its influence on (NOD–like receptor protein 3, NLRP3) inflammasomes signaling pathway. Methods 80 cases of patients selected from Shenzhen Luohu District Hospital of Traditional Chinese Medicine (Shenzhen Hospital of Shanghai University of Traditional Chinese Medicine) from October 2019 to May 2021 with acute gouty arthritis were randomly divided into two groups, with 40 cases each group. The patients of the group A and the group B were treated with colchicine tablets and ibuprofen sustained-release capsules, and additionally, the group B was given modified Simiao powder, the treatment lasted for 1 week continuous days, before and after treatment, we observed the levels of serum uric acid, erythrocyte sedimentation rate, C-reactive protein, interleukin-1β and interleukin-18, the expressions of NLRP3, ACS, Caspase-1 mRNA in peripheral blood mononuclear cells (PBMCs) and the curative effect of TCM syndrome. Results After treatment, The levels of serum uric acid, erythrocyte sedimentation rate, C-reactive protein, interleukin-1β and interleukin-18, the expressions of NLRP3, ACS, Caspase-1 mRNA in peripheral blood mononuclear cells (PBMCs) of the group B were better than group A (P < 0.05 or P < 0.01). The total curative effective rate of the TCM syndrome in group A was 87.50%, and that group B was 95.00%. The difference between two groups was statistically significant (P < 0.05). Conclusion On the basis of routine western medicine treatment, the combination of modified Simiao powder can more effectively improve the symptoms of gouty arthritis, and its mechanism may be related to the inhibition of NLRP3, ACS, Caspase-1 gene expression in PBMCs, and reducing the release of IL-1 β and IL-18 inflammatory factors.