〔Abstract〕 Objective To investigate the protective effect of modified Taohong Siwu decoction on limb ischemia-reperfusion injury after tourniquet application. Methods A total of 80 patients with traumatic closed fracture of limbs admitted to Kunshan Integrated Traditional Chinese and Western Medicine Hospital from July 2020 to December 2021 were selected as the study objects, and were divided into an observation group and a control group by random number table method, with 40 cases in each group. The control group received 20 % mannitol injection intravenously after operation, the observation group was treated with modified Taohong Siwu decoction orally after operation. The swelling, pain, joint movement and peripheral circulation of the two groups were compared before and after treatment. The serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), thromboxane B2 (TXB2), and prostacyclin I2 (PGI2) in the two groups were analyzed before and after treatment, and the clinical efficacy was evaluated comprehensively. Results After treatment, the swelling degree, pain degree and joint motion score of the two groups decreased to varying degrees, and the peripheral circulation score increased to varying degrees. After treatment, the swelling degree, pain degree and joint motion score of the observation group were lower than in the control group, and the peripheral circulation score was higher than in the control group, the differences were statistically significant (P < 0.05). After treatment, serum TNF-α and IL-6 were decreased to varying degrees, while TXB2 and PGI2 were increased to varying degrees, and the levels of TNF-α and IL-6 in the observation group were lower than those in the control group, while the levels of TXB2 and PGI2 were higher than those in the control group, the differences were statistically significant (P < 0.05). The total effective rate of the observation group was 97.50 %, which was higher than that in the control group (82.50 %), and the difference was statistically significant (P < 0.05). Conclusion Modified Taohong Siwu decoction has excellent therapeutic effect in patients with limb ischemia reperfusion injury. It can reduce the serum levels of TNF-α and IL-6 and increase the levels of TXB2 and PGI2 to improve the inflammatory response and blood hypercoagulability of patients, so as to effectively relieve the clinical symptoms such as limb swelling and pain and improve the joint range of motion and peripheral circulation of patients.