〔Abstract〕 Objective To study and analyze the effect of Tiaowei Chengqi Decoction on intra-abdominal pressure and inflammatory factors in critically ill patients with sepsis complicated by gastrointestinal failure. Methods A total of 32 patients diagnosed with critical sepsis complicated by gastrointestinal failure from February 2018 to December 2022 at Henan Provincial Hospital of Traditional Chinese Medicine were selected as the retrospective study subjects. They were divided into a control group (17 cases) and an observation group (15 cases) based on different treatment regimens. The control group received conventional Western medical treatment, while the observation group received conventional Western medicine plus Tiaowei Chengqi Decoction treatment. The clinical effects of different regimens were compared. Results After treatment, the acute physiology and chronic health evaluation II (APACHE II) and acute gastrointestinal injury (AGI) scores in the observation group were lower than those in the control group, and the differences were statistically significant (P < 0.05); the intra-abdominal pressure in the observation group was lower than that in the control group, and the frequency of bowel sounds was higher than that in the control group, and the differences were statistically significant (P < 0.05); the levels of white blood cell (WBC) count, serum procalcitonin (PCT), and serum C-reactive protein (CRP) in the observation group were lower than those in the control group, and the differences were statistically significant (P < 0.05); the total effective rate of treatment in the observation group was 100.00%, which was higher than 64.71% in the control group, and the difference was statistically significant (P < 0.05). Conclusion Adding Tiaowei Chengqi Decoction to conventional Western medicine treatment for critically ill patients with sepsis complicated by gastrointestinal failure can promote the improvement of gastrointestinal function, effectively reduce intra-abdominal pressure and the level of inflammatory factors in the body, and is beneficial for disease control.