〔Abstract〕 Objective To explore the efficacy and safety of recombinant human brain natriuretic peptide combined with Chinese medicine for nourishing qi and strengthening heart in the treatment of acute left heart failure. Methods A total of 80 patients with acute left heart failure diagnosed and treated in Zhangzhou Changtai District Hospital from January 2020 to January 2022 were selected as the research objects. They were divided into an observation group (40 cases were treated with recombinant human brain natriuretic peptide combined with traditional Chinese medicine for improving qi and strengthening heart) and a control group (40 cases were treated with recombinant human brain natriuretic peptide) by randomized control method.The effects, complications, cardiac function, myocardial enzyme profile and markers of heart failure were compared between the two groups. Results The total effective rate of the observation group was 92.5 %, which was higher than that of the control group 72.5 %, the difference was statistically significant (P < 0.05). There was no significant difference in complications between the two groups (P > 0.05). After treatment, the left ventricular end diastolic dimension (LVEDD), Tei index, creatine kinase Isoenzyme–MB (CK-MB) and high sensitivity cardiac troponin I (Hs-CTNI) in the observation group were significantly lower than those in the control group, while left ventricular ejection fraction (LVEF) was significantly higher than that in the control group, with statistical significance (P < 0.05). After treatment, the N terminal pro B type natriuretic peptide (NT-probNP) in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusion Recombinant human brain natriuretic peptide combined with Chinese medicine for Yiqi and Qiangxin can significantly improve the cardiac function of patients with acute left heart failure, reduce the level of markers of heart failure without significantly increasing the incidence of complications, and its efficacy is significantly higher than that of recombinant human brain natriuretic peptide.