Objective To investigate the clinical effect of spleen-activating and turbid pathogen-eliminating therapy in the treatment of hyperuricemia with spleen deficiency. Methods A retrospective study was conducted, and the electronic medical record system of Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine was searched to collect the clinical data of patients with hyperuricemia with spleen deficiency who were hospitalized in the recent 5 years. A total of 45 patients who received the spleen-activating and turbid pathogen-eliminating therapy were enrolled as spleen-activating and turbid pathogen-eliminating group, and the propensity score matching method was used to select 45 patients who received conventional Western medicine treatment as conventional treatment group; the course of treatment was 2 weeks for both groups. The two groups were compared in terms of serum uric acid and symptom score of spleen deficiency before and after treatment. 〖JP2〗Results After treatment, both groups had a significant reduction in serum uric acid (P<0.05), and the two groups had a similar rate of reaching the standard uric acid level (40% for the spleen-activating and turbid pathogen-eliminating group and 55.56% for the conventional treatment group) and a similar response rate of uric acid-lowering treatment (P>0.05). Both groups had a significant reduction in the symptom score of spleen deficiency after treatment (P<0.05), and the spleen-activating and turbid pathogen-eliminating group had a significantly greater reduction than the conventional treatment group (P<0.05); there was also a significant difference in the treatment outcome of traditional Chinese medicine symptoms between the two groups (P<0.05). Conclusion In the treatment of hyperuricemia with spleen deficiency, spleen-activating and turbid pathogen-eliminating therapy can effectively reduce serum uric acid level and improve the symptoms of spleen deficiency.