Objective To evaluate the clinical efficacy of combining herbal fumigation （Xiaoqinglong Decoction） and sharp hook needle therapy on the basis of mometasone furoate nasal spray in treating allergic rhinitis with lung?qi deficiency and cold syndrome. Methods A randomized controlled trial was conducted. A total of 144 patients with allergic rhinitis of lung?qi deficiency and cold syndrome， treated at the Beibei Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from January to July 2025， were enrolled. Patients were divided into： Control group （mometasone furoate nasal spray）， Fumigation group （mometasone furoate nasal spray + herbal fumigation）， Hook needle group （mometasone furoate nasal spray + sharp hook needle）， and Combination group （mometasone furoate nasal spray + herbal fumigation + sharp hook needle）. Mometasone furoate nasal spray was administered twice daily， 2 sprays per nostril each time， for 14 days. Herbal fumigation was applied for 6 days， followed by a 2-day break， then another 6 days， totaling 14 days. Sharp hook needle therapy was performed once on the day of enrollment and again on day 8， totaling 2 sessions. The corresponding procedures in the other three groups followed the same schedule as the Combination group. Serum levels of interleukin-4 （IL-4）， interleukin-5 （IL-5）， interleukin-13 （IL-13）， immunoglobulin E （IgE）， thymic stromal lymphopoietin （TSLP）， and interferon-gamma （IFN-γ） were measured by enzyme-linked immunosorbent assay （ELISA） before and after treatment. The distribution degree of eosinophils （EOS） in nasal secretions and subjective symptom scores were also assessed. Results After treatment， serum levels of IL-4， IL-5， IL-13， IgE， TSLP， EOS distribution scores， and subjective symptom scores decreased significantly in all four groups compared to before treatment （P < 0.05）. The Combination group showed significantly greater reductions in serum inflammatory factor levels， TNNSS， and VAS scores compared to the other three groups （P < 0.01）， and greater reductions in EOS distribution scores， TNSS， and RQLQ scores compared to the Control group （P < 0.05）. Serum IFN-γ levels increased after treatment in the Combination， Fumigation， and Hook needle groups （P < 0.05）， while no statistically significant change in IFN-γ was observed in the Control group before and after treatment （P > 0.05）. Conclusion The combination of herbal fumigation （Xiaoqinglong Decoction） and sharp hook needle therapy on the basis of mometasone furoate nasal spray is safe and effective in regulating inflammatory cytokine levels and alleviating subjective symptoms in patients with allergic rhinitis of lung?qi deficiency and cold syndrome.