Objective To evaluate the clinical efficacy of Xiaozhong Tounong Decoction in combination with antibiotics in patients with periappendiceal abscess of damp-heat syndrome. Methods A total of 64 eligible patients were recruited and randomly allocated into two groups， with 32 patients in each group. The control group underwent conventional treatment using antibiotics， whereas the experimental group received additional treatment with Xiaozhong Tounong Decoction. The primary and secondary outcome measures encompassed the time for abscess resolution， the duration of antibiotic administration， the time to defervescence， traditional Chinese medicine syndrome scores， visual analogue scale pain scores， inflammatory laboratory indicators， overall clinical efficacy， and the incidence of adverse events. Results Compared with the control group， the experimental group exhibited significantly shorter durations in abscess resolution， antibiotic use， and defervescence， along with notably lower scores in traditional Chinese medicine syndromes， visual analogue scale pain， and laboratory parameters （all P < 0.05）. The hierarchical clinical efficacy of the experimental group was significantly superior to that of the control group （P < 0.001）. There was no statistically significant difference in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusions Xiaozhong Tounong Decoction combined with antibiotics yields favorable clinical outcomes in the treatment of periappendiceal abscess with dampness-heat syndrome. This integrated treatment approach effectively shortens the treatment duration and significantly alleviates clinical symptoms.