OBJECTIVE： To observe clinical efficacy and safety of Modified xiaohuang paste in the treatment of paralytic ileus after thoracolumbar fractures. METHODS： One hundred and thirty-eight patients with paralytic ileus after thoracolumbar fractures were divided into control group （group A， 43 cases）， Xiaohuang paste group （group B， 47 cases） and Modified xiaohuang paste group （group C， 48 cases）. Group A was given routine treatment as fasting， gastrointestinal decompression， fluid replacement， nutritional support； group B was additionally given Xiaohuang paste on the basis of group A； group C was additionally given Modified xiaohuang paste on the basis of group A. Group B and C were given relevant paste every 12 h until intestinal peristalsis was recovered and gas exhausted from anus， at the most for 5 days. The improvement time of clinical symptom improvement， VAS score and CRP level were compared among 3 groups as well as the occurrence of ADR. RESULTS： After treatment， the time of gastrointestinal decompression， bowel sound recovery and passage of gas by anus in group B and C were significantly shorter than group A， and group C was significantly shorter than group B， with statistical significance （P＜0.05）. Before treatment， there was no statistical significance in VAS score and CRP level among 3 groups （P＞0.05）. After treatment， VAS score of abdominal pain and distension， CRP level of 3 groups were decreased significantly compared to before treatment； those of group C were significantly lower than group A and B， and CRP level of group B was significantly lower than that of group A， with statistical significance （P＜0.05）. There was no statistical significance in VAS score between group A and B （P＞0.05）. No significant ADR was found in 3 groups. CONCLUSIONS： For paralytic ileus after thoracolumbar fracture， Modified xiaohuang paste can significantly shorten treatment duration， relieve abdominal distension and pain， inflammation with good safety.