Objective: To explore the clinical efficacy of Zhitong Rushen Decoction fumigation and sitz bath in the treatment of thrombotic external hemorrhoids. Methods: 50 patients with thrombotic external hemorrhoids in Nanjing Lishui District Hospital of Traditional Chinese Medicine from December 2019 to December 2021 were randomly divided into control group and treatment group, with 25 cases in each group. Both groups took citrus flavone tablets orally and applied Gangtai ointment externally. The control group was treated with potassium permanganate solution fumigation and sitz bath, while the treatment group was treated with modified Zhitong Rushen Decoction fumigation and sitz bath, and the curative effects and pain score of the two groups were compared and analyzed. Results: The total effective rate was 100% in the treatment group and 76% in the control group, the difference was statistically significant(P<0.05), with the former better than the latter. There was no significant difference in pain score between the two groups before treatment, but after treatment, the pain score of the treatment group was (0.27±0.28) points, which was significantly lower than (0.82±0.35) points of the control group, with a statistical significance(P<0.05). Conclusion: Zhitong Rushen Decoction combined with fumigation and sitz bath, oral citrus flavone tablets, and external application of Gangtai ointment can effectively relieve perianal local pain and perianal foreign body sensation in the treatment of thrombotic external hemorrhoids.