“Stroke is the leading cause of death and disability among adults in China, and its common complications include digestive system abnormalities, cognitive impairment, depression, post-stroke associated pneumonia, and hemiplegia. The combination of traditional Chinese and Western medicine has great potential for the treatment of stroke and its complications. Among them, Xinglou Chengqi Decoction is a representative formula for treating stroke from the top to the bottom, with precise efficacy and high safety. In clinical practice, Xinglou Chengqi Decoction is commonly used to treat stroke and its complications. However, the quantity and quality of clinical trials on Xinglou Chengqi Decoction for treating stroke complications need to be improved. At the same time, its basic research is weak, and the effective ingredients and multi-target mechanism of action are unclear. This article reviews the pharmacological basis, drug properties, safety evaluation, clinical research and mechanism of action of Xinglou Chengqi Tang in the treatment of stroke complications. This article summarizes 22 key active ingredients of Xinglou Chengqi Tang in the treatment of acute stroke complicated with phlegm heat and organ excess syndrome, among which seven ingredients, resveratrol, kaempferol, luteolin, genistein, apigenin, (+) - catechin, and adenosine, have good pharmacokinetic properties and high bioavailability. The mechanism of action of Xinglou Chengqi Tang in treating stroke complications is complex, including inflammatory response, brain gut axis, hypothalamic pituitary adrenal axis (HPA axis), gut microbiota, neurotrophic factors, autophagy, oxidative stress, free radical damage, etc. This article contributes to a deeper understanding of the pharmacological basis and mechanism of action of Xinglou Chengqi Decoction in treating stroke complications, providing a theoretical basis for the clinical application and drug development of Xinglou Chengqi Decoction in the treatment of stroke complications. Rewrite: Experts reviewed the research progress of Xinglou Chengqi Decoction in treating stroke complications, summarized its key active ingredients, revealed its complex mechanism of action, and provided theoretical basis for clinical application and drug development.”