Objective: To investigate the efficacy and safety of Tiaoqiheying decoction in treating acute ischemic stroke. Methods: This prospective randomized study enrolled 102 patients with ischemic stroke who were randomly assigned to the control (placebo), external (external Tiaoqiheying decoction), and external/internal groups (oral and external Tiaoqiheying decoction) groups. Cholesterol (CHO), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels and the National Institute of Health Stroke Scale (NIHSS), modified Ashworth scale (AMS), visual analog scale (VAS), Barthel Index (BI), and Fugl-Meyer score (FMS) were determined before and after treatment. Results: NIHSS scores were lower in the external/internal group than in the external and placebo groups. MAS and VAS scores for all patients were also lower after 4 weeks than before treatment, and they were significantly lower in the external/internal group versus the control group. CHO, TG, and LDL levels were significantly lower after 2 and 4 weeks, and their levels were lower in the external/internal group than in the other two groups. BI and FMS were higher in the external/internal group than in the other groups after 2 and 4 weeks of treatment. Conclusion: Tiaoqiheying decoction may improve spasmodic pain and lipid metabolism after stroke.