Objective To observe the clinical efficacy of laparoscopy and intraoperative choledochoscope combined with sequential Chinese medicine in the treatment of patients with syndrome of Liver Constraint and Spleen Deficiency after extrahepatic cholangiolithiasis, and to provide evidence for the application of Chinese medicine in perioperative period after biliary tract surgery. Methods Forty patients with extrahepatic bile duct calculi hospitalized in the Department of General Surgery of the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2019 to December 2021 were selected and randomly divided into observation group and control group, with 20 patients in each group. The control group was treated with laparoscopy combined with intraoperative choledochoscope, i.e. On the basis of the control group, the observation group was orally treated with Traditional Chinese medicine Buzhong Yiqi Decoction combined with Sini SAN after surgery, and the clinical efficacy, TCM syndrome grading quantitative score, 24-hour bile drainage flow and inflammatory indicators of the two groups were compared: Blood routine examinations, hS-CRP, serum leukotriene B4 , liver function, and serum bile biochemical indexes. Results In terms of clinical efficacy after treatment, the total effective rate of the control group and the observation group was 90.00% and 95.00%, respectively, with no statistical significance. The scores of TCM syndrome grading were significantly lower in the observation group than in the control group (P < 0.05). At the same time, compared with the bile drainage in T tube, the bile drainage in the observation group began to decrease significantly in the 5th day the bile drainage in T tube after surgery, and the improvement in bile drainage was statistically significant compared with the control group (P < 0.05). In terms of inflammatory indicators, all indicators in 2 groups were improved, and compared with the control group, all indicators in observation group were improved more significantly (P < 0.05). Liver function and serum bile biochemical indexes in the observation group were significantly better than those in the control group (P < 0.01). Conclusion Buzhong Yiqi Decoction combined with Sini SAN has a significant clinical effect on the treatment of extrahepatic bile duct stones with syndrome of Liver Constraint and Spleen Deficiency, which can effectively improve the clinical symptoms and signs, improve liver function, reduce postoperative inflammatory reaction, reduce cholecystasis, and is safe and effective in clinical application.