Objective To investigate the clinical efficacy and safety of Zishen Jianpi Shugan Decoction combined with acupuncture in the treatment of decreased ovarian reserve (DOR). Methods Seventy patients with DOR who visited Dongcheng District Maternal and Child Health Care and Family Planning Service Center from January 2023 to June 2024 were selected as the subjects of this study. They were divided into two groups according to different treatment methods, 35 patients with DOR in the study group and 35 patients in the control group, and all DOR patients in the control group received hormone therapy. On the basis of the control group, the study group was given Zishen Jianpi Shugan Decoction combined with acupuncture treatment. To record and compare the hormone levels and ovarian stromal artery blood flow parameters of the two groups before treatment and after 3 months of treatment. Results After 3 months of treatment, the levels of E₂, LH and FSH were significantly compared between the two groups (P<0.05), and the levels of E₂ were increased and the levels of LH and FSH were decreased in both groups. The comparison of RI and S/D values between groups after 3 months of treatment was statistically significant (P<0.05). Conclusions For patients with DOR, the active use of traditional Chinese medicine Zishen Jianpi Shugan Decoction combined with acupuncture and moxibustion has a significant effect, which is conducive to obtaining better hormone levels, ovarian stromal artery blood flow parameters.