OBJECTIVE: To observe the effects of modified Pingchen decoction combined with fire needle on gastrointestinal motile regulation, microvascular circulation, glucagon (GLC), Ghrelin and connexin 43(Cx43) in type 2 diabetic gastroparesis (damp heat affecting the spleen pattern). METHODS: Totally 104 patients with type 2 diabetic gastroparesis (damp heat affecting the spleen pattern) treated in Affiliated Hospital of Shaanxi University of Chinese Medicine from Jun. 2021 to Jun. 2023 were extracted to be divided into two groups through the random number table method. Fifty-two cases in the conventional treatment group were given basic Western medicine treatment, while 52 cases in the traditional Chinese medicine combination group received modified Pingchen decoction combined with fire needle based on the conventional treatment group. The clinical efficacy of two groups was compared. Traditional Chinese medicine syndrome, Gastroparesis Cardinal Symptom Index (GCSI) score before and after treatment were evaluated. Gastric evacuation rate, antrum contraction frequency, plasma viscosity, platelet aggregation rate and fibrinogen level were detected. The levels of GLC, 2 h postprandial Blood glucose (2 hBG), Ghrelin, and Cx43 were measured. RESULTS: The total effective rate of traditional Chinese medicine combination group was 96. 15% (50/52), higher than 80. 77% (42/52) of conventional treatment group, the difference was statistically significant (P<0. 05). After treatment, traditional Chinese medicine syndrome score and GCSI score of the traditional Chinese medicine combination group were lower than those in the conventional treatment group, gastric evacuation rate, antrum contraction frequency were higher than those in the conventional treatment group, plasma viscosity, platelet aggregation rate and fibrinogen level were lower than those in the conventional treatment group, GLC and 2 hBG levels were lower than those in the conventional treatment group, Ghrelin and Cx43 levels were higher than those in the conventional treatment group, the differences were statistically significant (P<0. 05). CONCLUSIONS: Modified Pingchen decoction combined with fire needle in the treatment of patients with type 2 diabetic gastroparesis (damp heat affecting the spleen pattern) can regulate blood sugar, improve GLC, Ghrelin and Cx43 levels, improve microvascular circulation and gastrointestinal motility, alleviate patients’ condition and improve clinical efficacy. [ABSTRACT FROM AUTHOR]