Objective To analyze the effect of Guizhi decoction combined with conventional Western medicine on skin lesion severity and pruritus symptoms in patients with atopic dermatitis. Methods A total of 74 patients with atopic dermatitis admitted to the First People's Hospital of Xining from February 2024 to September 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 37 patients in each group. The control group was treated with conventional Western medicine, and the study group was treated with Guizhi decoction combined with conventional Western medicine. The skin lesion severity, pruritus symptoms, treatment effect and adverse reactions were compared between the two groups. Results After 8 weeks of treatment, the scores of EASI and BRS in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P<0.05). The total effective rate of the study group (100.00%) was higher than that of the control group (86.49%) (P<0.05). There was no signiffcant difference in the incidence of dry skin, drowsiness, gastrointestinal discomfort and abnormal liver function between the two groups (P>0.05). Conclusion Guizhi decoction combined with conventional Western medicine in the treatment of atopic dermatitis can effectively reduce the severity of patients' skin lesions, improve pruritus symptoms, help to improve the overall treatment effect, and will not increase the incidence of adverse reactions.