Objective To analyze the effect of 595 nm pulsed dye laser combined with Liangxue Qingfei decoction on clinical symptoms and skin physiological indicators in patients with erythematous rosacea. Methods A total of 46 patients with erythematous rosacea admitted to the Department of Dermatology, Ganzhou Dermatosis Hospital from July 2020 to July 2023 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 23 patients in each group. The control group was treated with 595 nm pulsed dye laser, and the observation group was treated with Liangxue Qingfei decoction on the basis of the control group. The clinical efficacy, clinical symptom scores, skin physiological indicators, quality of life and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group (95.65%) was higher than that in the control group (82.61%) (P <0.05). The scores of erythematous vessels, facial flushing, papules and pain in the observation group after treatment were lower than those in the control group (P <0.05). After treatment, the stratum corneum hydration in the observation group was higher than that in the control group, and the skin erythema was lower than that in the control group (P <0.05). The DLQI score of the observation group after treatment was lower than that of the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion Liangxue Qingfei decoction combined with 595 nm pulsed dye laser in the treatment of erythematous rosacea can improve the total effective rate of treatment, ameliorate skin physiological indicators, reduce clinical symptoms, and enhance patients' quality of life without increasing adverse reactions, which is a safe and effective treatment scheme.