Objective To study the effect of Shenfu injection combined with low dose glucocorticoid on endothelial function and blood coagulation in elderly patients with severe pneumonia. Methods 120 patients with severe pneumonia in our hospital from January 2014 to January 2017 were selected,and randomly divided into treatment group and control group,60 cases in each groups.. All patients were treated with conventional treatment. On this basis, the control group was treated with small dose of glucocorticoid. The treatment group was treated with Shenfu Injection on the basis of the control group. The severity, endothelial function and coagulation function of the two groups were compared at different times after treatment. Results The scores of APACHE and 120 h in the two groups were significantly lower than those in the control group (P<0.05). The score of the treatment group was lower (P<0.05) than that of the control group (96 h). After treatment, the two groups of patients with s E-selectin, V WF, APTT, D-D were significantly decreased, PLT significantly increased, significant difference (P<0.05); compared with the control group, s E-selectin, V WF, APTT, D-D and other indicators of the treatment group decreased and PLT increased even more sharply, there is statistical significance (P<0.05). Conclusion Shenfu injection combined with small dose of glucocorticoid therapy, can alleviate the function and coagulation function in patients with endothelial damage, relieve endothelial dysfunction, improve coagulation status of patients, and has higher application value.