Objective To investigate the clinical effects of acupuncture combined with enema in the treatment of acute pelvic inflammatory, and its effects on uterine hemodynamics and seurm levels of high mobility group box-1 protein (HMGB1), toll-like receptor 4 (TLR4). Methods A total of 66 patients with acute pelvic inflammatory were enrolled in the study, randomly divided into the combination treatment group (n=33) and conventional treatment group (n=33). The patients in the combination treatment group were given with acupuncture combined with enema on the basis of conventional therapy. After 10 d treatment, the effective rate was observed. The changes of serum HMGB1 and TLR4 were compared and analyzed. Results After 10 d treatment, the total effective rate was 90.91% (30/33) in the combination treatment group, and 69.70% (23/33) in the conventional treatment group. There were statistically significant differences between the two groups (χ2=8.246,P<0.05).After treatment,the left Vmax(39.16 ± 0.73 cm/s vs.35.47 ± 0.83 cm/s),right Vmax(41.23 ± 1.12 cm/s vs.36.24 ± 0.75 cm/s),left PI(2.23 ± 0.25 cm/s vs.3.11 ±0.45 cm/s),right PI(2.17 ± 0.22 cm/s vs. 2.62 ± 0.23 cm/s),left RI(0.48 ± 0.08 cm/s vs.0.73 ± 0.13 cm/s)and right RI(0.43 ± 0.11 cm/s vs.0.71 ± 0.16 cm/s)of the combined treatment group were significantly superior to the conventional treatment group (all P<0.01). The levels of serum HMGB1(17.45 ± 5.01 ng/ml vs.21.32 ± 6.15 ng/ml,t=2.803)and TLR4(1.05 ± 0.64 ng/ml vs. 1.75 ± 0.91 ng/ml, t=3.614) in the combination treatment group were significantly lower than those in conventional treatment group (all P<0.01). Conclusions Acupuncture combined with traditional Chinese medicine enema treatment of acute pelvic inflammatory disease is better, improve the uterine hemodynamics. The mechanism may be related to inhibit the release of HMGB1, TLR4 and its induced inflammatory response.