Objective To investigate the clinical efficacy of Zhuangjin Yangxue decoction on Hepple stage Ⅰ and Ⅱ of osteochondral lesion of the talus(OLT).Methods From February 2021 to December 2022,a total of 62 cases of OLT were seleted from the Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine.According to random number table method,the patients were divided into observation group and control group,with 31 cases in each group.The control group was treated with Western medicine,and the observation group received an additional treatment of Zhuangjin Yangxue decoction alongside with Western medicine.Serum matrix metalloproteinase 13(MMP-13),tumor necrosis factor-α(TNF-α),ankle visual analogue scale(VAS)score,American Orthopedic Foot and Ankle Society(AOFAS)ankle-hind foot function score,TCM syndrome score and magnetic resonance observation of cartilage repair tissue(MOCART)score before and after treatment were compared between two groups.Results After 5 weeks and 3 months of treatment,MMP-13,TNF-α,VAS score and TCM syndrome score in two groups were significantly lower than before treatment,and AOFAS ankle-hind foot function score and MOCART score were significantly higher than before treatment(P<0.05).MMP-13,TNF-α and TCM syndrome scores in observation group were significantly lower than those in control group,and MOCART score was significantly higher than that in control group(P<0.05).After 5 weeks of treatment,VAS score of observation group was significantly lower than that of control group,and AOFAS ankle-hind foot function score was significantly higher than that of control group(P<0.05).Conclusion Zhuangjin Yangxue decoction shows a good short-term efficacy in treating Hepple stage Ⅰ and Ⅱ of OLT,with anti-inflammatory and analgesic effects,improved joint function,and promotion of cartilage repair.