Objective To seek an effective and safe therapy for acute variceal hemorrhage of patients with Child class C cirrhosis. Methods One hundred and nine Child class C cirrhotic patients with an acute hemorrhage from esophageal varices were reviewed. Sixty - one patients received medical therapy;29 patients were underwent sur- gical operations and 19 patients received TIPSS. Results The surgical group had a higher mortality rate during hos- pitalization(65. 5 % ) than either of the other groups(36. 1 % and 26. 3 % respectively ). The rebleeding rates during hospitalization were 24. 1 %, 36. 1 % and 15. 8 % respectively in the surgical group, medical group and TIPSS group. Rebleeding rate during following- up period were 33. 0%, 36. 1 % and 21 .4% respectively. The rebleeding rate was significantly higher in the medical group than that in either of the other groups during the two phases. Kaplan - Meier survival analysis didn' t show significant difference among the three groups. Conclusions The results showed that TIPSS is a good alternative to surgical or medical therapy for patients with Child class C cirrhosis and acute vericeal bleeding.