To study the clinical efficacy of magnesium isoglycyrrhizinate combined with total glucosides of peony (TGP) in the treatment of rheumatoid arthritis (RA) with hepatic dysfunction and its effect on immune and liver function. Methods: A total number of 76 RA patients with hepatic dysfunction were randomly divided into treatment group and control group, 38 cases in each group. The treatment group was treated with magnesium isoglycyrrhizinate combined with TGP and the control group was treated with conventional energy mixture. Both groups were treated for 14 days consecutively. Changes in immune function, liver function and serum RA were compared before and after treatment, and the incidence of adverse reactions was analyzed. Results: DAS28 in the treatment group was significantly lower than that before the treatment and of the control group (P<0.01). There was no significant difference in morning stiffness time, swelling joints number, tender joints number, grip strength and HAQ score between the two groups (P>0.05). After the treatment, serum IgE, sIL-2R, ALT and AST levels in the two groups were significantly lower and the treatment group was superior to the control group (P<0.01). The levels of CRP and TNF-α in the treatment group after the treatment were significantly lower than those before treatment and in the control group (P<0.05; P<0.01). No serious adverse reaction was detected in the two groups. Conclusion: Magnesium isoglycyrrhizinate combined with TGP may improve the immune function and liver function of patients with hepatic dysfunction and RA activity without obvious adverse reactions, which is worthy of clinical application.