Objectives To evaluate the effect of TianmaGouteng decoction on the quality of life of patients with extrapyramidal adverse reactions in schizophrenia. Methods A total of 90 patients were randomly divided into TianmaGouteng decoction group （study group） and Benzhexol group （control group）. The patients were followed up for 8 weeks. The extrapyramidal adverse reactions， quality of life and adverse reactions were evaluated by Abnormal Involuntary Movement Scale （AIMS）， Rating Scale for ExtrapyramdalSide Effects（RSESE）， MOS Item Short- Form Health Survey（SF-36） and Treatment Emergent Symptom Scale（TESS） before and after treatment. Results （1） There was no difference in the changes in AIMS and RSESE between the two groups before and after treatment （P ＞ 0. 05）. （2） The main effects analysis of the repeated-measures analysis of variance shows that the time main effects of role limitations due to emotional problems（RE）， mental component summary （MCS） and health transitions （HT） changes after intervention are statistically significant （P＜ 0.05）； There was no significant difference in the main effect between the two groups （all P＞ 0.05）； but interaction effects were statistically significant in physical functioning （PF）， roe limitations due to physical health （RP）， general health perceptions（GH）， physical component summary （PCS） and total score of SF-36 （P＜0.05）. Individual effect analysis shows there were significant differences in PF， RP， GH， PCS and total score of SF-36 in the study group before and after treatment， with statistical significance （all P＜ 0.01）. There were significant differences in PF， PCS in the control group before and after treatment， with statistical significance （all P＜ 0.05）. （3） After treatment， the improvement of AIMS scale and RSESE scale in the study group was positively correlated with the improvement of PF （r=0.385，P=0.012；r=0.381，P=0.012） and RP （r=0.416，P=0.006； r=0.314，P=0.040）， the improvement of GH was positively correlated with the improvement of RSESE scale （r=0.342，P=0.025）. The improvement of total score of SF-36 was positively correlated with the improvement of AIMS scale （r=0.300，P=0.007）.The improvement of PCS was positively correlated with the improvement of AIMS scale and RSESE scale （r=0.338，P=0.002；r=0.275，P=0.011）. （4） There was a significant difference in the score difference of TESS symptom severity between the two groups before and after treatment （Z= -3.506，P ＜ 0.001）. Conclusions TianmaGouteng decoction can improve the quality of life of patients with schizophrenia， which may be related to its effect on improving extrapyramidal adverse reactions.In addition， the adverse reaction was less than that of Benzhexol.