**Objective** To investigate the clinical value of modified Huangan Lipi Decoction combined with tiapride hydrochloride in the treatment of tic disorder (TD) in children with spleen deficiency and liver hyperactivity pattern. **Methods** A total of 120 children with TD of the spleen deficiency and liver hyperactivity pattern were enrolled and randomly allocated to two groups. The control group received tiapride hydrochloride, and the observation group was additionally given modified Huangan Lipi Decoction on the basis of the control group, with a 12-week course of treatment for both groups. Clinical efficacy, Yale Global Tic Severity Scale (YGTSS) scores, TCM symptom scores, serum levels of dopamine (DA) and 5-hydroxytryptamine (5-HT), and adverse reactions were compared between the two groups. **Results** The total effective rate of the observation group was 88.33%, which was significantly higher than that of the control group (73.33%, P<0.05). After treatment, the total YGTSS scores and the scores of motor and phonic tics in both groups decreased compared with baseline (P<0.05), and all these scores in the observation group were lower than those in the control group (P<0.05). The scores of irritability, poor appetite, and restless sleep in both groups declined after treatment (P<0.05), and the observation group showed significantly lower scores than the control group (P<0.05). Serum DA levels decreased and 5-HT levels increased in both groups after treatment, and the post-treatment levels of both DA and 5-HT in the observation group were higher than those in the control group (P<0.05). No obvious adverse reactions were observed in the observation group, whereas 2 cases of mild somnolence occurred in the control group; the difference in the incidence of adverse reactions between the two groups was not statistically significant (P>0.05). **Conclusion** Modified Huangan Lipi Decoction combined with tiapride hydrochloride can further improve the core tic symptoms of TD in children with the spleen deficiency and liver hyperactivity pattern, as well as pattern-related symptoms such as irritability, poor appetite, and restless sleep, without increasing obvious adverse reactions. The therapeutic effect may be associated with strengthening the spleen and soothing the liver, extinguishing wind and resolving phlegm, and regulation of neurotransmitter homeostasis, although the underlying mechanism warrants further investigation.