Objective：To investigate the effect of kidney-tonifying and blood-activating decoction combined with intrauterine perfusion on improvement of clinical symptoms and transforming growth factor-beta1（TGF-β1），Smad2，and Smad3 in patients with intrauterine adhesions. Methods：A total of 60 patients with intrauterine adhesions admitted to our hospital from July 2017 to July 2018 were en－rolled and equally divided into the experimental group and the control group in accordance with the random number table. The con－trol group was treated with estradiol valerate，and the experimental group was treated with kidney-tonifying and blood-activating de－coction combined with intrauterine perfusion of Danshen injection. Clinical improvement in two groups was observed. Levels of matrix metalloproteinases-2（MMP-2），matrix metalloproteinases-3（MMP-3） and matrix metalloproteinases-9（MMP-9） in two groups were detected by ELISA. Levels of TGF-β1，Smad2 and Smad3 protein and mRNA in the endometrial tissues in two groups before and after treatment were detected by Western blot and Q-RT-PCR. Results：After treatment，the endometrium thickness，MMP-2，MMP-3 and MMP-9 levels were significantly increased in both groups，and the endometrial blood flow parameters of pulsatility index（PI），resistance index（RI），adhesion type，adhesion range，menstrual status and total score were all decreased. The en－dometrium thickness，MMP-2，MMP-3 and MMP-9 levels in the experimental group were higher than those in the control group；the PI，RI，adhesion type，adhesion range，menstrual status and total score were lower than those in the control group（all P<0.05）. After treatment，levels of TGF-β1，Smad2，and Smad3 protein and mRNA were reduced in both groups. Levels of TGF-β1，Smad2 and Smad3 protein and mRNA in the experimental group were lower than those in the control group（P<0.05）. Conclusion：Kidney-tonify－ing and blood-activating decoction and intrauterine perfusion can improve the blood flow parameters of intrauterine adhesion and prevent the recurrence of intrauterine adhesion. The mechanism may be related to the up-regulation of MMP-2，MMP-3 and MMP-9 expression，and the down-regulation of TGF-β1，Smad2 and Smad3 expression.