Objective To explore the effect of Miao medicine gout decoction on inflammatory reaction and NALP3 inflammasome pathway of gouty arthritis. Methods A total of 40 healthy SD rats were randomly divided into control group, model group, diclofenac sodium enteric-coated tablet group, low-dose and high-dose Miao Yao gout decoction group. The rat model of acute gouty arthritis was successfully established via a one-time injection of sodium urate into ankle joint cavity. After successful modeling, the rats in the control group and model group were given physiological salt water, diclofenac sodium enteric-coated tablets group and low-dose and high-dose Miao medicine gout decoction groups respectively according to the corresponding dose for 5 days. The rats were killed, and the synovium of knee joint was taken. The pathological changes of synovial tissue were observed by HE staining, the serum levels of TNF-α, IL-1β, IL-8,β-gal, NAG, SOD and MDA were detected by ELISA, and the expression of NALP3, Caspase-1 and ASC mRNA in synovial tissue was detected by qRT-PCR. Western Blotting was used to detect the expression of NALP3, Caspase-1 and pro-IL-1β protein in synovial tissue. Results Compared with the control group, a large number of inflammatory cells infiltrated the lower layer of synovial tissue, and the joint swelling index increased significantly in the model group, and the levels of TNF-α, IL-1β, IL-8, β-gal, NAG, MDA, NALP3, Caspase-1, ASC and pro-IL-1β increased significantly, while the level of SOD decreased significantly in the model group (P＜0.05). Compared with the model group, the levels of TNF-α, IL-1β, IL-8, β-gal, NAG, MDA, NALP3, Caspase-1, ASC and pro-IL-1 β in the high dose group of Miao medicine gout decoction decreased significantly, while the level of SOD increased significantly(P＜0.05). Conclusion Miao medicine gout decoction can reduce the degree of inflammation with gout rat model, and down-regulate the expression of NALP3 and inflammatory factors, which may play an important role in inhibiting the attack of acute gouty arthritis.