Objective: To summarize the diagnosis and treatment process of a patient with dementia with Lewy bodies accompanied by psychotic symptoms, and to explore the clinical value of integrated traditional Chinese and western medicine in the management of complex neuropsychiatric symptoms.

Methods: A retrospective analysis was conducted on the clinical data, treatment course, and follow-up outcomes of a 74-year-old woman with dementia with Lewy bodies accompanied by psychotic symptoms. The patient initially presented with Parkinsonian motor symptoms and subsequently developed cognitive decline, visual hallucinations, nocturnal dream-enactment behaviors, and autonomic dysfunction. During hospitalization, traditional Chinese medicine based on syndrome differentiation was added on the basis of adjustment of western medications. The syndrome pattern was identified as "marrow sea insufficiency with phlegm and blood stasis obstructing the collaterals."

Results: After dynamic adjustment of neurological and psychiatric medications combined with syndrome-differentiated traditional Chinese medicine treatment based on tonifying the kidney and replenishing essence, resolving phlegm, and removing blood stasis, the patient showed improvement in visual hallucinations, nocturnal dream-enactment behaviors, and daytime somnolence. Constipation was relieved, mental status, medication adherence, and activity safety improved, caregiver burden was reduced, and no further falls or other adverse events occurred during follow-up.

Conclusion: Patients with dementia with Lewy bodies accompanied by psychotic symptoms often have complex clinical conditions and high sensitivity to medications. Western medicine alone frequently faces difficulty in balancing symptom control and adverse effects. On the basis of careful assessment and dynamic adjustment, integrated traditional Chinese and western medicine may serve as a supplementary strategy for individualized comprehensive management; however, its independent efficacy still requires further validation in more rigorous studies.