Objective To investigate the effect of Xiaozhang plaster in the treatment of cirrhotic ascites and its influence on the renin-angiotensin-aldosterone system. Methods A total of 220 patients with cirrhotic ascites who were hospitalized in Department of Gastroenterology in Shanghai Baoshan Integrated Traditional Chinese and Western Medical Hospital from March 2015 to March 2016 were enrolled and divided into routine treatment group with 60 patients, Xiaozhang plaster group with 60 patients, and terlipressin group with 100 patients. The patients in the routine treatment group received the routine treatment of cirrhotic ascites with a limitation of the dose of diuretics, those in the Xiaozhang plaster group were treated with Xiaozhang plaster in addition to the routine treatment, and those in the terlipressin group were treated with terlipressin in addition to the routine treatment. The three groups were observed in terms of related outcome measures ( depth of ascites, 24-hour urine volume, abdominal circumference, body weight, and Child-Pugh score) , symptoms and signs ( abdominal distension, diet, passage of gas by anus, and defecation) , hepatic and renal function, electrolytes, routine blood test results, coagulation function, portal vein diameter, glomerular filtration rate, and vasoactive substances [plasma renin activity ( PRA) , angiotensin Ⅱ ( AngⅡ) , and aldosterone ( ALD) ]. An analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for comparison within each group. Results There were significant differences between the three groups in depth of ascites, urine volume, abdominal circumference, Child-Pugh score, AngⅡ level, and ALD level on days 14 and 28 of treatment ( day14: F = 6. 566, 16. 236, 10. 856, 5. 727, 41. 860, and 20. 845, all P < 0. 05; day 28: F = 169. 311, 67. 686, 13. 521, 39. 721, 159. 256, and 80. 400, all P < 0. 05) . There were significant differences between the three groups in body weight and PRA level on day 28 of treatment ( F = 5. 068 and 0. 012, both P < 0. 05) . There were also significant differences between the three groups in the scores of abdominal distension, passage of gas by anus, and defecation on days 7, 14, and 28 of treatment ( day 7: F = 38. 311, 33. 405, and 33. 996, all P < 0. 05; day 14: F = 64. 414, 39. 481, and 52. 455, all P < 0. 05; day 28: F = 57. 596, 23. 041, and 47. 576, all P < 0. 05) . Conclusion Both Xiaozhang plaster and terlipressin can reduce ascites volume in patients with cirrhotic ascites, but they may have different action characteristics. Xiaozhang plaster is superior to terlipressin in the treatment of cirrhotic ascites and can significantly improve clinical symptoms, possibly by reducing the levels of PRA, AngⅡ, and ALD.