Objective To explore the impact of acupuncture and medicine combination on exercise endurance in patients with chronic heart failure in the real world based on the "three identifications, three phases, and three adjustments". Methods Based on the integrated database of large hospital information system(HIS), 1 080 patients with chronic heart failure diagnosed as discharged, were selected. from the First Affiliated Hospital of Yunnan University of Chinese Medicine,Yunnan Provincial Hospital of Traditional Chinese Medicine from January 2017 to August 2022. 529 cases of using the combination therapy of "three identifications, three phases, and three adjustments" acupuncture and medicine were set as the observation group, while 551 cases of not using the combination therapy of "three identifications, three phases, and three adjustments" acupuncture and medicine were set as the control group. Adopt χ2 Test and propensity score matching were used to analyze the effect of exercise endurance of patients in the two groups. Results The propensity score method showed that the total effective rate of the observation group was significantly better than that of the control group before and after treatment(P<0.001). Conclusion The combination therapy of acupuncture and medicine based on the principle of "three identifications, three phases, and three adjustments" can significantly improve the exercise endurance of patients with chronic heart failure.