Background To evaluate the clinical efficacy of psychotherapy combined with acupoint herbal application on elderly patients with pulmonary tuberculosis. Methods From January 2019 to January 2021, sixty elderly patients with pulmonary tuberculosis treated in our hospital were assessed for eligibility and recruited. They were concurrently assigned (1:1) via the random envelope method to receive either psychotherapy plus acupoint herbal application (observation group) or conventional treatment (conventional group) acupoint herbal application. Results Psychotherapy plus acupoint herbal application was associated with significantly higher levels of pulmonary functions indices and immune function indices versus conventional treatment. Psychotherapy plus acupoint herbal application resulted in lower SAS and SDS scores versus conventional treatment. The combined treatment showed a better clinical efficacy and sputum negative rate versus conventional treatment. Conclusion Psychotherapy plus acupoint herbal application improves the lung function and immune function of patients with pulmonary tuberculosis and relieves their negative emotions, which contributes to better treatment efficacy and merits clinical promotion.