Objective To determine the effects of thunder-fire moxibustion combined with cardiac rehabilitation therapy on myocardial perfusion, exercise tolerance and quality of life in elderly patients with coronary heart disease (CHD). Methods A total of 86 elderly patients with CHD admitted to Qionghai Hospital of Traditional Chinese Medicine from January 2021 to January 2022 were recruited as the research subjects, and randomly divided into study group and control group, with 43 cases in each group. The control group was given conventional cardiac rehabilitation therapy, while the study group was treated with thunder-fire moxibustion additionally. Myocardial perfusion status, exercise tolerance, therapeutic efficacy and quality of life were compared between two groups after treatment. SPSS statistics 19.0 was used for statistical analysis. Data comparison between two groups was perfomed using t test orχ² test depending on data type. Results After intervention, the number of involved ischemic myocardial segments was reduced in both study group and control group [(7.45±2.15) vs (3.15±0.75), (7.51±2.17) vs (5.69±1.16); both P<0.001], and the number in the study group was significantly less than that in the control group (P<0.001). The study group had obviously higher peak oxygen uptake [(25.36±4.16) vs (21.16±3.79) and (17.63±2.83) ml/(min·kg)] and anaerobic threshold [(16.98±3.69) vs (14.07±2.83) and (11.47±2.66) ml/(min·kg)], when compared with the control group after intervention and the baseline values before treatment (P<0.05). The control group had obviously higher peak oxygen uptake [(21.16±3.79)vs(17.71±3.15) ml/(min·kg)] and anaerobic threshold [(14.07±2.83) vs(11.53±2.74) ml/(min·kg)] when compared with the baseline values before treatment (P<0.05). The total efficiency rate was statistically higher in the study group than the control group [38 (88.37%) vs 30 (69.77%), P<0.05]. The score of Seattle Angina Questionnaire after intervention was increased in both groups [(76.69±13.87) vs (61.15±12.16) points, (66.16±14.05) vs (61.43±11.47) points; both P<0.05], and that of the study group was notably higher than that of the control group (P<0.05). Conclusion On the basis of cardiac rehabilitation therapy, thunder-fire moxibustion can effectively improve the therapeutic efficacy for CHD and improve the exercise tolerance and quality of life in the patients.