Abstract： Objective： To observe the clinical effect of Guixiong Huoxue Xingqi Decoction combined with Methylcobalamin in the treatment of cervical spondylotic radiculopathy （CSR）. Methods：A total of 94 CSR patients admitted to Xuchang Central Hospital from March 2022 to February 2024 were divided into a Methylcobalamin group and a combination group using the random number table method，with 47 cases in each group. The Methylcobalamin group was treated with Methylcobalamin alone，and the combination group was treated with Methylcobalamin combined with Guixiong Huoxue Xingqi Decoction. Cervical spine function，vertebrobasilar artery blood flow，cervical muscle tension， and clinical effects were compared between the two groups. Results： After treatment， the average blood flow velocity （VM） and peak systolic velocity （PSV） of the left and right vertebral arteries and basilar artery in both groups were higher than those before treatment，and the pulsatility index （PI） was lower than that before treatment；the VM and PSV of the left and right vertebral arteries and basilar artery in the combination group were higher than those in the Methylcobalamin group， and the PI was lower than that in the Methylcobalamin group， with differences being significant（ P＜0.05）. After treatment，the neck muscle tension in the two groups was higher than that before treatment， and the neck muscle tension in the combination group was higher than that in the Methylcobalamin group， with differences being significant （P＜0.05）. After treatment，the Japanese Orthopedic Association （JOA） scores in the two groups were higher than those before treatment，and the combination group had higher scores than the Methylcobalamin group， with differences being significant （P＜0.05）. The total clinical effective rate was 95.74%（45/47） in the combination group and 70.21%（33/47） in the Methylcobalamin group，with the difference being significant （P＜0.05）. Conclusion：The combination of Guixiong Huoxue Xingqi Decoction and Methylcobalamin can effectively improve the blood flow of the vertebrobasilar arteries in CSR patients， and enhance their cervical muscle tension， cervical spine function，and clinical effects.