Abstract： Objective： To observe the clinical effect of Huayu Tongluo moxibustion on vascular cognitive impairment. Methods：A total of 40 patients with vascular cognitive impairment who were admitted to the clinic or ward of Department of Neurology and Acupuncture and Moxibustion Department of Funan County Hospital of Chinese Medicine from January 2020 to December 2022 were randomly divided into the Huayu Tongluo moxibustion group and the western medicine group，with 20 cases each. The Huayu Tongluo moxibustion group was treated with Huayu Tongluo moxibustion， while the western medicine group was treated with oral administration of Donepezil Hydrochloride. Observed the changes in cognitive function（evaluated using MoCA and TMT-A scales)， ferroptosis serum markers (including GPX4，GSH，and ACSL4），and remyelination serum markers （including MOG and MBP） before and after treatment in the two groups. Results：After treatment，the scores of all items in the MoCA scale in both groups were higher than those before treatment，and the orientation score of the MoCA scale in the Huayu Tongluo moxibustion group was higher than that in the western medicine group， differences being significant （P＜0.05）； the TMT-A scores in both groups were lower than those before treatment， and the TMT-A scores in the Huayu Tongluo moxibustion group were lower than those in the western medicine group， differences being significant （P＜0.05）. After treatment， the ACSL4 levels in both groups were lower than those before treatment，and the GPX4 levels were higher than those before treatment， differences being significant （P＜0.05）； however， there was no significant difference in GSH content before and after treatment （P＞0.05）. After treatment，the ACSL4 level in the Huayu Tongluo moxibustion group was lower than that in the western medicine group，and the difference being significant （P＜0.05）；there was no significant difference in the levels of GPX4 and GSH between the two groups （P＞0.05）. After treatment，the levels of MBP and MOG in both groups were higher than those before treatment；the MBP level in the Huayu Tongluo moxibustion group was higher than that in the western medicine group， differences being significant （P＜0.05）， and there was no significant difference in the MOG levels between the two groups （P＞0.05）. Conclusion：Huayu Tongluo moxibustion can significantly improve the cognitive function of patients with vascular cognitive impairment，and its improvement in orientation is better than simply taking oral Donepezil Hydrochloride. It is speculated that the mechanism of action is to inhibit the ferroptosis pathway，promote axonal remyelination，and thus play a protective role.