Abstract： Objective： To observe the clinical effect of the combination use of Tongyuan acupuncture and Quyu Huatan Qingxuan Prescription on posterior circulation ischemic vertigo and its effect on blood velocity of vertebrobasilar artery and indexes of hemorheology. Methods： A total of 122 patients with posterior circulation ischemic vertigo admitted to Chinese Medicine Hospital of Puyang from July 2022 to March 2024 were selected and divided into the study group and the control group according to the random number table method， with 61 cases in each group. Both groups were given conventional treatment， the control group was additionally treated with Quyu Huatan Qingxuan Prescription， and the study group was additionally treated with Tongyuan acupuncture based on the treatment of the control group. Both groups were treated for four weeks. After treatment，the clinical effects were evaluated；the blood velocity of vertebrobasilar artery，indexes of hemorheology，levels of fibroblast growth factor 21 （FGF21） and soluble cluster of differentiation 40 ligand（ sCD40L） were compared before and after treatment in the two groups；the incidence of adverse reactions was observed. Results： The total effective rate was 95.08%（58/61） in the study group， higher than that of 81.97% （50/61） in the control group （P＜0.05）. After treatment，the blood velocity of basilar artery，left vertebral artery and right vertebral artery in the two groups was respectively elevated when compared with those before treatment（ P＜0.05），and the blood velocity of basilar artery，left vertebral artery and right vertebral artery in the study group were higher than those in the control group （P＜0.05）. After treatment， the whole blood high-shear viscosity， whole blood low-shear viscosity and plasma viscosity in the two groups were reduced when compared with those before treatment （P＜0.05），and the whole blood high-shear viscosity，whole blood low-shear viscosity and plasma viscosity in the study group were lower than those in the control group （P＜0.05）. After treatment， the levels of FGF21 and sCD40L in the two groups were down-regulated when compared with those before treatment （P＜0.05），and the above two levels in the study group were lower than those in the control group （P＜0.05）. There were no obvious adverse reactions in the two groups during the four weeks of treatment. Conclusion： The combination use of Tongyuan acupuncture and Quyu Huatan Qingxuan Prescription can improve the blood velocity of vertebrobasilar artery and blood flow of patients with posterior circulation ischemic vertigo，promote the recovery of normal levels of FGF21 and sCD40L and enhance the curative effect with great safety.