Abstract： Objective： To observe the efficacy of Tongyuan acupuncture combined with conventional western medicine in treating consciousness disorders in elderly stroke. Methods：A total of 90 elderly patients with early-stage post-stroke consciousness disorders treated at Nanhai Maternity and Child Healthcare Hospital Affiliated to Guangzhou University of Chinese Medicine from June 2023 to June 2024 were randomly divided into the control group and the observation group， with 45 cases each. The control group received conventional western medicine， while the observation group received additional Tongyuan acupuncture. Clinical efficacy was compared between the two groups. Changes in neurotrophic factors [brain-derived neurotrophic factor（BDNF）， and neuron-specific enolase（NSE）]， cerebral hemodynamics [mean blood flow velocity（Vm）， and peak systolic velocity（Vs）]， and consciousness / neurological function [Glasgow Coma Scale（GCS），Mini-Mental State Examination（MMSE），and National Institutes of Health Stroke Scale（NIHSS）] were evaluated before and after treatment. Results： The total effective rate was 88.89%（40/45）in the observation group and 71.11%（32/45）in the control group（P＜0.05）. After treatment，both groups showed increased BDNF（P＜0.05）and decreased NSE（P＜0.05）；the BDNF level in the observation group was higher than that in the control group（P＜0.05），and NSE level was lower（P＜0.05）. After treatment，cerebral artery Vm and Vs values improved in both groups（P＜0.05）， showing greater improvement in the observation group （P＜0.05）. After treatment， GCS and MMSE scores increased while NIHSS scores decreased in both groups（P＜ 0.05）， with higher GCS and MMSE scores（P＜0.05）and lower NIHSS score（P＜0.05）in the observation group. Conclusion： Tongyuan acupuncture combined with conventional western medicine demonstrates good efficacy for consciousness disorders in elderly stroke by improving cerebral hemodynamics， reducing brain cell damage， and promoting cognitive recovery of patients.