Abstract： Objective： To observe the clinical efficacy of regulating conception vessel and unblocking governor vessel acupuncture in treating cognitive impairment caused by cerebral small vessel disease （CSVCI）. Methods：Sixty patients with CSVCI admitted to Shenzhen Traditional Chinese Medicine Hospital from January 1，2023，to January 1， 2024，were selected and randomly divided into the observation group and the control group using the random number table method，with 30 cases in each group. The control group received conventional acupuncture，while the observation group received regulating conception vessel and unblocking governor vessel acupuncture. The treatment lasted for four weeks. Changes in Montreal Cognitive Assessment （MoCA） scores，Mini-Mental State Examination （MMSE） scores， and the Scale for the Differentiation of Syndromes of Vascular Dementia （SDSVD） scores were observed before and after treatment in both groups. Results： After treatment， the total effective rate was 86.67% （26/30） in the observation group and 63.33% （19/30） in the control group，with a statistically significant difference between the two groups （P＜ 0.05）. After treatment，MoCA and MMSE scores increased in both groups compared to before treatment，and the MoCA and MMSE scores in the observation group were higher than those in the control group （P＜0.05）. After treatment， SDSVD scores decreased in both groups compared to before treatment，and the SDSVD score in the observation group was lower than that in the control group （P＜0.05）. No significant adverse reactions were observed in either group during the treatment. Conclusion：Regulating conception vessel and unblocking governor vessel acupuncture for CSVCI can effectively improve patients' cognitive levels and delay the progression of dementia， demonstrating significant clinical efficacy.