Abstract： Objective： To observe the clinical efficacy of modified Tianma Gouteng Decoction combined with electroacupuncture on patients with acute ischemic stroke of upper hyperactivity of liver yang type. Methods：A total of 260 patients with acute ischemic stroke of upper hyperactivity of liver yang type admitted to Nanshi Hospital of Nanyang from May 2023 to November 2024 were randomly divided into the control group and the observation group by the random number table method，with 130 cases in each group．The control group was treated with oral administration of Aspirin and Clopidogrel Bisulfate， and the observation group was additionally given modified Tianma Gouteng Decoction combined with electroacupuncture based on the treatment in the control group. The clinical efficacy，and the changes in levels of cerebral vascular hemodynamic indexes [mean flow velocity （Vm），systolic peak flow velocity （Vs），diastolic end flow velocity （Vd）]， Barthel Index （BI） scores， traditional Chinese medicine syndrome scores， coagulation function indicators [prothrombin time （PT）， activated partial thromboplastin time （APTT）， thrombin time （TT）]， levels of inflammatory markers [high-sensitivity C-reactive protein （hs-CRP），interleukin-1β （IL-1β），interleukin- 6 （IL-6）， tumor necrosis factor-α （TNF-α）， interleukin-10 （IL-10）] before and after treatment were compared between the two groups．Results：After treatment，the total effective rate was 88.46% （115/130） in the observation group，higher than that of 77.69% （101/130） in the control group，the difference being significant （P＜0.05）. After treatment，the levels of Vm，Vs，and Vd in both groups increased when compared with those before treatment （P＜ 0.05），and the above three levels in the observation group were higher than those in the control group （P＜0.05）. After treatment，the BI scores in the two groups increased when compared with those before treatment （P＜0.05），and the traditional Chinese medicine syndrome scores reduced when compared with those before treatment （P＜0.05）；the BI score in the observation group was higher than that in the control group （P＜0.05）， and the traditional Chinese medicine syndrome scores were lower than those in the control group （P＜0.05）. After treatment，PT，APTT，and TT in both groups increased when compared with those before treatment （P＜0.05），and the above three indicators in the observation group were longer than those in the control group （P＜0.05）． After treatment， the levels of hs-CRP， IL-1β，IL-6，and TNF-α in both groups decreased when compared with those before treatment （P＜0.05），and the IL-10 levels increased when compared with those before treatment （P＜0.05）；the levels of hs-CRP，IL-1β，IL-6， and TNF-α in the observation group were lower than those in the control group （P＜0.05），and the IL-10 level was higher than that in the control group （P＜0.05）. Conclusion： The combination use of modified Tianma Gouteng Decoction and electroacupuncture has a definite curative effect on acute ischemic stroke of upper hyperactivity of liver yang type， which can effectively inhibit the inflammatory responses， improve the cerebral blood flow state and coagulation function，enhance the activity of daily living，and mitigate the traditional Chinese medicine syndromes.