Abstract： Objective： To observe the clinical efficacy of Huohua Tongluo Prescription combined with western medicine in treating symptomatic intracranial atherosclerotic stenosis （sICAS） of qi deficiency and blood stasis type. Methods： A total of 98 patients with sICAS of qi deficiency and blood stasis type admitted to The First Affiliated Hospital of Henan University from October 2022 to February 2024 were selected and randomly divided into an observation group and a control group using a random number table method，with 49 cases in each group．Both groups received conventional symptomatic treatment， including Aspirin Enteric-Coated Tablets and Clopidogrel Bisulfate Tablets．The observation group additionally received Huohua Tongluo Prescription．Both groups were treated for three months．Before and after treatment，intracranial arterial hemodynamic parameters [peak systolic velocity （Vs），mean velocity （Vm）， pulsatility index （PI）]， cerebrovascular reactivity index [breath-holding index （BHI）]， serum concentrations of Tau protein and visinin-like protein-1 （VILIP-1） were measured． National Institutes of Health Stroke Scale （NIHSS） scores， modified Rankin Scale （mRS） scores， and Montreal Cognitive Assessment （MoCA） scores were assessed．Clinical efficacy，incidence of adverse reactions，and recurrence rate were compared between the two groups．Results：After treatment，the total effective rate in the observation group was higher than that in the control group （P＜0.05）． The scores for primary and secondary symptoms of traditional Chinese medicine syndrome decreased in both groups compared to before treatment （P＜0.05），with the observation group showing lower scores for primary and secondary symptoms of traditional Chinese medicine syndrome than the control group （P＜0.05）．The BHI values increased in both groups compared to before treatment （P＜0.05）， and the observation group had higher BHI values than the control group （P＜0.05）． The NIHSS and mRS scores decreased in both groups compared to before treatment， while MoCA scores increased， with differences being significant （P＜0.05）． The observation group had lower NIHSS and mRS scores and higher MoCA scores than the control group，with differences being significant （P＜ 0.05）．The Vs and Vm values increased in both groups compared to before treatment，while PI values decreased，with differences being significant （P＜0.05）．The observation group showed higher Vs and Vm values and lower PI values than the control group，with differences being significant（ P＜0.05）．Serum concentrations of Tau protein and VILIP-1 decreased in both groups compared to before treatment （P＜0.05）， with the observation group having lower concentrations than the control group （P＜0.05）． There was no statistically significant difference in the incidence of adverse reactions between the two groups （P＞0.05）．The recurrence rate in the observation group was lower than that in the control group （P＜0.05）．Conclusion：The Huohua Tongluo Prescription combined with western medicine can improve clinical efficacy in patients with sICAS of qi deficiency and blood stasis type， effectively enhance cerebral hemodynamics and cerebrovascular reactivity， promote neurological recovery， reduce neurological deficits， improve cognitive function，lower the recurrence rate，and demonstrate favorable safety.