Abstract： Objective： To observe the clinical effect of Shexiang Sihuang tang combined with recombinant tissue plasminogen activator(rt- PA) for acute ischemic cerebrovascular disease(AICD). Methods： A total of 90 cases of AICD patients were selected and randomly divided into the reference group and the experiment group，45 cases in each group. The reference group was treated with intravenous thrombolysis with rt- PA，and the experiment group was additionally treated with Shexiang Sihuang tang based on the treatment of the reference group. The clinical effect，the laboratory indexes and the incidence of adverse reactions in the two groups were compared. Results： The total effective rate was 93.33% in the experiment group， significantly higher than that of 66.67% in the reference group(P＜0.05). After treatment， the levels of neuron specific enolase(NSE) and endothelin-1(ET-1) in serum in the two groups were decreased when compared with those before treatment(P＜0.05)，and the levels of superoxide dismutase(SOD) and nitric oxide(NO) in serum were increased(P＜ 0.05)；the levels of NSE and ET-1 in serum in the experiment group were lower than those in the reference group(P＜0.05)， and the levels of SOD and NO in serum were higher(P＜0.05). The incidence of adverse reactions was 6.67% in the experiment group and 4.44% in the reference group，there being no significance in the difference(P＞0.05). Conclusion：The therapy of Shexiang Sihuang tang combined with rt- PA for AICD can effectively relieve the neurological impairment and improve the vascular function of patients，with low incidence of adverse reactions.