Abstract： Objective： To observe the clinical effect of the therapy of Tianma Gouteng Decoction combined with acupuncture on posterior circulation ischemia vertigo (PCIV) with ascendant hyperactivity of liver yang syndrome. Methods： A total of 98 cases of PCIV patients with ascendant hyperactivity of liver yang syndrome were selected and divided into the combination group and the acupuncture group according to the random number table method， with 49 cases in each group. The acupuncture group was given acupuncture for treatment， and the combination group was treated with Tianma Gouteng Decoction combined with acupuncture. Both groups were treated for 1 month. The clinical effects，traditional Chinese medicine (TCM) syndrome scores， vertigo frequency， scores of dizziness handicap inventory (DHI)， risk levels of stroke and blood flow velocity of vertebrobasilar artery were compared between the two groups. Results：After treatment，the total effective rate was 93.88% in the combination group，higher than that of 77.55% in the acupuncture group (P＜0.05). After treatment， the scores of vertigo and tinnitus， headache and feeling of fullness in the head，irritability and susceptibility to rage，red face and eyes and bitter mouth in both groups were decreased when compared with those before treatment (P＜0.05)，and the above five TCM syndrome scores in the combination group were lower than those in the acupuncture group (P＜0.05). The vertigo frequency and DHI scores in both groups were decreased when compared with those before treatment (P＜0.05)，and the vertigo frequency and DHI score in the combination group were lower than those in the acupuncture group (P＜0.05). The low risk rate of stroke was 61.22% in the combination group，higher than that of 34.69% in the acupuncture group (P＜0.05). The blood flow velocity of basilar artery (BA)， right vertebral artery (RVA) and left vertebral artery (LVA) in both groups were decreased when compared with those before treatment (P＜0.05)，and the blood flow velocity of BA，RVA and LVA in the combination group were higher than those in the acupuncture group (P＜0.05). Conclusion： The therapy of Tianma Gouteng Decoction combined with acupuncture can enhance the blood flow velocity of vertebrobasilar artery of patients with PCIV with ascendant hyperactivity of liver yang syndrome，mitigate the clinical symptoms and reduce the risk of stroke.