Objective To observe the clinical efficacy of Xingnao Kaiqiao(awakening the mind and opening the orifices)Acupuncture combined with Xifeng Huatan Tongluo(extinguishing wind,resolving phlegm,and unblocking collaterals)Decoction in treating posterior circulation ischemic vertigo(PCIV).Methods A total of 90 patients diagnosed with PCIV who were treated in the rehabilitation department wards and outpatient clinics of the First Affiliated Hospital of Hebei University of Chinese Medicine between July 2022 and July 2024 were selected as study subjects.Patients were randomly divided into an observation group and a control group using a random number table,with 45 cases in each group.Both groups received conventional western medical treatment.The control group received Xingnao Kaiqiao Acupuncture therapy,while the observation group received additional Xifeng Huatan Tongluo Decoction based on the control group's treatment.The treatment duration was 2 weeks.After treatment,clinical efficacy was evaluated by observing changes in blood flow velocity of the vertebrobasilar artery,left vertebral artery,and right vertebral artery,as well as serum levels of nitric oxide(NO)and endothelin-1(ET-1)before and after treatment in both groups.Changes in Dizziness Assessment Rating Scale(DARS)scores and Berg Balance Scale(BBS)scores were compared,and safety and adverse reactions were assessed.Results(1)The total effective rate was 91.11％(41/45)in the observation group and 73.33％(33/45)in the control group.The efficacy of the observation group was significantly superior to that of the control group,with a statistically significant difference(P＜0.05).(2)After treatment,blood flow velocity in the basilar artery,left vertebral artery,and right vertebral artery were significantly improved in both groups(P＜0.05),and the improvement in the observation group was significantly greater than that in the control group(P＜0.05).(3)After treatment,serum levels of NO and ET-1 were significantly improved in both groups(P＜0.05),and the improvement in the observation group was significantly greater than that in the control group,the difference being statistically significant(P＜0.05).(4)After treatment,DARS and BBS scores were significantly improved in both groups(P＜0.05),and the improvement in the observation group was significantly greater than that in the control group,the difference being statistically significant(P＜0.05).(5)During treatment,the incidence of adverse reactions was 13.33％(6/45)in the control group and 4.44％(2/45)in the observation group.There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion Xingnao Kaiqiao Acupuncture combined with Xifeng Huatan Tongluo Decoction significantly improves cerebral blood flow velocity,ameliorates endothelial dysfunction,and consequently regulates balance and alleviates vertigo in patients with PCIV,demonstrating notable clinical efficacy and good safety.