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Objective: To observe the effects of " Tongdu Tiaoshen " acupuncture on cerebral blood flow in high-risk patients of cerebral ischemic stroke based on arterial spin labeling (ASL) and perfusion-weighted imaging (PWI), and to evaluate the clinical efficacy., Methods: A total of 180 patients with transient ischemic attacks (TIA) / minor ischemic stroke (MIS) were randomly divided into an acupuncture A group, an acupuncture B group and a medication group, 60 cases in each group. The patients in the acupuncture A group were treated with " Tongdu Tiaoshen " acupuncture at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), Dazhui (GV 14), Shenzhu (GV 12), Zhiyang (GV 9), Mingmen (GV 4), Yaoyangguan (GV 3) and Jingjiaji (EX-B 2), once a day; the patients in the acupuncture B group were treated with identical acupoints but was given once every other day; the patients in the medication group were treated with oral administration of nimodipine tablets, 30 mg, three times daily. All the three groups were treated for four weeks. ASL and PWI, including relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), relative mean transit time (rMTT) and relative time to peak (rTTP), were conducted before and after treatment; the changes of the test indexes were compared before and after treatment. The clinical efficacy of the three groups was compared., Results: Compared before treatment, the numbers of ASL normal perfusion in the 3 groups were significantly increased after treatment (all P <0.01); the number of ASL normal perfusion in the acupuncture A group was higher than that in the acupuncture B group ( P <0.05), but was not significantly different from that in the medication group ( P >0.05). Compared before treatment, rCBV and rCBF in the 3 groups were significantly increased after treatment (all P <0.01), and rMTT and rTTP were significantly reduced (all P <0.01). After treatment, rCBV and rCBF in the acupuncture A group were higher than those in the acupuncture B group (all P <0.05); the rMTT and rTTP in the acupuncture A group were lower than those in the acupuncture B group (all P <0.05); the differences of PWI parameters after treatment were not statistically significant between the acupuncture A group and medication group (all P >0.05). The total effective rate was 88.3% (53/60) in the acupuncture A group, 73.3% (44/60) in the acupuncture B group and 90.0% (54/60) in the medication group; the total effective rate in the acupuncture A group was superior to that in the acupuncture B group ( P <0.05), but was not significantly different from that in the medication group ( P >0.05)., Conclusion: " Tongdu Tiaoshen " acupuncture could effectively improve the hypoperfusion of cerebral blood flow in patients with high risk of cerebral ischemic stroke, reduce the incidence of severe CIS; acupuncture for once a day is better than once every other day.