Abstract: Objective To explore the curative effect of Tianma Gouteng Decoction combined with betahistine on vertigo patients and its influence on transcranial doppler(TCD) parameters, Hemorheology and endothelin-1(ET-1). Methods The 142 patients with vertigo admitted to our hospital from March 2018 to March 2019 were randomly divided into control group(71 cases) and treatment group(71 cases) by random number table method. The patients in the control group were treated with betahistine and the patients in the treatment group were treated with Tianma Gouteng Decoction on the basis of the control group. Both groups were treated for 14 days. The therapeutic effects, DHI score, vertigo symptom score, TCD parameters, Hemorheology and ET-1 level changes, and adverse reactions were compared between the two groups before and after treatment. Results The total effective rate of the treatment group(92.96%) was higher than that of the control group(73.24%)(P<0.05). After treatment, DHI score and vertigo symptom score in the two groups were lower than those before treatment(P<0.05); DHI score and vertigo symptom score in the treatment group were lower than those in the control group(all P<0.05); the cerebral blood flow velocity of basilar artery, left vertebral artery and right vertebral artery in the two groups were higher than that before treatment(all P<0.05). After treatment, the cerebral blood flow velocity of basilar artery, left vertebral artery and right vertebral artery in the treatment group were higher than that in the control group(all P<0.05); the plasma viscosity, hematocrit and erythrocyte aggregation index in the two groups were lower than those before treatment(P<0.05), while the plasma viscosity, hematocrit and erythrocyte aggregation index in the treatment group were lower than those in the control group(all P<0.05). The serum ET-1 level in the two groups was lower than that before treatment(P<0.05), and the serum ET-1 level in the treatment group was lower than that in the control group(P<0.05). Conclusion Tianma Gouteng Decoction combined with betahistine has a good effect on vertigo patients. It can improve cerebral hemodynamics and hemorheology, and reduce the level of ET-1, which is worthy of clinical reference.