Objective To observe the clinical efficacy of different acupuncture manipulations in the treatment of posterior circulation ischemia vertigo（ PCIV） and discuss the possible mechanisms. Methods Totally 120 PCIV patients were randomly divided into FC1 group of 29 cases

FC2 group of 31 cases

FC3 group of 30 cases

and FC4 group of 30 cases. Fengchi（ GB20） was the main acupoint for all groups with twirling manipulation

while the FC1 group was needled towards the outer corner of the contralateral eye

60 r / min; the FC2 group was needled towards the Adam’s apple

60 r / min; the FC3 group was needled towards the outer corner of the contralateral eye

120 r / min;and the FC4 group was needled towards the Adam’ s apple

120 r / min. The course was 14 times

3 or 4 times per week. The serum levels of 5-hydroxytryptamine（ 5-HT）

norepinephrine（ NE）

gamma aminobutyric acid（ GABA）

and glutamate（ Glu） were measured before and after treatments

the degree of vertigo was evaluated

and the clinical efficacy was observed. Result There was no significant difference in the clinical efficacy among the four groups（ P > 0. 05）. After the treatments

the symptom of vertigo improved significantly in each group（ P < 0. 05）

especially in the FC3 group（ P < 0. 05）

NE increased significantly in each group（ P < 0. 05）

and GABA decreased significantly in the FC4 group（ P < 0. 05）. Conclusions Conclusions Acupuncture could improve the symptom of vertigo in PCIV patients and different manipulations led to different results. The FC3 group showed the best results

which may be related to its regulation of NE.