Objective To investigate the therapeutic effect of Tongdu Tiaoshen acupuncture in patients with vascular mild cognitive impairment and its effect on serum brain-derived neurotrophic factor (BDNF) and plasma homocysteine (Hcy). Methods A total of 61 patients with vascular mild cognitive impairment were randomly divided into treatment group with 31 patients and control group with 30 patients. The patients in the control group were given oral donepezil for two months, and those in the treatment group were given Tongdu Tiaoshen acupuncture for 4 courses in addition to oral donepezil. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to evaluate the change in cognitive level after treatment, ELISA was used to measure the serum level of BDNF, and enzymatic cycling assay was used to measure plasma Hcy. Results After treatment, both groups had significant increases in MMSE and MoCA scores (P<0.05), and there were significant differences between the two groups in the changes in MMSE and MoCA scores after treatment (P<0.05). After treatment, both groups had a significant increase in the serum level of BDNF and a significant reduction in the plasma level of Hcy (P<0.05), and compared with the control group, the treatment group had a significantly greater increase in serum BDNF and a significantly greater reduction in plasma Hcy (P<0.05). Based on MMSE score, the treatment group had a significantly better clinical outcome than the control group (P<0.05). Conclusion For patients with vascular mild cognitive impairment, Tongdu Tiaoshen acupuncture can improve their cognitive function score, increase the expression of related cytokines, and reduce the impact of related risk factors.