Vertebrobasilar dolichoectasia(VBD) is a posterior circulation vascular anomaly with a poor prognosis，and effective preventive and treatment measures are currently lacking.Through a summary and analysis of its pathological mechanisms，clinical features，and outcomes，combined with the theory of traditional Chinese medicine(TCM) on “deficiency of qi and stagnation”，an innovative pathogenesis hypothesis has been proposed.It postulates that “deficiency of qi” is the root cause of VBD，while “stagnation” is the pathological manifestation.These two aspects are mutually causal and reinforcing，aligning with the disease's spiral progression and dynamic evolution pattern.Based on this hypothesis，a treatment strategy has been developed，which emphasizes “reinforcing healthy qi and supporting the brain to tonify deficiency，removing toxins，and dredge collaterals，thereby alleviating stagnation”.This approach aimed to explore the TCM syndrome differentiation and evaluation methods for VBD and provide a basis for clinical practice.It is of significant importance in improving clinical efficacy and reducing the burden of related neurological disorders.