Objective To investigate the efficacy of self-made Tianma Decoction combined with betahistine on residual dizziness and quality of life of the elderly patients with benign paroxysmal positional vertigo (BPPV) after reduction. Methods A retrospective analysis was made of the clinical data of 200 elderly BPPV patients who were treated in the First Affiliated Hospital of Air Force Medical University from January 2016 to January 2018. They were divided into control group and observation group according to different treatments, with 100 patients in each group. The control group was given betahistine mesylate, and the observation group was given self-made Tianma Decoction on the basis of the control group. After treatment, the two groups were compared for the efficacy, TCM syndrome score, visual analog scale (VAS) score and dizziness handicap inventory (DHI). SPSS statistics 19.0 was used for statistical analysis. Data comparison between groups was perfomed by using χ² test or t test depending on data type.Results After treatment, the TCM syndrome and VAS score score in the observation group were significantly lower than those in the control group [( 5.78±4.66) vs (9.21±5.18) points, (1.52±0.69) vs (3.41±0.88) points; P<0.05]. The observation group were lower than the control group in DHI scores of function [(10.08±2.54) vs (15.72±2.80)points], emotion [(8.44±2.99) vs (13.56±3.70)points], and physical body [(7.26±1.34) vs (12.49±2.11)points], the differences being statistically significant(all P<0.05). The recurrence rate and incidence of adverse reactions in the observation group were significantly lower than those in the control group [9.0%(9/100) vs 39.0%(39/100), 5.0%(5/100) vs 14.0%(14/100); all P <0.05]. Conclusion The self-made Tianma Decoction combined with betahistine is effective in treating residual dizziness in the elderly patients with benign paroxysmal positional vertigo, significantly alleviating the symptoms of vertigo, improving the quality of life, and reducing the recurrence rate with high safety.