Objective To analyze the joint efficacy of butylphthalide （NBP） and limb ischemic postconditioning （LIPost C） in the treatment of elderly patients with atherosclerotic cerebral infarction. Methods A total of 160 patients with large atherosclerotic cerebral infarction hospitalized in Bijie Hospital from October 2020 to October 2022 were divided into four groups： NBP， LIPost C， NBP + sham LIPost C， and NBP + LIPost C by the random number table method， with 40 cases in each group. Before and after one-month treatment， the four groups were compared in terms of collateral circulation evaluated by the leptomeningeal scoring （rLMC）， neurological function evaluated by the National Institutes of Health Stroke Scale （NIHSS）， limb function disability evaluated by the Modified Rankin Scale （MRS）， cognitive function evaluated by the Mini Mental State Scale （MMSE）， daily living ability evaluated by the Barthel Index， as well as the occurrence of bleeding adverse events. Results After one-month treatment， the four groups all showed an increase in the rLMC score， with the NBP + LIPost C group significantly higher than the other three groups （P < 0.05）， and a decrease in the scores of NIHSS and MRS at each time point， with the NBP + LIPost C group significantly lower than the other three groups （P < 0.05）. Additionally， the four groups demonstrated an increase in the MMSE score and Barthel index at each time point （P < 0.05）， with the NBP + LIPost C group higher than the other three groups （P < 0.05）. Moreover， all the four groups showed no statistically significant difference in the incidence of bleeding adverse events （P > 0.05）. Conclusion NBP combined with LIPost C can effectively promote the establishment of collateral circulation and the recovery of neurological function in elderly patients with atherosclerotic cerebral infarction. Meanwhile， it can improve their motor function， daily living ability， and cognitive function. Moreover， it has high safety.