Objective To explore effect of acupuncture combined with Chinese and western medicine treatment plan on balance and quality of life in elderly cardiovascular-cerebral disease under rehabilitation engineering concept. Methods A total of 96 elderly patients with cardiovascular and cerebrovascular diseases who were admitted to the Traditional Chinese Medicine Hospital of Henan (Zhengzhou) Modern Medical Research Institute from January 2023 to December 2024 were included. They were randomly divided into the observation group and the control group using a random number table method, with 48 cases in each group. Control group received conventional western medicine; observation group additionally received acupuncture and herbal decoction (Buyang Huanwu/ Banxia Baizhu Tianma). Both groups were intervened for 12 weeks. The changes in balance function and gait indicators between the two groups, as well as the changes in daily living ability and quality of life scores were compared. And the frequency of dizziness attacks, the number of fall incidents, and the occurrence of adverse events (AE) were recorded. Results The endpoint of the study: 2 cases dropped out in the observation group (n＝46), and 2 cases dropped out in the control group (n＝46). In the end, 46 cases were included in each group. At 12 weeks after the intervention, the scores of the Berg balance scale (BBS), the Timed Up and Go Test (TUG), and the Tinetti performance oriented mobility assessment-gait (POMA-G) in the observation group all showed significant improvements compared to the control group (all P＜0.01). The improvement in scores of the Barthel index (BI) and the 36-item short form health survey (SF-36) were also greater than that of the control group (all P＜0.05); The scores of the physical, psychological and social function dimensions in the generic quality of life inventory-74 (GQOLI-74) were significantly higher than those in the control group (all P＜0.05), but there was no statistically significant difference in the material life dimension (P＝0.067). At 12 weeks after the intervention, the frequency of dizziness attacks in the observation group was significantly lower than that in the control group (P＝0.015). Both groups experienced one fall incident each, and no SAE occurred in either group. Conclusion Under the guidance of rehabilitation engineering concepts, the acupuncture combined with Chinese and Western medicine treatment plan can effectively enhance the balance function and dynamic gait performance of elderly patients with cardiovascular and cerebrovascular diseases, reduce the risk of falls, improve their daily living ability and quality of life, and has good safety.