Objective To explore the efficacy of Wenyang Tongdu Acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of patients with post-stroke hemiplegia.Methods A total of 80 patients with post-stroke hemiplegia who were diagnosed and treated at our hospital from October 2023 to January 2026 were selected and divided into the control group and the study group by the random number table method, with 40 cases in each group. Both groups received routine treatment, and the control group received rTMS treatment. Additionally, the study group was also treated with Wenyang Tongdu Acupuncture. The clinical efficacy in the two groups after 4 weeks of treatment was evaluated. The differences in muscle strength, motor function [Fugl-Meyer Assessment (FMA) scores], balance function [Berg Balance Scale (BBS) scores] and activities of daily living [Modified Barthel Index (MBI) scores] were compared between the two groups of patients before treatment and after 4 weeks of treatment. The adverse reactions during treatment in the two groups were statistically analyzed.Results After 4 weeks of treatment, the overall response rate in the study group (92.5%) was higher than that in the control group (72.5%) (P < 0.05). After treatment, the muscle strength scores, all subscale scores of the FMA (including upper extremity, lower extremity, muscle strength, coordination, sensation), BBS scores, and MBI scores in the study group were higher than those in the control group (P < 0.05). In both groups, the muscle strength scores, all subscale scores of the FMA, BBS scores, and MBI scores after treatment were higher than those before treatment (P < 0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05).Conclusion Wenyang Tongdu Acupuncture combined with rTMS can enhance muscle strength, promote the recovery of motor function and balance function, and increase the activities of daily living in patients with post-stroke hemiplegia, with definite clinical efficacy and good safety.