Objective:To systematically assess the effectiveness and safety of acupuncture for spastic hemiplegia after ischemic stroke. Methods:Randomized controlled trials(RCTs)of acupuncture treatment for spastic hemiplegia after ischemic stroke meeting the inclusion criteria in Cochrane Library,Medline,Excerpta Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure(CNKI),SinoMed,Chongqing VIP Database(VIP),and Wanfang Data Knowledge Service Platform(Wanfang)published from each database's inception to February 2023 were retrieved by computer.Two reviewers independently extracted data and evaluated the risk of bias using Cochrane's risk of bias tool.Review Manager 5.4 was used for data analysis.Continuous data were evaluated using mean difference(MD)with a 95%confidence interval(CI),and dichotomous data were analyzed using risk ratio(RR). Results:A total of 24 trials,including 1 970 participants,were included in the study.The meta-analysis of 7 trials showed that compared to the rehabilitation therapy,acupuncture therapy was more effective in improving the simplified Fugl-Meyer assessment score after 1-month treatments[MD=10.52,95%CI(7.81,13.23),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.18,95%CI(11.34,27.02),P<0.001],and the 6-month treatment course resulted in better outcomes than the 1-month course.The meta-analysis of 8 trials showed that acupuncture had a better improvement on the Barthel index score than rehabilitation therapy after 1-month treatments[MD=10.78,95%CI(8.91,12.64),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.94,95%CI(19.02,20.87),P<0.001],and the 6-month course was better than the 1-month course.The meta-analysis of 2 trials showed that the effective rate of the modified Ashworth scale score improvement was more notable in the acupuncture group after 1-month treatments[RR=1.20,95%CI(1.02,1.40),P=0.020].One trial reported no adverse event,and 1 trial reported 3 adverse events without severe influence. Conclusion:Acupuncture might be an effective and safe therapy for spastic hemiplegia after ischemic stroke,but more high-quality,large-sample objectively-evaluated RCTs are needed to validate the conclusion.