Abstract： Objective： To observe the effect of fire needling combined with moxibustion on central nervous regulation and surface electromyography of post-stroke spastic dystonia through toll-like receptor 4 （TLR4） signaling pathway. Methods：A total of 98 patients with post-stroke spastic dystonia treated in Zhoukou Central Hospital from January 2020 to May 2023 were selected and divided into the moxibustion group and the combination group according to random number table method，with 49 cases in each group. The two groups were given modern medical treatment；the moxibustion group was additionally given moxibustion，and the combination group was additionally given fire needling and moxibustion. The clinical effects in the two groups were compared. The changes in traditional Chinese medicine syndrome scores， Clinical Spasticity Index （CSI） and Modified Ashworth Scale （MAS）， Fugl-Meyer Assessment（ FMA），Trunk Impairment Scale（ TIS），China Stroke Scale（ CSS），surface electromyography [integrated electromyography （iEMG），root mean square of electromyography （RMS）]，and levels of serum lipoprotein-associated phospholipase A2 （Lp-PLA2），TLR4，and serum phosphorylated α-synuclein （α-syn） were compared between the two groups before and after treatment. Results：The total effective rate in the combination group was better than that in the moxibustion group，the difference being significant （P＜0.05）. After treatment，the traditional Chinese medicine syndrome scores of hemiparalysis， hypoaesthesia， speechlessness， deviated tongue and mouth， spontaneous sweating， pale facial complexion， and shortness of breath and lack of strength in the two groups were all decreased when compared with those before treatment （P＜0.05）， and the above seven traditional Chinese medicine syndrome scores in the combination group were all lower than those in the moxibustion group （P＜0.05）. After treatment，the CSI and MAS scores in the two groups were decreased when compared with those before treatment，and the FMA scores were increased，differences being significant （P＜0.05）. The CSI and MAS scores in the combination group were lower than those in the moxibustion group， and the FMA score was higher， differences being significant （P＜0.05）. After treatment，the TIS scores in the two groups were increased when compared with those before treatment，and the CSS scores were decreased，differences being significant（ P＜0.05）. The TIS score in the combination group was higher than that in the moxibustion group，and the CSS score was lower，differences being significant （P＜0.05）. After treatment， the RMS and iEMG of biceps in both groups were decreased when compared with those before treatment （P＜0.05）， and the RMS and iEMG of biceps in the combination group were lower than those in the moxibustion group （P＜0.05）. After treatment，the levels of Lp-PLA2，TLR4 and α-syn in both groups were decreased when compared with those before treatment （P＜0.05），and the levels of Lp-PLA2，TLR4 and α-syn in the combination group were lower than those in the moxibustion group （P＜0.05）. Conclusion：The therapy of fire needling combined with moxibustion has a great therapeutic effect on post-stroke spastic dystonia， which can regulate the central nervous system through TLR4 signaling pathway，reduce inflammatory response and nerve injury，improve spasticity，muscle tone level and surface electromyography，alleviate the disease conditin，and enhance the body's trunk control ability and upper limb function.