Abstract： Objective： To observe the effects of Chinese medicine-directed penetration combined with scalp acupuncture on circumference，blood flow，and muscle strength of the affected limbs of senile patients with post-stroke hemiplegia. Methods： A total of 198 senile patients with post-stroke hemiplegia who were hospitalized at Lishui People's Hospital from January 2022 to January 2023 were selected and divided into the treatment group and the control group according to the random number table method， with 99 cases in each group. The control group received conventional rehabilitation treatment， and the treatment group received Chinese medicine-directed penetration combined with scalp acupuncture in addition to the conventional rehabilitation treatment. Clinical effects were compared between the two groups； the changes in traditional Chinese medicine symptom scores， circumference of the affected limbs，cervical artery resistance index （RI），and limb muscle strength scores in the two groups were compared before and after treatment. Results： After treatment， traditional Chinese medicine symptom scores for joint swelling， joint pain， and range of joint motion in the two groups were decreased when compared with those before treatment （P＜ 0.05），and the above three traditional Chinese medicine symptom scores in the treatment group were lower than those in the control group （P＜0.05）. Circumferences of the affected limbs in the two groups were reduced when compared with those before treatment （P＜0.05）， and the circumference in the treatment group was smaller than that in the control group （P＜0.05）. Cervical artery RI and vertebral artery RI in the two groups were reduced when compared with those before treatment （P＜0.05），with the treatment group showing lower RI values than the control group （P＜0.05）. After treatment， muscle strength scores of the affected limbs in the two groups were increased when compared with those before treatment （P＜0.05）， with the treatment group scoring higher than the control group （P＜0.05）. The total effective rate of clinical effect was 90.91% （90/99） in the treatment group and 71.72% （71/99） in the control group， with a significant difference between the two groups （P＜0.05）. Conclusion：Chinese medicine-directed penetration combined with scalp acupuncture can improve circumference，blood flow，and muscle strength of the affected limbs of senile patients with post-stroke hemiplegia，playing a positive role in their rehabilitation treatment.