Abstract：Objective：To observe the efficacy of early application of wrist-ankle acupuncture based on the twelve cutaneous regions theory in preventing and treating shoulder-hand syndrome （SHS） in senile acute ischemic stroke. Methods：A total of 78 elderly patients with acute ischemic stroke hospitalized at Tongde Hospital of Zhejiang Province from August 2022 to July 2024 were selected as the study subjects and were divided into the control group and the observation group using the random number table method， with 39 cases in each group. Both groups received conventional medical treatment and rehabilitation exercises. The control group received conventional point acupuncture， while the observation group received wrist-ankle acupuncture based on the twelve cutaneous regions theory. The incidence of SHS， Visual Analogue Scale （VAS） pain scores， Fugl-Meyer Assessment （FMA） scores， Modified Barthel Index （MBI） scores，Disabilities of the Arm，Shoulder，and Hand （DASH） scores，and adverse events were compared between the two groups. Results：At one and three months after stroke，the incidence of SHS was 5.13%（ 2/ 39） and 7.69% （3/39） in the observation group respectively，compared to 23.08% （9/39） and 28.21% （11/39） in the control group， differences being significant （P＜0.05）. Before treatment， there was no significant difference in VAS and FMA scores between the two groups （P＞0.05）. After treatment，the observation group had lower VAS scores and higher FMA scores than the control group （P＜0.05）. Before treatment，there was no significant difference in MBI and DASH scores between the two groups （P＞0.05）. After treatment， the observation group had higher MBI scores and lower DASH scores than the control group （P＜0.05）. During the treatment period， all patients remained stable condition， with no adverse events such as bleeding， fainting， needle breakage， or needle stagnation. Conclusion： Early application of wrist-ankle acupuncture based on the twelve cutaneous regions theory can reduce the incidence of SHS in elderly patients with acute ischemic stroke，alleviate pain，and improve motor function，daily living ability， and upper limb function.