Clinical Efficacy of “Left Disease, Right Treatment” Acupuncture Therapy in the Treatment of Lower Limb Dysfunction After Ischemic Stroke

Objective This study aimed to investigate the efficacy of acupuncture based on “Zhenjiu Dacheng” by Yang Jizhou, specifically the “treating left-sided disorders from the right” principle, in improving lower limb dysfunction after ischemic stroke and explore the underlying neural mechanisms using resting-state functional magnetic resonance imaging (rs-fMRI). Methods This single-center, randomized controlled trial enrolled 84 adults aged 40–75 years with first-episode ischemic stroke and unilateral lower limb dysfunction. The participants were randomized in a 1:1 ratio to the “left disease, right treatment” acupuncture group (contralateral acupoint) or the conventional acupuncture group (ipsilateral acupoint). Both groups received standardized conventional rehabilitation therapy plus 20 sessions of acupuncture over 4 weeks. Outcome measures included Fugl–Meyer Assessment for Lower Extremity (FMA-LE), Modified Barthel Index, Modified Ashworth Scale (MAS), gait speed, and rs-fMRI regional homogeneity (ReHo) at baseline, posttreatment (T1), and 3-month follow-up (T2). Results At T1 and T2, the “left disease, right treatment” acupuncture group showed significantly greater improvements in FMA-LE, MAS, and gait speed compared with the conventional acupuncture group (all P < 0.05). rs-fMRI revealed posttreatment ReHo increases in the “left disease, right treatment” acupuncture group in the claustrum, putamen, and inferior parietal lobule and decreases in the superior frontal gyrus and precentral gyrus—distinct from changes in the conventional acupuncture group. Only mild adverse events occurred in both groups. Conclusion Acupuncture guided by the “Zhenjiu Dacheng” theory effectively improves lower limb motor function after ischemic stroke, potentially via modulation of brain functional connectivity in sensorimotor networks. It is safe and merits further clinical translation. Clinical trial registration: National Universal Health Security Information Platform (Medical Research Registration and Filing Information System) ( https://www.medicalresearch.org.cn/login , MR-33-22-001799).