To discuss the acupuncture of Tiaoshen Dongjin (regulating the mind and activating the sinews) in treating spastic paralysis after stroke (SPAS) based on the "brain-meridian-sinew". The "brain-meridian-sinew" system takes the brain as its core, with its structural and functional components closely interconnected, forming a limb motor regulation system. The pathogenesis of SPAS presents a dynamic evolution process characterized by damage to brain collaterals, obstruction of orifices and concealment of the spirit, blockage of meridians, imbalance of ying and wei, and spasm of sinews with coexistence of deficiency and stasis. Combined with the ideas and clinical experience of contemporary acupuncture physicians in treating SPAS, the acupuncture differentiation and treatment approach of "regulating the mind and activating the sinews" is summarized. It emphasizes prioritizing "regulating the mind," selecting nearby acupoints such as Baihui (GV20), Sishencong (EX-HN1), Fengchi (GB20), and Yintang (GV24⁺) to awaken the brain and regulate the mind; and selecting distal acupoints such as acupoints on the Governor Vessel, Jiaji (EX-B2), or Back-shu points to unblock the Governor Vessel, nourish the marrow, and regulate the balance of the five zang organs, thereby stabilizing the spirit. "Activating the sinews" is regarded as the key, primarily selecting acupoints of the hand and foot yangming meridians, and emphasizing the importance of applying motion-oriented acupuncture techniques to activate the sinews and regulate qi. Under the guidance of the integration of disease and syndrome differentiation and the theory of tension balance, approaches for activating the sinews and relieving spasm are further expanded.