Abstract： Objective： To observe the curative effect of Tongdu Xingshen acupuncture combined with repetitive transcranial magnetic stimulation on post-stroke cognitive impairment （PSCI）. Methods：A total of 98 cases of PSCI patients treated at Wenzhou TCM Hospital of Zhejiang Chinese Medical University from June 2023 to June 2024 were selected and divided into the control group and the trial group using the random number table method，with 49 cases in each group. Ultimately，47 cases in each group completed the study. Both groups received basic treatment；the control group additionally received repetitive transcranial magnetic stimulation，and the trial group was additionally treated with Tongdu Xingshen acupuncture combined with repetitive transcranial magnetic stimulation. Clinical efficacy was compared between the two groups after eight weeks of treatment. Changes in Montreal Cognitive Assessment （MoCA） scores， Mini-Mental State Examination （MMSE） scores， Functional Activities Questionnaire （FAQ） scores， Modified Barthel Index（ MBI） scores，and levels of serotonin（ 5-HT），norepinephrine（ NE），and dopamine（ DA） in the two groups were compared before and after treatment. Results：After eight weeks of treatment，the total effective rate of clinical efficacy was 91.49% （43/47） in the trial group and 76.60% （36/47） in the control group， with a significant difference between the two groups （P＜0.05）. After eight weeks of treatment，the scores of MoCA and MMSE in the two groups were increased when compared with those before treatment （P＜0.05），with the trial group showing higher scores than the control group （P＜0.05）. After eight weeks of treatment， FAQ scores in the two groups were decreased when compared with those before treatment （P＜0.05）， and MBI scores in the two groups were increased when compared with those before treatment （P＜0.05）；FAQ score in the trial group was lower than that in the control group （P＜0.05），and MBI score in the trial group was higher than that in the control group （P＜0.05）. After eight weeks of treatment， the levels of 5-HT， NE， and DA in the two groups were increased when compared with those before treatment （P＜0.05），with the trial group showing higher levels than the control group （P＜0.05）. Conclusion： Tongdu Xingshen acupuncture combined with repetitive transcranial magnetic stimulation has a good curative effect in treating PSCI， which can reduce the degree of cognitive impairment， improve neurotransmitter levels， and enhance activities of daily living，thereby providing a synergistic effect.