Objective To observe the effects of acupuncture combined with symmetrical weight-bearing sitting and standing transfer training on lower limb motor function and electromyography in patients with hemiplegia after stroke. Methods 92 patients with hemiplegia after stroke admitted to our hospital from January 2023 to January 2024 were selected as the study objects. Patients were divided into control group (n=46) and observation group (n=46) according to the order of treatment. The control group underwent the symmetrical weight-bearing sitting-standing transfer training; The observation group was combined with the acupuncture intervention on the basis of the control group. The lower limb motor function [Fugl-Meyer (FM) Motor function Rating Scale] and electromyography [integrated electromyography values of femoris rectus and biceps femoris (iEMG) ] and the Berg Balance Scale (BBS) of the two groups were analyzed and compared. Results After 4 weeks of intervention, the lower limb FM motor function score of both groups was significantly higher than that before intervention, and the lower limb FM motor function score of the observation group was significantly higher than that of the control group (P < 0.05). After 4 weeks of intervention, the iEMG of rectus femoris and biceps femoris in both groups was significantly higher than that before intervention, and the iEMG of rectus femoris and biceps femoris in observation group was significantly higher than that in control group (P < 0.05). After 4 weeks of intervention, the BBS scores of both groups were significantly higher than those before intervention, and the BBS scores of the observation group were significantly higher than those of the control group (P < 0.05). Conclusion After stroke patients with hemiplegia can improve the lower extremity motor function, electromyography index and balance function by acupuncture combined with symmetrical weight-bearing sitting and standing transfer training.