Abstract: Objective To investigate the clinical effect on Kaiqiao Xingshen decoction combined with acupuncture at “four gates” and “three wind” points for post-stroke dysphagia. Methods A total of 90 post-stroke dysphagia patients with qi deficiency and blood stasis pattern who were admitted to the 983rd Hospital of the Joint Logistic Support Force from January 2022 to December 2024 were selected. They were divided into a control group and an intervention group, with 45 patients in each group, using a computer-generated random number table and sealed envelopes for allocation concealment. The control group received conventional rehabilitation intervention, while the intervention group received Kaiqiao Xingshen decoction combined with acupuncture at “four gates” and “three wind” in addition to conventional rehabilitation. The clinical efficacy, surface electromyography results (maximum amplitude and swallowing duration), swallowing function standardized swallowing assessment (SSA) score, quality of life swallowing quality of life (SWAL-QOL) score, and incidence of adverse events were compared between the two groups. Results The total clinical effective rate in the intervention group was higher than that in the control group (P ＜ 0.05). After 7 and 14 days of treatment, the intervention group showed higher maximum amplitudes in the infrahyoid and submental muscle groups, shorter swallowing duration, lower SSA scores, and higher SWAL-QOL scores compared to the control group (P ＜ 0.05). Repeated measures analysis of variance showed that both group differences and time changes had significant effects on the maximum amplitude of the infrahyoid and submental muscle groups, swallowing duration, SSA scores, and SWAL-QOL scores (P ＜ 0.05), with no significant interaction between group and time (P ＞ 0.05). The total incidence of adverse events in the intervention group was lower than that in the control group (P ＜ 0.05). Conclusion Kaiqiao Xingshen decoction combined with acupuncture at “four gates” and “three wind” points can improve swallowing function and quality of life, strengthen the contraction strength of swallowing-related muscles, increase clinical efficacy, and reduce the incidence of adverse events in post-stroke dysphagia patients with qi deficiency and blood stasis pattern.