To determine the clinical efficacy and safety of electro-scalp acupuncture in the treatment of patients with acute ischemic stroke. Totally 74 patients with acute ischemic stroke were enrolled and divided into either body acupuncture (Control) or electro-scalp acupuncture (ESA) groups according to randomized controlled principle. The patients in the control group were given body acupuncture treatment once daily for 28 d, whereas except for the body acupuncture, electro-scalp acupuncture was additional treatment given to the ESA group. Neurological deficits, everyday motor function and muscle strength were evaluated at baseline and the 28th d by NIH Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index Score (MBI), respectively. There were not obvious between-group differences in the baseline efficacy parameters (NIHSS, FMA and MBI) (all P > 0.05), whereas significant between-group differences were found in post-treatment NIHSS, FMA-UE and MBI scores (all P < 0.05). After acupuncture treatment, systematic within-group improvements were found in the two groups for any of the efficacy parameters assessed (all P < 0.01), and the ESA group showed higher significant improvements in NIHSS, FMA-UE and MBI scores (all P < 0.05). Electro-scalp acupuncture was efficacious in the treatment of acute ischemic stroke, which resulted in meaningful improvements in neurologic function, motor function and activities of daily living of patients.