Objective: This study aimed to evaluate the effects of Xingnao Kaiqiao acupuncture on neurological function and hemorheology in patients with acute cerebral infarction through meta-analysis. Methods: China National Knowledge Infrastructure (CNKI), Wanfang Medical, VIP Database, and PubMed were searched from inception to December 2025 for studies assessing Xingnao Kaiqiao acupuncture in acute cerebral infarction, using keywords related to Xingnao Kaiqiao acupuncture, neurological function, and hemorheology. Study quality was assessed using Cochrane criteria. Meta-analysis was performed with RevMan 5.3. Results: Seven studies (all published in Chinese) involving 712 patients were included (control, conventional Western therapy, n = 332; intervention, Xingnao Kaiqiao acupuncture plus conventional therapy, n = 380). Outcomes included National Institutes of Health Stroke Scale (NIHSS) (seven studies), whole blood viscosity (three studies), plasma viscosity (three studies), hematocrit (three studies), and platelet aggregation rate (two studies). Pooled analyses showed no significant heterogeneity for these outcomes. Compared with controls, the acupuncture group demonstrated significantly lower NIHSS scores and improved hemorheological indices, including plasma viscosity, whole blood viscosity, hematocrit, and platelet aggregation rate (all P ≤ 0.003). Overall study quality generally met the predefined standards, and no obvious publication bias was suggested. Conclusion: Xingnao Kaiqiao acupuncture combined with conventional therapy may improve neurological function and reduce hemorheological parameters (whole blood viscosity, plasma viscosity, hematocrit, and platelet aggregation) in acute cerebral infarction.