Objective To investigate the clinical efficacy of myofascial release in the management of upper limb spastic paralysis after stroke （SPAS） and its impact on the central nervous system. Methods The patients with upper limb spasticity who visited Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2023 to March 2024 were randomly divided into a control group （n = 50） receiving conventional treatment and acupuncture， and a treatment group （n = 50） receiving conventional treatment and myofascial release. The clinical response rate was assessed by comparing the modified Ashworth Spasticity Scale （MAS） scores between the two groups. Additionally， changes in simplified Fugl-Meyer Assessment （FMA） scores， electromyographic F-waves， and serum gamma-aminobutyric acid （GABA） levels were compared. Results The total effective rate of the treatment group was 96%， while that of the control group was 86%， showing no statistically significant difference （P = 0.08）. However， the effective rate in the treatment group was significantly higher than that in the control group （P < 0.05）. Following treatment， both groups exhibited a significant reduction in MAS scores （P < 0.001）， with a notably greater decrease observed in the observation group compared to the control group （P < 0.05）. Moreover， after treatment， there was a significant increase in FMA scores for both groups （P < 0.05）， and this increase was significantly more pronounced in the observation group than in the control group （P < 0.05）. After treatment， both groups exhibited a significant reduction in electromyographic F-waves amplitude and a significant increase in threshold （P < 0.05）. Moreover， the observation group demonstrated a significantly greater degree of change compared to the control group （P < 0.05）. Following treatment， serum GABA levels significantly decreased in both groups （P < 0.001）， with the observation group showing a markedly higher decrease than the control group （P < 0.001）. Conclusion In comparison to conventional acupuncture， myofascial release demonstrates superior efficacy in improving muscle tension and limb motor function for the treatment of upper limb SPAS， while also facilitating central nervous system regulation.