Objective The aim of this study is to use functional magnetic resonance imaging （fMRI） technology and double regression analysis method to explore the effect of Tongdu Tiaoshen acupuncture on cognitive network changes in patients with acute ischemic stroke （AIS）. Methods 140 AIS patients hospitalized in the hospital from June 2023 to August 2024 were selected as the research subjects. The patients were randomly divided into an experimental group （n = 70） and an observation group （n = 70） using a central randomization system. 1：1 After matching， there were 48 patients in each group. Both groups received basic medication and rehabilitation treatment. The experimental group was treated with Tongdu Tiaoshen acupuncture on this basis， while the observation group was treated with sham acupuncture on this basis. Obtain brain structure and function data of patients through fMRI technology， and evaluate changes in patients' cognitive networks using double regression analysis method. Results A comparison of clinical data between the two groups of subjects revealed no statistically significant differences in age， gender， history of diabetes， body mass index （BMI）， and history of hypertension （P > 0.05）. After matching， there was no significant difference in clinical data （P > 0.05）. After matching， the histograms tended to be consistent， effectively improving the balance of baseline characteristics. Compared to the observation group， the experimental group scored lower in cognitive function， memory function assessment， language assessment ability， and executive function assessment scales （P < 0.05）； Compared to the experimental group， the observation group scored lower in terms of mental assessment， daily living ability， and emotional state estimation （P < 0.05）. For the comparison of different brain networks between the two groups of subjects， after the experiment， compared with the observation group， the experimental group showed more significant brain network enhancement in the anterior central gyrus， auxiliary motor area， middle frontal gyrus， and posterior central gyrus， but weaker brain network influence in the middle frontal gyrus （P < 0.05， adjusted by Alphasim）. The functional connectivity analysis based on abnormal fALFF values in brain regions showed that the functional connectivity of the right inferior temporal gyrus and left inferior parietal gyrus in the experimental group was enhanced， while the functional connectivity of the right superior frontal gyrus was weakened. In the correlation analysis between different brain regions and clinical indicators in two groups of subjects， Pearson correlation analysis was used to determine that there were significant differences （P < 0.05） between different brain regions in the experimental group and clinical indicators such as the National Institutes of Health Stroke Scale （NIHSS）， Fugl Meyer （FMA） Cumulative Score Scale for Stroke， Barthel Index， and Mini Mental State Examination （MMSE）. The covariance analysis of the differences in brain regions and clinical indicators between the two groups of subjects showed that the functional connectivity of the central anterior gyrus in the trial patients increased， which was positively correlated with MMSE and NIHSS scores Barthel index scores （R = 0.254，P < 0.001；R = 0.309，P < 0.001 R = 0.314， P = 0.018）. Conclusions The dual regression evaluation of fMRI shows that the Tongdu Tiaoshen acupuncture method can significantly enhance the functional connectivity of some brain areas in patients， such as the anterior central gyrus， auxiliary motor area， middle frontal gyrus， and posterior central gyrus， effectively improving NIHSS and MMSE cognitive related scores， providing imaging and multidimensional data support for its clinical application.