Objective To investigate the therapeutic effect of acupuncture on hand motor dysfunction in patients with hypertensive intracranial hemorrhage using tractography. Methods Corticospinal tract (CST) fibers from precentral knobs of 21 hypertensive intracranial hemorrhage patients were three-dimentionally recontructed. Furthermore， the different changes of NHISS scores and Brunnstrom hand stage scores were analyzed in accordance with different damage extent of CTS. Results In patients with undamaged CTS， NHISS scores， not Brunnstrom hand stage scores， were improved significantly after acupuncture treatment (P＜ 0.05). In patients with partially damaged CTS， both NHISS scores and Brunnstrom hand stage scores were improved significantly after acupuncture treatment (P ＜0.05). However， in patients with fully damaged CTS， neither NHISS scores nor Brunnstrom hand stage scores were changed significantly. Conclusions Tractography can clearly demonstrate the damage extent of CTS fibers from hand knobs， which proves that acupuncture may obviously improve hand motor dysfunction in patients with partially damaged CTS.