Objective To investigate the effect of the modified Tai Chi on the balance of stroke patients and on serum alkaline phosphatase (ALP), neuropeptide Y (NPY) and interleukin (IL)-6. Methods A total of 86 patients with stroke and hemiplegia were enrolled in the study, who were admitted to the Department of Neurology of Xuzhou Central Hospital from Sep. 2017 to Dec. 2018. They were randomly divided into two groups with 43 in each group. The control group received routine rehabilitation and the study group received additional training of modified Tai Chi 3 times a week for 12 weeks. The two groups were compared in the balance adjustment ability index, plantar pressure, Berg balance scale (BBS), simplified Fugly-Meyer motor assessment (FMA),timed up and go test (TUGT) and 6-minute walking test (6MWT), and serum ALP, NPY, and IL-6 as measured before treatment and after 12 weeks of treatment. SPSS statistics 23.0 was used for data analysis, and depending on data type, t test or χ² test was used for comparison between groups. Results After training, the peak pressure and average pressure of healthy foot, envelope ellipse area, ratio of envelope ellipse area to pressure center offset, ellipse trajectory length, TUGT, ALP, NPY and IL-6 decreased, while the peak pressure and average pressure of diseased foot, ellipse trajectory length of pressure center offset, BBS, FMA and 6MWT increased in both groups. (P<0.05). After training, the study group improved more significantly than the control group in the peak foot pressure of healthy foot[(207.54±31.20) vs (264.87±38.73) N], the average healthy foot pressure [(60.51±12.87)% vs (81.20±16.27)%], peak diseased foot pressure [(180.83±29.20) vs(163.52±26.30) N], average diseased foot pressure[(51.20±8.40) % vs (40.58±6.87)%], envelope ellipse area[(125.42±32.70) vs (170.26±38.05)mm²], elliptical trajectory length [(542.20±68.41) vs (425.21±48.23)mm], ratio of envelope ellipse area to elliptical trajectory length[(0.23±0.02) vs (0.40±0.04)], TUGT [(13.87±2.62) vs (17.52±2.86)s], ALP[(72.27±6.37) vs (77.81±7.05)U/L], NPY[(128.60±15.79) vs (150.24±17.98)μg/L], IL-6 [(6.68±0.87) vs (13.20±1.76)pg/ml], BBS[(28.05±3.41) vs (23.08±2.97) score], FMA[(29.26±3.50) vs (23.57±3.02) score], and 6MWT[(302.97±58.62) vs (256.52±49.67)m], the differences being statistically significant (P<0.05). Conclusion Modified Tai Chi can effectively improve balance, movement and walking in the stroke patients, and its mechanism may be related to the down-regulation of ALP, NPY and IL-6.