During the process of internal cylindrical ultrasonic-assisted electrochemical grinding (ICUAECG), both the workpiece and the conductive grinding wheel are rotating, the machining space is closed and narrow, the electrolyte is difficult to spray into the machining area, and the insulation between the workpiece and the machine bed is challenging. According to the machining characteristics of ICUAECG, the structure of a special machine tool was designed to mitigate these problems. In particular, the rotation, electrolyte supply, electric connection, and insulation modes of the workpiece clamping parts were studied, yielding a novel workpiece clamping- and rotating-device design. This structure can fully use the internal space of the hollow spindle of the machine tool, effectively reduce the external moving parts, and achieve the appropriate liquid injection angle of the electrolyte. The ultrasonic vibration system and its installation mechanism, the dressing device of the conductive grinding wheel, and the electric grinding spindle-mounting and -fixing device were analyzed in detail. Then, a special machine tool for ICUAECG was designed, the operability and feasibility of which were verified by experiments involving conductive grinding wheel dressing and ICUAECG.