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Understanding the Role of Acupuncture in Immune Modulation

Key Topics: Immune & Inflammation
December 2, 2023 • 4 min read

Acupuncture influences immune system function through direct and indirect mechanisms. Clinical studies have found several benefits from utilizing acupuncture for immune disorders and general immune system support.

Acupuncture has been used for thousands of years as a key component of Eastern medicine to treat a variety of conditions and to strengthen the body, allowing it to resist disease and restore normal functions.1-3 As a part of modern medicine, acupuncture has been used as a complementary and alternative approach to alleviate metabolic issues, neurological disorders, musculoskeletal injuries, and immune disorders.1 While acupuncture can reduce symptoms of immune disorders, it can also modulate the immune system, maintaining homeostasis and preventing issues from developing.1-3

The Science Behind Acupuncture and Immunity

The practice of acupuncture has been refined over millennia. Given the growing popularity of Eastern medicine in the West, there has been a concerted effort to understand how acupuncture works using the language and theories of Western science.  From a Western medicine perspective, acupuncture involves the placement of needles in specific sites of the body which activates mechanosensitive sensory neurons on the surface of the skin.1 Molecular signals are then produced and transduced through sensory afferent nerve fibers up to the spinal cord, brainstem, and hypothalamus. From there, the signals are sent out to the appropriate neural pathway and target organs via efferent nerves, regulating processes and functions of the body.1,2 Although acupuncture does not directly neutralize pathogens, it modulates the immune system directly and indirectly, including through the neuro-endocrine-immune network.1

First, acupuncture can directly influence the number and activity of immune cells. Mast cells, the first responders that trigger an inflammatory response when exposed to a stimuli such as temperature, pressure, pathogens, or trauma, can be activated by acupuncture and are enriched near certain acupoints.1 Mast cells are also important in nerve transduction between the surface of the body, resulting in analgesic and anti-inflammatory effects.1 Acupuncture influences other immune cells and their function, including:1,2,4

  • Directing polarization of macrophages to enhance anti-inflammatory effect and tissue repair
  • Regulating number and activity of neutrophils
  • Increasing activity of natural killer (NK) cells by promoting crosstalk between endorphins and cytokines
  • Regulating proportion of NK cells
  • Triggering release of cytokines to promote analgesia and healthy stress response
  • Balancing subsets of T cells by regulating their differentiation

In addition to direct effects on immune cells, acupuncture can indirectly support immune health by restoring proper inflammation, typically by promoting anti-inflammatory pathways.3 Acupuncture modulates the production and release of cytokines, helping reduce the inflammatory response in the body, and also regulates several inflammatory pathways.1 For example, acupuncture at ST36 can regulate the vagal-adrenal anti-inflammatory pathway as well as the spinal sympathetic pathway to exert an anti-inflammatory effect.1 Acupuncture also impacts the immune system via the cholinergic anti-inflammatory pathway and the neurotransmitter acetylcholine which regulates immune cells.1

Finally, acupuncture appears to influence the gut-brain axis and hypothalamic-pituitary-adrenal (HPA) axis, regulating intestinal and stress-induced inflammation, respectively.1 Specifically, acupuncture may be able to restore balance to the gut-brain axis via regulating inflammatory signals and neurotransmitters, altering gut microbiome populations, and influencing signals of immune activation.1 Within the HPA axis, acupuncture promotes homeostasis of the body via the synthesis and release of various HPA axis hormones and alleviates inflammation that is induced by stress.1

Acupuncture supports immune health by increasing the number and activity of immune cells, modulating inflammation, and regulating multiple signaling pathways throughout the body.


Clinical Studies Supporting Acupuncture for Immune Modulation

Various clinical studies have investigated the specific effects of acupuncture on immune function and immune conditions. In patients with Crohn’s disease (CD), an autoimmune disorder, acupuncture has shown many benefits. In one study, patients with active CD received three treatment sessions per week for 12 weeks and were re-evaluated at 24 weeks.5 Acupuncture decreased the CD Activity Index Score, improved symptoms after treatment and at follow-up, improved quality of life ratings, decreased CRP levels, a marker of inflammation, and improved histopathological scores of the intestines.5

In a different randomized, controlled trial, patients with mild to moderate active CD who were unresponsive to drug treatment, exhibited significant improvements in clinical remission rate and clinical response rate after 12 weeks which was maintained at 48 weeks following acupuncture treatment.6 It also decreased CRP levels, CD endoscopic index of severity, histopathological score, and recurrence rate at 48 weeks. Mechanistically, acupuncture decreased inflammation, modified the relative abundance of specific bacteria in the gut, including increasing F. prausnitzii and R. faecis, decreased lipopolysaccharide levels and pro-inflammatory cytokines, and balanced Th17 and Treg cells in the intestinal mucosa.5-7 Other clinical studies have demonstrated improvements in immune function with acupuncture treatment in patients with conditions including anxiety, pain syndromes, multiple sclerosis, and stroke as well as in healthy adults.8-14


There is growing appreciation from Western medicine and scientific communities that acupuncture can enhance self-healing mechanisms in the body to restore homeostasis, helping the body optimize immune cell populations and regulate inflammation. Many clinical studies demonstrate the efficacy and therapeutic value of acupuncture for immune modulation and improvement of immune disorders. However, it is important to weigh the benefits with the risk of acupuncture, such as for those with a bleeding disorder or taking blood thinners. In general, acupuncture remains a very safe and effective approach to a variety of immune conditions as well as enhancing general immune function.

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  1. Wang, M., Liu, W., Ge, J., Liu, S. (2023). The immunomodulatory mechanisms for acupuncture practice. Front Immunol, 14:1147718.
  2. Ding, S.S., Hong, S.H., Wang, C., Guo, Y., Wang, Z.K., Xu, Y. (2014). Acupuncture modulates the neuro-endocrine-immune network. Q J Med, 107:341.
  3. Liang, F., Cooper, E.L., Wang, H., Jing, X., Quispe-Cabanillas, J.G., Kondo, T. (2015). Acupuncture and Immunity. Evid Based Complement Alternat Med, 2015:260620.
  4. Johnston, M.F., Sanchez, E.O., Vujanovic, N.L., Li, W. (2011). Acupuncture May Stimulate Anticancer Immunity via Activation of Natural Killer Cells. Evid Based Complement Alternat Med, 2011:481625.
  5. Bao, C.-H., Zhao, J.-M., Liu, H.-R., et al. (2014). Randomized controlled trial: Moxibustion and acupuncture for the treatment of Crohn’s disease. World J Gastroenterol, 20(31):1100.
  6. Bao, C., Wu, L., Wang, D., et al. (2022). Acupuncture improves the symptoms, intestinal microbiota, and inflammation of patients with mild to moderate Crohn’s disease: A randomized controlled trial. EClinicalMedicine, 45:101300.
  7. Zhao, C., Bao, C., Li, J., et al. (2014). Moxibustion and Acupuncture Ameliorate Crohn’s Disease by Regulating the Balance between Th17 and Treg Cells in the Intestinal Mucosa. Evid Based Complement Alternat Med, 2015:938054.
  8. Khodaie, F., Abbasi, N., Motlagh, A.H.K., Zhao, B., Moghadasi, A.N. (2022). Acupuncture for multiple sclerosis: A literature review. Mult Scler Relat Disord, 60:103715.
  9. Criado, M.B., Santos, M.J., Machado, J., Goncalves, A.M., Greten, H.J. (2017). Effects of Acupuncture on Gait of Patients with Multiple Sclerosis. J Altern Complement Med, 23(11):852.
  10. Khodaie, F., Moghadasi, A.N., Kazemi, A.H., Zhao, B. (2023). Effectiveness of acupuncture for fatigue in patients with relapsing-remitting multiple sclerosis: a randomized controlled trial. Acupunct Med, 41(4):199.
  11. Huang, W., Wu, H.-B., Feng, L.-D., Liang, D.-M., Wu, Z.-X. (2018). Effect of Acupuncture Combined with Rehabilitation on Immune and Neural Functions in Elderly Patients with Stroke. Zhen Ci Yan Jui, 43(9):567.
  12. Murakami, E., Uzawa, A., Ozawa, Y., et al. (2023). Effects of BL23 (Shenshu) acupuncture on serum cytokine levels in healthy adults: A randomized double-blind sham-controlled phase 1 study. J Neuroimmunol, 382:578165.
  13. Arranz, L., Guayerbas, N., Siboni, L., De la Fuente, M. (2007). Effect of acupuncture treatment on the immune function impairment found in anxious women. Am J Chin Med, 35(1):35.
  14. Petti, F., Bangrazi, A., Liguori, A., Reale, G., Ippoliti, F. (1998). Effects of acupuncture on immune response related to opioid-like peptides. J Tradit Chin Med, 18(1):55.

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