A Research-Backed Overview
Emerging science reveals how acupuncture may engage the immune system — reducing inflammatory markers, modulating immune cell behavior, and improving quality of life across several autoimmune conditions.
The Problem
Autoimmune conditions arise when the immune system misdirects its defense mechanisms against the body's own tissues. Persistent, dysregulated inflammation is the common thread — and the growing side-effect burden of conventional immunosuppressive drugs has fueled interest in complementary approaches that engage the body's own regulatory systems.
In conditions like rheumatoid arthritis (RA) and Hashimoto's thyroiditis, the immune system produces autoantibodies and proinflammatory cytokines — including TNF-α, IL-1, IL-6, IL-17, and CRP — that drive tissue destruction, joint damage, and systemic dysfunction. RA alone affects approximately 1% of the world's population and is characterized by progressive joint deformity and disability.
First-line therapies — NSAIDs, DMARDs, glucocorticoids, and biologics — reduce inflammation and slow joint destruction but carry significant side-effect profiles including life-threatening infections, increased cancer risk, cardiovascular complications, and high costs. Long-term drug dependence and non-response in a subset of patients create an urgent need for safe adjunct options.
Macrophages are central orchestrators of both innate and adaptive immunity. In allergic and autoimmune disorders, M1-type (proinflammatory) macrophage activity predominates, producing excess IL-1β, TNF-α, and IL-6. Restoring the balance between M1 and M2 (anti-inflammatory) macrophage phenotypes is a key therapeutic target — and one that acupuncture research has begun to address at a mechanistic level.
Allergic diseases have been increasing significantly worldwide, particularly among children and adolescents. In Western countries, allergic rhinitis now affects 20–30% of the population, while asthma prevalence continues to rise. Hashimoto's thyroiditis — an autoimmune thyroid condition — is similarly prevalent, with current treatment leaving many patients without full symptom resolution. These trends underscore the need for additional evidence-based therapeutic options.
Mechanisms of Action
Research over the past decade has moved well beyond placebo comparison — identifying specific cellular, molecular, and neuroimmune pathways through which acupuncture needle stimulation exerts its anti-inflammatory effects across multiple biological systems.
Acupuncture — particularly at acupoint ST36 — has been shown to suppress the proinflammatory M1-type macrophage population and upregulate anti-inflammatory M2-type macrophages. This shift operates via inhibition of the TLR4/MyD88 signaling pathway, reducing NLRP3/IL-1β expression and downstream release of IL-6, IL-12, IL-17, TNF-α, and CRP.
Li et al., 2021 (J Inflamm Res); Qu et al., 2025Acupuncture stimulation activates the PPARγ receptor in macrophages, which in turn inhibits the TLR/MyD88 and NOD signaling pathways. The downstream IκBα/NF-κB and P38 MAPK cascades are subsequently suppressed — reducing inflammasome activation and production of proinflammatory mediators that drive tissue injury in autoimmune disease.
Li et al., 2021; Dou et al., 2021Acupuncture modulates the balance of helper T-cell populations, particularly the Th1/Th2 ratio relevant in allergic disease. Electroacupuncture at ST36 and SP6 promotes proliferation and differentiation of regulatory T cells (Treg) and increases anti-inflammatory IL-10 expression in local tissues, while suppressing Th17 cells and TNF-α — effectively shifting immune activation toward tolerance.
Li et al., 2021; Qu et al., 2025Acupuncture activates multiple neuro-immune pathways at the central level — including the cholinergic anti-inflammatory pathway, the vagal-adrenal medulla-dopamine axis, and sympathetic pathways — which ultimately act on immune cells via release of neurotransmitters and hormones. This explains how distal needling can achieve systemic anti-inflammatory effects far from the needle site.
Li et al., 2021; Dou et al., 2021At the acupoint, needle stimulation deforms connective tissue and upregulates secretion of signaling molecules that activate NF-κB, MAPK, and ERK pathways in mast cells, fibroblasts, keratinocytes, and monocytes/macrophages. Somatic afferents in these activated acupoints then convey signals to the spinal cord, brainstem, and hypothalamic neurons, bridging local and systemic immune modulation.
Li et al., 2021Multiple studies have documented acupuncture's effects on specific inflammatory biomarkers in RA patients, including reductions in ESR, CRP, rheumatoid factor (RF), TNF-α, and interleukins (IL-1, IL-6, IL-8, IL-10, IL-17, IL-23). Acupuncture also modulates the antioxidant system by enhancing SOD activity via the Nrf2/HO-1 pathway, eliminating excess oxygen free radicals and reducing oxidative inflammatory cell infiltration.
Chou & Chu, 2018; Li et al., 2021Clinical Evidence
A growing body of randomized controlled trials and systematic reviews has examined acupuncture's clinical effects across specific autoimmune and inflammatory conditions. The evidence below draws exclusively from the attached research literature.
Two major systematic reviews and meta-analyses have assessed acupuncture's effects on RA. Chou & Chu (2018) reviewed 43 studies spanning 1974–2018 and concluded that acupuncture — alone or combined with other modalities — is beneficial to the clinical conditions of RA, capable of improving function and quality of life, with no adverse effects reported across the surveyed literature.
Lu et al. (2022) conducted a more targeted meta-analysis of 12 RCTs encompassing 874 patients, directly comparing acupuncture and related techniques (ACNRT) combined with Western medicine (WM) against WM alone. Patients receiving integrated ACNRT/WM treatment showed significantly greater reductions across all primary inflammatory outcomes compared to Western medicine alone.
Proposed mechanisms from the Chou & Chu review include: anti-inflammatory effects (the single most-cited proposed mechanism, supported across the majority of included studies), regulation of immune system function, and antioxidative effects. Acupoint ST36 was the most commonly selected treatment point across all studies, followed by GB34, LI4, BL60, and GB39.
Hashimoto's thyroiditis (HT) is a prevalent autoimmune thyroid disorder characterized by autoantibodies targeting thyroid-specific antigens. Oral levothyroxine significantly improves thyroid function but does not reduce thyroid-related antibody concentrations — a gap that acupuncture appears to address.
Wang et al. (2024) conducted a systematic review and meta-analysis of 14 RCTs including 1,020 patients, comparing acupuncture against levothyroxine sodium tablets. Results showed that acupuncture significantly regulated key thyroid and immune biomarkers across all major outcomes. Compared to levothyroxine alone, acupuncture produced statistically significant reductions in thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb) — the defining autoantibodies of Hashimoto's — which conventional drug therapy does not address.
The authors concluded that acupuncture can significantly regulate TPOAb, TGAb, free thyroid hormone levels (FT3, FT4), and TSH — providing a measurable immunomodulatory benefit that complements conventional hormone replacement. Importantly, TSH normalization and thyroid hormone improvements were achieved in addition to the antibody reductions.
Allergic rhinitis (AR) is a type I chronic inflammatory disease of the nasal mucosa mediated by immunoglobulin E (IgE) after allergen exposure. Annual AR-related healthcare costs are approximately $20 billion worldwide. Drug therapy and allergen immunotherapy — the current mainstays — are limited by high recurrence rates and side effects, prompting research into acupuncture as a complementary option.
Dong et al. (2024) reviewed the clinical evidence base for acupuncture in AR and summarized multiple RCTs. A meta-analysis across 30 RCTs (Du et al., 2022, summarized within) found that compared to sham acupuncture and no treatment, acupuncture significantly reduced clinical symptom scores (SMD −0.29) and improved quality of life (SMD −0.23), while reducing drug use scores (SMD −0.3). Acupuncture was superior to conventional medical therapy in reducing symptom scores (SMD −0.48).
Qu et al. (2025) provided mechanistic detail, identifying that acupuncture modulates macrophage activity to improve allergic reactions by downregulating proinflammatory M1-type macrophages and upregulating anti-inflammatory M2-type macrophages. Key acupoints for allergic conditions include GV14 (Dazhui), CV17 (Danzhong), BL13 (Feishu), LU1 (Zhongfu), and ST36 (Zusanli).
Chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF) are debilitating conditions with no clearly established etiology and no definitive conventional treatments. Their immune and inflammatory underpinnings — including dysregulated cytokine profiles and neuroimmune dysfunction — make them a plausible candidate for acupuncture intervention.
Kim et al. (2015) conducted a three-arm, multicenter, non-blinded randomized controlled trial at four hospitals across South Korea. 150 participants were divided into Group A (body acupuncture), Group B (Sa-am acupuncture), and Group C (usual care control). Treatment groups received 10 sessions over 4 weeks. Primary outcome was the Fatigue Severity Scale (FSS) at 5 weeks.
Stress response inventory (SRI) scores were significantly lower in both treatment groups versus control at both 5 weeks (Group A: P=0.032; Group B: P<0.001) and 13 weeks (Group A: P=0.037; Group B: P<0.001). Numeric rating scale pain scores were significantly reduced versus controls at both time points for both groups (P<0.001 at 5 weeks). The authors concluded that body acupuncture added to usual care may help improve fatigue in CFS and ICF patients.
Regarding safety, 10 adverse events were reported by 10 participants total. Only 2 of these were determined to be linked to or possibly associated with acupuncture, both were mild, and all participants continued in the study. No serious adverse events related to acupuncture were reported.
The Science of Neuroimmune Crosstalk
One of the most significant advances in acupuncture research has been the mapping of neuroimmune crosstalk as the central mechanism linking needle stimulation at peripheral acupoints to measurable immune changes in distant target organs. Dou et al. (2021) published a comprehensive review in Frontiers in Neuroscience characterizing this multi-level system across three anatomical levels.
At the local acupoint level, needle stimulation activates TRPV1 and TRPV2 channels on mast cells, promoting degranulation and the release of histamine, adenosine, and immune mediators that interact with nerve endings to initiate neuroimmune signaling. Acupuncture also alleviates peripheral neurogenic inflammation by inhibiting substance P (SP) and calcitonin gene-related peptide (CGRP) from dorsal root ganglia.
At the site of inflammation, acupuncture recruits immune cells and promotes the release of opioid peptides, exerting direct analgesic and anti-inflammatory effects. At the central nervous system level, acupuncture inhibits crosstalk between glial cells and neurons via p38 MAPK, ERK, and JNK signaling pathways, reducing excitatory neurotransmitter release and promoting inhibitory neurotransmitter activity.
Safety Profile
Across the autoimmune and inflammatory conditions studied in the attached literature, acupuncture consistently demonstrated a favorable safety profile — an important consideration for populations already managing the significant side-effect burdens of immunosuppressive and anti-inflammatory pharmacotherapy.
The Chou & Chu (2018) systematic review of 43 RA studies spanning 44 years of research found that no adverse effects of acupuncture were reported across the surveyed literature — a consistent finding in a population of patients for whom conventional DMARDs, biologics, and NSAIDs carry serious safety considerations including infection risk and organ toxicity.
Chou & Chu (2018), 43 studies reviewedKim et al. (2015) reported 10 adverse events across 150 participants over a 13-week period. Only 2 were determined to be linked to or possibly associated with acupuncture — both were mild in severity. All participants who experienced adverse events improved and continued in the study. No serious adverse events related to acupuncture were reported.
Kim et al. (2015), multicenter RCT of 150 participantsIn the Lu et al. (2022) meta-analysis, one study reported three minor adverse events from acupuncture (tingling sensation, herpes zoster, and dyspepsia — the latter two considered unrelated to treatment). In the EA-plus-WM group, six patients reported minor events such as abnormal throat sensations and subcutaneous hematoma. The incidence rate was 6.06% — mild and self-resolving.
Lu et al. (2022), 12 RCTs, 874 patientsDong et al. (2024) describe acupuncture as having "good efficacy and safety" in the treatment of persistent allergic rhinitis, noting that clinical studies recorded a low incidence of adverse effects compared to pharmacological alternatives. Given the chronic nature of AR and its treatment, the tolerability profile of acupuncture supports its viability as a long-term adjunct option.
Dong et al. (2024), Int J General MedicineThe World Health Organization recommends acupuncture for the treatment of 16 inflammatory pain-related diseases, including rheumatoid arthritis, acute gastritis, inflammatory bowel disease, frozen shoulder, and allergic rhinitis. This institutional recognition reflects a broad consensus on acupuncture's acceptable safety profile across inflammatory presentations.
Dou et al. (2021); Li et al. (2021)While the safety profile is consistently described as favorable, individuals with autoimmune conditions should consult with both their rheumatologist or specialist and a licensed acupuncturist before beginning treatment. Certain immunosuppressive medications may affect healing at needle sites, and individualized treatment protocols should account for disease activity, medication regimen, and skin integrity.
General clinical guidance; Chou & Chu (2018)Important Context
Across the RA literature, acupuncture was most consistently evaluated as a complement to Western medicine (DMARDs, NSAIDs, biologics), not as a standalone replacement. The Lu et al. (2022) meta-analysis specifically examined integrated ACNRT+WM versus WM alone. Current evidence does not support discontinuing conventional disease-modifying therapy in favor of acupuncture.
Chou & Chu (2018) noted inconsistency regarding clinical efficacy across RA studies and a lack of well-designed human/animal double-blinded RCTs. Future research with higher methodological standards — including larger samples and standardized protocols — is needed before definitive efficacy claims can be established.
The Wang et al. (2024) meta-analysis found significant effects on thyroid antibodies and hormone levels, but noted that subgroup analysis for TGAb showed no statistically significant difference in treatment duration subgroups (I² = 31%, P = .23). Longer-term, higher-quality multicenter RCTs are needed to confirm and extend these findings for Hashimoto's thyroiditis.
The Kim et al. (2015) CFS trial was explicitly non-blinded — a recognized limitation. Expectation effects and therapeutic interaction cannot be fully disentangled from needle-specific effects in open-label designs. The authors acknowledged this limitation and called for more rigorously designed trials in this difficult-to-study population.
Integrative Approaches
The evidence consistently shows that acupuncture performs best as a component of a comprehensive, integrative care plan — complementing conventional immunomodulatory therapies, reducing medication burden, and addressing dimensions of autoimmune disease that drugs alone do not target, such as quality of life, fatigue, and pain.
The most consistent finding across RA studies is that combining acupuncture and related techniques (ACNRT) with conventional Western medicine produces better outcomes than Western medicine alone. The Lu et al. (2022) meta-analysis demonstrated significant improvements in CRP, ESR, VAS, and disease activity scores specifically in the combined treatment group — supporting acupuncture as a meaningful adjunct to DMARDs and biologics.
Electroacupuncture — which applies mild electrical current through acupuncture needles — appears in multiple studies within the RA meta-analysis and is noted by several authors as producing superior effects to manual acupuncture for inflammatory biomarker suppression. EA's specific activation of the vagal anti-inflammatory axis via the dopaminergic pathway makes it particularly relevant for systemic inflammatory conditions.
Several studies within the Chou & Chu (2018) RA review and the Lu et al. (2022) meta-analysis incorporated moxibustion (thermal acupoint stimulation with Artemisia vulgaris) alongside needling. Combined acupuncture-plus-moxibustion protocols were among the most commonly used and showed meaningful reductions in VAS pain scores (WMD −1.760 to −9.150) and inflammatory markers in RA patients.
For Hashimoto's thyroiditis, Wang et al. (2024) evaluated acupuncture against levothyroxine sodium tablet therapy. While drug therapy addresses thyroid hormone levels, acupuncture uniquely reduced autoantibody titers (TPOAb and TGAb) — suggesting complementary rather than competing mechanisms. A combined approach may address both hormone deficiency and immune dysregulation simultaneously.
In the Kim et al. (2015) CFS trial, both acupuncture arms were specifically evaluated as add-ons to usual care. This design is clinically meaningful: it reflects how acupuncture would realistically be implemented and demonstrates incremental benefit over baseline care, with improvements in fatigue, stress response, and pain scores sustained at 13 weeks of follow-up.
Qu et al. (2025) extend the macrophage polarization model to allergic asthma and atopic skin disorders in addition to rhinitis, noting that acupuncture's ability to modulate M1/M2 macrophage balance offers a common mechanism across the spectrum of type I allergic diseases. This suggests potential utility beyond rhinitis — though disease-specific clinical evidence varies in maturity.
Referenced Literature
All content presented on this page is drawn directly from the following peer-reviewed publications. Claims have not been extrapolated beyond what the studies demonstrate.