Acupuncture-driven exosomes: an emerging therapy

doi:10.19852/j.cnki.jtcm.2026.03.017

Abstract

Abstract:

Acupuncture, as a significant component of Traditional Chinese Medicine (TCM), has attracted increased attention for its mechanism of controlling the physiological functions of the human body and promoting the recovery of diseases by stimulating specific acupoints. Despite its long history and wide clinical application, the mechanism of action of acupuncture is still not fully understood. More research needs to be done on how acupuncture affects molecular communication and cellular function. Exosomes are nanoscale vesicles that rely on cellular multivesicular bodies (MVBs) fused with cell membranes to be released into the extracellular matrix. They are crucial for information transfer between cells and are currently a hot research topic in the world’s cutting-edge life sciences. Previous research has demonstrated that the therapeutic effect of acupuncture may be related to stimulating certain cells to secrete exosomes, that exosomes released may contain “acupuncture information”, and that manipulating the back-injection of exosomes to produces “acupuncture-like” effects. These findings suggest that exosomes could serve as a bridge between conventional acupuncture therapy and modern precision medicine. They also offer fresh prospects and difficulties for acupuncture translational medicine research. To better define the relationship between exosomes and acupuncture, we reviewed and systematized the literature on past studies related to exosomes and acupuncture. This paper provides a significant theoretical and experimental foundation for applying exosomes in precision medicine by summarizing and analyzing the relationship between acupuncture stimulation and exosome function. This is expected to promote the combination of traditional acupuncture therapy and modern biotechnology and bring innovation and progress to future medical practice.

Key words: acupuncture, exosomes, network regulation, medicine, Chinese traditional, mechanisms, review

JIAN Jiawei, DING Zhimin, ZHUANG Yueyang, WANG Junzi, YANG Minguang, LIU Weilin. Acupuncture-driven exosomes: an emerging therapy[J]. Journal of Traditional Chinese Medicine, 2026, 46(3): 768-778.

Figures/Tables 4

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Exosome source	Study	Acupoint	Disease	Active ingredient	Mechanism
Serum	Liang XS et al 2023³⁶	Jiaji (EX-B2)	Spinal cord injury	-	Inhibit the inflammatory response
	Kuang HJ et al 2022¹⁰	Tianshu (ST25), Dachangshu (BL25)	Slow transit constipation	miR-34c-5p	Stem cell factor/c-kit signaling pathway
	Klein JD et al 2018¹¹	Yanglingquan (GB34), Zusanli (ST36)	Normal mice	miR-181	Increase renal blood flow
	Huang Y et al 2021³⁸	Yanglingquan (GB34), Zusanli (ST36)	Normal mice	let-7c-5p	Increase protein synthesis
	Liu YP et al 2022¹²	Huantiao (GB30), Zusanli (ST36)	Peripheral nerve injury	miR-21	Promote neurite outgrowth
	Zhang Q 2020⁴⁰	Heding (EX-LE2), Neixiyan (EX-LE4), Dubi (ST35), Xuehai (SP10), Liangqiu (ST34), Yinlinquan (SP9), Yanglingquan (GB34), Zusanli (ST36)	Knee osteoarthritis	miR-338-3p, miR-15b-3p, miR-199b-5p, miR-3168, miR-1296-5p	MAPK pathway and apoptosis
	Liu L et al 2022⁴²	Baihui (GV20), Shuaigu (GB8), Fengchi (GB20)	Migraine without aura	has-miR-369-5p, has-miR-145-5p, has-miR-5010-3p	-
	Liang BX et al 2025³⁷	Neiguan (PC6), Gongsun (SP4)	Coronary atherosclerosis	circ_0001439S	Inhibit lipid deposition
	Ling FY 2024⁴¹	Neiguan (PC6), Zusanli (ST36), Yinxi (HT6)	Acute myocardial ischemia-percu-taneous coronary intervention	hsa-miR-151b, hsa-miR-4454	MAPK pathway
Plasma	Ding R et al 2024⁴³	Neiyingxiang (EX-HN9)	Allergic rhinitis	rno-miR-92a-3p, rno-let-7d-3p	MAPK pathway
	Xu SY et al 2022⁴⁴	Renzhong (GV26), Baihui (GV20)	Hypoxia-induced human umbilical vein endothelial cells	miR-210	HIF-1α/VEGF/Notch 1 signal pathway
	Shou Y et al 2019⁴⁵	Zusanli (ST36), Pishu (BL20)	Type 2 diabetes mellitus	circINPP4B	Regulation of thyroid hormone and phosphatidylinositol signaling
	Shou Y et al 2025⁴⁶	Zusanli (ST36), Pishu (BL20)	Type 2 diabetes mellitus	CircEZH1	Exosomal CircEZH1-mediated β-cell survival and insulin secretion pathway
	Hou ZN 2022⁴⁷	Daimai (GB26), Zhongwan (CV12), Liangmen (ST21), Tianshu (ST25), Daheng (SP15), Shuidao (ST28), Zusanli (ST36), Shangjuxu (ST37), Fenglong (ST40), Zulinqi (GB41)	Abdominal obesity	has-miR-125a-5p, has-miR-361-3p, has-miR-486-5p	p38MAPK/TNF-α pathway
	Qin HY 2024⁵⁴	Quchi (LI11), Sanyinjiao (SP6), Xuehai (SP10)	Urticaria	FcεRI	IgE/FcεRI pathway
Immune cells	Wang K 2023⁴⁸	Tianshu (ST25), Zusanli (ST36), Taichong (LR3)	Irritable bowel syndrome with diarrhea	miR-22-5p, miR-149-5p	Regulation of tight junction protein expression and repair of intestinal epithelial barrier function
Others	Pan Y 2022⁴⁹	Zigong (EX-CA1), Guanyuan (CV4), Sanyinjiao (SP6)	Intrauterine adhesions	-	Improve endometrial tolerance and promote endometrial repair
	Zou Y et al 2021⁵⁰	Feishu (BL13), Zusanli (ST36)	Chronic obstructive pulmonary disease	-	Inhibition of NLRP3 inflammatory vesicles
	Zhang SH et al 2020⁹	Quchi (LI11), Zusanli (ST36)	Ischemic stroke	miR-146b	Promoting differentiation of endogenous neural stem cells

Exosome source	Study	Acupoint	Disease	Active ingredient	Mechanism
Serum	Liang XS et al 2023³⁶	Jiaji (EX-B2)	Spinal cord injury	-	Inhibit the inflammatory response
	Kuang HJ et al 2022¹⁰	Tianshu (ST25), Dachangshu (BL25)	Slow transit constipation	miR-34c-5p	Stem cell factor/c-kit signaling pathway
	Klein JD et al 2018¹¹	Yanglingquan (GB34), Zusanli (ST36)	Normal mice	miR-181	Increase renal blood flow
	Huang Y et al 2021³⁸	Yanglingquan (GB34), Zusanli (ST36)	Normal mice	let-7c-5p	Increase protein synthesis
	Liu YP et al 2022¹²	Huantiao (GB30), Zusanli (ST36)	Peripheral nerve injury	miR-21	Promote neurite outgrowth
	Zhang Q 2020⁴⁰	Heding (EX-LE2), Neixiyan (EX-LE4), Dubi (ST35), Xuehai (SP10), Liangqiu (ST34), Yinlinquan (SP9), Yanglingquan (GB34), Zusanli (ST36)	Knee osteoarthritis	miR-338-3p, miR-15b-3p, miR-199b-5p, miR-3168, miR-1296-5p	MAPK pathway and apoptosis
	Liu L et al 2022⁴²	Baihui (GV20), Shuaigu (GB8), Fengchi (GB20)	Migraine without aura	has-miR-369-5p, has-miR-145-5p, has-miR-5010-3p	-
	Liang BX et al 2025³⁷	Neiguan (PC6), Gongsun (SP4)	Coronary atherosclerosis	circ_0001439S	Inhibit lipid deposition
	Ling FY 2024⁴¹	Neiguan (PC6), Zusanli (ST36), Yinxi (HT6)	Acute myocardial ischemia-percu-taneous coronary intervention	hsa-miR-151b, hsa-miR-4454	MAPK pathway
Plasma	Ding R et al 2024⁴³	Neiyingxiang (EX-HN9)	Allergic rhinitis	rno-miR-92a-3p, rno-let-7d-3p	MAPK pathway
	Xu SY et al 2022⁴⁴	Renzhong (GV26), Baihui (GV20)	Hypoxia-induced human umbilical vein endothelial cells	miR-210	HIF-1α/VEGF/Notch 1 signal pathway
	Shou Y et al 2019⁴⁵	Zusanli (ST36), Pishu (BL20)	Type 2 diabetes mellitus	circINPP4B	Regulation of thyroid hormone and phosphatidylinositol signaling
	Shou Y et al 2025⁴⁶	Zusanli (ST36), Pishu (BL20)	Type 2 diabetes mellitus	CircEZH1	Exosomal CircEZH1-mediated β-cell survival and insulin secretion pathway
	Hou ZN 2022⁴⁷	Daimai (GB26), Zhongwan (CV12), Liangmen (ST21), Tianshu (ST25), Daheng (SP15), Shuidao (ST28), Zusanli (ST36), Shangjuxu (ST37), Fenglong (ST40), Zulinqi (GB41)	Abdominal obesity	has-miR-125a-5p, has-miR-361-3p, has-miR-486-5p	p38MAPK/TNF-α pathway
	Qin HY 2024⁵⁴	Quchi (LI11), Sanyinjiao (SP6), Xuehai (SP10)	Urticaria	FcεRI	IgE/FcεRI pathway
Immune cells	Wang K 2023⁴⁸	Tianshu (ST25), Zusanli (ST36), Taichong (LR3)	Irritable bowel syndrome with diarrhea	miR-22-5p, miR-149-5p	Regulation of tight junction protein expression and repair of intestinal epithelial barrier function
Others	Pan Y 2022⁴⁹	Zigong (EX-CA1), Guanyuan (CV4), Sanyinjiao (SP6)	Intrauterine adhesions	-	Improve endometrial tolerance and promote endometrial repair
	Zou Y et al 2021⁵⁰	Feishu (BL13), Zusanli (ST36)	Chronic obstructive pulmonary disease	-	Inhibition of NLRP3 inflammatory vesicles
	Zhang SH et al 2020⁹	Quchi (LI11), Zusanli (ST36)	Ischemic stroke	miR-146b	Promoting differentiation of endogenous neural stem cells

Study	Acupoint	Disease	Acu-exo
Study	Acupoint	Disease	Source	Administration	Concentration	Dosage
Zhang JY et al 2023⁵¹	Zusanli (ST36)	Sepsis	Normal mice	ip	0.4 mg/mL	0.1 mL/10 g
Yang KJ et al 2022⁵³	Zusanli (ST36), Huantiao (GB30)	Adjuvant arthritis	Normal rat	Articular injection	2.6 mg/mL	0.1 mL
Xu SY et al 2022⁵⁵	Renzhong (GV26), Baihui (GV20)	Cerebral ischemia-reperfusion	MCAO	icv	/	20 μL
Chen Yet al 2024⁵²	Zusanli (ST36)	Sepsis-cardiomyopathy	Normal mice	ip	/	4 mg/kg
Shan K et al 2021⁵⁶	Zusanli (ST36)	Hypoxic	Normal mice	ip	0.4 mg/ mL	0.1 mL/10 g

Study	Acupoint	Disease	Acu-exo
Study	Acupoint	Disease	Source	Administration	Concentration	Dosage
Zhang JY et al 2023⁵¹	Zusanli (ST36)	Sepsis	Normal mice	ip	0.4 mg/mL	0.1 mL/10 g
Yang KJ et al 2022⁵³	Zusanli (ST36), Huantiao (GB30)	Adjuvant arthritis	Normal rat	Articular injection	2.6 mg/mL	0.1 mL
Xu SY et al 2022⁵⁵	Renzhong (GV26), Baihui (GV20)	Cerebral ischemia-reperfusion	MCAO	icv	/	20 μL
Chen Yet al 2024⁵²	Zusanli (ST36)	Sepsis-cardiomyopathy	Normal mice	ip	/	4 mg/kg
Shan K et al 2021⁵⁶	Zusanli (ST36)	Hypoxic	Normal mice	ip	0.4 mg/ mL	0.1 mL/10 g

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