Since the first report of the success of acupuncture anesthesia in the 1970s, much attention has been drawn to the effectiveness of acupuncture therapy worldwide . Analgesia is one of the most important effects of acupuncture. Generally, the mechanisms of acupuncture analgesia contain mechanisms of acupuncture anesthesia, but the latter does not represent the entirety of acupuncture analgesia. Indeed, acupuncture treats not only acute or transient pain, but also chronic or persistent pain resulting from inflammation or other causes. Clinically, pain usually occurs before acupuncture; needling or moxibustion can be used for treatment. For acupuncture anesthesia, an acupuncture induction period is required before surgery and only needling or acupressure can be applied. Additionally, surgical pain belongs to the category of acute pain. However, most modern studies on the mechanisms of acupuncture analgesia are conducted focusing on the mechanisms of acupuncture anesthesia. In the following discussion, we will first review these studies on acupuncture anesthesia, then provide further explanation on the mechanisms of clinical acupuncture analgesia, and finally analyze their implications in improving analgesia outcomes clinical. Mainly, the mechanisms of acupuncture anesthesia or analgesia include two closely associated aspects: neuronal and humoral mechanisms [27].1.1. Neural Mechanisms The qi arrival effect, literally meaning that pain is eliminated instantly when needling sensations are acquired after needle insertion, is a familiar clinical fact when acupuncture is used to treat certain types of pain. Of course, such rapid responses are not the result of changes in humoral factors. There have been similar successes during anesthesia, ear needling is often used. By stimulating the sensory receptors at the ear points, signals entering the body are transmitted through the trigeminal lemniscus instead of the spinal cord. Studies have demonstrated that the anterior and posterior parts of the spinal tract core of the trigeminal nerve have feedback effects similar to those of the posterior horn gate system of the spinal cord, which could be used to modulate the transmission of pain impulses . This could explain why ear acupuncture has analgesic effects on surgical or painful irritations of the head and face. However, the anesthesia effects of auricular acupuncture during thoracic and abdominal surgeries cannot be explained by any hypothesis about gate control occurring either at the posterior horns of the spinal cord or at the core of the spinal cord. spinal tract of the trigeminal nerve. [27].