Ulcerative colitis (UC) is a chronic inflammatory bowel disorder. Currently, the global incidence of UC has significantly increased. Traditional treatment methods are relatively limited, with generally poor efficacy and many side effects. In contrast, acupuncture holds great promise due to its significant efficacy, reduced relapse rate, and minimal side effects. In recent years, basic research on acupuncture treatment for UC has achieved substantial progress. However, the specific targets and pathways involved are still unclear. Therefore, this review aims to summarize and consolidate the mechanisms of acupuncture and acupuncture combined with drug therapy for UC. We primarily review the mechanisms of acupuncture treatment for UC from two aspects: intestinal inflammation and intestinal barrier. In terms of intestinal inflammation, acupuncture improves UC by regulating various inflammatory molecules such as TNF-alpha, IL-1beta, IL-10, NF-kappaB, and immune cells such as neutrophils, Th1, Th2, Treg, Th17. Concerning the intestinal barrier, we focus on the impact of acupuncture on the damage to intestinal epithelial cells (IECs). Moreover, acupuncture also possesses the capacity to reshape the gut microbiota, thereby repairing the biological barrier. Furthermore, the combination of acupuncture and medication for treating UC is a promising direction, which requires further exploration by researchers. This review thoroughly explains the molecular mechanisms of acupuncture in treating UC, establishing a foundation for further research on the effectiveness of acupuncture in UC treatment and offering a new perspective on the combination of acupuncture and medication. Key words Acupuncture " Electroacupuncture " Ulcerative colitis " Intestinal inflammation " Intestinal barrier.