Acupuncture for Autism Spectrum Disorder by Targeting the Endocannabinoid System

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by deficits in social communication and the presence of restricted, repetitive behaviors. Given the limited pharmacological interventions available for core symptoms, complementary therapies including acupuncture have garnered growing research interest. Concurrently, the endocannabinoid system (ECS) has emerged as a critical neuromodulatory network implicated in ASD pathophysiology. This review synthesizes the burgeoning evidence suggesting that acupuncture may exert its therapeutic effects in ASD by targeting the ECS. We explore two key mechanistic pathways: the modulation of central neurotransmitter networks dopamine, serotonin, and gamma-aminobutyric acid/glutamate that are dysregulated in ASD and modulated by the ECS, as well as the regulation of neuroinflammation, a defining pathological feature of ASD. We detail how acupuncture, particularly electroacupuncture, can mitigate central and peripheral inflammation by influencing microglial activation and cytokine profiles, often through the microbiota–gut–brain axis, a pathway intricately linked to both the ECS and the vagus nerve. By activating cannabinoid receptors (CB1 and CB2), acupuncture appears to restore neurochemical balance and attenuate the inflammatory cascade. This review synthesizes preclinical and clinical evidence to propose the ECS as a key mediator of acupuncture multisystem actions, thereby providing a novel framework for understanding acupunctures’ therapeutic potential in ASD.