The occurrence of ischemic stroke is closely related to multiple inflammatory pathways

and acupuncture can improve neurological function in ischemic stroke by regulating inflammatory signaling pathways. At the level of pattern recognition receptors

acupuncture can inhibit high mobility group box 1 (HMGB1)/Toll-like receptor 4 (TLR4)

NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome

and cyclic GMP-AMP synthase(cGAS)/stimulator of interferon genes (STING) pathways

thereby inhibiting excessive activation of innate immunity. At the level of transcription factors

acupuncture can downregulate pro-inflammatory signals such as nuclear factor-κ B (NF-κ B) and Janus kinase (JAK)/signal transducer and activator of transcription (STAT)

and activate protective pathways such as nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) and peroxisome proliferator-activated receptor γ(PPAR-γ)

promoting microglial polarization toward an anti-inflammatory phenotype. At the level of kinase signaling

acupuncture synergistically exerts anti-inflammatory and neuroprotective effects by inhibiting the mitogen-activated protein kinase (MAPK) pathway and activating the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway. Through coordinated regulation at multiple levels and multiple pathways

acupuncture systematically exerts multi-target anti-inflammatory effects

providing a basis for mechanistic research and clinical intervention in ischemic stroke.