Objectives: Acupuncture restores the flow of vital energy in the body by stimulating the organ-specific meridians and enhances cardiac vagal activity and suppresses sympathetic activity. The purpose of this review is to summarize and evaluate the acupuncture studies on autonomic nervous system (ANS). Methods: We conducted a PubMed search to obtain a fair sample of acupuncture studies related ANS published in English in 2007. Each article was reviewed for study objectives and outcomes, as well as acupuncture points, experimental and control interventions. Results: We reviewed a total of 15 studies published from 1997 to 2007. In normal states, acupuncture enhanced either vagal or sympathetic tone depending on the stimulated acupuncture point sites. On the other hand, most of studies demonstrated that acupuncture restored the autonomic dysfunctions in various kinds of stressful states. Conclusions: We reviewed studies that contributed to an understanding of the autonomic mechanisms of acupuncture with the hope that this review will be of benefit to the future studies. Although the relationship between acupuncture and ANS response is still uncertain, acupuncture would be a noteworthy modality for modulating autonomic dysfunction.