BACKGROUND: Acupuncture and moxibustion, as traditional therapies in Chinese medicine, are widely recognized for their therapeutic effects, particularly in pain relief. Nevertheless, the exact mechanisms underlying their analgesic effects remain to be fully elucidated. Advancements in neuroimaging techniques have opened a novel pathway for investigating alterations in brain function resulting from acupuncture and moxibustion analgesia. PURPOSE: The purpose of this study was to investigate the brain regions activated during acupuncture and moxibustion treatment for pathological pain using neuroimaging, to better understand the underlying analgesic mechanisms. PATIENTS AND METHODS: An electronic search of PubMed was conducted using the keywords "acupuncture", "moxibustion", "analgesia", and "neuroimaging". A total of 37 articles, focusing on 14 diseases, were identified and analyzed. RESULTS: Acupuncture primarily activated regions in the frontal, parietal, and temporal lobes, with key areas including the anterior cingulate cortex (ACC), insula, prefrontal cortex (PFC), and primary somatosensory cortex (S1). Different stimulation modes and disease types produced distinct patterns of brain region activation. CONCLUSION: Acupuncture and moxibustion modulate key brain regions involved in pain perception, emotional regulation, and cognitive functions. Acupuncture predominantly affects the sensory cortex, enhancing pain perception, while moxibustion has a more pronounced effect on the limbic system and thalamus, influencing emotional and cognitive aspects of pain. The findings indicate that acupuncture and moxibustion serve as effective non-pharmacological therapies for pain management, offering valuable insights into their underlying analgesic mechanisms. Future research should focus on further elucidating these mechanisms and optimizing clinical applications.