Insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) are representative metabolic diseases, and no pharmacological therapeutic strategies have been developed worldwide. In recent studies, acupuncture has increasingly been used as an integrative or complementary therapy for IR and NAFLD. In this review, we summarized 18 clinical trials and 25 animal studies to reveal the function and potential molecular mechanisms of acupuncture for IR and NAFLD treatment. We found that acupuncture can be a first-line treatment strategy for IR and has a positive therapeutic effect on NAFLD. Thus, this review provides clinicians with a deeper understanding of the scientific evidence for acupuncture treatment of IR and NAFLD. Finally, we highlighted three potential limitations of existing studies on acupuncture for the treatment of IR and NAFLD, including small sample sizes and inconsistent operating techniques.