In recent years, a growing body of research has demonstrated that acupuncture can be used to effectively treat a diverse range of diseases, including functional gastrointestinal disorders, cardiovascular diseases, as well as anxiety and depression, through the modulation of the paraventricular hypothalamic nucleus (PVN). Acupuncture may exert its therapeutic effect either by modulating specific neurons within the PVN, such as corticotropin releasing hormone (CRH) neurons, or by regulating the release of hormones, such as oxytocin (OXT) and vasopressin (VP), and the activity of neural circuits associated with the PVN. This review summarizes the mechanisms by which PVN is involved in acupuncture treatment, including its regulatory mechanisms in gastrointestinal diseases, cardiovascular diseases, and negative emotions and pain. Future research should be conducted to further explore the precise mechanisms by which acupuncture regulates PVN to treat diseases, focusing on clarifying the specific processes of signaling pathway transduction, and exploring the specific effects of acupunture of different acupoint combinations and stimulation frequencies and intensity on PVN.