Acupuncture, as a traditional medicine applied worldwide, is considered an effective treatment for numerous chronic diseases. Many researches have explored the biological mechanisms of acupuncture, including the skin-neuro-immune axis and inflammation-immune modulation. However, traditional acupuncture faces several limitations, such as its complex operation, the wide variety of acupoint combinations, long treatment durations, and susceptibility to individual differences between the practitioner and the patient. These challenges highlight the urgent need for intelligent medical devices that enable more precise and efficient modern acupuncture treatment. In response to this, this manuscript introduces engineered acupuncture needles (EANs) using techniques such as macroscopic mechanical etching, microscopic surface modification, and biomedical nanotechnology. These modified needles enhance acupuncture treatment by incorporating drug delivery, electrical stimulation, and thermal stimulation technologies. Here we provide an overview of recent advancements in EANs in terms of materials, fabrication methods, engineering technologies, acupoints, as well as disease models. The relevant bottlenecks and future prospects of their development are also discussed.