Elephants in general are the largest land-dwelling mammals on earth. They are strong, powerful creatures but are also highly intelligent animals capable of independent thought and action. In captivity they have a number of disease conditions that respond to veterinary treatment. Although information is limited, acupuncture has been used as an adjunctive therapy in elephants for conditions such as pain management, paralysis, and lameness. An elephant has deeply grounded Qi and is enormously responsive to body stimulation of any kind. This makes them an excellent candidate for acupuncture treatment. Descriptions of the location of acupuncture points in the elephant, however, are sparse. Additionally, elephants lack many of the visible or palpable landmarks used to identify acupuncture points in domestic species. The acupoints presented in the figures and tables in this article are predominantly from the transpositional point system used in domestic species; however, other systems (Chakra, microsystems, vital energy areas) used successfully by the author are also documented for practitioners to consider for unique consideration when treating this species. Guidance on safely working with an elephant through using a considerate, careful approach (due to their massive size) is emphasized. A clinical case of a 46-year-old Asian elephant that developed difficulty walking after a fall and had become recumbent, is presented. After failure of allopathic treatments, a successful traditional Chinese medicine approach is described using acupuncture points and areas of energy illustrated in the figures of this article.