Acupuncture is the most extensively researched modality under the umbrella of both traditional Chinese medicine (TCM) and traditional Chinese veterinary medicine (TCVM). It has been demonstrated that it induces local, segmental, central and autonomic effects, many of which have the potential to strongly decrease nociceptive signals and pain perception. Acupuncture has been used for many equine clinical conditions including lameness and is now a familiar treatment modality to both horse owners and equine veterinary practitioners. This paper will review the main factors that impact clinical results, describe treatment plans for common lameness presentations, and outline several case examples.