Acupuncture therapy has garnered growing attention and recognition in the clinical management of neurological disorders, attributed to its notable efficacy, favorable safety profile, and minimal adverse reactions. Over the past decade, the research paradigm of acupuncture for neurological diseases has shifted from verifying universal therapeutic effects to in-depth exploration of its action rules and underlying mechanisms, with continuous advancements toward a more profound understanding. Acupuncture has been extensively applied in major neurological conditions such as stroke, Parkinson's disease and Alzheimer's disease—two common neurodegenerative disorders—and substantial progress has been achieved in elucidating its mechanisms of action. Studies have demonstrated that acupuncture exerts unique advantages in improving motor dysfunction, cognitive impairment, and neural repair through multi-targeted, holistic regulation, with abundant and reliable evidence-based medical evidence accumulated particularly in post-stroke rehabilitation and primary insomnia. However, while advancing the standardization and normalization of acupuncture protocols, full consideration must be given to individual patient differences (e.g., age, disease stage, and constitution). Currently, high-quality evidence-based research on this therapy remains relatively insufficient, and its complex neurophysiological mechanisms urgently await further in-depth interpretation. This review summarizes the clinical research progress of acupuncture in treating neurological diseases over the past decade, aiming to provide a more practically instructive reference for the standardized application of acupuncture in the clinical diagnosis and treatment of neurological disorders.