The exosome, released from mast cells, T cells, B cells and many other types of cells, is the common form of vesicle transportation between cells and participates in the exchange of information between cells, and may be also involved in acupuncture induced clinical effects. In the present paper, the authors reviewed recent development of researches on this field from 1) acupuncture stimulation induces changes of number and function of mast cells in the local acupoint area, probably being the key factor for initiating acupuncture effect; 2) acupuncture stimulation induces release of neurotransmitters, hormones, cytokines, Ca2+, etc., in the local acupoint region, possibly being closely associated with the production of clinical effects; 3) acupuncture stimulation results in excitation of sensory afferent nerve fibers, triggering neuro-regulation; 4) exosomes derived from mast cells contain multiple neurotransmitters, hormones, cytokines, etc. to activate immune cells and sensory afferent fibers, inducing immuno-regulation and neuro-regulation; and 5) acupuncture stimulation induced release of Ca2+, ATP, etc. may potentiate release and transportation of exosomes. However, current researches are lack of excavation of network connection and transformation from basic research to clinical application. The authors hold that the exosome, released from mast cells by needling acupoints, acts as a messenger in network connection of nerve-mast cell-signal molecule in the body and may be one of the key factors of therapeutic effects.