Integrating evidence from clinical and animal studies, our findings demonstrate that acupuncture can effectively modulate insulin resistance and metabolic disturbances in women with PCOS by regulating the bile acid–insulin resistance metabolic axis, offering a non-pharmacological therapeutic option for this condition, enhancing understanding of acupuncture’s multi-level regulatory effects on endocrine and metabolic dysfunction, underscoring its potential as a comprehensive intervention. The gene discussed is INS; the disease is polycystic ovary syndrome.