〔Abstract〕 This review summarizes the research on using acupuncture to improve heart rate variability (HRV) in the past five years. HRV is the change in heart rate between different points in time. It is a valuable indicator that reflects the activity of the autonomic nervous system and quantitatively evaluates the tone and balance of cardiac sympathetic nerves and vagus nerves. Acupuncture can adjust the balance of autonomic nerves, change sympathetic/parasympathetic nerve tension, and thereby change HRV. Based on the regulation effect of acupuncture and moxibustion on HRV in patients with various diseases, this study discusses the clinical efficacy and operation methods of acupuncture and moxibustion to improve HRV. Acupuncture is highly operable to improve HRV, has good clinical efficacy, and has no obvious adverse reactions.