Abstract: Breast cancer is the most prevalent malignant tumor among women worldwide. For patients with hormone receptor (HR)-positive breast cancer, aromatase inhibitors (AIs) serve as the cornerstone of endocrine therapy. However, the incidence of aromatase inhibitor-related musculoskeletal symptoms (AIMSS) exceeds 47%, often manifesting as joint pain, morning stiffness, and functional limitations, which significantly reduce patients' quality of life and may lead to decreased treatment compliance, thereby increasing the risk of disease recurrence and metastasis. Existing evidence suggests that the pathogenesis of AIMSS is closely related to a chronic low-grade inflammatory state, involving abnormal activation of pro-inflammatory cytokines (such as IL-6 and TNF-α). Although acupuncture, as an external treatment method of traditional Chinese medicine, has potential advantages in alleviating pain and regulating immunity, its clinical efficacy and anti-inflammatory mechanisms urgently require systematic validation. This review summarized the epidemiology, pathophysiology, and current management strategies of AIMSS, and focused on exploring the potential molecular mechanisms by which acupuncture alleviated AIMSS through regulating inflammatory pathways, aiming to provide a theoretical basis and research direction for integrated traditional Chinese and western medicine interventions.