BACKGROUND The National Institutes of Health Consensus Panel on Acupuncture has listed as a priority the study comparing indications and patterns of use of acupuncture in different countries. METHODS I visited an outpatient acupuncture clinic in China and reviewed the clinical files. A MEDLINE search was done to compare the use of acupuncture in North America and China. RESULTS The most common disorder treated in the clinic was musculoskeletal pain. Less common indications included stroke rehabilitation, Bell's palsy, cholelithiasis, tinnitus, insomnia, migraine, and visceral pain. In North America, acupuncture is primarily for pain relief. Other uses include stroke rehabilitation, various emetic problems, migraine, and various addictions. CONCLUSIONS Acupuncture is most frequently used in China and North America for pain relief. Other common indications include peripheral nerve palsy, peripheral nerve neuralgia, stroke rehabilitation, psychoemotional disorders, migraine, visceral pain, emesis, asthma, and tinnitus. Acupuncture for cholelithiasis in China but not in the United States suggests a novel use of this modality.