The study systematically reviewed 76 randomized controlled trials with 7,484 participants comparing different acupuncture-related therapies for ulcerative colitis (UC). AA + CHM (auricular acupressure + Chinese herbal medicine) significantly improved the overall effective rate (RR 1.71; 95% CI 1.47–1.99; SUCRA = 99.9%). Acupuncture combined therapy (ACU-CT) showed the best efficacy for improving the Mayo score (SMD -4.85; 95% CI -6.66 to -3.05; SUCRA = 97.5%). ACU-CT was also most effective in reducing Baron's endoscopic score (SMD −2.31; 95% CI −3.81 to −0.81; SUCRA = 84.1%). Warm acupuncture (WA) reduced IL‑6 levels the most (SMD -3.10; 95% CI -4.56 to -1.65; SUCRA = 96.1%) and WA‑CT reduced TNF‑α the most (SMD -2.32; 95% CI -4.54 to -0.10; SUCRA = 76.8%). Acupuncture (ACU) achieved the greatest reduction in relapse rate (OR 0.15; 95% CI 0.03–0.65; SUCRA = 89.3%). The SUCRA analysis showed that WA, ACU‑CT, WA‑CT, and acupoint catgut embedding (ACE) ranked highest in several evaluated outcomes. The study identified the most commonly used acupuncture points in UC including ST25, ST36, ST37, CV12, CV4, BL25, BL20, CV8 and others.