This presentation reviews the application and theory of acupuncture and Traditional Chinese Medicine (TCM) in exotic patients (companion mammals, reptiles, fish, and wildlife). Species-specific anatomical and physiological factors are reviewed to guide safe point selection, needling technique, and treatment modification, particularly in scaleless, scaled, and aquatic animals. Recent studies and clinical reports suggest potential benefits in managing pain, musculoskeletal injury, neurologic disorders, gastrointestinal dysfunction, systemic inflammation, and stress-related illness across these diverse taxa. Case discussions illustrate how these modalities can complement conventional medicine, especially in situations with limited diagnostic access or when standard therapies are poorly tolerated.