not-yet-known not-yet-known not-yet-known unknown Discussion: Although acupuncture is used to treat a wide range of conditions, the evidence base for clinical efficacy is largely limited to back and neck pain, assisted conception, idiopathic headache, and nausea/vomiting caused by chemotherapy or in a postoperative setting (5). One must be willing to accept a certain risk of complications as long as there is an evidence-based indication for acupuncture. However, our patient was in severe respiratory distress when she was admitted, and her condition had most likely worsened quickly due to low oxygen saturation and the development of a tension pneumothorax, with a chest X-ray showing moderate displacement of the mediastinum to the left side. The sequence of events in our case suggests a clear relationship between acupuncture and pneumothorax. Unlike most iatrogenic causes of pneumothorax, our patient’s symptoms developed much later. This might be due to the size of the bronchopleural fistula formed by the acupuncture needle. A small pneumothorax may be completely asymptomatic or develop symptoms later. Our patient’s initial X-ray did not reveal the presence of a big pneumothorax, but she quickly deteriorated. A malfunction in the ball valve mechanism could result in rapid worsening of the patient’s clinical condition, posing an immediate threat to life (6). As a result, the patient was treated with a chest tube, but it took two days before the size of the pneumothorax was reduced and the symptoms were relieved. Pneumothorax can be treated with both chest tubes and pigtails. Pigtails, when compared to chest tubes, are simple to install, have reduced complication rates, and are connected with early and effective removal and a shorter duration of hospital stay (7). The use of pigtails could also have been considered for our patient. As the number of acupuncture patients and practitioners grows, so will the complications of these practices. The rate of serious adverse events was found to be very low, 0.05 per 10,000 treatments, with pneumothorax being the most common adverse event, even accounting for deaths (8). Acupuncture-related adverse events were primarily caused by the patient’s mental tension, the doctor’s improper operation, and the inadequacy of sterilization. The majority of them are avoidable by standardizing teaching and clinical practices. Making the necessary safety standards can significantly reduce the risk of adverse events and protect patient safety to the greatest extent possible (9).