<p><b>Objectives: </b>The purpose of this ethnographic study was to describe the philosophy and practice of acupuncture practitioners in Japan and to explain philosophical concepts, diagnostic methods and treatment principles. This article summarizes the characteristics of Japanese acupuncture.</p> <p><b>Methods:</b> Between August 2012 and October 2018, ethnographic fieldwork was conducted in Japan. Thirty-eight participants were recruited by chain referral and emergent sampling. Data was collected through participant observation, interviews and by collecting documents. Twenty two participants agreed to clinical observation; 225 treatments were observed with 175 patients. Seventeen participants consented to formal interviews and 28 to informal interviews. Thematic analysis was used to critically evaluate data. </p> <p><b>Results:</b> Japanese acupuncture can be described in terms of philosophical concepts, diagnostic methods and treatment principles. Regarding Traditional East Asian Medicine knowledge, Ki, channels and the 8 principles are emphasised in Japanese acupuncture. Inquiry and palpation are the most significant diagnostic methods. These diagnostic methods often result in simple patterns of disharmony or the location of abnormal body tissue. In treatment, tool manipulation and stimulation is performed in small amounts over many treatment locations. Needle and moxibustion methods are minimally intrusive and dependent on immediate feedback to gauge treatment success. </p> <p><b>Conclusion:</b> Japanese acupuncture is a unique system of traditional medicine that stands apart from Chinese acupuncture. An enhanced understanding of Japanese acupuncture could benefit acupuncture at government, research, education and clinical levels, with the goal of providing better care for individual patients all over the world. </p>