To determine the effects of manual acupuncture stimulation (MAS) on skin sympathetic nerve activity (SSNA), SSNA and skin blood flow (SBF) were measured during a resting period and during MAS. Twelve healthy male subjects were divided into an acupuncture group (n = 7) and a control group (n = 5). SSNA was recorded from the left median nerve at the elbow using microneurography, while SBF was recorded using laser Doppler flowmeter. In the acupuncture group, MAS was delivered to LI 4 point in the right thenar muscle. The acupuncture needle was retained for 2 minutes before being removed. SSNA and SBF recordings were performed for a total of 12 minutes, from 5 minutes prior to MAS until the end of the trial. In the control group, the 2-minute period of acupuncture was replaced by 2 minutes of rest. During the first minute of MAS, we observed an increase in SSNA accompanied by a reduction in SBF. In the acupuncture group, these parameters returned to baseline values in the second minute of MAS. Parameters in the control group were unchanged throughout the experimental procedure. A significant negative correlation was observed between changes in SSNA and SBF during the first minute of MAS. In addition, a negative correlation was demonstrated between the basal value of SSNA and the change in SSNA in response to MAS. These results suggest that MAS elicited a transient increase in SSNA and that this increase is dependent on the baseline of SSNA.