The legislation of traditional Chinese medicine(TCM) acupuncture and moxibustion represents the recognition and protection of the TCM acupuncture and moxibustion industry，marking an important symbol of the mature development of the acupuncture and moxibustion sector overseas.It is also an inevitable trend in the internationalization of TCM.As the two major countries in North America，the United States and Canada share similar national systems and legal frameworks，making them typical and representative examples among countries with acupuncture and moxibustion legislation.North America is currently the region with the most acupuncture and moxibustion-related bills and the most comprehensive legal system for TCM.By reviewing the historical process and general status of acupuncture and moxibustion legislation in the United States and Canada，it is observed that both countries share a long and challenging legislative journey，with similar legislative procedures.However，there are differences in their legislative methods，orientations，and attitudes.A comparative analysis of acupuncture and moxibustion legislation in these two countries，combined with the overall trends in international acupuncture and moxibustion legislation，suggests that during the process of TCM legislation overseas，it is crucial to further advance national-level legislation for TCM acupuncture and moxibustion，including accelerating the inclusion of acupuncture and moxibustion in medical insurance systems and expanding the overall scope of TCM and acupuncture and moxibustion legislation.These efforts will provide valuable insights for the establishment of a legal status for TCM abroad and facilitate the international dissemination of TCM.