Objective: To investigate whether early acupuncture affects arousal in rats with traumatic brain injury (TBI) by regulating P2rx7 receptor-mediated neuronal activity in the ventrolateral periaqueductal gray (vPAG) region. Methods: Forty-eight male Sprague-Dawley rats were randomly divided into four groups (n=12 each): control (Con), sham, model (Mod), and acupuncture (Acu). TBI was induced in the Mod and Acu groups using an electronic controlled cortical impact (eCCI) device. The sham group underwent craniotomy only without cortical impact, and the Con group received standardized housing. Injury severity and recovery were assessed using the Level I-VI consciousness scale, coma duration measurement, and neurological deficit score. Midbrain tissue was harvested, and the ultrastructure of vPAG neurons was examined by transmission electron microscopy. Protein and mRNA expression levels of P2rx7 and c-Fos in the midbrain were determined by Western blot and RT-qPCR. Results: Compared with the Mod group, the Acu group showed the most pronounced change in consciousness level at 12 h after modeling, significantly shortened coma duration, and a stabilized neurological deficit score after 24 h (P<0.01). Transmission electron microscopy revealed relatively intact nuclei, intact pre- and postsynaptic membranes, and increased postsynaptic density protein in the Acu group. Compared with the Mod group, the Acu group exhibited significantly elevated protein and mRNA expression levels of P2rx7 and c-Fos (P<0.01). Conclusion: Early acupuncture may promote arousal in comatose TBI rats by activating P2rx7 receptors in the vPAG region, thereby improving neuronal activity and repairing damaged brain tissue.