Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 54 10 2025 10 31 2089 2100 Rupei Zhang Medical School, Nantong University Shan Zhou Medical School, Nantong University Baoyi Sun Medical School, Nantong University Zongyuan Xuan Medical School, Nantong University Xiaolei Sun Medical School, Nantong University Jun Yan Medical School, Nantong University 2025 04 18 2025 06 21 Background: This study aimed to conduct a systematic evaluation of the efficacy and safety of acupuncture and moxibustion in treating insomnia, and to provide evidence-based guidance for clinical practice. Methods A comprehensive literature search was performed using PubMed, CNKI, and other databases to identify randomized controlled trials (RCTs) and clinical controlled trials of acupuncture or moxibustion for the treatment of insomnia. The search was conducted up to March 2025. The articles were screened based on the inclusion and exclusion criteria and the quality of the literature was assessed using the Cochrane 5.1.0 bias risk assessment tool. Meta-analysis was conducted using Review Manager 5.4 software. Results A total of 1019 subjects were included in 23 relevant articles. The results of the Meta-analysis showed that acupuncture or moxibustion therapy was effective in significantly reducing the scores of the Pittsburgh Sleep Quality Index (WMD=3.87, 95% CI: 2.90, 4.84, p<0.05), Self-rating Depression Scale (WMD=11.45, 95% CI: 4.38, 18.52, p<0.05), and Self-rating Anxiety Scale (WMD=7.88, 95% CI: 2.32, 13.43, p<0.05) in patients with insomnia. The incidence of adverse reactions was relatively low. Conclusion Acupuncture or moxibustion therapy demonstrates potential advantages in the treatment of insomnia and warrants further investigation in a clinical setting. https://ijph.tums.ac.ir/index.php/ijph/article/view/38849 https://ijph.tums.ac.ir/index.php/ijph/article/download/38849/8669