Abstract： Objective： To observe the therapeutic effect of liver-softening and spirit-regulating acupuncture combined with Huanglian Wendan Decoction in treating sleep disorders after cerebral hemorrhage surgery in elderly patients. Methods：A total of 126 patients with cerebral hemorrhage treated at Xinchang Hospital Affiliated to Wenzhou Medical University from March 2021 to March 2024 were selected and divided into an observation group and a control group，with 63 cases in each group，using a stratified random grouping method. Both groups received modern medical treatment. The control group was treated with Huanglian Wendan Decoction， while the observation group was treated with liver-softening and spirit-regulating acupuncture in addition to the treatment of the control group. Clinical efficacy and the incidence of adverse reactions were compared between the two groups， as well as changes in total sleep time （TST）， sleep efficiency（SE）， 5-hydroxytryptamine（5-HT）， brain-derived neurotrophic factor（BDNF）， sleep latency（SL），wake time after sleep onset（AWT），Pittsburgh Sleep Quality Index（PSQI），Athens Insomnia Scale （AIS）， and neuron-specific enolase（NSE）levels before and after treatment. Results： After treatment， the total effective rate of clinical efficacy in the observation group was 95.24%（60/63），higher than that in the control group at 84.13%（53/63），with a significant difference between the two groups（P＜0.05）. After treatment，TST and SE values increased in both groups compared to before treatment（P＜0.05）， while SL and AWT values decreased（P＜0.05）. The observation group had higher TST and SE values and lower SL and AWT values than the control group（P＜0.05）. After treatment， PSQI and AIS scores decreased in both groups compared to before treatment（P＜0.05）， while melatonin levels increased（P＜0.05）. The observation group had lower PSQI and AIS scores and higher melatonin levels than the control group（P＜0.05）. After treatment，5-HT and BDNF levels increased in both groups compared to before treatment（P＜0.05）， while NSE levels decreased（P＜0.05）. The observation group had higher 5-HT and BDNF levels and lower NSE levels than the control group（P＜0.05）. The incidence of adverse reactions was 3.17%（2/ 63）in the observation group and 12.70%（8/63）in the control group，with significant difference between the two groups （P＜0.05）. Conclusion： Liver-softening and spirit-regulating acupuncture combined with Huanglian Wendan Decoction is effective in treating sleep disorders after cerebral hemorrhage surgery in elderly patients. It can improve sleep disorders，promote the recovery of neurological functions，and reduce the occurrence of adverse outcomes.