Abstract：Objective：To observe the clinical efficacy of acupoint catgut-embedding therapy in the treatment of primary insomnia （PI） based on the defensive qi circulation theory and its effect on the hypothalamus-pituitaryadrenal （HPA） axis. Methods：A total of 70 patients with PI who were treated in the Department of Acupuncture and Moxibustion，Longyan First Hospital Affiliated to Fujian Medical University from September 2023 to October 2024 were selected and randomly divided into the treatment group and the control group using the random number table method， with 35 cases in each group. The control group received oral administration of Estazolam Tablets，while the treatment group received acupoint catgut-embedding therapy based on the defensive qi circulation theory. The treatment course for both groups was 30 days. The clinical efficacy was compared between the two groups. Changes in Pittsburgh Sleep Quality Index （PSQI） scores and levels of adrenocorticotropic hormone （ACTH） and cortisol （CORT） were observed before and after treatment in both groups. Results：After treatment，the total effective rate was 94.29% （33/35） in the treatment group，which was significantly higher than 54.29%（ 19/35） in the control group（ P＜0.05）. Scores on the six items and the total score of the PSQI，as well as the levels of ACTH and CORT，decreased compared with those before treatment in both groups. Scores on the six items and the total score of the PSQI， as well as the levels of ACTH and CORT in the treatment group were significantly lower than those in the control group， with the differences being statistically significant （P＜0.05）. Conclusion：In improving insomnia symptoms and inhibiting HPA axis excitability in PI patients， acupoint catgut-embedding therapy based on the defensive qi circulation theory is more advantageous than oral administration of Estazolam Tablets.