Abstract：Objective：To observe the efficacy of acupoint intradermal needling combined with modified Gouteng Xuanshen Prescription under the guidance of midnight-noon ebb-flow theory in treating essential hypertension with liver yang hyperactivity syndrome. Methods： A total of 86 patients with essential hypertension of liver yang hyperactivity syndrome，admitted from June 2022 to June 2024，were selected and randomly divided into a western medicine group and a Chinese medicine group using the random number table method， with 43 cases in each group. After excluding drop-out cases，41 cases in each group completed the study. The western medicine group received conventional western medication，while the Chinese medicine group received acupoint intradermal needling combined with modified Gouteng Xuanshen Prescription under the guidance of midnight-noon ebb-flow theory in addition to the treatment of the western medicine group. Clinical efficacy was compared， along with changes in serological indicators， circadian rhythm of blood pressure，vascular compliance parameters，traditional Chinese medicine syndrome scores，and Pittsburgh Sleep Quality Index （PSQI） scores between the two groups before and after treatment. Results： The total effective rate of clinical efficacy was 92.68% （38/41） in the Chinese medicine group，significantly higher than that of 75.61% （31/41） in the western medicine group （P＜0.05）. After treatment， levels of CC chemokine ligand 2 （CCL2） ， fractalkine （FKN），tumor necrosis factor-α （TNF-α），and endothelin-1 （ET-1） decreased in both groups compared to before treatment （P＜0.05）， with lower levels in the Chinese medicine group than in the western medicine group （P＜0.05）. After treatment， circadian rhythms of systolic blood pressure （SBP） and diastolic blood pressure （DBP） improved in both groups compared to before treatment （P＜0.05）， with better improvements in the Chinese medicine group （P＜0.05）. After treatment， brachial-ankle pulse wave velocity （baPWV） decreased （P＜ 0.05），while small artery elasticity （C1，C2） increased in both groups compared to before treatment （P＜0.05）. The Chinese medicine group showed lower baPWV and higher C1 and C2 values than the western medicine group（ P＜0.05）. After treatment，traditional Chinese medicine syndrome scores and PSQI scores decreased in both groups （P＜0.05）， with lower scores in the Chinese medicine group （P＜0.05）. Conclusion： Acupoint intradermal needling combined with modified Gouteng Xuanshen Prescription under the guidance of midnight-noon ebb-flow theory can improve vascular compliance， alleviate symptoms， enhance sleep quality， and increase efficacy in treating essential hypertension with liver yang hyperactivity syndrome.