Abstract: Objective To evaluate the therapeutic effect of the Bian-shi therapy on young and middle-aged patients with chronic insomnia, and unravel the possible mechanism. Method Ninety-two young and middle-aged patients with chronic insomnia were randomly divided into the Bian-shi group （n = 46） and control group （n = 46）. In the control group, patients were orally given with zopiclone tablets 7.5 mg before sleep, and their counterparts in the Bian-shi group were treated with Bian-shi treatment on the basis of oral intake of zopiclone tablets, once a week, 40 min for each therapy and 30 days for each course. The sleep quality was evaluated by Pittsburgh Sleep Quality Index （PSQI） in two groups. The insomnia severity index （ISI）, self-rating anxiety scale （SAS） and self-rating depression scale （SDS） scores before and after one course treatment were recorded in two groups. The serum levels of 5-hydroxytryptamine （5-HT） before and after treatment were determined. The above items were compared between two groups. Results Before treatment, there was no significant statistical difference in ISI, SAS and SDS scores between two groups （all P > 0.05）. At 4 weeks after treatment, the effective rate of insomnia in the Bian-shi group was 93.5%, higher than 76.1% in the control group （P < 0.05）. In addition, ISI, SAS and SDS scores were significantly lower （all P < 0.05）, and the serum levels of 5-HT were significantly higher compared with those before treatment in two groups （both P < 0.05）. In the Bian-shi group, ISI, SAS and SDS scores were significantly lower, whereas serum 5-HT level was significantly higher compared with those in the control group （all P < 0.05）. Conclusions Bian-shi therapy is safe and green, which can effectively improve the insomnia and accompanying symptoms in young and middle-aged patients with chronic insomnia. The potential mechanism may be involved with neurotransmitters, such as 5-HT.