Objective To evaluate the clinical efficacy of modified Suanzaoren decoction combined with auricular point pressing with beans in the treatment of insomnia during pregnancy， thereby providing a reference for clinical practice. Methods A total of 120 pregnant patients with insomnia were randomly assigned to either the control group （n = 60） or the treatment group （n = 60）. The control group received modified Suanzaoren decoction， whereas the treatment group received additional auricular point pressing with beans based on the same herbal treatment. The treatment duration was 4 weeks. Outcomes including clinical efficacy， TCM syndrome scores， sleep monitoring parameters （total sleep time， wake-up time， and awakening frequency）， PSQI scores， serum FPG levels， and neurotransmitter levels （DA， GABA， 5-HT， and NE） were assessed before and after intervention， along with the incidence of adverse reactions. Results The total effective rate in the treatment group was significantly higher than that in the control group （P < 0.05）. Following treatment， TCM syndrome scores， awakening time， awakening frequency， PSQI score， serum FPG， and NE levels were significantly reduced in both groups （P < 0.05）， while sleep duration and serum levels of DA， GABA， and 5-HT were significantly increased （P < 0.05）. These improvements were more pronounced in the treatment group （P < 0.05）. No significant difference was observed in the incidence of adverse reactions between the two groups （P > 0.05）. Conclusion The modified Suanzaoren decoction combined with auricular point pressing using beans demonstrates definite therapeutic efficacy in pregnant patients with insomnia， effectively alleviating sleep-related symptoms， reducing serum FPG levels， and modulating neurotransmitter release， thereby indicating considerable clinical application value.