Objective: This study aims to verify the clinical efficacy of the “regulating liver and nourishing blood” acupuncture method in treating insomnia during perimenopause. Method: A total of 84 patients were randomly divided into an experimental group (EG) and a control group (CG). The CG received 0.4 mg alprazolam tablets, once nightly, for 4 weeks, whereas the EG was treated with “regulating liver and nourishing blood” acupuncture. The treatment duration was 30 min per session, once daily, for a total of 4 weeks. Changes in Pittsburgh sleep quality index (PSQI), Kupperman index (KI), menopause-specific quality of life (MENQOL) questionnaire, self-rating depression scale (SDS), and self-rating anxiety scale (SAS) scores and serum E2, LH, FSH, and AMH levels were compared between the two groups before and after treatment. Result: After 4 weeks of treatment, the PSQI, KI, MENQOL, SDS, and SAS scores in the EG were significantly lower than those before treatment and those in the CG (p < 0.05). Serum E2 and AMH levels in the EG were significantly higher than those before treatment and those in the CG. FSH levels in the EG were significantly lower than those in the CG (p < 0.05), while LH levels showed no significant change (p > 0.05). Conclusion: Acupuncture with the “regulating liver and nourishing blood” method can improve sleep quality, alleviate anxiety and depression, enhance the quality of life, and regulate hormonal imbalances in perimenopausal women.