〔Abstract〕 Objective To observe the clinical efficacy of Yangxin Anshen decoction combined with ear acupuncture in the treatment of post-stroke insomnia patients with deficiency of both heart and spleen. Methods A total of 74 patients with post_x0002_stroke insomnia admitted to the First Affiliated Hospital of Henan University from November 2018 to June 2020 were randomly divided into observation group and control group, with 37 cases in each group. The control group was given alprazolam, and the observation group was given Yangxin Anshen decoction combined with ear acupuncture treatment on the basis of the control group. The pittsburgh sleep quality index (PSQI), hamilton depression scale (HAMD) score, serum 5-hydroxytryptamine (5-HT) and norepinephrine (NE) of the two groups were observed, and the clinical efficacy were compared. Results The total effective rate of treatment in the observation group was 94.59%, which was higher than 78.38% in the control group. The difference was statistically significant (P < 0.05). After 2 weeks of treatment and 4 weeks of treatment, the PSQI scores of the two groups of patients were reduced to varying degrees, and the PSQI score of the observation group was lower than that of the control group, the difference was statistically significant (P < 0.05). After treatment, the HAMD scores of the two groups of patients decreased to varying degrees, and the HAMD score of the observation group was lower than that of the control group, and the difference was statistically significant (P < 0.05). After treatment, the level of 5-HT of the two groups of patients increased to different degrees, and the level of NE decreased to different degrees. The level of 5-HT of the observation group was higher than that of the control group, and the level of NE was lower than that of the control group. The differences were statistically significant (P < 0.05). In the control group, there were 2 cases of headache, 2 cases of dizziness, and 3 cases of gastrointestinal reactions, the total incidence of adverse reactions was 18.92% (7/37). In the observation group, only 1 patient had itching and redness at the local acupuncture site, the total incidence was 2.70% (1/37). The total incidence of adverse reactions of the observation group was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion Yangxin Anshen decoction combined with ear acupuncture has a good effect on the treatment of post-stroke insomnia. It can effectively improve the patient's sleep quality, regulate neurotransmitter levels, relieve depression, and improve the quality of life.