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Objective: To explore the effect of acupuncture with mind regulating method on heart rate variability in patients with primary insomnia. Methods: A total of 120 patients with primary insomnia treated in the Insomnia Clinic of Acupuncture Center of Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from July 2014 to May 2017 were enrolled. The patients were randomly divided into the treatment group and the sham acupuncture group with 60 cases in each group. Patients in the treatment group were treated by acupuncture with mind regulating method. Patients in the sham acupuncture group were treated with acupuncture at ineffective points. The treatment should be given 3 times in a week, and continuous 4 weeks of treatment was needed. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the changes of sleep quality. Fatigue Scale-14 (FS-14) was used to evaluate the changes of fatigue degree. In addition, the changes of heart rate variability (HRV) before and after treatment were detected respectively, in order to analyze the regulating effect of acupuncture on sympathetic and parasympathetic function of primary insomnia. Results: After 4 weeks of treatment and during the follow-up period, (1) PSQI score: Compared with the sham acupuncture group, the PSQI score of the treatment group decreased significantly, and the difference was statistically significant (P < 0.01). (2) FS-14 score: Compared with the sham acupuncture group, the difference in the treatment group at the fourth week of treatment was statistically significant (P < 0.05). (3) Low-frequency power (LF) and LF/HF index of heart rate variability: LF and LF/HF in the treatment group after treatment were significantly lower than those before treatment. High-frequency power (HF) in the treatment group after treatment increased compared with that before treatment, but there was no significant difference (P > 0.05). LF and LF/HF in the treatment group were significantly lower than those in the sham acupuncture group at the fourth week of treatment, and the difference was statistically significant (P < 0.05). After treatment, HF in the treatment group was higher than that in the sham acupuncture group, but there was no statistical significance (P > 0.05). Conclusions: The acupuncture with mind regulating method can improve sleep quality, reduce fatigue degree, improve heart rate variability, and reduce sympathetic excitability in patients with primary insomnia, as well as balance the excitability of sympathetic and parasympathetic nerves. [ABSTRACT FROM AUTHOR]