Abstract： Objective： To observe the clinical effect of modified Xiaochaihu Decoction for perimenopausal insomnia and its effects on sleep quality and hormones. Methods：A total of 154 cases of patients with perimenopausal insomnia who were admitted from October 2022 to October 2023 were retrospectively selected and divided into the control group and the observation group by different treatment methods， with 77 cases in each group. The control group was given conventional western medicine treatment， and the observation group was additionally treated with modified Xiaochaihu Decoction on the basis of the treatment of the control group. Clinical effects， as well as scores of traditional Chinese medicine (TCM) syndrome，Pittsburgh Sleep Quality Index (PSQI)，Hamilton Anxiety Rating Scale (HAMA)， and sleep latency，sleep efficiency，wakefulness time，and total sleep time，and serum hormone levels before and after treatment were compared between the two groups. Results：The total effective rate was 92.21% in the observation group， higher than that of 80.52% in the control group (P＜0.05). After treatment， TCM syndrome scores， PSQI scores， HAMA scores， and levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in serum were declined when compared with those before treatment， and sleep latency and wakefulness time were shortened (P＜0.05); sleep latency and wakefulness time in the observation group were shorter than those in the control group (P＜0.05)，and TCM syndrome scores， PSQI scores， HAMA scores， and levels of LH and FSH in serum in the observation group were lower than those in the control group (P＜0.05). After treatment，sleep efficiency and levels of serum estradiol (E2) in the two groups were increased when compared with those before treatment， and total sleep time was prolonged (P＜0.05); sleep efficiency and levels of serum E2 in the observation group were higher than those in the control group (P＜0.05)， and total sleep time in the observation group was longer than that in the control group (P＜0.05). Conclusion：Modified Xiaochaihu Decoction combined with western medicine for perimenopausal insomnia can regulate sleep structural parameters and hormone levels，improve sleep quality，and alleviate anxiety，with significant therapeutic effects.