Under the theoretical guidance of the essence-function relationship between yin and yang and from the point of view of adjusting yin and yang to return to the standard，the present study analyzed the key influencing factors of perimenopausal insomnia that yang fails in promoting yin，and discussed the clinical thinking of acupuncture and moxibustion in the treatment of perimenopausal insomnia.Yin deficiency，yang deficiency，or deficiency of both yin and yang in the perimenopausal period can cause yang qi to float upward，deviating from the inner site downward.Insomnia occurs when yang fails in promoting yin，which is the main etiology and pathogenesis of perimenopausal insomnia.Therefore，this study put forward the treatment principle of coordinating the descending of yang and restoring the original structure of “internal yang and external yin”.Additionally，based on the physiological functions of triple energizers，this study proposed the treatment protocol of acupuncture and moxibustion，i.e.，purging floating yang by clearing upper energizer，descending yang by activating middle energizer，and improving yang and returning yin by tonifying lower energizer，and expounded treatment thinking of this disease by descending the external floating yang to the inner site to restore the structure of “internal yang and external yin”.