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Object: We conducted a systematic review of the auricular therapy, aiming to evaluate the advantages of auricular acupuncture with seed or pellet attachments for the treatment of primary insomnia.Methods: A search of relevant literatures published between the inception and the first quarter of 2013 was performed on major medical databases, including Medline, Embase, CENTRAL, PsycINFO, ProQuest, CBM, CNKI, VIP, Wanfang Data and ICTRP, and CCTCTR.Risk of bias evaluation, meta-analysis, sensitivity analysis and evidence rating of all extracted information were conducted.Results: A total of 1381 records were identified, with 15 studies deemed eligible for the present review.Altogether, these studies enrolled 1429 participants, aged between 18 and 78 years old.Meta-analyses were conducted in two comparisons separately: participants received auricular acupuncture were more likely to make an improvement in clinical effective rate (RR=1.40, 95% CI 1.07 to 1.83)], sleep duration (MD=56.46, 95% CI 45.61 to 67.31), sleep efficiency(MD=l 2.86, 95% CI 9.67 to 16.06), global score on PSQI (MD=-3.41, 95% CI-3.92 to-2.89), number of awakenings(MD=-3.27, 95% CI-6.30 to-0.25) and sleep onset latency(MD=-10.35, 95% CI-14.37 to-6.33) when compared to sham auricular acupuncture or placebo;while in auricular acupuncture VS medications comparison, a better effective rate (RR=l.24, 95% CI 1.15 to 1.35), better sleep efficiency(MD=21.44, 95% CI 16.30 to 26.58), lower PSQI score (MD=-3.62, 95% CI-4.59 to -2.65) and less adverse effect (RR=0.11, 95% CI 0.04 to 0.26) can be seen also in auricular acupuncture group.Although these results suggested benefits of auricular acupuncture, the overall quality of evidence rated by the GRADE system was low.Conclusion: Statistical analyses of the outcomes revealed a positive correlation between auricular acupuncture and primary insomnia.Nonetheless, considering the poor methodological quality,insufficient sample size and possible publication bias, current evidences are yet adequate to provide a strong support for the use of auricular acupuncture in the treatment of primary insomnia.More strictly designed clinical studies will be needed to obtain a more explicit conclusion.