Objective To explore the influence of Tianma Gouteng drink combined with head scraping on blood pressure, Pittsburgh Sleep Quality Index (PSQI) score, serum homocysteine (Hcy) and cortisol (Cor) in patients with essential hypertension and sleep disorders. Methods Totally 120 patients with essential hypertension and sleep disorders who received treatment in the hospital were selected from April 2023 to April 2024 as the research subjects, and were randomized into study group and control group by block randomization method, 60 cases in each group. The control group was treated with conventional western medicine combined with head scraping, while the study group was combined with Tianma Gouteng drink on the basis of the control group. The TCM symptoms scores, blood pressure variability ［24h systolic blood pressure variability (SBPV), daytime SBPV, nighttime SBPV and 24h diastolic blood pressure variability (DBPV), daytime DBPV, nighttime DBPV］, PSQI and polysomnography parameters ［actual sleep time, sleep efficiency, sleep maintenance rate, sleep latency, rapid eye movement (REM ) latency, REM sleep ratio, nighttime awakening frequency, total awakening time), serum Hcy, Cor and serum monoamine neurotransmitters ［5-hydroxyindoleacetic acid (5-HIAA), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP)］ were compared between groups before and after treatment. Results After treatment, the scores of TCM symptoms and total score of PSQI were decreased in both groups, and the scores in study group were lower (P<0.05). After treatment, the actual sleep time, sleep efficiency, sleep maintenance rate, sleep latency, REM latency, 5-HT5 and β-EP in both groups were enhanced while 24h SBPV, daytime SBPV, night SBPV, 24h DBPV, daytime DBPV, night DBPV, REM sleep ratio, nighttime awakening frequency, total awakening time and serum Hcy, Cor and 5-HIAA levels were declined, and the actual sleep time, sleep efficiency, sleep maintenance rate, sleep latency, REM latency, 5-HT5 and β-EP in the study group were higher while 24h SBPV, daytime SBPV, nighttime SBPV, 24h DBPV, daytime DBPV, nighttime DBPV, REM sleep ratio, nighttime awakening frequency, total awakening time and serum Hcy, Cor and 5-HIAA levels were lower (P<0.05). Conclusion Tianma Gouteng drink combined with head scraping has a significant therapeutic effect on patients with essential hypertension complicated with sleep disorders. It can effectively control blood pressure, and significantly improve sleep quality and polysomnography monitoring results. Its mechanism may be related to the regulations of Hcy, Cor and monoamine neurotransmitters