This pilot study first aimed to evaluate the safety and efficacy of this twenty-day auricular acupressure using Semen Vaccariae (Wang Bu Liu Xing) in improving the sleeping conditions of primary insomnia patients. The secondary aim was to evaluate the improvement of some other self-reported symptoms caused by insomnia. A clinical prospective pre–post study was designed, enrolling 60 primary insomnia patients. Each patient was administered the auricular acupressure on five acupoints of NADA protocol of both ears by applying the Vaccariae seeds and was instructed to gently press 1 minute/acupoint each time, four times a day for twenty consecutive days. After 20 days, the mean total sleep time increased significantly from 3.8 ± 1.0 to 5.4 ± 1.0 (hours) (p<0.05). The mean ISI score decreased from 19.3 ± 5.4 at D0 to 9.5 ± 4.7 (points). The sleep efficiency increased significantly from 52.7 ± 13.9 to 80.7 ± 10.0 (%) (p<0.05). The number of patients suffering from self-reported insomnia-related symptoms (including fatigue, decreased concentration, anxiety, decreased memory, dizziness) decreased significantly compared to those at baseline (p<0.05). Auricular acupressure using Semen Vaccariae ear seeds followed the NADA protocol showed both safety and potential efficacy in improving sleep quality and other insomnia-related symptoms.