Object to investigate moxibustion’s role and mechanism in the treatment of noise-induced tinnitus. Methods C57 mice were exposed to white noise (100 dB L, 2 h) to generate animal model of tinnitus. Moxibustion, which bakes acupoints with burning moxa wool, was set on particular acupoints such as Ermen (TW21)/Tinggong (SI19). GPIAS detection was performed to identify the mice with tinnitus behavior, and the GPIAS detection was conducted after moxibustion management to estimate the changes of tinnitus behavior. Hearing function was evaluated using ABR, Immunostaining was applied to examine alterations of cochlear ribbon synapses. The RNA-seq has been utilized to explore the singling pathways responsible to the changes of tinnitus. Results Significant differences of inhibition rates of GPIAS have been found seen among control, noise exposure, and moxibustion treated group. The inhibition rates decreased after noise exposure, and moxibustion treatment was able to increase the inhibition rate. Hearing function was not significantly affected in consistent with the changes of GPIAS inhibition rates, cochlear ribbon synapses showed a similar alteration with noise and moxibustion treatment. Further, we conducted at the whole cochlea RNA-seq analysis, and we found that Npas4 might be responsible for moxibustion’s effect on tinnitus and synaptic alterations. Conclusions moxibustion on Ermen (TW21)/Tinggong (SI19) acupoints can alleviate the noise-induced tinnitus through specific repair of cochlear ribbon synapses.