Objective: To analyze the clinical therapeutic effect of fire needle combined with modified Puqian Qingfei Decoction on patients with lung meridian wind-heat type acne vulgaris, and to investigate the effect on the skin aesthetic appearance of these patients. Methods: From June 2024 to June 2025, 80 patients with lung meridian wind-heat type acne vulgaris admitted to the medical aesthetics department and dermatology department of our hospital were selected. Using the random number table method, the patients were divided into the control group and the observation group, with 40 cases in each group. The control group received treatment with modified Puqian Qingfei Decoction, while the observation group received combined fire needle treatment based on the control group. The total clinical effective rate, improvement of acne lesions, skin aesthetic appearance score, inflammatory factor levels, and incidence of adverse reactions were compared between the two groups. Results: The total effective rate of the observation group (95.00%) was higher than that of the control group (77.50%) (P < 0.05); after 8 weeks of treatment, the improvement of acne lesions in the observation group was better than that in the control group (P < 0.05); the skin aesthetic appearance score of the observation group was better than that of the control group (P < 0.05); the inflammatory factor levels of the observation group were lower than those of the control group (P < 0.05); there was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: Using fire needle combined with modified Puqian Qingfei Decoction for the treatment of patients with lung meridian wind-heat type acne vulgaris has a good therapeutic effect. It can quickly reduce the number of lesions, reduce the degree of inflammatory response, improve the skin aesthetic appearance of patients, and has good safety.