Objective To explore the effect of Qingre Lishi prescription on clinical symptom scores in patients with acne of damp-heat type. Methods A total of 52 patients with acne of damp-heat type who visited the outpatient department of the First People's Hospital of Lianyungang from August 2024 to August 2025 were selected, and they were divided into the control group and the experimental group by the random number table method, with 26 patients in each group. The control group was treated with tretinoin cream combined with clindamycin gel, and the experimental group was treated with Qingre Lishi prescription on the basis of the control group. The clinical symptom scores, VISIA measurement results, skin physiological indicators and adverse reaction rate were compared between the two groups. Results After treatment, the scores of papules, pustules, skin greasiness and pain in the experimental group were lower than those in the control group (P<0.05). After treatment, the scores of brown spots, red areas, porphyrin and pores in the experimental group were lower than those in the control group (P<0.05). After treatment, the sebum score and pH value of the experimental group were lower than those of the control group, and the moisture score was higher than that of the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The application of Qingre Lishi prescription in the treatment of patients with acne of damp-heat type has a good effect. It can relieve various symptom manifestations, reduce clinical symptom scores, improve patients' skin texture, optimize their skin physiological indicators, and does not increase the risk of adverse reactions, with high application safety.