Objective To explore the effect of Sangqin mixture combined with ffre needle and traditional Chinese medicine mask on skin physiological indicators in patients with moderate to severe acne. Methods A total of 60 patients with moderate to severe acne admitted to Department of Traditional Chinese Medicine Dermatology, Qinhuai District Fuzimiao Community Health Service Center from January to August 2025 were selected as the research subjects, and they were divided into the control group and the study group by the random number table method, with 30 patients in each group. The control group was treated with fusidic acid cream and doxycycline hydrochloride tablets, and the study group was treated with Sangqin mixture combined with ffre needle and traditional Chinese medicine mask. The skin lesions, skin physiological indicators, clinical efffcacy and adverse reaction rate were compared between the two groups. Results The GAGS score in the study group at 8 weeks after treatment was lower than that in the control group (P<0.05). The stratum corneum hydration and skin oil index in the study group at 8 weeks after treatment were higher than those in the control group, and the transepidermal water loss was lower than that in the control group (P<0.05). The total effective rate of the study group (96.67%) was higher than that of the control group (80.00%) (P<0.05). The incidence of adverse reactions in the study group (3.33%) was lower than that in the control group (20.00%) (P<0.05). Conclusion Sangqin mixture combined with ffre needle and traditional Chinese medicine mask in the treatment of moderate to severe acne can improve skin physiological indicators of patients, effectively relieve