Objective To analyze the effect of ffre needle combined with modiffed Pipa Qingyin decoction on aesthetics in patients with acne vulgaris of lung meridian wind-heat type. Methods A total of 80 patients with acne vulgaris of lung meridian wind-heat type admitted to the Department of Medical Aesthetics and Department of Dermatology, Yangzhou Hospital of TCM from June 2024 to June 2025 were selected. According to the random number table method, they were divided into the control group and the observation group, with 40 patients in each group. The control group was treated with modiffed Pipa Qingyin decoction, and the observation group was treated with ffre needle on the basis of the control group. The clinical efffcacy, acne lesion improvement, aesthetics, inffammatory factor levels and adverse reaction rate were compared between the two groups. Results The total effective rate in the observation group (95.00%) was higher than that in the control group (77.50%) (P<0.05). After treatment, the number of acne lesions in the observation group was better than that in the control group (P<0.05). The aesthetics score in the observation group was better than that in the control group (P<0.05). After treatment, the levels of inffammatory factors in the observation group were all lower than those in the control group (P<0.05). There was no signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Fire needle combined with modiffed Pipa Qingyin decoction is effective in the treatment of acne vulgaris of lung meridian wind-heat type. It can reduce the number of lesions, decrease inflammatory factor levels, improve skin aesthetics, and does not increase the incidence of adverse reactions.