Objective To explore the effect of emotional nursing on lesion severity in patients with moderate to severe acne after Chinese medicine collapse stains. Methods A total of 96 patients with moderate to severe acne admitted to Ili Kazakh Autonomous Prefecture Hospital of Traditional Chinese Medicine from January 2024 to August 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 48 patients in each group. Both groups received Chinese medicine collapse stains. The control group was given conventional nursing, and the observation group received emotional nursing on the basis of the control group. The lesion severity, psychological status and treatment compliance were compared between the two groups. Results After 4 and 8 weeks of intervention, the GAGS score of the observation group was lower than that of the control group (P<0.05). After 8 weeks of intervention, the scores of HAMA and HAMD in the observation group were lower than those in the control group (P<0.05). The compliance of the observation group (91.67%) was higher than that of the control group (72.92%) (P<0.05). Conclusion The effect of emotional nursing in patients with moderate to severe acne during the treatment of Chinese medicine collapse stains is good. It can effectively relieve skin lesion severity, reduce negative emotions and improve patient compliance.