Objective To evaluate the effect of tretinoin cream combined with Jianpi Xiaocuo decoction in the treatment of acne of spleen deficiency and dampness heat type. Methods A total of 80 patients with acne of spleen deficiency and damp-heat type admitted to our hospital from January 2021 to January 2024 were selected as the research objects. They were divided into control group and combined group by random number table method, with 40 patients in each group. The control group was treated with tretinoin cream, and the combined group was treated with Jianpi Xiaocuo decoction on the basis of the control group. The TCM syndrome scores, skin lesions, clinical efficacy and recurrence of the two groups were compared. Results After treatment, the score of TCM syndromes in the two groups was lower than that before treatment, and that in the combined group was lower than that in the control group (P <0.05). The score of skin lesions in the two groups after treatment was lower than that before treatment, and that in the combined group was lower than that in the control groupt (P <0.05). The total effective rate of treatment in the combined group was 95.00%, which was higher than 77.50% in the control group (P <0.05). The recurrence rate of the combined group was 5.00%, which was lower than 25.00% of the control group (P <0.05). Conclusion The combination of tretinoin cream and Jianpi Xiaocuo decoction in the treatment of acne of spleen deficiency and damp-heat type can effectively improve the therapeutic effect, improve the skin lesions, reduce clinical symptoms and reduce the risk of recent recurrence.