Objective To explore the effect of Qingre Chushi decoction combined with fire needle therapy on traditional Chinese medicine syndrome scores and skin satisfaction in patients with herpes zoster. Methods A total of 90 patients with herpes zoster admitted to Urumqi Hospital of Traditional Chinese Medicine from June 2022 to October 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 45 patients in each group. The control group was treated with conventional western medicine, and the observation group was additionally treated with Qingre Chushi decoction combined with fire needle therapy on the basis of conventional western medicine. The clinical efficacy, traditional Chinese medicine syndrome scores, pain degree scores, inflammatory factor levels [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)], adverse reaction rate and skin satisfaction were compared between the two groups. Results Compared with the total effective rate of treatment in the control group (73.33%), the total effective rate of treatment in the observation group was higher, reaching 91.11% (P <0.05). The scores of bright red skin lesions, blister wall rupture, burning and stabbing pain and red tongue with yellow coating in the observation group after treatment were lower than those in the control group (P <0.05). The VAS scores of the observation group at 3, 7, and 14 days of treatment were lower than those in the control group (P <0.05). The ESR and CRP levels in the observation group after treatment were lower than those in the control group (P <0.05). The incidence of adverse reactions in the observation group (11.11%) was similar to that in the control group (8.89%), and the difference was not statistically significant (P>0.05). Compared with the skin satisfaction in the control group (75.56%), the skin satisfaction in the observation group was higher, reaching 93.33% (P<0.05). Conclusion The combination of Qingre Chushi decoction and fire needle therapy combined with western medicine has good clinical efficacy in the treatment of herpes zoster. It can reduce traditional Chinese medicine syndrome scores, relieve pain, inhibit the levels of inflammatory factors, improve patients' skin satisfaction, and has good safety.