Objective To explore the effect of Sini powder combined with Guizhi Fuling pills and fire needle therapy in patients with acne vulgaris of damp-heat accumulation syndrome. Methods A total of 106 patients with acne vulgaris of damp-heat accumulation syndrome who were treated in Jinan City Hospital of Integrated Traditional Chinese and Western Medicine from January 2023 to January 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 53 patients in each group. The control group was given fire needle therapy, and the observation group was given Sini powder combined with Guizhi Fuling pills and fire needle therapy. The clinical efficacy, TCM syndrome scores and skin lesion score were compared between the two groups. Results The total effective rate of the observation group was 98.11%, which was higher than 81.13% of the control group (P<0.05). After treatment, the scores of halitosis, yellow urine, facial greasiness and rash pustules in the observation group were lower than those in the control group (P<0.05). After treatment, the skin lesion score of the observation group was lower than that of the control group (P <0.05). Conclusion The application of Sini powder combined with Guizhi Fuling pills and fire needle therapy in patients with acne vulgaris of damp-heat accumulation syndrome has a definite effect, which can effectively improve skin lesion conditions and help to alleviate related symptoms. It is worthy of clinical application.