Objective To explore the effect of Sanpi Xiaocuo decoction combined with guasha therapy on skin lesion symptoms in patients with acne vulgaris of wind-heat syndrome in lung meridian. Methods A total of 84 patients with acne vulgaris of windheat syndrome in lung meridian admitted to our hospital from January 2022 to January 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 42 patients in each group. The control group was treated with conventional Western medicine, and the observation group was treated with Sanpi Xiaocuo decoction combined with guasha therapy. The skin lesion symptoms, clinical efficacy and adverse reactions were compared between the two groups. Results After treatment, the GAGS score of the observation group was lower than that of the control group, and the difference was statistically significant (P <0.05). The total effective rate of treatment in the observation group (92.86%) was higher than that in the control group (76.19%), and the difference was statistically significant (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion Sanpi Xiaocuo Decoction combined with guasha therapy has an ideal clinical effect in the treatment of patients with acne vulgaris of wind-heat syndrome in lung meridian. It can effectively improve skin lesion symptoms, without increasing the incidence of adverse reactions.