Objective To explore the effect of red and blue light irradiation combined with moxibustion and acupuncture on skin physiological indicators in patients with moderate to severe acne. Methods A total of 100 patients with moderate to severe acne admitted to Yutian County Hospital from January 2024 to May 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 50 patients in each group. The control group was treated with red and blue light irradiation, and the observation group was treated with red and blue light irradiation combined with moxibustion and acupuncture. The clinical efffcacy, TCM syndrome scores and skin physiological indicators were compared between the two groups. Results The total effective rate of the observation group (94.00%) was higher than that of the control group (72.00%) (P<0.05). The TCM syndrome scores of the two groups after treatment were lower than those before treatment (P<0.05). The TCM syndrome scores of the observation group after treatment were lower than those of the control group (P<0.05). After treatment, the skin physiological indicators of the observation group were better than those of the control group (P<0.05). Conclusion Red and blue light irradiation combined with moxibustion and acupuncture can improve the treatment effect of moderate to severe acne, alleviate clinical symptoms, and optimize skin physiological status, which is worthy of clinical application.