Objective To explore the effect of Modiffed Wuwei Xiaodu decoction on acne severity in patients with mild to moderate acne. Methods A total of 70 patients with acne diagnosed and treated in Jiangning Hospital of Traditional Chinese Medicine from January 2023 to January 2024 were selected. According to the random number table method, they were divided into the control group and the observation group, with 35 patients in each group. The control group was treated with fusidic acid cream combined with adapalene gel, and the observation group was treated with Modified Wuwei Xiaodu decoction on the basis of the control group's regimen. The acne severity, treatment effect and quality of life were compared between the two groups. Results After 8 weeks of treatment, the GAGS score of the two groups was lower than that before treatment, and that of the observation group was lower than that of the control group (P<0.05). The total effective rate of the observation group was 85.71%, which was higher than 60.00% of the control group (P<0.05). After 8 weeks of treatment, the DLQI score of the two groups was lower than that before treatment, and that of the observation group was lower than that of the control group (P<0.05). Conclusion Modified Wuwei Xiaodu decoction in the treatment of mild to moderate acne can effectively reduce skin lesion severity, accelerate inffammation subsidence and tissue repair, and improve patients' clinical discomfort symptoms, thus enhancing their quality of life.