Objective: Cystic acne is a common and frequently occurring disease in clinical practice, with limited efficacy from Western medical treatments. This study explores this issue against such background. Methods: A total of 49 patients with cystic acne treated in our hospital from June 2024 to January 2026 were selected and randomly divided into a control group 24 cases and a treatment group 25 cases. The control group received topical fusidic acid cream, while the treatment group was administered a modified Haizao Yuhu Decoction combined with fire needle therapy. Results: After one month of continuous treatment, the total effective rate and stratum corneum hydration in the treatment group were higher than those in the control group, while inflammatory lesion scores, transepidermal water loss, and desquamated protein content were lower P 0.05. Conclusion: This study demonstrates that tailoring the modified Haizao Yuhu Decoction to individual patients and combining it with direct fire needle application at lesion sites yields synergistic therapeutic effects, providing a novel approach for the clinical management of cystic acne.