Objective To observe the clinical cosmetic effect of fire needle combined with Shugan Jianpi traditional Chinese medicine in the treatment of cystic acne. Methods 68 patients with cystic acne were selected as the research object, and were treated in our hospital from January 2024 to January 2025. According to the random number table method, all the participants were divided into the reference group (n=34, conventional treatment) and the study group (n=34, additional implementation of fire needle combined with Shugan Jianpi traditional Chinese medicine oral treatment). After 3 months of treatment, the therapeutic effect was compared. Results compared with the control group, the clinical efficacy of the study group was higher, the severity of skin lesions and pigmented sequelae were milder, and the long-term recurrence rate was lower, with statistical differences (P 〈 0.05). Conclusion fire needle combined with Shugan Jianpi traditional Chinese medicine can effectively improve the degree of skin lesions and pigmented sequelae of cystic acne, with low long-term recurrence rate, outstanding beauty and clinical application value, and has promotion value.