Objective To study the effect of Xiyu Qing Jingfu solution combined with Xiaocuo Jiedu decoction in the treatment of acne with lung and stomach heat type. Methods A total of 68 patients with acne of lung and stomach heat type admitted to Pingchao Central Hospital of Tongzhou District in Nantong from April 2021 to October 2022 were randomly divided into reference group (given western medicine therapy) and research group (given Xiyu Qing Jingfu solution combined with Xiaocuo Jiedu decoction), with 34 patients in each group. The clinical efficacy, TCM syndrome score, immune function, serological index and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the research group was 97.06%, which was higher than 82.35% in the reference group (P＜0.05). After treatment, the scores of TCM syndromes in the research group were lower than those in the reference group (P＜0.05). After treatment, the levels of CD3+ , CD4+ and CD4+ /CD8+ in the research group were higher than those in the reference group, and the level of CD8+ was lower than that in the reference group (P＜0.05). After treatment, the levels of IL-4, IL-17, TNF-α and SIL-2R in the research group were lower than those in the reference group (P＜0.05). The incidence of adverse reactions in the research group was 5.88%, which was lower than 23.53% in the reference group (P＜0.05). Conclusion Xiyu Qing Jingfu solution combined with Xiaocuo Jiedu decoction can improve the clinical symptoms and immune function of acne patients with lung and stomach heat type, regulate serological indicators, achieve the expected medication effect, and have a low incidence of adverse reactions, which is worthy of clinical application.