Objective To explore the effect of Niuhuang Shangqing pill in the treatment of acne vulgaris. Methods A total of 70 patients with acne vulgaris who were treated in our hospital from January 2022 to August 2023 were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 35 patients in each group. The control group was given conventional western medicine orally, and the observation group was treated with Niuhuang Shangqing pill on this basis. The clinical efficacy, inflammatory factor levels and incidence of adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 94.29%, which was higher than 77.14% in the control group, and the difference was statistically significant (P <0.05). After treatment, the levels of IL-6 and IL-10 in the two groups were lower than those before treatment, and those in the observation group were lower than those in the control group, the differences were statistically significant (P <0.05). The incidence of adverse reactions in the observation group was 14.29%, which was lower than 34.29% in the control group, and the difference was statistically significant (P <0.05). Conclusion Niuhuang Shangqing pill is effective in the treatment of acne vulgaris, which can improve the clinical efficacy, reduce the level of inflammatory factors and the occurrence of adverse reactions, and has high application value.