Abstract：Objective：To observe the clinical efficacy of fire needling combined with Doxycycline Hyclate Tablets in treating moderate-to-severe acne. Methods： A total of 99 patients with moderate-to-severe acne treated at Nanchang Hongdu Hospital of Traditional Chinese Medicine from December 2023 to September 2024 were divided into the observation group， the control group A， and the control group B according to the random number table method， with 33 cases in each group. The observation group received fire needling combined with Doxycycline Hyclate Tablets， the control group A received fire needling alone，and the control group B received Doxycycline Hyclate Tablets alone. All groups were treated for four weeks. Clinical efficacy was compared， along with the Global Acne Grading System （GAGS） scores， Échelle d'Évaluation Clinique des Cicatrices d'Acné （ECCA） scores， and Acne-Induced Melanin Hyperpigmentation （AMH） scores before and after treatment. Adverse reactions were also observed. Results： After four weeks of treatment，the total effective rates were 93.55%（ 29/31） in the observation group，83.33%（ 25/30） in the control group A，and 60.71% （17/28） in the control group B. The observation group showed significantly higher efficacy than both control groups（ P＜0.017），and the control group A was more effective than the control group B（ P＜ 0.017）. GAGS scores decreased in all three groups （P＜0.05），with the observation group showing significantly lower scores than both control groups （P＜0.017），and the control group A having lower scores than the control group B （P＜ 0.017）. ECCA and AMH scores increased in all groups（ P＜0.05），but were significantly lower in the observation group compared to both control groups （P＜0.017）. There was no statistically significant difference in ECCA and AMH scores between control group A and control group B （P＞0.017）. No significant adverse reactions were observed during treatment. Conclusion： Fire needling combined with Doxycycline Hyclate Tablets is more effective than either treatment alone in improving inflammatory acne lesions， inhibiting post-inflammatory hyperpigmentation， and preventing scar formation in moderate-to-severe acne，with good safety.