Objective To investigate the clinical effect of Shierwei Zeqi Granule combined with milli-fire needle in the treatment of blood-heat psoriasis. Methods A total of 39 patients with blood-heat psoriasis were randomly divided into treatment group with 20 patients and control group with 19 patients. The patients in the treatment group received oral administration of Shierwei Zeqi Granule combined with milli-fire needle, and those in the control group received oral administration of Tripterygium Glycosides Tablets, with a course of treatment of 8 weeks for both groups. The two groups were compared in terms of the changes in Psoriasis Area and Severity Index (PASI) score, blood-heat syndrome score, numerical rating scale (NRS) score for pruritus, and body surface area (BSA) score after treatment, and clinical outcome was assessed based on the reduction rate of PASI score. Results There was no significant difference in overall clinical outcome between the two groups (P>0.05). Both groups had significant reductions in PASI score, blood-heat syndrome score, NRS score for pruritus, and BSA score after 2, 4, 6, and 8 weeks of treatment (P<0.05). Compared with the control group, the observation group had a significantly lower PASI score after 4 and 6 weeks of treatment (P<0.05), a significantly lower blood-heat syndrome score after 8 weeks of treatment (P<0.05), and a significantly lower NRS score for pruritus after 2, 4, 6, and 8 weeks of treatment (P<0.05), and there was no significant difference in BSA score between the two groups at each time point (P>0.05). No serious adverse reactions were observed in either group during treatment. Conclusion Shierwei Zeqi Granule combined with milli-fire needle has a marked clinical effect and good safety in the treatment of blood-heat psoriasis.