Objective To investigate the clinical effect of stomach heat- purging and spleen- tonifying acupuncture in the treatment of patients with prediabetes. Methods A total of 60 patients were divided into acupuncture group (32 patients) and control group (28 patients) using a random number table. The patients in the acupuncture group were given scientific lifestyle intervention followed by acupuncture with stomach heat- purging and spleen- tonifying principles for acupoint selection, and those in the control group were given lifestyle intervention alone. The syndrome score was recorded before and after treatment, and the changes in fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) after treatment were measured to evaluate the therapeutic effect. Results There was a significant difference in the distribution of clinical outcomes between the two groups (P<0.05). The acupuncture group had a significant reduction in syndrome score after 1 month of treatment (P<0.05); both groups had significant reductions in syndrome score after 2 months of treatment (P<0.05), and the acupuncture group had a significantly lower syndrome score than the control group after 1 and 2 months of treatment (P<0.05). Both groups had significant reductions in FPG and HbA1c after treatment (P<0.05), and the acupuncture group had significantly greater reductions in FPG and HbA1c compared with the control group (P<0.05). Conclusion Stomach heat- purging and spleen- tonifying acupuncture is an effective therapy for patients with prediabetes and can improve their symptoms.