Objective To investigate the effect of Hui Feng Huoxue Decoction combined with fire acupuncture in the treatment of vitiligo and the immune imbalance of Th17/Treg. Methods Sixty patients with vitiligo admitted to The Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine were included in the study, and divided into observation group and control group by stratified and randomized grouping method, 30 cases in each group. The two groups were given 0.1% tacrolimus ointment externally (twice a day), the control group was additionally treated with fire acupuncture therapy (once a week), and the observation group was additionally treated with Hui Feng Huoxue decoction orally (twice a day) on the basis of the control group. The therapeutic effects were observed after continuous treatment for 12 weeks. VASI score, pigmentation score of skin lesions, percentage of Th17 and Treg cells in CD4+T cells, Th17/Treg ratio and serum IL-17, TNF-α and IFN-γ levels were compared before and after treatment. The color recovery of skin was observed dynamically by dermoscope. Results The effective rate of the observation group was 86.21%, and significantly higher than that of the control group (60.71%) (2=4.774, P＜0.05). After treatment, the pigmentation score of skin lesions and the percentage of Treg cells in CD4+T cells in the observation group were significantly increased compared with the control group (P＜0.05), the percentage of Th17 in CD4+T cells, the ratio of Th17/Treg and the levels of IL-17, TNF-α and IFN-γ in the observation group were significantly decreased compared with the control group (P＜0.05). After 6 weeks of treatment, pigments at hair follicle margins and early islands of pigments were observed in the lesions, as well as telangiectasia. After 12 weeks of treatment, a large number of pigmentation islands were observed, and the white spots were almost multicolor under dermoscope. Conclusion Hui Feng Huoxue Decoction combined with fire acupuncture has a significant effect on the treatment of vitiligo, which can effectively control the development of vitiligo and promote vitiligo recoloration. This therapeutic effect may be related to the regulation of Th17/Treg immune balance of the body and the inhibition of inflammatory response.