OBJECTIVE: Traditional Chinese Medicine (TCM) has been proven to have a stable therapeutic effect and low toxicity. This study explored the effect of acupuncture combined with a heat-clearing prescription on patients with prediabetes mellitus (PDM) caused by excessive heat with yin deficiency. METHODS: This retrospective analysis was conducted at the Changxing County TCM Hospital. A total of 297 cases of PDM caused by excessive heat with yin deficiency was conducted using clinical records of patients treated in the hospital from February 2023 to July 2024. Patients receiving acupuncture combined with a heat-clearing prescription (TCM group, n=40) were matched based on age at a 1:1 ratio with a cohort of 40 patients receiving traditional treatment (traditional group). The primary outcome was blood glucose levels, and the secondary outcomes were pancreatic beta cell function, cytokines, quality of life (QOL), and adverse events. RESULTS: After treatment, the decrease in blood glucose levels in the TCM group was significantly lower than the traditional group (P<0.05). The improvement of homeostasis model assessment of beta-cell function (HOMA-β), Fasting Insulin (FINS), and HOMA insulin resistance (HOMA-IR) in the TCM group was better than the traditional group (P<0.05). The decrease in inflammatory cytokine levels in the TCM group was lower than the traditional group (P<0.05). Similarly, the decrease in diabetes-specific QOL scale (DSQL) score in the TCM group was lower than in the traditional group (P<0.05). CONCLUSIONS: Compared with traditional therapies, acupuncture combined with heat-clearing prescription has a more significant effect on treating patients with PDM caused by excessive heat with yin deficiency.