Medicated thread moxibustion of Zhuang medicine is a distinctive external treatment technique of the Zhuang ethnic group. In recent years, it has been widely applied in the treatment of various skin conditions, including eczema, herpes zoster, acne, vitiligo, psoriasis and chronic urticaria. Clinical studies have demonstrated that this therapy is effective and offers advantages such as being minimally invasive and painless, high patient compliance and low cost; it also produces significant synergistic benefits when used in combination with both Chinese and Western medicines. Experimental studies suggest that its mechanism of action involves immunomodulatory pathways, such as the regulation of T-lymphocyte subsets, the reduction of serum IgE levels, and the inhibition of inflammatory cytokine release. However, existing research consists predominantly of small-sample, single-center exploratory studies, lacking unified standardized operating procedures and a quantitative system for evaluating therapeutic efficacy; the specific targets and molecular mechanisms remain unclear. Future research should involve large-scale, multicentre, randomized controlled trials to strengthen the evidence base, clarify the molecular mechanisms and establish standardized protocols, thereby promoting the standardized clinical application of this technique with distinctive ethnic characteristics.