Objective To evaluate the clinical effect of treating postherpetic neuralgia (PHN) with fire needle acupuncture based on meridian differentiation. Methods 150 PHN patients were randomly divided into observation group,control group A and control group B,each with 50 cases. Control group A was treated with ordinary acupuncture,control group B was treated with oral gabapentin capsule,and observation group was treated with fire needle acupunture. The clinical efficacy,Visual Analogue Scale (VAS) score,Pittsburgh Sleep Quality Index (PSQI) score and 36-Item Short-Form Health Survey (SF-36) score were compared among the three groups. Results The total clinical effective rate of the observation group was 96%,which was significantly higher than that of control group A (84%) and control group B (80%),and the difference was statistically significant (P<0.05). After treatment,the observation group had VAS score of (3.76±1.61) points and PSQI score of (6.56±1.43) points,which were significantly lower than those of control group A[(4.70±1.90) and (9.16±2.46) points]and control group B[(4.95±1.99) and (10.51±2.69) points],and the difference was statistically significant (P<0.05). In observation group,the physical functioning score was (92.40±6.08) points,the emotional functioning score was (90.70±6.67) points,the social functioning score was (91.09±6.17) points,the health status score was (91.82±6.37) points,and the vitality score was (91.96±6.45) points,which were significantly higher than control group A[(83.31±5.91),(82.72±5.35),(82.44±5.32),(83.57±5.88),and (82.76±5.41) points]and control group B[(81.35±5.43),(80.21±4.95),(80.01±4.58),(81.02±4.78),and (80.06±5.02) points],and the difference was statistically significant (P<0.05). Conclusion The clinical effect of fire needle acupuncture is remarkable on PHN,and it has positive effect on relieving neuralgia and improving sleep.