Typical ultra-deep fractured tight sandstone gas wells, such as those in the Kuqa Piedmont, exhibit significant sand production after hydraulic fracturing or acidizing stimulation, particularly under complex production conditions involving high-rate water production and alternating gas-water injection-production. However, the mechanisms and dominant controlling factors of sand production remain unclear. Using cores of fractured tight sandstone reservoirs from typical gas fields in the Kuqa Piedmont of the Tarim Basin, the processes of hydraulic fracturing or acidizing stimulation, along with production scenarios involving high-rate water production and alternating gas-water injection-production, were first simulated. Subsequently, sand production simulation experiments were conducted to investigate the patterns of sand production. The results show that under conventional production conditions, no significant sand production occurs during the entire displacement process in the fractured tight sandstone gas reservoirs of the Kuqa Piedmont. However, a relatively large production pressure difference is found to induce slip failure of fracture surfaces. After hydraulic fracturing stimulation, sand production is observed when the main fractures penetrate the cores and the flow conditions necessary for sand particle migration within the fractures are satisfied. Acidizing stimulation is identified as the primary cause of sand production in deep fractured tight sandstone reservoirs. Its fundamental mechanism lies in the dissolution of fracture fillings and fracture surfaces by acid etching, which leads to reservoir damage and sand production, as well as the hydration or acid etching of local zones with high shale content, triggering sand production. During acidizing treatment of deep fractured tight sandstone, a substantial quantity of movable particles is generated, serving as the main sand source. The average particle shedding caused by acidizing is approximately three times the mass of sand particles produced during the post-acidizing displacement phase. Furthermore, the median particle size of the detached particles is significantly larger than that of the sand produced during displacement. The primary mechanisms of post-acidification sand production are determined to be the acid dissolution of fracture-filling materials, which generate movable particles, and the hydration and dispersion of clay-rich zones. High-rate water production is found to significantly weaken natural fracture fillings through hydration and to exacerbate sand production. The volume of sand produced during the high-water-cut stage is comparable to, or even higher than, that produces during the post-acidification production phase. In comparison, the subsequent gas-water alternating injection-production phase has a relatively minor impact on sand production. The research results provide a direct basis for formulating sand control strategies, such as optimizing stimulation measures and implementing water control during production in deep tight sandstone reservoirs.