Objective To analyze the effect of Qingre Qushi decoction combined with catgut implantation at acupoint on pigmentation in melasma patients with damp heat accumulation type. Methods A total of 213 melasma patients with damp heat accumulation type admitted to the Department of Medical Aesthetics, the Fourth Affiliated Hospital of Nanjing Medical University from January 2020 to June 2025 were selected, and they were divided into the control group (n =106) and the observation group (n =107) by the random number table method. The control group was given conventional western medicine treatment, and the observation group was given Qingre Qushi decoction combined with catgut implantation at acupoint on the basis of the control group. The TCM syndrome score, clinical efficacy, pigmentation and serum oxidative stress indicators were compared between the two groups. Results The TCM syndrome score of the observation group after treatment was lower than that of the control group (P <0.05). The total effective rate of the observation group was 96.26%, which was higher than 84.91% of the control group (P <0.05). The MASI score of the observation group after treatment was lower than that of the control group (P <0.05). The level of SOD in the observation group after treatment was higher than that in the control group (P <0.05). Conclusion Qingre Qushi decoction combined with catgut implantation at acupoint can effectively improve the TCM syndrome score of melasma patients with damp heat accumulation type, enhance clinical efficacy, reduce skin pigmentation, and reduce serum oxidative stress indicators, which has good clinical application value.