Objective To analyze the efficacy and safety of Q-switched laser combined with TCM acupuncture and pricking and cupping therapy in the treatment of melasma. Methods A total of 108 patients with melasma diagnosed and treated in the Hospital of Yutian County from January 2023 to December 2024 were selected. According to the random number table method, they were divided into the control group and the observation group, with 54 patients in each group. The control group received Q-switched laser, and the observation group received Q-switched laser combined with TCM acupuncture and pricking and cupping therapy. The treatment effect, skin lesions, oxidative stress indicators and adverse reaction rate were compared between the two groups. Results The total effective rate of the observation group (96.30%) was higher than that of the control group (79.63%) (P<0.05). At 3 months after treatment, the scores of skin lesion area and skin lesion color depth in the observation group were lower than those in the control group (P<0.05). At 3 months after treatment, the level of MDA in the observation group was lower than that in the control group, while the levels of SOD and GSH-Px were higher than those in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group (P>0.05). Conclusion Q-switched laser combined with TCM acupuncture and pricking and cupping therapy has a good effect in the treatment of melasma. It can effectively alleviate skin lesion symptoms, improve oxidative stress response, and does not increase the incidence of adverse reactions, showing good application efficacy and safety.