Objective To analyze the effect of acupuncture combined with Yurong Huayu Decoction on symptom improvement and serum indicators in patients with melasma. Methods A total of 200 patients with melasma admitted to Jingjiang People's Hospital from January 2023 to January 2024 were selected, and they were divided into the control group and the study group by the random number table method, with 100 patients in each group. The control group was treated with acupuncture, and the study group was treated with acupuncture combined with Yurong Huayu decoction. The symptom improvement, serum indicators, treatment effect and adverse reaction rate were compared between the two groups. Results At 12 and 24 weeks after treatment, the melasma area score, color score and total score of the study group were lower than those of the control group (P<0.05). At 24 weeks after treatment, the level of SOD in the study group was higher than that in the control group, and the levels of MDA and VEGF were lower than those in the control group (P<0.05). The total effective rate of the study group (97.00%) was higher than that of the control group (89.00%) (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Acupuncture combined with Yurong Huayu decoction can effectively improve the clinical symptoms and serum indicators of patients with melasma, which is conducive to enhancing the treatment effect. Moreover, the incidence of adverse reactions after treatment is low, and the safety is good.