Objective To investigate the effect of self-made Quban decoction combined with acupuncture on TCM syndrome scores in patients with melasma of qi stagnation and blood stasis type. Methods A total of 80 female patients with melasma of qi stagnation and blood stasis type treated in Qinhuai District Fuzimiao Community Health Service Center from January 2023 to December 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the study group, with 40 patients in each group. The control group received conventional western medicine treatment, and the study group received self-made Quban decoction combined with acupuncture on the basis of the control group. The Melasma Area and Severity Index (MASI), skin physiological indicators, clinical efffcacy and TCM syndrome scores were compared between the two groups. Results The MASI score in the study group after 2 months of treatment was lower than that in the control group (P<0.05). The skin elasticity and moisture in the study group after 2 months of treatment were better than those in the control group (P<0.05). The total effective rate in the study group (95.00%) was higher than that in the control group (80.00%) (P<0.05). The TCM syndrome scores of soreness and weakness of the waist and knees, distending pain in the chest and hypochondrium in the study group after 2 months of treatment were lower than those in the control group (P<0.05). Conclusion Self-made Quban decoction combined with acupuncture can improve MASI and skin physiological indicators of patients with melasma of qi stagnation and blood stasis type, enhance treatment effect and alleviate TCM syndromes.