Objective To investigate the effect of acupuncture combined with facial three yang meridians self-blood therapy on melasma symptom scores in treatment of melasma. Methods A total of 100 patients with melasma admitted to Jianhu County Gangdong Health Center from January 2023 to October 2024 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 50 patients in each group. The control group was treated with acupuncture, and the observation group was treated with acupuncture combined with facial three yang meridians self-blood therapy. The melasma symptom scores, clinical efficacy, adverse reaction rate and recurrence rate were compared between the two groups. Results After treatment, the scores of pigmentation area, color depth and uniformity in the observation group were lower than those in the control group, and the differences were statistically significant (P <0.05). The total effective rate of treatment in the observation group (98.00%) was higher than that of the control group (80.00%), and the difference was statistically significant (P <0.05). The incidence of adverse reactions in the observation group (0) and the recurrence rate (4.00%) were both lower than those in the control group (14.00% and 22.00%, respectively), and the differences were statistically significant (P <0.05). Conclusion In the clinical treatment of melasma, acupuncture combined with facial three yang meridians self-blood therapy can be employed, yielding definite effects. It can effectively improve melasma symptoms, with high safety and low recurrence rate, making it worthy of clinical application.