Objective To analyze the effect of Xuefu Zhuyu decoction combined with pulsed laser therapy on the improvement of lesion area and color in patients with melasma. Methods A total of 64 patients with melasma who received treatment in Donghai County Tuofeng Central Health Center from February 2022 to December 2024 were selected, and they were divided into the control group and the observation group by simple randomization method, with 32 patients in each group. The control group was given Xuefu Zhuyu decoction, and the observation group was given Xuefu Zhuyu decoction combined with pulsed laser therapy. The quality of life, improvement of lesion area and color, TCM syndrome score and aesthetic satisfaction were compared between the two groups. Results After intervention, the quality of life score of the observation group was lower than that of the control group (P <0.05). The improvement of lesion area and color in the observation group was better than that in the control group (P <0.05). The TCM syndrome score of the observation group was lower than that of the control group (P <0.05). The aesthetic satisfaction of the observation group was 100.00%, which was higher than 81.25% of the control group (P <0.05). Conclusion The combination of Xuefu Zhuyu decoction and pulsed laser in the treatment of melasma helps to reduce the TCM syndrome score of patients, improve the color and area of lesions, enhance the quality of life, and increase their aesthetic satisfaction.