To analyze the effect and safety of traditional Chinese medicine combined with acupuncture and moxibustion in the treatment of chloasma. Methods A total of 80 patients with chloasma admitted to Daye People's Hospital from June 2022 to May 2023 were randomly divided into control group and observation group, with 40 patients in each group. The control group was treated with traditional Chinese medicine, and the observation group was treated with traditional Chinese medicine combined with acupuncture and moxibustion. The clinical efficacy, degree of skin lesions, emotional state, quality of life and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 95.00%, which was higher than 80.00% of the control group, the difference was statistically significant (P <0.05). After treatment, the skin lesion color, skin lesion area, SAS and SDS scores of the two groups were lower than those before treatment, and the observation group was lower than the control group, the difference was statistically significant (P <0.05). The quality of life scores of the two groups after treatment were higher than those before treatment, and the observation group was higher than the control group, the difference was statistically significant (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The effect and safety of traditional Chinese medicine combined with acupuncture and moxibustion in the treatment of chloasma are high, which can effectively reduce the color and area of skin lesions, alleviate bad mood and improve the quality of life.