Objective To evaluate the clinical efficacy and safety of acupuncture and moxibustion in the treatment of postoperative pain of hemorrhoids compared with traditional Chinese medicine and western medicine. Methods The CNKI, pubMed, Cochrane Library, Science Direct, Wan Fang, VIP, CBM, WOS, Bailian Yun Library and other databases were systematically retrieved from 2017 to October 2022 for clinical randomized controlled trials of acupuncture versus traditional Chinese and Western medicine for postoperative pain in hemorrhoids. The two evaluators independently retrieved, sifted through literature and extracted data for inclusion in a randomized controlled trial of acupuncture for the treatment of hemorrhoid pain that matched the study. Literature quality assessment was performed using RevMan5.4 for meta-analysis. Results A total of 540 related literature articles were retrieved, of which 139 were from CNKI, 104 from Wan Fang, 104 from VIP26, 7 from PubMed, 9 from Cochrane, 35 from WOS, 173 from China Biomedical Literature Database, 1 from Science Direct and 46 from the Bailian Yun Library, Screening resulted in inclusion of 10 RCTs including 870 patients. Meta analysis showed that there was no significant difference in the degree of pain in 2 hours [MD=0.01, 95%CI (- 0.23, 0.24), P ≤ 0.95]. And it showed that the total effective rate of the two groups was [RR=1.14, 95%CI (1.06, 1.24), P ≤ 0.0001], intervention for 2days pain degree was [MD=-0.41, 95%CI (- 0.69, 0.13), P ≤ 0.004], the incidence of adverse reaction was [RR=0.15, 95%CI (0.03, 0.79), P=0.03], the difference was statistically significant (P<0.05). Conclusion Drug treatment is effective quickly, analgesia effect is better than acupuncture in early treatment, but the effect is not lasting. Acupuncture treatment is slow to start but the effects of acupuncture will gradually become apparent at a later stage. However, due to the low quality of inclusion, multicenter, large sample size and double-blind randomized controlled trials are still needed.