Trichosanthes cucumerina Linn. is a medicinal vine with great potential that can be used as a vegetable. In this study, an efficient in vitro regeneration system of T. cucumerina was established by inducing adventitious buds and controlling Shoot Tip Necrosis (STN) in vitro culture. The results of hormone single factor and orthogonal experiments showed that 6-BA had a significant effect on inducing adventitious buds. The best medium for bud proliferation was MS + 6-BA 3.0 mg·L-1 + KT 2.0 mg·L-1 + NAA 0.5 mg·L-1, and the proliferation coefficient was 14.68. However, after three consecutive subcultures, a higher incidence of STN (78.86%) was observed. The results of the STN control experiment showed that reducing the concentration of inorganic salt, shortening the subculture interval, and increasing the Ca2+ in the medium could effectively control the occurrence of STN. When the subculture interval was 40 d, the stem segments obtained the lowest STN incidence (8.3%) and higher shoot proliferation coefficient (10.02) on the medium of MS + 3.0 mg·L-1 6-BA + 2.0 mg·L-1 KT + 0.5 mg·L-1 NAA + 360.36 mg·L-1 Ca2+. The best rooting medium for stem segments was MS + 0.50 mg·L-1 NAA; the rooting rate was 100%, and no STN occurred. After acclimation, the survival rate of the rooted plantlet reached 95% after 40 days in the soil matrix of coconut husk: humus soil: perlite = 2: 2: 1 (v/v). The results of this study not only reveal the mechanism of STN in T. cucumerina, but also provide technical support and a theoretical basis for its further artificial breeding and cultivation.