Objective To explore the effect of Honghua Xiaoyao tablets combined with oral administration and topical fumigation and washing of traditional Chinese medicine in the treatment of liver-qi stagnation type melasma. Methods A total of 63 patients with liver-qi stagnation type melasma admitted to Huai'an Maternity and Children Hospital from June 2022 to May 2025 were selected and divided into group A, group B and group C by the random number table method, with 21 patients in each group. Group A was treated with Honghua Xiaoyao tablets, group B was treated with Honghua Xiaoyao tablets combined with oral administration of traditional Chinese medicine, and group C was treated with Honghua Xiaoyao tablets combined with oral administration and topical fumigation and washing of traditional Chinese medicine. The treatment effect, treatment satisfaction and Melasma Area and Severity Index (MASI) were compared among the three groups. Results The total effective rate of treatment in group C (95.24%) was higher than that of group A (61.90%) and group B (52.38%) (P <0.05). The treatment satisfaction score of group C was higher than that of group A and group B (P <0.05). The MASI score of group C after treatment was lower than that of group A and group B (P <0.05). Conclusion The application of Honghua Xiaoyao tablets combined with oral administration and topical fumigation and washing of traditional Chinese medicine in the treatment of liver-qi stagnation type melasma has a definite effect. It can improve the total effective rate of treatment, promote the improvement of patients' symptoms, and obtain high satisfaction, which is worthy of clinical application.