Objective To analyze the effect of modiffed self-made Meirong Xiaoban decoction in the treatment of female patients with melasma of liver qi stagnation type. Methods A total of 64 female patients with melasma of liver qi stagnation type admitted to the General Practice of Qinhuai District Fuzimiao Community Health Service Center from May 2024 to May 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 32 patients in each group. The control group was treated with tranexamic acid tablets, and the study group was treated with modiffed self-made Meirong Xiaoban decoction on the basis of the control group. The clinical efffcacy, TCM syndrome scores and melasma severity were compared between the two groups. Results The total effective rate of the study group was 93.75%, which was higher than 75.00% of the control group (P<0.05). After 3 months of treatment, the TCM syndrome scores of fullness in chest and hypochondrium and restlessness in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P<0.05). After 3 months of treatment, the MASI score of the two groups was lower than that before treatment, and that of the study group was lower than that of the control group (P<0.05). Conclusion The application of modiffed self-made Meirong Xiaoban decoction in female patients with melasma of liver qi stagnation type has a good effect. It can improve the total effective rate of treatment, reduce TCM syndrome scores, and alleviate the severity of melasma, with deffnite clinical application value.