Objective To explore the effect of facial moxibustion combined with traditional Chinese medicine fumigation and washing on symptom improvement in patients with melasma of qi stagnation and blood stasis type. Methods A total of 80 patients with melasma of qi stagnation and blood stasis type treated in Nanjing Gaochun Traditional Chinese Medicine Hospital from January to December 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. Both groups received basic treatment. On this basis, the control group was treated with facial traditional Chinese medicine fumigation and washing, and the observation group was treated with facial moxibustion combined with traditional Chinese medicine fumigation and washing. The MASI score, treatment effect and symptom improvement were compared between the two groups. Results After treatment, the MASI score of the observation group was lower than that of the control group (P<0.05). The total effective rate of the observation group (97.50%) was higher than that of the control group (80.00%) (P<0.05). The scores of pigmentation area, color uniformity and melasma color in the observation group after treatment were lower than those in the control group (P<0.05). Conclusion Facial moxibustion combined with traditional Chinese medicine fumigation and washing has deffnite aesthetic effects in the treatment of melasma of qi stagnation and blood stasis type, which can effectively reduce skin lesions, and relieve clinical symptoms.