Objective To observe the effect of Xiaoyao powder combined with modified Taohong Siwu decoction and traditional Chinese medicine facial mask pouring on MASI score of chloasma patients with liver-qi stagnation type. Methods A total of 66 chloasma patients with liver-qi stagnation type admitted to our hospital from January 2020 to December 2022 were selected as the research subjects. According to different traditional Chinese and western medicine treatments, they were divided into control group and observation group, with 33 patients in each group. The control group was given western medicine, and the observation group was given Xiaoyao powder combined with modified Taohong Siwu decoction and traditional Chinese medicine facial mask pouring. The clinical efficacy, melasma area and severity index (MASI) and adverse reactions were compared between the two groups. Results The total effective rate in the observation group was 87.88%, which was higher than 66.67% in the control group (P <0.05). After treatment, the MASI score in the observation group was better than that in the control group, and the efficacy index was higher than that in the control group (P <0.05). The incidence of adverse reactions in the observation group was 9.09%, which was slightly lower than 12.02% in the control group, but the difference was not statistically significant (P >0.05). Conclusion The combination of Xiaoyao powder and modified Taohong Siwu decoction, along with traditional Chinese medicine facial mask pouring in the treatment of chloasma with liver-qi stagnation type have better effect on reducing the chloasma area and lightening the chloasma color, with high safety, which is worthy of clinical application.