Objective To explore the effect of traditional Chinese medicine facial care on skin pigment index and facial uniformity in patients with chloasma of spleen deficiency type. Methods A total of 60 patients with chloasma of spleen deficiency type admitted to Zhangdian District Traditional Chinese Medicine Hospital from January 2021 to May 2023 were selected, and they were divided into the control group and the study group by the random number table method, with 30 patients in each group. The control group received routine treatment (laser+tranexamic acid), and the study group received traditional Chinese medicine facial care treatment on the basis of the control group. The treatment effect, skin pigment index, facial uniformity score, satisfaction with facial condition improvement and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the study group was 96.67%, which was higher than 73.33% in the control group (P <0.05). After treatment, the skin pigment index in the study group was lower than that in the control group, and the facial uniformity score was higher than that in the control group (P <0.05). The total satisfaction with facial condition improvement in the study group was 96.67%, which was higher than 76.67% in the control group (P <0.05). There were no serious adverse reactions in the two groups during the treatment period. Conclusion Traditional Chinese medicine facial care has a good effect in the treatment of chloasma of spleen deficiency type. It can effectively improve the facial condition of patients, enhance patients' satisfaction, and has high safety.