Objective To study the effect of Jieyu Hehuan decoction combined with Q-switched laser therapy in melasma patients with liver depression and qi stagnation type. Methods A total of 86 melasma patients with liver depression and qi stagnation type admitted to our hospital from October 2023 to October 2024 were selected, and they were divided into the control group and the observation group according to the random number table method, with 43 patients in each group. The control group was given Q-switched laser therapy, and the observation group was combined with Jieyu Hehuan decoction on the basis of the control group. The clinical efficacy, melasma severity, treatment satisfaction, anxiety score and depression score were compared between the two groups. Results Compared with 79.07% of the total effective rate of the control group, the total effective rate of the observation group was higher, reaching 95.35% (P <0.05). After treatment, the MASI scores of the forehead, right cheek, left cheek and mandible in the observation group were lower than those in the control group (P <0.05). Compared with 74.42% of the control group, the treatment satisfaction of the observation group was higher, reaching 97.67% (P <0.05). After treatment, the scores of anxiety and depression in the observation group were lower than those in the control group (P <0.05). Conclusion For melasma patients with liver depression and qi stagnation type, the combination of Jieyu Hehuan decoction and Q-switched laser therapy can reduce the area and severity of melasma, improve the clinical effect and satisfaction, and relieve their negative emotions, which is worthy of clinical application.