Objective To explore the efficacy and safety of Erzhi pills combined with auricular acupressure in the treatment of patients with melasma with liver-kidney yin deficiency type. Methods A total of 62 patients with melasma (liver-kidney yin deficiency type) admitted to the First People's Hospital of Guannan from February 2022 to January 2025 were selected as the research subjects, and they were divided into the control group (February 2022-December 2023) and the observation group (January 2024-January 2025) according to different admission time, with 31 patients in each group. The control group was treated with Erzhi pills, and the observation group was treated with auricular acupressure on the basis of Erzhi pills. The clinical efficacy, melasma syndrome manifestations, Melasma Area and Severity Index (MASI) and adverse reaction rate were compared between the two groups. Results The total effective rate of the observation group (96.77%) was higher than that of the control group (74.19%) (P <0.05). The scores of various melasma syndrome manifestations in the observation group after treatment were lower than those in the control group (P <0.05). The scores of various items of MASI in the observation group after treatment were lower than those in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The application of Erzhi pills combined with auricular acupressure in patients with melasma with liver-kidney yin deficiency type can effectively improve the total effective rate, reduce the melasma area and severity index, help to alleviate melasma symptoms, and does not increase the risk of adverse reactions, with good efficacy and safety.