Objective To explore the effect of individualized TCM Yangyan decoction based on TCM constitution differentiation on skin status in females with skin water-oil imbalance. Methods A total of 90 female patients with skin water-oil imbalance admitted to the Department of Dermatology, Hongze District Hospital of Traditional Chinese Medicine from June 2021 to December 2023 were selected, and they were divided into group A, group B, and group C according to TCM constitution classiffcation, with 30 patients in each group. Group A was given ZiyinYangyan decoction, group B was given Ziyin Runfu decoction, and group C was given Qingre Lishi decoction. The skin moisture content scores, skin sebum content scores, facial skin problem score and TCM syndrome score were compared among the three groups. Results The skin moisture content scores of the T zone and U zone in the three groups after treatment were lower than those before treatment, and those in group B were lower than those in group A and group C (P<0.05). The skin sebum content scores of the T zone and U zone in the three groups after treatment were lower than those before treatment, and those in group C were higher than those in group A and group B (P<0.05). The facial skin problem score in the three groups after treatment was lower than that before treatment (P<0.05), but there was no statistically significant difference among the groups after treatment (P>0.05). The score of TCM syndromes in the three groups after treatment was lower than that before treatment (P<0.05), but there was no statistically signiffcant difference among the groups after treatment (P>0.05). Conclusion TCM Yangyan decoction based on constitution differentiation can effectively improve skin moisture content and sebum secretion status, relieve facial skin problems, correct constitution bias by regulating theinternal environment of the body, and has good safety.