To investigate the effects of Xiaoyao pill and Hydroquinone cream combined with moxibustion on the skin lesions and hormone levels of chloasma. Methods A total of 74 female chloasma patients admitted to Shanghai Luodian Hospital from June to October 2022 were selected as the research objects. They were divided into reference group and experimental group by random number table method, with 37 patients in each group. The reference group was treated with tretinoin cream, and the experimental group was treated with Xiaoyao pill, hydroquinone cream combined with moxibustion. The skin lesion score, TCM syndrome score, hormone level, clinical efficacy and adverse reactions were compared between the two groups. Results After treatment, the scores of skin lesions and TCM syndromes in the experimental group were lower than those in the reference group, the differences were statistically significant (P <0.05). After treatment, the levels of FSH, E2 and LH in the experimental group were lower than those in the reference group, the differences were statistically significant (P <0.05). The total effective rate of treatment in the experimental group was 97.30%, which was higher than 81.08% in the reference group, and the difference was statistically significant (P <0.05). The incidence of adverse reactions in the experimental group was 5.40%, which was lower than 24.32% in the reference group, and the difference was statistically significant (P <0.05). Conclusion The combined treatment of Xiaoyao pill, hydroquinone cream and moxibustion can effectively regulate the level of sex hormones for patients with chloasma, reduce their skin lesions, improve clinical symptoms, and has certain therapeutic safety, which is worthy of clinical application.