Objective To observe the clinical effect of modified Taohong Siwu decoction combined with picosecond laser on CHloasma of qi stagnation and blood stasis type. Methods A total of 52 patients with chloasma who were admitted to our hospital from January 2022 to December 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 26 patients in each group. The control group was treated with super picosecond laser, and the observation group was treated with modified Taohong Siwu decoction on the basis of the control group. The clinical efficacy, chloasma area, chloasma color score, color spot residue score (PGA), skin disease quality of life index (DLQI), TCM symptom score and clinical adverse reaction rate were compared between the two groups. Results The total effective rate of treatment in the observation group was 96.15%, which was higher than 80.77% in the control group (P <0.05). After treatment, the chloasma area, chloasma color score, PGA score, DLQI score and TCM symptom score in the observation group were lower than those in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P >0.05). Conclusion The clinical effect of Taohong Siwu decoction combined with picosecond laser in the treatment of chloasma of qi stagnation and blood stasis type is definite, which can reduce the TCM syndrome score, PGA and chloasma color score, reduce the area of chloasma, improve the quality of life of patients, and will not increase adverse reactions.