Melasma is a common clinical facial pigmentation skin disease. It mostly occurs in young and middle-aged women, affecting their appearance and bringing a lot of troubles and pains to patients’ life and spirit. The causes of chloasma are complex and the treatment is difficult. Diagnostic criteria According to the “Clinical Diagnosis and Efficacy Criteria of Melasma (2003 Revision)” formulated by the Pigmentology Group of the Chinese Society of Integrative Medicine in 2003. The main points are as follows: ①Pale brown to dark brown, well-defined patches on the face. ②No obvious self-conscious symptoms. ③More frequent in females, mainly occurring after puberty. ④The condition can be seasonal, often heavy in summer and light in winter. ⑤Exclude other facial pigmented skin diseases (such as zygomatic brown nevus, Riehl’s melanosis and pigmented photodepleted lichen planus, etc.). Rash and efficacy determination ①Visual observation. The efficacy was judged according to the fading area of the discoloration and the area of the lesion scored, before and after comparison. ②Take photos by digital camera and compare before and after. ③Skin image analysis system (plan to order skin tester). Laboratory tests Blood routine, urine routine, liver and kidney function or biochemistry, reproductive hormones, thyroid function, adrenal function (including ACTH, MSH), coagulation function. Liver and biliary ultrasound, kidney and adrenal ultrasound, gynecologic ultrasound. Treatment ① General treatment medications: vitamin C, vitamin E, Chinese herbal medicines such as Liu Wei Di Huang Wan, Yi Yao Wan, etc. Side effects of vitamin E: causes gastrointestinal discomfort and even gastrointestinal bleeding; can affect blood pressure and cause thrombophlebitis; can affect vision and hearing; in women it can also cause changes in menstrual cycle and menstrual volume, breast lumps, etc. ② Tranexamic acid tablets. Low dose long course, usage: 0.25g, one month as a course of treatment, follow-up visits to observe the efficacy, can be used up to 12 months. The low-dose, long-course usage is safe, with a few patients experiencing mild gastrointestinal reactions and decreased menstrual flow. ③Our homemade mother-of-pearl spot-removal soup and spot-removal formula are taken orally. Choose them according to the patient’s condition, and use the spot removal formula if there is irregular menstruation. ④Facial massage and homemade herbal mask (Wai Yam, Angelica, Chuanxiong, etc.). ⑤L-vitamin C ultrasonic audio ion introduction. ⑥Q-switched Nd:YAG laser. Large spot, low dose, determine the treatment interval and frequency according to the skin lesion. Cold spray or cold wet compress for 20min after treatment with moisturizing cream. Side effects: some patients have local redness, papules and pain after treatment, and a few patients have hyperpigmentation and hypopigmentation. (7) Chinese medicine evidence-based treatment. The following points should be noted in the history taking: 1. Repeated over-stimulation of the facial skin, such as excessive force in washing the face. Work and sun exposure. 2. Sleep and stool conditions, mental and emotional conditions. 3, history of previous systemic diseases, including liver, biliary and renal diseases, gynecological diseases including gynecological inflammation, uterine fibroids, ovarian cysts, etc., thyroid diseases, history of tuberculosis, history of visceral tumors. 4. History of medication use, including contraceptives, antiepileptic drugs such as phenytoin sodium and chlorpromazine, common photosensitizing drugs such as sulfonamide, tetracycline and quinolone antibiotics, some diuretics and antiepileptic drugs. 5. Cosmetics and topical drug use. 6. Pregnancy history, menstrual condition including whether the period is regular, the amount of menstruation and whether it is dysmenorrhea.