Hyperpigmentation-induced skin conditions such as chloasma and freckles are common disfiguring skin diseases, which not only affect appearance and undermine patients' confidence but also increases the burden of social interaction. Safe and effective skin whitening and spot removal have become a global health and beauty concern. Traditional Chinese medicine (TCM) , with its holistic view and syndrome differentiation and treatment characteristics, has shown unique advantages in this field. In traditional Chinese medicine, skin pigmentation problems are classified into categories such as “chloasma”, “melanosis”, and “facial dust”, and are believed to be related to liver, spleen, and kidney dysfunction, as well as the imbalance of qi and blood. Throughout history, TCM practitioners have created various classic and empirical prescriptions for regulating qi and blood and soothing the liver and relieving depression, following the principle of the sovereign, minister, assistant, and courier ingredients, to achieve the effect of “nourishing the exterior from within”. However, traditional prescriptions have limitations such as unclear mechanisms of action. The development of modern science and technology and the upgrading of demands bring both opportunities and challenges for their transformation. This article systematically reviews representative TCM classic and empirical prescriptions for skin whitening and spot removal, explores their composition principles, traditional functions, and modern pharmacological foundations, and highlights key improvements and transformation strategies in classical applications and modern practices. It summarizes the experiences and challenges of integrating ancient and modern knowledge, providing insights and theoretical basis for the modernization, scientific validation and international application of these prescriptions, and promoting the inheritance and innovation of TCM in the field of skin beauty, to meet people' s demands for safe and efficient skin care.