Objective:To systematically evaluate the efficacy and safety of Xiaoxuming Decoction combined with conventional western medicine for acute ischemic stroke (AIS).Methods:Randomized controlled trials of Xiaoxuming Decoction combined with conventional western medicine on AIS were retrieved from various databases including CNKI, SinoMed, WanFang, VIP, The National Library of Medicine (MEDLINE), Excerpt Medica Database (EMBASE), the Cochrane Central Register of Controlled Trials (CENTRAL) with the deadline of March 31th, 2021. The risk of bias of included trials was assessed in the light of the criteria recommended by the Cochrane Handbook 5.0.1 for Systematic Reviews of interventions. Data were retrieved and analysed by Review Manager 5.3 software.Results:Thirteen qualified trials with 1 007 patients were included, with the control group given conventional western medicine ( n=488) and the treatment group on the basis of the CG adding Xiaoxuming Decoction ( n=519). The risk of bias was general high among the included studies. Meta analyses showed that Xiaoxuming Decoction combined with conventional western medicine on AIS was significantly better to attenuate NIHSS scores and improve clinical effective rate than the routine treatment of western medicine, with MD=-2.51, 95% CI [-3.55, -1.47], P<0.05 and RR=1.14, 95% CI [1.07, 1.21], P=0.07. Two articles truthfully reported and recorded the incidence rate of total adverse events with 3.45% and 6.82%. Conclusion:Current evidence indicates that treating acute ischemic stroke with Xiaoxuming Decoction combined with conventional western medicine can improve the clinical efficacy and attenuate NIHSS scores.