ObjectiveTo evaluate the efficacy and safety of spleen-strengthening therapy in the treatment of postoperative colorectal adenoma. MethodRandomized controlled trials （RCTs） of spleen-strengthening therapy for postoperative colorectal adenoma published in the databases of China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， SinoMed， PubMed， Cochrane Library， Embase， Web of Science， and Clinical Trials registry center from database inception to February， 2024 were retrieved and selected based on inclusion and exclusion criteria. The included RCTs were subjected to Meta-analysis using RevMan 5.3 software. ResultA total of 29 articles were included， involving 2 935 patients， with 1 462 in the experimental group and 1，473 in the control group. The Meta-analysis results showed that compared with conventional Western medical treatment alone， the experimental group that combined the spleen-strengthening therapy with conventional Western treatment had a significantly lower recurrence rate at six months post-surgery ［relative risk （RR）=0.45， 95% confidence interval （CI） ［0.37， 0.53］， P<0.000 01］， and at one year post-surgery （RR=0.54， 95%CI ［0.47， 0.63］， P<0.000 01）. Additionally， the experimental group showed significant improvement in clinical symptoms （RR=1.28，95%CI ［1.17，1.40］， P<0.000 01） and more pronounced effects in suppressing inflammatory factors， with no serious adverse reactions observed. The differences were all statistically significant. The analysis of the Chinese medicines used in the included articles revealed 28 prescriptions with 99 different drugs used 369 times in total. The most frequently used drug was Atractylodis Macrocephalae Rhizoma， followed by Codonopsis Radix， Poria， Glycyrrhizae Radix et Rhizoma， and Citri Reticulatae Pericarpium. Furthermore， correlation analysis showed that spleen-strengthening drugs were often used in combination with heat-clearing and toxin-removing drugs， qi-regulating drugs， and blood-activating drugs such as Hedyotidis Diffusae Herba， Citri Reticulatae Pericarpium， and Curcumae Rhizoma. ConclusionThe spleen-strengthening therapy demonstrates good clinical efficacy and high safety for patients with postoperative colorectal adenoma. However， due to the limitations in the quantity and quality of the included RCTs， more high-quality clinical trials are needed to verify these conclusions.