To evaluate the clinical efficacy and safety of Guizhi Shaoyao Zhimu Decoction in combination with chemical drugs for the treatment of rheumatoid arthritis(RA).Methods:A computer-based search was conducted across multiple databases,including CNKI,CSPD,CCD,China Biology Medicine(CBM),PubMed,and Cochrane Library,with the search covering both Chinese and English literature from the inception of the databases up to March 21,2021.Manual assistance was also used to retrieve relevant studies to avoid missing any literature.The Cochrane Collaboration's risk of bias assessment criteria were used for literature screening,data extraction,and quality evaluation.Meta-analysis was performed using RevMan 5.3 software.Results:A total of 18 studies,including 1 683 patients,were included in this research.The Meta-analysis showed that,compared to chemical drugs alone,Guizhi Shaoyao Zhimu Decoction combined with chemical drugs significantly improved the DAS28 score(MD=1.11,95%CI 0.61 to 1.62,P<0.000 1).The total effective rate of the combination therapy was superior to that of chemical drugs alone(OR=4.95,Z=9.73,P<0.000 1).The combination therapy significantly improved clinical symptoms,such as joint pain count(MD=1.21,95%CI 0.25 to 2.18,P=0.01) and grip strength in both hands(MD=14.14,95%CI 11.72 to 16.55,P<0.000 01).It also effectively improved laboratory indicators,including rheumatoid factor(SMD=1.19,95%CI 0.46 to 1.92,P=0.001),C-reactive protein(MD=3.77,95%CI 1.26 to 6.28,P=0.003),and erythrocyte sedimentation rate(MD=8.09,95%CI 3.40 to 12.77,P=0.000 7).Guizhi Shaoyao Zhimu Decoction significantly reduced the incidence of adverse reactions caused by chemical drugs alone(RR=0.24,95%CI 0.14 to 0.42,P<0.000 1).Conclusion:Guizhi Shaoyao Zhimu Decoction in combination with chemical drugs is more effective than chemical drugs alone in the treatment of RA.It improves clinical symptoms and laboratory markers and is safer than using chemical drugs alone.