This study evaluated the efficacy and safety of Liangxue Jiedu therapy in the treatment of hepatitis B and acute-on-chronic liver failure(HBV-ACLF).Methods:We searched the major databases for randomized controlled trials on the treatment of HBV-ACLF with Liangxue Jiedu therapy(January 2010-May 2020)，followed by screening accoring to the exclusion criteria，quality assessment，and data collection.RevMan5.3 was employed for Meta-analysis.Results:A total of 20 randomized controlled trials involving 1 812 cases were included.Meta-analysis results showed that Liangxue Jiedu therapy can significantly raise the total clinical effective rate(OR=2.61，95%CI 1.93 to 3.52，Z=6.24，P<0.000 01)，reduce clinical mortality(OR=0.39，95%CI 0.29 to 0.53，Z=6.14，P<0.000 01)，GPT(MD=-20.86，95%CI -29.91 to -11.80，Z=4.51，P<0.000 01)，GOT(MD=-4.99，95%CI -8.05 to -1.92，Z=3.19，P=0.001)，TBil(MD=-40.47，95%CI -45.69 to -35.25，Z=15.19，P<0.000 01)，and MELD(MD=1.19，95%CI 0.29 to 2.09，Z=2.90，P=0.01)，and improve levels of ALB(MD=2.57，95%CI 1.95 to 3.19，Z=8.13，P<0.000 01)，CHE(MD=1.15，95%CI 0.37 to 1.92，Z=2.90，P=0.004)，and PTA(MD=11.2，46，95%CI 9.32 to 13.60，Z=10.50，P<0.000 01)，and traditional Chinese medicine(TCM) syndrome(MD=-3.65，95%CI -4.63 to -2.67，Z=7.92，P<0.000 01).Four studies reported the relevant adverse reactions of the Liangxue Jiedu therapy，all of which，however，disappeared spontaneously.Conclusion:Liangxue Jiedu therapy can raise the clinical effective rates in patients with HBV-ACLF，thus reducing the mortality，and improve liver function and blood coagulation，with seldom occurrence of adverse reactions.