Objective To systematically evaluate the effectiveness of Wuzi Yanzong pills in the treatment of oligoasthenospermia. Methods CNKI, Wanfang Database, VIP, CBM, Pubmed, Cochrane Library and Embase databases were searched for the randomized controlled trials of Wuzi Yanzong pill in treatment of oligonasthenospermia. The search time was from the self-established database to July 31, 2022. Literature screening and data extraction were performed to assess the risk of bias, and Meta-analysis was performed using RevMan 5.3 software. Results A total of 16 studies were included, including 1 960 patients, and subgroup analysis was performed according to the intervention measures. The results of Meta-analysis showed that after treatment, sperm density [MD=5.28, 95%CI(1.55, 9.02), P=0.006], grade A sperm [MD=6.69, 95%CI(5.01, 8.38), P<0.000 01] and grade A+B sperm [MD=10.57, 95%CI (7.28, 13.85), P<0.000 01] pregnancy rates, spouse [RR=1.25, 95%CI(1.13, 1. 39), P<0.000 01), the total effective rate(RR=1.46, 95%CI(1.3, 1.63), P<0.000 01] were significantly higher than those in western medicine group. Combination group after treatment in semen volume[MD=0.88, 95%CI(0.71, 1.04), P<0.000 01), sperm density [MD= 7.19, 95%CI(1.92, 12.46), P=0.007), grade A sperm[MD=7.9, 95%CI(4.59, 11.2), P<0.000 01), A+B grade sperm[MD=8.52, 95%CI(3.99, 13.04), P=0.000 2), spouses pregnancy rate(RR=1.79, 95%CI(1.31, 2.44), P=0.000 3), the total effective rate(RR=1.23, 95%CI(1.12, 1.35), P<0.000 01) were significantly higher than western medicine group. Conclusion Wuzi Yanzong pill alone or combined with western medicine is superior to western medicine in improving sperm density, grade A sperm, grade A+B sperm, conjugal pregnancy rate and total effective rate.