Objective To systematically review the effectiveness and safety of Dahuang Mudanpi Decoction on acute appendicitis. Methods Four Chinese databases(CNKI, CBM, VIP, WanFang) were searched for the study of randomized controlled trials(RCTs) of Dahuang Mudanpi Decoction on acute appendicitis. Two researchers independently screened the literature, extracted effective data, assessed the risk of bias, and analyzed the data by RevMan 5.3 software. Results Eventually fifteen literatures were included containing 1 436 patients. The Meta-analysis indicated that compared with control groups, the trail groups could improve the clinical efficacy in acute appendicitis patients[RR=1.20, 95%CI(1.15, 1.25), P<0.000 01], promote the temperature to return to normal[RR=-2.14, 95%CI(-2.45, -1.83), P<0.000 01], abridge the duration of acute abdominal pain[RR=-1.65, 95%CI(-2.10, -1.20), P<0.000 01] and tenderness [RR=-2.03, 95%CI(-2.75, -1.31), P<0.000 01]. Meantime, inflammation markers declined, including the white blood cell counts[RR=-1.58, 95%CI(-2.43, -0.73), P=0.000 3], percentage of neutrophils[RR=-4.50, 95%CI(-5.95, -3.05), P<0.000 01], high-sensitivity C-reactive protein[RR=-2.17, 95%CI (-2.53, -1.81), P<0.000 01]. Conclusion Dahuang Mudanpi Decoction could further improve clinical efficacy compared with routine treatment alone, abridge the duration of partial (acute abdominal pain and tenderness) and systematic (temperature) symptoms, reduce the inflammation markers. Literature of higher quality is still needed to support the conclusion due to the uneven quality of the literature.