Objective To systematically evaluate the effectiveness of Banxia Xiexin Decoction in the treatment of gastroesophageal reflux disease (GERD), and to provide clinical evidence for the diagnosis and treatment of prescriptions. Methods Search the databases of CNKI, VIP, WanFang, PubMed, Embase, The Cochrane Library, and search for the treatment of Banxia Xiexin Decoction published at home and abroad. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and evaluated the inclusion for the quality of the study, Revman5.3 software was used for Meta-analysis, TSA0.9 software was used for trial sequential analysis, Stata15.0 software was used for publication bias evaluation, and GRADE3.6 software was used for evidence quality evaluation. Results A total of 13 studies were included, with a total of 1089 patients. In fact, there were 576 cases in the test group and 513 cases in the control group. (1) The results of Meta-analysis show that Banxia Xiexin Decoction can effectively improve the clinical cure rate [RR=1.55, 95%CI=(1.17, 2.05), P=0.002] and the cure rate of gastroscopy [RR=1.45, 95%CI=(1.07, 1.98), P=0.02], total clinical effective rate[RR=1.15, 95%CI=(1.10, 1.21), P＜0.000 01] and total effective rate of gastroscopy[RR=1.21, 95%CI=(1.09, 1.35), P=0.000 3], reduce the recurrence rate[RR=0.25, 95%CI=(0.09, 0.72), P=0.01]. (2) Trial sequential analysis: The cumulative Z value of the clinical total effective rate crossed the traditional boundary value and the TSA boundary value in the fifth study, and the corrected results are consistent, which can be used as definite evidence. (3) Publication bias: Harbord test showed that there was no significant publication bias(P=0.12). (4) Evidence quality evaluation: The quality of evidence for clinical cure rate, gastroscopy cure rate, clinical total effective rate, total gastroscopy effective rate, and recurrence rate are all medium, and the recommendation strength is weak recommendation. Conclusion The clinical efficacy of Banxia Xiexin Decoction applied to gastroesophageal reflux disease is better than the optimal combination of western medicine, and it has the value of promotion and application in the clinical diagnosis and treatment of GERD.