Objective To evaluate the clinical efficacy of Buyang Huanwu Decoction (BYHW) in the treatment of heart failure with reduced ejection fraction(HFrEF). Methods A systematic search of the randomized controlled trial literature on the addition of BYHW to conventional treatment for HFrEF was performed using Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure(CNKI), China Science and Technology Journal Database(VIP), China Biomedical and Medical Database(CBM), Wanfang Database, etc, for all studies published until 31 August 2024. The Rev Man 5.4 software was employed to conduct Meta analysis on indicators such as the clinical efficacy of traditional Chinese medicine, left ventricular ejection fraction(LVEF), left ventricular end-diastolic diameter(LVEDD), and left ventricular end-systolic diameter (LVESD) in the literature, systematically evaluating the clinical efficacy of BYHW in treating HFrEF. Results A total of 19 studies involving 1 769 patients were included. The Meta analysis showed that BYHW significantly improved the traditional Chinese medicine effects[OR＝4.73, 95%CI(3.4, 6.59), P＜0.000 01], and increased the LVEF [MD＝7.3, 95%CI(3.22, 11.38), P＝0. 000 5] of HFrEF patients, reduce LVEDD[MD＝-5.67, 95%CI( -6.50, -4.85), P＜0. 000 01] and LVESD[MD＝-4.49, 95%CI( -5.26, -3.72), P＜0. 000 01]. Conclusion The addition of BYHW on the basis of conventional modern medical treatment can further improve the clinical efficacy of HFrEF patients.