Banxia Xiexin decoction (BXD), a classical formula of traditional Chinese medicine (TCM), has been wildly used for chronic atrophic gastritis (CAG) patients with the cold-heat complex syndrome in China, and achieved satisfied effects. However, the clinical effects of it remains unclear. The purpose of this article is to evaluate the clinical efficacy and safety of BXD for CAG treatment. We searched seven electronic databases including Ovid, Embase, PubMed, Cochrane Library, Wan-fang database, VIP (Chinese Scientific Journals Database) and CNKI (China National Knowledge Infrastructure) from their inception to September 21, 2020. We used Jadad scale and Cochrane Collaboration's risk of bias tool to make evaluation of methodological quality. Revman 5.3 statistical software was used for statistical processing to evaluate the clinical efficacy and safety of BXD. 26 randomized controlled trials (RCTs) totaling 1985 patients were identified for analysis. Meta-analysis showed that BXD treatment was more effective (RR 1.29; 95%CI 1.24, 1.35; P<0.00001) and safe (MD 0.33; 95%CI 0.18, 0.58; P = 0.0002) than Chinese patent medicine + western medicine. Furthermore, BXD had improvement on symptoms scores such as stomach distending pain, and belching. Besides, BXD was more effective in inhibiting Helicobacter Pylori (HP), improving HP-related inflammation, and relieving the degree of glandular atrophy, intestinal metaplasia (IM), and dysplasia of gastric mucosa (GM). The meta-analysis showed that BXD was more effective and safer for CAG patients than the control group. However, due to limitations of methodological quality and small sample size of the included studies, further standardized research of rigorous design should be needed.