OBJECTIVE: The present study aimed to comprehensively assess the efficacy and safety of Chinese herbal compounds in the management of acute gouty arthritis (AGA). MATERIALS AND METHODS: A systematic search was performed across multiple databases, including PubMed, The Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP, and Wanfang, from their inception until December 1, 2024, to identify relevant randomized controlled trials (RCTs) involving Chinese herbal compounds for AGA. Two independent researchers were responsible for the retrieved literature screening, data extraction, and quality evaluation. A meta-analysis of RCTs that fulfill the inclusion criteria will be executed utilizing Stata 14.0 software. The quality of the outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: A total of 28 studies, encompassing 2100 participants, were included in the analysis. The meta-analysis showed that compared with conventional Western medicine, Chinese herbal compounds significantly enhance the overall efficacy of AGA treatment (RR = 1.11, 95 %CI (1.05, 1.16), P <
0.00001
Level of evidence: very low). It also demonstrated improvements in the Visual Analogue Scale (VAS) (SMD = -1.46, 95 %CI(-2.17, -0.75), P <
0.00001
Level of evidence: very low), serum uric acid levels (SMD = -0.67, 95 %CI (-1.00, -0.33), P <
0.00001
Level of evidence: very low), blood sedimentation levels (SMD = -0.71, 95 %CI (-1.08, -0.33), P <
0.00001
Level of evidence: very low), C-reactive protein (CRP) levels (SMD = 0.89, 95 %CI(-1.33, -0.45), P <
0.00001
Level of evidence: very low), and the traditional Chinese medicine syndrome score(SMD = -0.93, 95 %CI (-1.37, -0.49), P <
0.00001
Level of evidence: very low). Additionally, a reduced incidence of adverse effects was noted (RR = 0.26, 95 %CI (0.18, 0.39), P <
0.00001
Level of evidence: moderate). Subgroup analysis revealed that regardless of whether the treatment duration was less than or more than 1 week, Chinese herbal compounds were effective in improving the total effective rate of AGA treatment, VAS scores, serum uric acid levels, blood sedimentation levels, CRP levels, and Traditional Chinese medicine symptom scores, while simultaneously decreasing the occurrence of adverse reactions. CONCLUSION: Chinese herbal compounds demonstrated superior efficacy and safety compared to conventional Western medicine in treating AGA. However, further validation through multicenter, high-quality RCTs is warranted to strengthen this conclusion.