ETHNOPHARMACOLOGICAL RELEVANCE: The clinical efficacy of ginkgo diterpene lactone meglumine (GDLM), a Chinese patent medicine, in acute ischemic stroke (AIS) has garnered attention. However, the impact of GDLM on functional recovery in AIS patients has not been systematically reviewed or meta-analyzed. AIM OF THE STUDY: To evaluate the functional outcomes of GDLM in AIS patients. MATERIALS AND METHODS: We conducted a search of seven databases from inception to July 10, 2024, for pertinent randomized controlled trials (RCTs). We performed trial selection, data extraction, and bias assessment. Meta-analysis was conducted to evaluate functional and safety outcomes. Quality of evidence was assessed. RESULTS: We included eight RCTs involving 4041 patients. Compared to those receiving only conventional treatments (CTs), patients treated with GDLM in combination with CTs exhibited a significantly higher proportion of patients achieving excellent (modified Rankin Scale [mRS] 0-1) or favorable functional outcomes (mRS 0-2) (risk ratio [RR] for excellent functional outcome = 1.16, 95% confidence interval [CI] 1.08 to 1.24, p <
0.001
RR for favorable functional outcome = 1.21, 95% CI 1.17 to 1.26, p <
0.001) and had lower mRS scores (mean difference [MD] = -0.66, 95% CI -0.73 to -0.59, p <
0.001) at 90 days. The evidence supporting GDLM's role in restoring functional independence was rated as moderate in certainty. Additionally, the incidences of adverse events and reactions did not differ significantly between the two groups. CONCLUSION: Moderate-certainty evidence suggests that GDLM may be a beneficial adjunct therapy for improving functional outcomes in AIS patients. Nonetheless, further validation of GDLM's efficacy and safety in real-world settings is warranted through future practice.