This study systematically evaluated the efficacy and safety of Ling Gui Zhu Gan Decoction for treating non-alcoholic fatty liver disease. Registered under CRD42024501460 on the PROSPERO platform, we searched eight major databases, including Web of Science, PubMed, Cochrane, Embase, China National Knowledge Infrastructure, Wanfang database, Chinese Scientific Journals Database, and Chinese Biomedicine Database, from inception to December 2023 for randomized controlled trials on Ling Gui Zhu Gan Decoction in non-alcoholic fatty liver disease treatment. We extracted data on total efficiency, TC, TG, ALT, AST, GGT, and HOMA-IR, analyzing results with RevMan 5.4 software. Twelve studies met the inclusion criteria, encompassing 970 cases. Ling Gui Zhu Gan Decoction, alone or combined with standard therapy, significantly improved non-alcoholic fatty liver disease outcomes, regardless of treatment duration. Only one study reported adverse events, including bloating, diarrhea, nausea, vomiting, and rash. Ling Gui Zhu Gan Decoction appears to be an effective and safe option for non-alcoholic fatty liver disease treatment. However, due to limited studies and methodological weakness, further rigorous randomized controlled trials are necessary for conclusive results.
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