BackgroundTo conduct a comprehensive evaluation of the efficacy and safety of combining Traditional Chinese medication (TCM) with Western medication to improve secondary stroke prevention. Through meticulous analysis, we investigate the combined approach's potential to yield superior outcomes compared to stand-alone Western medical treatments. MethodsWe carefully searched for randomized controlled trials (RCTs) on secondary stroke prevention using TCM and Western medicine from database inception to October 2023. We found relevant studies using PubMed, EMBASE, Cochrane Library, CNKI, SinoMed, WanFang, and VIP. Comprehensive meta-analyses were conducted using Stata 16.0 software, with predetermined inclusion and exclusion criteria. ResultsOur comprehensive study included 40 RCTs with 3478 treatment and 3396 control individuals. Our meta-analysis shows that integrating TCM and Western medicine significantly improves secondary stroke prevention rates compared to Western medicine alone (OR=0.83, 95% CI: 0.55-1.12, p< 0.001). Significantly, the integrated strategy reduced the NIHSS score compared to Western medical treatment for secondary stroke prevention (OR=-0.62, 95% CI: -0.89, -0.35, p< 0.001). Additionally, this combined technique reduced stroke recurrence rates more effectively than Western medical care alone (OR=-0.94, 95% CI: -1.10, -0.76, p< 0.001). The rate of adverse reactions was not statistically different between Western medical treatment and integrated TCM (OR=0.01, 95% CI: -0.18, 0.05, p = 0.131). ConclusionThe evidence shows that combining TCM and Western therapy improves secondary stroke prevention. Besides improving clinical effectiveness, this integrated approach may reduce stroke recurrence. These findings strongly support the widespread use of this integrated approach in clinical practice.