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BackgroundYupingfeng Powder (YPF), a classical Chinese herbal formula composed of Astragalus membranaceus, Atractylodes macrocephala, and Saposhnikovia divaricata, has demonstrated potential efficacy in the treatment of adult bronchial asthma when combined with conventional biomedical therapy (CBT), as indicated by multiple recent clinical studies. However, existing research is limited by small sample sizes, inconsistent methodological quality, and non-uniform syndrome differentiation, resulting in insufficient evidence strength. Moreover, traditional meta-analysis methods struggle to address study heterogeneity, and its definitive efficacy remains inadequately validated.ObjectiveTo systematically evaluate the clinical efficacy and safety of YPF combined with CBT in the treatment of adult bronchial asthma, and to clarify the heterogeneity sources.MethodsStrictly adhering to the PRISMA 2020 guidelines, the study protocol was registered in PROSPERO (registration number: CRD420251172600). A systematic search was conducted in seven databases (PubMed, Embase, Cochrane Library, China, etc., up to 20 October 2025), and randomized controlled trials (RCTs) comparing YPF+CBT with CBT alone in adults with bronchial asthma were included. The Cochrane ROB 2.0 tool was used to assess the risk of bias, and meta-analysis was performed using RevMan 5.4 and Stata 18 software. Subgroup analysis and Meta regression were employed to explore the sources of heterogeneity.ResultsA total of 20 RCTs were ultimately included, involving 1,896 participants (950 in the intervention group and 946 in the control group). The meta-analysis revealed that the YPF+CBT group demonstrated significantly higher clinical overall response rate compared to the CBT group [risk ratio (RR) = 1.20, 95% CI (1.16, 1.25), P < 0.001, I2 = 0.0%]. Significant improvements were observed in pulmonary function parameters (FEV1, FVC, FEV1/FVC, PEF) and asthma control test (ACT) scores [SMD were 1.32, 1.78, 1.09, 1.15, and 1.80, respectively, all P < 0.05]. No statistically significant difference was found in the CD4+/CD8+T lymphocyte subset ratio between the two groups [SMD = 0.50, 95%CI(-0.44, 1.44), P = 0.301]. Subgroup analysis and meta-regression confirmed that treatment duration (P = 0.03) and study year (P = 0.043) were the primary sources of heterogeneity. In terms of safety, only two studies reported mild adverse events (e.g., gastrointestinal discomfort, dry mouth), with no significant difference in incidence between the groups and no serious adverse events. Clinical significance analysis showed that the clinical overall response rate in the YPF+CBT group was 86.8%, which was compared to 72.3% in the CBT group, with an absolute risk reduction (ARR) of 14.5%, indicating clear clinical benefits of this combination therapy.ConclusionYPF combined with CBT can significantly improve clinical efficacy, pulmonary function, and symptom control in adult bronchial asthma patients. However, due to limitations such as moderate methodological quality of the included studies, geographical constraints, and insufficient adverse event data, the conclusions require further validation through high-quality RCTs with large sample sizes, double-blind design, and placebo control.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1172600, identifier CRD420251172600.
