Background: Chinese herbal medicine has been used to treat millions of people with schizophrenia for thousands of years. Aims: To evaluate Chinese herbal medicine as a treatment for schizophrenia. Method: A systematic review of randomised controlled trials (RCTs). Results: Seven trials were included. Most studies evaluated Chinese herbal medicine in combination with Western antipsychotic drugs; in these trials results tended to favour combination treatment compared with antipsychotic alone (Clinical Global Impression 'not improved/ worse' n=123, RR=0.19, 95% CI 0.1-0.6, NNT=6,95% CI 5-11; n=109, Brief Psychiatric Rating Scale 'not improved/ worse' RR=0.78, 95% CI 0.5-1.2; n=109, Scale for the Assessment of Negative Symptoms 'not improved/worse' RR=0.87, 95% CI 0.7-1.2; n=109, Scale for the Assessment of Positive Symptoms 'not improved/worse' RR=0.69, 95% CI 0.5-1.0, NNT=695% CI 4-162). Medium-term study attrition was significantly less for people allocated the herbal/antipsychotic mix (n=897, four RCTs, RR=0.34, 95% CI 0.2-0.7, NNT=23, 95% CI 18-43). Conclusions: Results suggest that combining Chinese herbal medicine with antipsychotics is beneficial.