Herbal medicine based on pattern identification (PI) is used widely in Traditional Chinese Medicine. Proper herbal medicine based on PI has been suggested for effective weight reduction and decreasing the adverse events. This systematic review examined the effectiveness and safety of herbal medicine, focusing on PI in treating obesity.Eight electric databases were used for searching randomized controlled trials (RCT) (to August 31, 2021). RCTs which prescribed herbal medicine to obese patients based on PI were included. Body weight (BW) and body mass index (BMI) were the primary outcomes. The risk of bias was assessed using Cochrane risk of bias tool, and the meta-analysis was conducted. Grading the evidence was conducted by using GRADEpro.Sixteen RCTs (1052 patients) were included: 2 studies compared herbal medicine to placebo (128 patients); 2 studies compared them to western medication (161 patients); 12 studies compared them with usual care (763 patients). The meta-analysis showed that the herbal formulas reduced the BW and BMI without significant Adverse events compared to the control group (BW: mean difference = -4.10, 95% confidence interval: -5.14 to -3.06, I2 = 2% and BMI: mean difference = -1.53, 95% confidence interval: -1.88 to -1.19, I2 = 25%). Moderate-quality evidence on the primary outcomes was found.Herbal medicine - has good clinical efficacy and safety in treating obesity. This study has limitations that some literatures with high risk of bias in blinding or without using a standardized diagnosis of PI were included. However, the current evidence suggests the possibility of precision medicine using PI.