Background Influenza is an acute infectious respiratory disease causing substantial public health and economic burdens. Multiple clinical studies have investigated traditional Chinese medicine (TCM) for influenza prevention. Objective To assess the effectiveness and safety of TCM preventive interventions against influenza through direct comparisons. Methods We systematically searched PubMed, EMbase, CENTRAL, Web of Science, CNKI, WanFang, CQVIP, and Sinomed up to August 14, 2025. A two-stage screening process (title/abstract screening followed by full-text screening) was implemented. Data extraction utilized predefined templates, followed by methodological quality assessment, statistical analysis, and GRADE assessment. All procedures were independently conducted by two investigators with cross-verification, with discrepancies resolved by a third party. Results 19 studies involving 55,183 healthy participants were included, comprising special populations of 600 pregnant women, 226 children, and 31,889 school populations, 3,238 community residents, and 210 military residents. Compared with no intervention, TCM demonstrated potential reduction in influenza incidence (RR = 0.23, 95% CI 0.12–0.43, P 0.00001, I 2 = 94%, 13 studies, 38,463 participants) and influenza-like illness (RR = 0.38, 95% CI 0.23–0.63, 6 studies, 10,754 participants), with no statistically significant difference in adverse event rates (RR = 5.00, 95% CI 0.59–42.37, P = 0.14, I 2 = 0%, 6 studies, 7,486 participants). Conclusion TCM interventions may exhibit potential efficacy for influenza prevention, though the confidence in this conclusion is limited by the methodological limitations of included studies involving healthy populations. Very low certainty of the evidence suggests that TCM might reduce influenza and influenza-like illness incidence with potential safety profiles. We did not identify high certainty of the evidence regarding the effectiveness and safety of any preventive measures. Future research should employ rigorous methodologies, standardized influenza diagnostic criteria, and core outcome measures specific to influenza prevention. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024506941 , identifier CRD42024506941
Huang et al. (2026) studied this question.