Objective:To systematically evaluate the clinical efficacy and safety of Xuanbai Chengqi decoction (XBCQD) in the treatment of severe pneumonia of phlegm-heat obstructing lung pattern. MethodsCNKI, Wanfang Data Knowledge Service Platform, VIP, SinoMed, EMbase, PubMed, the Cochrane Library and other databases were searched systematically. According to the pre-set inclusion and exclusion criteria, the clinical randomized controlled trials (RCTs) research literatures were screened, the research quality was evaluated by risk assessment tools, and the data were extracted and meta-analyzed by RevMan 5.3 and R 3.6. 1 software.  Results:A total of 11 papers involving 882 patients were included. Meta-analysis results showed that compared with the routine treatment of western medicine alone, the modified XBCQD can improve the total effective rate [OR=5. 19,95% CI (3.33, 8.07), P<0.000 01], reduce the lactic acid content in peripheral arterial blood [WMD=-2.04,95% CI(-2.30,-1.79), P<0.000 01], invasive mechanical ventilation time [WMD=-125.33,95% CI(-132.21,-118.44), P<0.000 01], clinical pulmonary infection score [WMD=-1.93, 95% CI(-2.29, -1.57), P<0.000 01], acute physiological and chronic health II score [WMD=-7.94,95% CI(-8.47,-7.41), P<0.000 01]. Only 2 papers reported adverse reactions. The results showed that there was no obvious adverse reaction in the treatment of severe pneumonia of phlegm-heat obstructing lung pattern with modified XBCQD on the basis of conventional western medicine therapy.  Conclusion:The application of XBCQD on the basis of conventional western medicine therapy to treat severe pneumonia of phlegm-heat obstructing lung pattern can improve clinical efficacy and life quality of patients compared with conventional western medicine therapy alone. However, as the quantity and quality of literatures included were limited, the relevant conclusions need further verification.