Abstract： Objective： To systematically evaluate the clinical efficacy and safety of Buyang Huanwu Tang combined with conventional western medicine in the treatment of post-stroke sequelae in the elderly. Methods： A computer-based search was conducted in Chinese and English databases，including CNKI，Wanfang，PubMed，etc.， from January 2004 to January 2025， to identify randomized controlled trials （RCTs） comparing the combination of Buyang Huanwu Tang and western medicine with western medicine alone in the treatment of post-stroke sequelae in the elderly. Two researchers independently screened the literature， extracted data， and assessed the risk of bias. Metaanalysis was performed using RevMan 5.3 software， with effect sizes expressed as odds ratios （OR） or mean differences（ MD） and 95% confidence intervals（ CI）. Results：A total of 9 RCTs involving 762 patients were included. The Meta-analysis showed that the total effective rate was higher in the trial group than in the control group [OR= 0.18， 95%CI（0.11， 0.29）， P＜0.000 01]；the improvement in neurological deficit scores was more significant in the trial group [MD=-4.69， 95%CI （-5.13， -4.25）， P＜0.000 01]； the trial group had better outcomes in whole blood viscosity [MD=-0.97，95%CI （-1.17，-0.77），P＜0.000 01]，plasma viscosity [MD=-1.81，95%CI （-1.99， -1.62）， P＜0.000 01]， and fibrinogen [MD=-0.71， 95%CI （-0.85， -0.58）， P＜0.000 01] compared with the control group； there was no statistically significant difference in the incidence of adverse reactions between the two groups [OR=0.53， 95%CI （0.17， 1.64）， P=0.27]. Conclusion： Buyang Huanwu Tang combined with western medicine can significantly improve the neurological function and hemorheological indicators of patients with post-stroke sequelae in the elderly，and has good safety.