Aim To systematically evaluate the efficacy and safety of Tongxinluo capsule combined with rosuvastatin in the treatment of carotid atherosclerosis. Methods A comprehensive screening of Tongxinluo capsule combined with rosuvastatin was performed by Web searching the CNKI, Wanfang Data, VIP, PubMed, Embase, The Cochrane Library, and Web of Science from the construction of the database to August 1,3, to comprehensively screen the literature of randomized controlled studies of Tongxinluo capsule combined with rosuvastatin in the treatment of carotid atherosclerosis in the literature of randomized controlled studies, and Meta-analysis was performed using RevMan 5.4 software. Results A total of 8 studies were included with 858 total cases, 426 in the treatment group and 432 in the control group.Meta-analysis showed that the addition of Tongxinluo capsule to rosuvastatin treatment lowered total cholesterol (MD＝－0.4,5%CI:－0.61～－0.46, P＜0.00001), triglyceride (MD＝－0.8,5%CI:－0.37～－0.20, P＜0.00001), low density lipoprotein cholesterol (MD＝－0.5,5%CI:－0.42～－0.29, P＜0.00001) and increased high density lipoprotein cholesterol (MD＝0.7,5%CI:0.05～0.50, P＝0.02) levels, lowered carotid intima-media thickness (MD＝－0.5,5%CI:－0.48～－0.22, P＜0.00001) and plaque Crouse's score (MD＝－1.3,5%CI:－2.11～－0.55, P＝0.0009), and the differences were statistically significant (P＜0.05). Adverse effects were reported in five studies, and the difference was not statistically significant (MD＝1.0,5%CI:0.80～4.08, P＝0.16). Conclusion Tongxinluo capsule combined with rosuvastatin in the treatment of carotid atherosclerosis can improve the blood lipid level and reduce the degree of atherosclerosis, with better efficacy and safety, which can be further promoted for clinical use.