Objective To evaluate the effectiveness and safety of Chinese angelica decoction (CAD) versus conventional treatment (CT) for chronic urticaria (CU). Methods Systematic searches were conducted in PubMed, The Cochrane Library, SCI, EMbase, VIP, CNKI and CBM to collect randomized controlled trials (RCTs) on CAD treating CU from inception to July 2011. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0.2. Results A total of 11 RCTs involving 1081 patients were included. The results of meta-analysis demonstrated that compared with the CT group (antihistamine therapy), CAD seemed higher in the cure rate (OR=2.36, 95%CI 1.80 to 3.10, I2=22%, Plt;0.000 01), improvement rate (OR=4.56, 95%CI 2.65 to 7.87, I2=0%, Plt;0.000 01), and lower in the relapse rate at the third month after the treatment (OR=0.43, 95%CI 0.22 to 0.82, I2=0%, P=0.01). No study reported the quality of life and severe adverse reactions after CAD treatment. Conclusion Current evidence shows CAD may be superior to CT in treating CU patients. However, due to lack of enough high-quality studies, CAD has to be further studied by conducting more strictly-designed, multicenter, large-scale and double-blind RCTs.