Abstract：Objective：To explore the clinical application of thunder and fire moxibustion therapy based on the randomized controlled trials(RCT)l iteratures，analyze the main clinical indications and high frequency disease， and provide evidence for clinical treatment. Methods： Seven major Chinese and English databases including CNKI， Wanfang Medical Network Database， Chongqing VIP Database and PubMed were searched， RCT literatures of thunder and fire moxibustion were included， and corresponding diseases in the included literatures were classified according to The International Statistical Classification of Diseases and Related Health Problems 10th Revision(ICD- 10). The annual publication trend of RCT literatures of thunder and fire moxibustion and the number of literatures of thunder and fire moxibustion for the treatment of major disease systems were analyzed statistically， and the main indications and high frequency disease were summarized. Results：A total of 88 qualified literatures were included. The trend of publication in each year showed that the RCT literatures of thunder and fire moxibustion were first published in 1996. From 1996 to 2010， only seven articles were published. Since 2011， the volume of literature published showed an upward trend of volatility，and reached its peak from 2018 to 2020. Thunder and fire moxibustion therapy involved 12 major disease systems， and its main indications in RCT clinical studies amounted to 50 kinds. The indications in gynecology and obstetrics diseases were the most，accounting for 22.00%(11/50) of all indications；diseases of digestive system followed，accounting for 20.00%(10/50) of all indications. The high frequency disease were mainly distributed in musculoskeletal system and connective tissue diseases，diseases of five sensory organs，factors affecting health status and urogenital system diseases. Among them， there was one dominant disease in musculoskeletal system and connective tissue diseases， which was osteoarthritis of the knee； there was one dominant disease in diseases of five sensory organs， which was allergic rhinitis； there was one dominant disease in factors affecting health status，which was the side effect after chemotherapy；there was a dominant disease in genitourinary system diseases，which was postoperative urinary dysfunction. According to meta-analysis， the total effective rate of thunder and fire moxibustion therapy in the treatment of diseases in 12 major disease systems was better than that in the control group [OR=4.36，95%CI(3.69，5.15)，P＜0.000 01]. The results of subgroup analysis indicated that， in addition to the total effective rate in the mental and behavioral disorders [OR=3.52，95%CI(0.65，19.17)，P=0.15]，the total effective rate of the rest systemic diseases in the 12 major disease systems was better than that in the control group. Conclusion： At present，thunder and fire moxibustion has a wide range of indications in RCT studies of acupuncture and moxibustion， and the high frequency disease are relatively concentrated， represented by knee osteoarthritis，allergic rhinitis，and side effects after chemotherapy.