Abstract： Objective： To systematically evaluate the efficacy and safety of Chinese herbal compound prescription in the treatment of prediabetes. Methods：A computer search was conducted on 13 Chinese and English databases and clinical trial registration centers，and randomized controlled trials were included. The treatment group used Chinese herbal compound prescriptions，and the quality of the included literature was evaluated. Trial sequential analysis (TSA) and efficacy evaluation were conducted on the outcome indicators，and the GRADE system was used to evaluate the level of evidence. Results：A total of 22 RCT trials were included，with a total sample size of 3 063 cases. Incidence rate of diabetes：RR=0.52，95% CI [0.43，0.62]，Z=7.20，P＜0.05. Prediabetes reversal rate：RR=1.69，95% CI[1.50，1.90]，Z=8.76，P＜ 0.05. Fasting blood glucose： MD=- 0.23， 95% CI [- 0.27， - 0.19]， Z=10.78， P＜0.05. 2- hour blood glucose tolerance test (OGTT)： MD=- 0.93， 95% CI [- 1.26， - 0.60]， Z=5.49， P＜0.05. Hemoglobin： MD=-0.39，95% CI [-0.54，-0.25]，Z=5.19，P＜0.05. Safety analysis：RR=1.34，95% CI [0.79，2.30]， Z=1.08，P=0.28＞0.05，adverse events and reactions were mild，and no serious adverse reactions were reported. TSA： Analysis of the above 5 outcome indicators showed that the sample size of the current study exceeded the required information size (RIS)， indicating that the research outcome was positively concluded in advance. GRADE evaluation was conducted on the above five outcome indicators， and the level of evidence reached medium and high quality. Among them，the incidence rate of diabetes was high quality evidence， and the blood glucose index was medium quality evidence， which further verified the efficacy of Chinese herbal compound prescription in the intervention of prediabetes. Conclusion： The existing evidence shows that the Chinese herbal compound prescription has obvious advantages in reducing the incidence rate of diabetes and improving the reversion rate of prediabetes，and it also reduces the blood glucose indicators， especially the OGTT 2 h blood glucose (0.93 mmol/L). The Chinese herbal compound prescription intervention in prediabetes has good clinical efficacy and safety.