Introduction Immunoglobulin A nephropathy (IgAN) is a primary glomerulonephritis which may lead to end-stage renal disease. This article aims to provide the latest evidence with respect to the efficacy and safety of traditional Chinese medicine (TCM) in the treatment of IgAN. Methods We systematically searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database (VIP), and WanFang databases for randomized controlled trials from inception until 31 December, 2020. The quality of the included studies was evaluated using the Cochrane Reviewers’ Handbook 5.3 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results In total, 47 eligible studies with 3523 patients were included. Three were multicenter, double-blind studies which included a placebo, 13 studies used a patented TCM, 28 studies used TCM decoctions, and 6 studies used granules. The results indicated that, compared with routine treatment alone, a combination of TCM with routine treatment improved 24-h urine protein levels (mean difference [MD] = −0.36, 95% confidence interval [CI] = −0.44 to −0.29, P < 0.001; GRADE rating: moderate), serum creatinine levels (MD = −8.68, 95% CI = −10.72 to −6.64, P < 0.001; GRADE rating: moderate), the estimated glomerular filtration rate (MD = 4.15, 95% CI = 1.01 to 7.28, P = 0.01; GRADE rating: low), and the urine red blood cell count (MD = −7.58, 95% CI = −10.79 to −4.37, P < 0.001; GRADE rating: low), and reduced the incidence of adverse events (risk ratio = 0.54, 95% CI = 0.41 to 0.72, P < 0.001). Sensitivity analysis showed the results were robust, and there was no significant publication bias. Conclusions Evidence from this meta-analysis suggests that the combination of routine treatment and TCM treatment was more effective in treating IgAN than routine treatment alone but heterogeneity is high due the different TCMs assessed. Safety remains unclear due to insufficient reporting. Before widespread use more long-term, multicenter, randomized, double-blind, and placebo controlled clinical trials are necessary.