Background <p>Chinese herbal medicine (CHM) is widely used for the treatment of spinal cord injury (SCI). However, its exact mechanisms are not yet fully understood.</p> Aim of the study <p>The aim of this study was to evaluate the clinical efficacy and potential pharmacological mechanisms of CHM in treating SCI.</p> Materials and methods <p>Eight databases were searched for randomized controlled trials (RCTs) published from their inception until January 2025 regarding the use of Chinese medicine for SCI. The quality of the included studies was assessed using the Cochrane risk of bias tool. A meta-analysis was performed to evaluate the efficacy of Chinese medicine in treating SCI, and data mining and network pharmacology were used to identify core drugs and active ingredients. Finally, clustering and enrichment analyses were performed to explore potential targets and signaling pathways.</p> Results <p>A total of 41 studies involving 2,483 patients were included. The meta-analysis showed that compared with the control group, the Chinese medicine group significantly improved sensory function (ASIS-SIS), motor function (ASIS-MS), activities of daily living (BI), and pain levels (VAS) in patients with SCI: ASIS-SIS: standardized mean difference (SMD) = 11.52, 95% confidence interval (CI) (10.52, 12.51), <i>p</i> = 0.02 &lt; 0.05, heterogeneity (I²) = 45%;ASIS-MS: SMD = 7.46, 95% CI (6.03, 8.9), <i>p</i> &lt; 0.00001, I² = 66% BI: SMD = 6.73, 95% CI (5.60, 7.89), <i>p</i> = 0.0001, I² = 62%;VAS: SMD = -1.05, 95% CI (-1.43, -0.67), <i>p</i> &lt; 0.00001, I² = 89%.From the 41 Chinese medicine prescriptions for SCI treatment, 9 core herbs were selected based on their frequent use and strong correlation. A total of 440 drugs intersecting with disease targets were identified. A “drug-component-intersecting target network” was constructed, revealing the top ten core active ingredients. The core target protein-protein interaction (PPI) network identified 92 core targets. Based on these, clustering and enrichment analyses were performed to explore the related pharmacological mechanisms, primarily including anti-inflammatory, anti-apoptotic, and oxidative stress regulation.</p> Conclusion <p>Compared to conventional treatments, Chinese medicine is effective in alleviating the symptoms of SCI. However, due to the difficulty of implementing blinded oral administration of Chinese medicine formulas, more high-quality studies are needed in the future. Chinese medicine formulas have the advantage of multi-component and multi-target action in treating SCI, and their active ingredients can improve the pathological environment of SCI through various mechanisms.</p> Clinical trial number <p>Not applicable.</p> PROSPERO registration number <p>CRD42025641947.</p>