To explore the efficacy and safety of Calculus Bovis Sativus (CBS) in treating neurological diseases through a Meta-analysis. Methods: Electronic databases such as PubMed, Web of science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and China Biology Medicine disc (CBMdisc) were searched for studies on CBS treatment of neurological diseases. The search period covered from the establishment of each database until December 4th, 2024. Studies were screened according to inclusion and exclusion criteria, relevant data were extracted, risk assessment was conducted using the bias risk assessment tool recommended by the Cochrane Systematic Review Handbook, and Meta-analysis was performed using RevMan 5.4 statistical software. Results: A total of five randomized controlled trials involving 414 patients were included. The Meta-analysis results showed that compared to the control group, the combination of conventional therapy and CBS significantly reduced tumor necrosis factor-α (TNF-α) levels [SMD=－1.40, 95% CI (－1.78, －1.01), P<0.001], significantly reduced interleukin-6 (IL-6) levels [SMD=－1.82, 95% CI (－2.23, －1.41), P<0.001], improved Glasgow coma scale (GCS) scores [SMD= 0.44, 95% CI (0.21, 0.68), P=0.002], and decreased National Institutes of Health Stroke Scale (NIHSS) scores [SMD=－ 0.49, 95% CI (－ 0.92, － 0.07), P=0.02]. Conclusion: CBS is effective and safe in treating stroke-related neurological diseases, but more high-quality research is needed for further support.