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Summary Aims To review the evidence from Cochrane systematic reviews for the effectiveness of traditional Chinese medicinal (TCM) herbs for treating acute respiratory tract infections (ARTIs) and to discuss the limitations of current clinical trials of TCM. Findings Evidence from six Cochrane systematic reviews was weak owing to the lack of high-quality TCM trials. Limitations were usually due to biases that influenced the validity of results. Conclusions TCM is widely used for treating ARTIs. However, none of the identified studies has been well designed or conducted. In this overview, we suggest that clinical trials of TCM for ARTIs need to be re-run in accordance with internationally recognized standards.