Background Erectile dysfunction (ED) is a tough problem in medicine. This article aims to provide the latest evidence for the efficacy and safety of traditional Chinese medicine (TCM) combined with tadalafil in treatment of erectile dysfunction. Methods All randomized controlled trials that Chinese herbal medicine combined with tadalafil for erectile dysfunction were included in databases of China National Knowledge Infrastructure (CNKI), Wanfang, Weip Database, China Biology Medicine disc (CBM), MEDLINE, EMBASE, and Cochrane Library. The quality of the included articles was evaluated using Cochrane Reviewer's Handbook 5.3, and meta-analysis was performed using Stata 13.1. Results A total of 11 studies including 451 cases in the treatment group and 452 cases in the control group were obtained. Compared with tadalafil alone, meta-analysis suggests there were statistically significant differences in International Index of Erectile Function-5 (IIEF-5), effective rate, Sexual Encounter Profile questions 2 and 3 (SEP-Q2, SEP-Q3) between traditional Chinese medicine combined with tadalafil, and no statistically significant differences in side effects between the two groups. All included studies were tested for publication bias, and the results indicated that there was no significant bias. Two of the articles mentioned the scheme that traditional Chinese medicine combined with low-dose tadalafil for erectile dysfunction by down stairs. Conclusion Traditional Chinese medicine combined with tadalafil has significant efficacy in the treatment of ED with no increase in side effects. The specific implementing regulations and effect of de-escalation therapy still need more long-term, multicenter, randomized, and double-blind clinical trials.