Puerarin, a form of herbal medicine, is widely used in the treatment of acute ischaemic stroke in China. To assess the efficacy and safety of puerarin in patients with acute ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (last searched August 2006), the Trials Register of the Cochrane Complementary Medicine Field (last searched June 2006) and the Chinese Stroke Trials Register (last searched June 2006). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2006), MEDLINE (1966 to August 2006), EMBASE (1980 to June 2006), AMED (1985 to June 2006) and the China Biological Medicine Database (CBM-disc, 1979 to June 2006). We searched reference lists, relevant clinical trials and research registers and contacted pharmaceutical companies and researchers in an effort to identify further published and unpublished studies. Randomised controlled trials or quasi-randomised controlled clinical trials comparing puerarin with placebo or open control (no placebo) in patients with acute ischaemic stroke. Two review authors independently applied the inclusion criteria, assessed trial quality and extracted the data. One trial, involving 98 participants, was included. No significant difference in death or dependency was shown between the treatment and control groups (odds ratio (OR) 0.81; 95% confidence interval (CI) 0.35 to 1.87). No serious adverse effects were reported. There is not enough evidence to evaluate the effect of puerarin on survival or dependency of patients with acute ischaemic stroke. High-quality and large-scale randomised controlled trials are needed to assess its efficacy.