This systematic review examined the efficacy of reflexology. The Cochrane Library, PubMed, Medline, EBM review, ProQuest Medical Bundle and Scopus databases were searched. Chinese articles were searched through the Chinese electronic periodical services and Wangfane database. The publication date was limited from 1996 to 2007. Studies were selected if they were written in English or Chinese, used a CCT design, used reflexology as a stand-alone modality, and reported such outcomes as symptom relief, QoL and patients’ perceptions of reflexology. Study quality was reviewed based on the evidence rating system of the US Preventive Services Task Force, and studies with the evidence rating of II-2 fair or above were included in this review. Among the five studies suitable for review, there was only one report of a statistically significant treatment effect. Among the 12 outcome variables examined, the treatment effect size for urinary symptoms was large, whereas the effect size for other conditions was negligible.