Traditional medicine has made use of many different plant extracts for treatment of fungal infections and some of these have been tested for in vitro antifungal activity. This systematic review evaluates antifungal herbal preparations that have been tested in controlled clinical trials. Four electronic databases were searched for controlled clinical trials of antifungal herbal medicines. Data were extracted in a standardized manner by two independent reviewers and are reviewed narratively. Seven clinical trials met our inclusion criteria. Tea tree oil preparations were tested in four randomized clinical trials and some positive outcomes were attributed to the intervention in all trials. Solanum species (two trials) and oil of bitter orange preparations (one trial) were compared with conventional treatments. In all cases encouraging results were reported. There are few controlled clinical trials of herbal antifungal medicines. The most thoroughly clinically tested is tea tree oil, which holds some promise. All herbal remedies require further investigation in rigorous clinical trials.