Codonopsis (Codonopsis pilosula (Franch.) Nannf.) is a common medicinal and edible plant with a variety of biological functions, including enhancing gastrointestinal motility, anti-inflammatory, antioxidant, regulating glucose and lipid metabolism, regulating immune response and anti-tumor. Aspirin is a widely used clinical drug with multiple therapeutic effects. However, long-term use of aspirin could also bring some side effects, including gastrointestinal discomfort, liver and kidney damage, asthma, and allergies. The present study is aimed to investigate the effect of Codonopsis decoction on aspirin-induced gastric injuries. Cell proliferation was evaluated by MTT assay and cell apoptosis was investigated by flow cytometry. Gastric mucosal injury index and HE staining were used to evaluate the pathological changes of gastric tissue. The levels of cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and transforming growth factor-α (TGF-α) in GES-1 cells culture supernatant were detected by ELISA kits. The levels of cyclooxygenase (COX), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and TGF-α in gastric tissue and serum were detected by ELISA kits. Results showed that Codonopsis decoction significantly attenuated the aspirin-induced cytotoxicity and apoptosis of GES-1 cells. Codonopsis decoction significantly increased the levels of COX-1, COX-2 and TGF-α in GES-1 cells treated by aspirin. Codonopsis decoction could also increase the expression levels of COX and TGF-α in vivo. Codonopsis decoction significantly reduced the levels of TNF-α and IL-6 both in vivo and in vitro. In addition, Codonopsis decoction could increase the daily weight gain of rats taking aspirin, and significantly reduce the gastric tissue damage and gastric mucosal injury index. These data indicated that Codonopsis decoction may possess potential to reduce the side effects caused by oral aspirin and may help the safe use of aspirin.