Objective To observe the possible changes in the content of lipoprotein related phospholipase A2 (Lp-PLA2) in various TCM Syndromes of carotid atherosclerosis, and to lay a theoretical basis for the treatment of high Lp-PLA2 in Chinese medicine and the development of carotid atherosclerosis. Methods 92 patients with carotid atherosclerosis were collected and the general data were collected. The Lp-PLA2 content of each patient was detected by a unified questionnaire. Results The difference of Lp-PLA2 content in different TCM syndrome types was statistically significant (P<0.05). The results showed that the mutual knot of phlegm and blood stasis>phlegm accumulation>liver kidney yin deficiency(P<0.05); the mutual knot of phlegm and blood stasis>Qi deficiency and blood stasis(P<0.05). There was no significant difference in Lp-PLA2 content between Qi deficiency, blood stasis and phlegm turbidity, Qi deficiency and blood stasis and liver kidney yin deficiency(P>0.05). Conclusion ①The clinical manifestation of carotid atherosclerosis is more marked by phlegm and blood stasis. ②The risk of future or recurrence of coronary artery disease and cerebral infarction in patients with phlegm and blood stasis type carotid atherosclerosis may be higher than that of liver kidney yin deficiency, Qi deficiency and blood stasis and phlegm accumulation of carotid atherosclerosis.