To explore the correlation between carotid atherosclerosis and stroke with the changes of TCM syndrome elements in the process in order to provide the evidence for prevention and treatment of cerebrovascular diseases. Methods:A total number of 542 patients with high risk of stroke were selected from Wangzuo Town in 2012,and were followed up for 3 years. They were divided into CAS group and non-CAS group and TCM symptoms,history of stroke,position and features of carotid atherosclerosis were analyzed. Changes of carotid atherosclerosis,risk factors and TCM symptoms were described in newly incident cases during the follow up period. Results:The proportion of patients who had stroke history in CAS group was higher than that in the non-CAS group and hypo or mixed echo plaque in carotid sinus were more common. There was no significant difference in single TCM syndrome elements between the two groups,but qi-deficiency plus phlegm and phlegm-fire showed significant difference in two groups. Patients with bilateral stenosis of carotid artery were much more than patients with lateral stenosis or without stenosis. Ten new cases occurred during the 3 years follow up and changes in TCM syndrome elements all had certain correlation with fire syndromes. Conclusion:Carotid atherosclerosis and bilateral stenosis of carotid artery were positively correlated with the occurrence of stroke,with the elements of qi-deficiency plus phlegm or phlegm-fire. Changes in fire,phlegm,and blood stasis appeared in the progression of stroke.