To explore the clinical characteristics of Xinglou Chengqi Decoction on acute ischemic stroke of phlegm heat excess syndrome and its effects on the evolution of disease syndrome. Methods:Forty cases of acute ischemic stroke with phlegm heat and bowel excess syndrome were studied. According to the ratio of 2:1, they were divided into treatment group (27 cases) and control group (13 cases). The control group received routine therapy, and the treatment group on the basis of adding Xinglou Chengqi Decoction orally. TCM symptoms score, phlegm heat and bowel excess syndrome score, NIHSS score of two groups before and after treatment were recorded, and the efficacy differences was evaluated. At the same time, the changes of hemorheology in the two groups were detected, and lipid metabolism were analyzed. Results:1) There was no difference between the two groups of TCM symptoms and signs before treatment (P>0.05). The score of TCM symptoms and signs in the treatment group was improved, and the difference was statistically significant after treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). 2) Two groups of phlegm heat excess syndrome score in treatment group after treatment, the fire, phlegm, yin deficiency and total score were lower than the control group (P<0.05). 3) The NIHSS score of the treatment group was lower than that of the control group after treatment (P<0.05). 4) The hemorheological indexes and lipid metabolism of the two groups were significantly decreased (P<0.05), and the treatment group was better than the control group after treatment (P<0.05). 5) The blood rheology index of the two groups was positively correlated with the total score of phlegm heat and bowel excess. There was no significant correlation between NIHSS score (P>0.05). Conclusion:Xinglou Chengqi Decoction on acute ischemic stroke in the patients with syndrome of phlegm heat, can effectively improve the patient's symptom scores and index, alleviate the clinical symptoms of TCM, fully embodies the advantages, which is worthy of promotion.