Spleen governs transportation and transformation of water and food, spreads food essence. Lipid also originates from food and water, and relies on spleen qi distributing essence, and is spread to the whole body by “vessels”. If abnormal lipid metabolism caused by spleen weakness happens, phlegm generates in the body which would obstruct of qi and blood running, leading to “unsmoothness of vessels”. Therefore, abnormal lipid metabolism caused by spleen weakness is a major factor which results in early atherosclerosis formation of fatty streaks. Focusing on the pathological change of fatty streak during early atherogenesis, begin from foam cell formation mechanism, with the aid of in vivo and in vitro experiments, exploration in the effects of lipid metabolic disorder caused by dysfunction of spleen in transportation in macrophage “foam cell formation” and to clarify the pathogenesis of “dysfunction of spleen in transportation” to “unsmoothness of vessels” by the influence of scavenger receptor on macrophages uptake of cholesterol in the blood vessels and the related gene expression of regulation of cholesterol metabolism in macrophages, which can reveal acting mechanism of invigorating spleen for eliminating phlegm Chinese medicine to protect vascular endothelial cells and inhibiting effect mechanism of macrophage “foam cell formation”. To illustrate scientific connotation “spleen disease syndrome, unsmoothness of vessels” in The Inner Cannon of Huangdi, and thus theoretical basis for clinical treated atherosclerosis from spleen could be provided.