To observe the clinical effect of Shenhong Tongluo Recipe on carotid atherosclerosis. Method: 72 patients were randomly divided into a control group (36 cases) and an experimental group (36 cases). The control group received atorvastatin calcium, while the experimental group received the Shenhong Tongluo formula. The treatment program consisted of 24 weeks. Observe the thickness of the intima media and plaque area of the carotid artery; Hs CRP, MLR (mononuclear C/lymphoid C), NLR (neutrophil C/lymphoid C); Clinical efficacy of traditional Chinese medicine and TCM syndrome score; Measurement of blood lipid levels (TG, TC, HDL, LDL); Homocysteine and uric acid; Changes in safety indicators. The total effective rate of the experimental group was higher than that of the control group (P<0.05). After treatment, the carotid intima-media thickness and plaque area in the experimental group; Hs CRP, MLR (mononuclear C/lymphoid C), NLR (neutrophil C/lymphoid C); Clinical efficacy of traditional Chinese medicine and TCM syndrome score; Blood lipid levels (TG, TC, LDL); Homocysteine and uric acid levels decreased (P<0.05), and the traditional Chinese medicine syndrome score was lower than that of the control group (P<0.05). No significant adverse reactions were observed in the experimental group’s control group. Conclusion Shenhong Tongluo Recipe can safely and effectively regulate the level of inflammation in the circulation of patients with carotid atherosclerosis, improve lipid metabolism disorder, reduce inflammatory reaction, alleviate and stabilize plaque and resist atherosclerosis.