〔Abstract〕 Objective To investigate the clinical effect of Tongmai Xiaoban ointment in the treatment of carotid artery plaque with phlegm and blood stasis. Methods A total of 60 patients with carotid atherosclerosis with phlegm and blood stasis treated in Shenzhen Hospital of Traditional Chinese Medicine from January 2021 to December 2021 were randomly divided into a control group and an observation group, with 30 cases in each group. The control group was treated with simvastatin tablets orally, and the observation group was treated with Tongmai Xiaoban ointment on the basis of the control group. The efficacy, blood lipid levels [triacylglycerol (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C)] and the changes of plaque indexes [intima-media thickness (IMT), plaque number and plaque area] were observed and compared between the two groups after 12 weeks of treatment. Results After 12 weeks of treatment, IMT and plaque quantity in the observation group were lower than those in the control group, the differences were statistically significant (P < 0.05). After 12 weeks of treatment, the Crouse score of the observation group was lower than that of the control group, and the difference was statistically significant (P < 0.05). After 12 weeks of treatment, the levels of TC, TG and LDL-C in the observation group were lower than those of the control group, while the levels of HDL-C was higher than that of the control group, the differences were statistically significant (P < 0.05). The total effective rate of the observation group was 83.33%, higher than 67.67% of the control group, the difference was statistically significant (P < 0.05). Conclusion Tongmai Xiaoban ointment combined with oral simvastatin tablets in the treatment of carotid atherosclerosis can significantly reduce the symptoms of patients, regulate the level of blood lipid, contribute to the stabilization of atherosclerotic plaque, and improve the clinical efficacy