〔Abstract〕 Objective To explore the relationship between TCM syndrome differentiation and classification of patients with recurrent ischemic stroke (RIS), inflammatory marks and cerebral magnetic resonance imaging (MRI). Methods A total of 120 RIS patients admitted to Shanghai Jiangong Hospital from May 2021 to May 2023 were collected for TCM syndrome differentiation and MRI examination. Clinical indicators, inflammatory indicators and demographic data of patients were collected, the differences of inflammatory indicators and brain MRI lesion distribution in patients with different TCM syndrome types were compared, and the differences in gender, age, body mass index (BMI), tobacco and alcohol history, diabetes, hypertension, hyperlipidemia and inflammatory indicators among different patients were analyzed. To explore the relationship between these factors and TCM syndrome types. Results Patients with wind-phlegm-stasis syndrome mainly distributed in basal ganglia and thalamus (P < 0.05). The syndrome type of liver-yang hyperactivity was more common in brain stem (P < 0.05). The lesions of Yin deficiency wind movement syndrome were more obvious in the cerebral lobe and basal ganglia (P < 0.05). The main lesions of phlegm-heat fu-organ were thalamus (P < 0.05). The proportion of cerebral lobular lesions in patients with Qi deficiency and blood stasis syndrome was the highest (P < 0.05). In addition, serum amyloid A (SAA), interleukin-6 (IL-6) and C-reactive protein (CRP) were significantly increased in patients with wind-phlegm-stasis, liver-yang hyperactivity and phlegm-heat fu-fu syndrome, among which the phlegm-heat fu-fu syndrome was the most obvious, while the levels of inflammatory indicators were lower in patients with Yin deficiency wind movement and Qi deficiency blood stasis syndrome. logistic regression analysis showed that gender, BMI, smoking history and history of hyperlipidemia were the influencing factors of TCM syndrome type, and inflammatory indicators were also the influencing factors of TCM syndrome type. Conclusion There is a certain relationship between head MRI and inflammation indicators of RIS patients and TCM syndrome differentiation. Head MRI imaging examination can be used as a reference for TCM syndrome differentiation, and inflammation indicators can be used as objective auxiliary indicators for the empirical type of syndrome differentiation.