Objectives To study the relationship between TCM syndromes and adiponectin (APN) level, carotid atherosclerosis plaque of hypertension complicated with carotid atherosclerosis, and provide evidence for clinical diagnosis and treatment. Methods One hundred patients of hypertension complicated with carotid atherosclerosis were divided into phlegm syndrome group, stasis syndrome group, and intermingled phlegm and blood stasis syndrome group, and compared with 30 healthy people as control. Carotid atherosclerosis plaque was detected with GE LOGIQ500 color ultrasound system. ELISA was used to determine the serum APN. Results APN of the intermingled phlegm and blood stasis syndrome group was obviously lower than other groups, and there were obvious differences among them. There were more plaques in the intermingled phlegm and blood stasis syndrome group. A negative correlationship was showed between carotid artery intima media thickness (IMT) and APN of hypertension complicated with carotid atherosclerosis. Conclusion There is correlation between TCM syndrome and APN level, carotid atherosclerosis plaque of hypertension complicated with carotid atherosclerosis. The anomalous change of APN and plaque formation of the patients can be preliminarily estimated with the syndrome of TCM.