Objective To investigate the interaction between traditional Chinese medicine syndromes of patients with chronic heart failure (CHF) and the primary pathogenesis of CHF, so as to grasp the distribution regularity of TCM syndrome caused by different primary diseases and provide reference for better intervention of CHF. Methods A total of 580 patients with CHF were included in the clinical cross-sectional study. The baseline data of the patients, the primary disease and the four diagnosis information of TCM were collected. The syndromes of TCM were judged and the logistic regression method was used to analyze the correlation of CHF and the distribution of syndromes. Results Analysis of TCM Syndromes of CHF showed that the main syndromes were Qi deficiency syndrome, blood stasis syndrome, water retention syndrome, yin deficiency syndrome, phlegm syndrome, and yang deficiency syndrome. Further analysis showed that the above causes of CHF were related to the distribution of TCM syndromes. When coronary heart disease is the primary disease, blood stasis syndrome, yang deficiency syndrome, and yin deficiency syndrome are related to the occurrence of CHF (χ2 values are 0.480, 4.445, 0.192, P<0.05). When hypertension is the primary disease, blood stasis syndrome and phlegm syndrome are related to the occurrence of CHF (χ2 values are 12.344, 10.990, P<0.05); dilated cardiomyopathy is the primary disease, blood stasis syndrome and yang deficiency syndrome and chronic heart failure It is related (χ2=5.222, 3.456, P<0.05). Conclusions The distribution patterns of TCM Syndromes of CHF caused by different primary diseases were different, which was related to the pathogenesis of CHF. It is of great significance for better application of traditional Chinese medicine CHF syndrome differentiation during treatment, so as to form optimal treatment to reduce re-admitted into hospitalization rate and mortality in patients with CHF.