Abstract: Atherosclerosis (AS) is a critical component of target organ damage caused by hypertension. Modern research indicates that traditional Chinese medicine (TCM) possesses unique advantages in the prevention and treatment of this condition. The course of AS is protracted, with symptoms developing gradually over time; it presents as a complex condition characterized by the interplay of constitutional deficiency and pathogenic excess. In TCM, this condition is often classified under categories such as “dizziness” and “pulse bi”. This article traces its origins to The yellow emperor’s inner classic, and examines the theory of “tonification by preference and draining by aversions”. Addressing the pathological mechanisms—such as qi stagnation, fire, phlegm, blood stasis, toxins, and deficiency—arising from liver qi stagnation, it adheres to the general principles of “acridity to tonify, sweetness to relieve, and sourness to purge”. Pungent herbs disperse to resolve stagnation; bitter herbs combine with fire to promote descent; and sour and sweet herbs harmonize the body and its functions. In clinical practice, it is essential to carefully assess the stage of disease progression. By integrating these three therapeutic principles, selecting formulas flexibly, and applying appropriate treatments, this approach opens new avenues for the diagnosis and treatment of AS with Chinese medicine.