Objective To investigate the clinical effect of Huanglian Jiedu decoction combined with acupuncture in the treatment of patients with carotid atherosclerosis（CAS）.Methods A total of 80 patients with CAS admitted to the Third Affiliated Hospital of Fujian University of Traditional Chinese Medicine from July 2021 to January 2023 were selected as the research objects,and they were divided into control group(40 cases)and treatment group(40 cases)according to the random number table method.The control group was treated with acupuncture,and the treatment group was treated with Huanglian Jiedu decoction combined with acupuncture,and the blood lipid indexes,carotid arteriosclerosis indexes and adverse reactions of the two groups were compared.Results After treatment,the triglyceride (TG),total cholesterol (TC),and low-density lipoprotein cholesterol (LDL-C) in the treatment group were lower than those in the control group,while high-density lipoprotein cholesterol(HDL-C)was higher than those in the control group,with statistical significances(P＜0.05).The carotid intima-media thickness(IMT),plaque area (PA),and plaque score (Course score) of the treatment group were lower than those of the control group after treatment,and the differences were statistically significant (P＜0.05).There was no statistically significant difference in the rate of moderate to severe carotid artery stenosis and adverse reactions between the two groups of patients before and after treatment (P＞0.05).Conclusion Huanglian Jiedu decoction combined with acupuncture in the treatment of CAS can effectively regulate blood lipid levels and improve carotid atherosclerosis,which has a high safety profile and is worthy of clinical promotion.