Abstract： Objective To explore the relationship between ischemic stroke with phlegm and blood stasis blocking collaterals and biochemical indexes.Methods Totally 71 patients with ischemic stroke with phlegm and blood stasis blocking collaterals(group A)and 55 patients with non-phlegm and blood stasis ischemic stroke(group B)treated in the Department of Acupuncture and Moxibustion,Beijing Hospital of Traditional Chinese Medicine(TCM),Capital Medical University from January to December 2021 were collected retrospectively.Another 70 healthy subjects who took part in physical examination in the same period were selected(group C).The serum biochemical indexes of subjects were measured and analyzed.The diagnostic value of each test index was analyzed and evaluated by drawing the receiver operating characteristic curve.Results The top five areas under the curve(AUC)indexes for diagnosing ischemic stroke of phlegm and blood stasis type were total protein,albumin,apolipoprotein A1(ApoA1),high density lipoprotein cholesterol(HDL-C)and cystatin C,and AUC were 0.930,0.912,0.811,0.802 and 0.754,respectively.The top five AUC indexes for diagnosis of non-phlegm and blood stasis type ischemic stroke were albumin,total protein,ApoA1,small and dense low density lipoprotein cholesterol(sdLDL-C)and cystatin C,which the AUCs were 0.962,0.908,0.879,0.831 and 0.830,respectively.The diagnostic value of total cholesterol,low density lipoprotein cholesterol(LDL-C),sdLDL-C and total bilirubin in ischemic stroke of non-phlegm and blood stasis type was significantly higher than that of phlegm and blood stasis type(Z=-2.083,P=0.037;Z=-2.705,P=0.007;Z=-3.056,P=0.002;Z=-2.264,P=0.024).Conclusions The detection of total cholesterol,HDL-C,LDL-C,ApoA1,sdLDL-C,cystatin C,total bilirubin,total protein and albumin has a certain reference value for TCM syndrome differentiation of ischemic stroke,but it is not recommended to use total cholesterol and other lipids as the basis of TCM syndrome differentiation of ischemic stroke.Total bilirubin may provide help and medication reference for the dialectical classification of phlegm and blood stasis blocking collaterals in ischemic stroke.