Objective: The aim of this study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and coronary atherosclerotic plaque in patients with chest Bi heart-aching Qi stagnation and blood stasis syndrome. Methods: The clinical data of 147 patients with qi stagnation and blood stasis syndrome who were suspected of coronary artery disease (CAD) and underwent coronary CTA examination in the physical examination center of the Affiliated People's Hospital of Fujian University of Chinese Medicine from January 2021 to May 2023 were selected. Patients were divided into an AS plaque group (n=95) and a non-AS plaque group (n=52) based on the presence or absence of coronary atherosclerotic plaque.By comparing the data of age, gender, underlying diseases, biochemical indexes and blood routine of the two groups, multi-factor Logistics regression analysis was conducted to determine the risk factors of AS occurrence. ROC curve was drawn to evaluate the predictive value of independent risk factors for AS occurrence. Spearman rank correlation analysis was used to evaluate the relationship between NLR and the severity of Qi-stagnation and blood-stasis syndrome. Results: Atherosclerotic plaque was found in 64.6% of patients suspected of coronary artery disease (CAD) in the study. Multivariate regression analysis showed that NLR (OR=8.4, 95% CI: 2.35-30.02, P=0.001) and smoking (OR=5.46, 95% CI: 2.32-12.85, P < 0.001) was an independent risk factor for the occurrence of coronary atherosclerotic plaques. The area under the ROC curve of NLR was 0.754, and when NLR value was greater than 1.769, it was strongly correlated with the occurrence of AS plaques. In addition, NLR was correlated with the severity of qi stagnation and blood stasis syndrome (Spearman's rho = 0.893).Conclusion: The incidence of coronary atherosclerotic plaque is relatively high, and the increase of NLR is independently correlated with smoking and the occurrence of AS. NLR, as a compound indicator of clinical supplement, has clinical potential to predict coronary atherosclerotic plaque. In addition,NLR is significantly correlated with the severity of Qi-stagnation and blood-stasis syndrome, suggesting that NLR can be used as an objective reference index to evaluate the clinical outcome of this syndrome type.