Abstract：Objective：To study the relationship between traditional Chinese medicine (TCM) syndrome and cranial MRI in acute cerebral infarction. Methods：A total of 174 patients with acute cerebral infarction were selected for TCM syndrome and cranial MRI examination. The detection rates of responsible lesions， distribution of lesion，and lesion manifestations in cranial MRI of patients with acute cerebral infarction of each syndrome type were observed. Results： Among 174 patients with acute cerebral infarction， wind phlegm obstruction syndrome and qi deficiency and blood stasis syndrome are common. A total of 170 responsible lesions were detected on cranial MRI， with a detection rate of 97.70% . The detection rates of responsible lesions in cranial MRI of different TCM syndrome types is similar. The lesions in patients with phlegm heat and bowel excess syndrome are mainly distributed in the anterior circulation cortex， accounting for 47.62%. The lesions in patients with qi deficiency and blood stasis syndrome and liver yang hyperactivity syndrome are mainly distributed in the posterior circulation cortex，accounting for 53.19% and 61.90% respectively. The lesions in patients with stirring of wind due to yin deficiency syndrome and windphlegm obstructing the collaterals syndrome are mainly distributed in the basal ganglia， accounting for 54.84% and 48.00% respectively. The lesions in patients with phlegm heat and bowel excess syndrome often appear in large patches，accounting for 61.90%. The lesions in patients with qi deficiency and blood stasis syndrome and liver yang hyperactivity syndrome，stirring of wind due to yin deficiency syndrome and wind- phlegm obstructing the collaterals syndrome are mostly small patches， accounting for 59.57% ， 66.67% ， 64.52% ， and 60.00% respectively. Conclusion： There is a close relationship between TCM syndrome and cranial MRI in acute cerebral infarction. TCM syndrome can be combined with cranial MRI examination to improve the accuracy of clinical diagnosis.