Macrophage is a kind of immune cell which is closely related to atherosclerosis (As). With the change of internal environment, macrophage can polarize into different phenotype. Under the physiological environment, the polarization of macrophages is in dynamic balance. In the As state, the polarization balance is destroyed and the corresponding phenotypic macrophages are differentiated, which play different roles in each stage of As. The debate between Zheng and Xie exists in the whole process of As formation and development, while macrophage polarization runs through the whole stage of As syndrome differentiation and change. On account of this, this paper discusses the relationship between macrophage polarization and As based on the theory of Zheng and Xie, and propose that attention should be paid to the combination of macro and micro in the clinical prevention and treatment of As, and it can control the inflammatory response and stabilize plaque by regulating the macrophage polarization, thus providing an emerging target for the treatment of As with traditional Chinese medicine.