Abstract： Hypertension in middle-aged and young adults has its particularity， which is related to long-term excessive stress and unhealthy lifestyles. Depression and fire run through the whole process of the disease. This paper starts from the perspectives of depression and fire，and based on the six types of depression，it explores the association between pathological factors and the pathogenesis of hypertension in middle-aged and young adults. It also identifies the fire of each viscus and the pathogenesis of hypertension in middle-aged and young adults according to the causes of fire. Following the principles that depression should be dispersed and fire should be cleared，this paper systematically and theoretically discusses the syndrome differentiation and treatment of hypertension in middle-aged and young adults， providing new ideas for the prevention and treatment with Chinese medicine.