Abstract： Objective： To observe the clinical effect of modified Tianma Gouteng Decoction in the treatment of hypertension with ascendant hyperactivity of liver yang syndrome and its effects on blood lipids and serum homocysteine （Hcy） levels. Methods： A total of 90 hypertension patients with ascendant hyperactivity of liver yang syndrome were selected and divided into the conventional group and the Chinese medicine group according to the random coin toss method， with 45 patients in each group. The conventional group was treated with Nifedipine Controlled-Release Tablets，while the Chinese medicine group was treated with modified Tianma Gouteng Decoction in addition to the treatment of the conventional group. The clinical effects were compared between the two groups. The traditional Chinese medicine （TCM） syndrome scores， blood pressure [systolic blood pressure （SBP） and diastolic blood pressure （DBP）]， blood lipids [total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C）]， and Hcy levels were compared between the two groups before and after treatment. Results： The total effective rate in the Chinese medicine group was 95.56%（43/45），while that in the conventional group was 82.22%（37/45），with the difference being significant （P＜ 0.05）. After treatment， TCM syndrome scores in the two groups were decreased when compared with those before treatment （P＜0.05）， and the TCM syndrome scores in the Chinese medicine group were lower than those in the conventional group （P＜0.05）. After treatment， the levels of SBP and DBP in the two groups were decreased when compared with those before treatment （P＜0.05），and the levels of SBP and DBP in the Chinese medicine group were lower than those in the conventional group （P＜0.05）. After treatment，the levels of TC，TG，and LDL-C in the two groups were decreased when compared with those before treatment （P＜0.05）， while the levels of HDL-C were increased when compared with those before treatment （P＜0.05）；the levels of TC，TG，and LDL-C in the Chinese medicine group were lower than those in the conventional group （P＜0.05）， and the level of HDL-C in the Chinese medicine group was higher than that in the conventional group （P＜0.05）. After treatment，the Hcy levels in the two groups were decreased when compared with those before treatment （P＜0.05）， and the Hcy level in the Chinese medicine group was lower than that in the conventional group （P＜0.05）. Conclusion：The modified Tianma Gouteng Decoction has a significant therapeutic effect on hypertension with ascendant hyperactivity of liver yang syndrome. It can significantly improve patients' blood pressure， blood lipids， and serum Hcy levels， and reduce the risk of cardiovascular diseases.