In traditional Chinese medicine, coronary heart disease falls under the categories of “chest impediment and heart pain” and “true heart pain”, with lipid metabolism disorder and the inflammatory response acting as biochemical manifestations of “phlegm and stasis” throughout the disease. The energy metabolism of macrophages is closely related to their immune function and is an important factor in regulating the metabolic disorder and inflammatory responses in coronary heart disease. This article reviews the role of macrophages in the pathophysiology of coronary heart disease. We discuss how these metabolic pathways affect the immune responses of macrophages and influence the disease. We delve into the different modes of macrophage energy metabolism in coronary heart disease, especially the metabolic characteristics and immune regulatory functions of pro-inflammatory M1 and anti-inflammatory M2 macrophages in the syndrome of phlegm and blood stasis. This provides a theoretical guidance for understanding the pathogenic mechanism of the syndrome of phlegm and blood stasis in coronary heart disease and developing new treatment strategies.