Objective To investigate the association between common traditional Chinese medicine (TCM) syndrome types of Wilsons disease (WD) and white matter fiber tract alterations. Methods A total of 102 WD patients with internal retention of damp-heat or intermingled phlegm and blood stasis were enrolled, and automatic fiber quantification was used to analyze the microstructural characteristics of white matter fiber tracts. A least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify key imaging variables, and the binary logistic regression analysis was used to investigate the association between these variables and TCM syndrome types. Results The LASSO analysis identified 16 key radiological features, including the radial diffusivity (RD) value of the small fiber bundle of the corpus callosum, the fractional anisotropy (FA) value of the uncinate fasciculus, and mean diffusivity (MD), and these variables were significantly associated with the TCM syndrome types of WD. The binary logistic regression analysis showed that the RD value of the small fiber bundle of the corpus callosum \[odds ratio (OR)=2.376；95% confidence interval (CI): 1.448-4.04, P<0.05\], the FA value of the left uncinate fasciculus (OR=2.367；95% CI:1.44-4.03；P<0.05), and the MD value of the left corticospinal tract (OR=1.987；95% CI:1.204-3.376；P<0.05) were significantly positively associated with the syndrome of internal retention of damp-heat in WD, while the RD value of the right uncinate fasciculus (OR=0.411；95% CI:0.245-0.666；P<0.05) was significantly negatively associated with the syndrome of internal retention of damp-heat in WD. Conclusion White matter fiber tract damage is significantly associated with the TCM syndrome types of WD.