Objective To investigate the distribution pattern of chronic atrophic gastritis and the relationship between CAG TCM syndrome differentiation and histopathological changes by combining the microscopic features of gastroscopic mucosa， provide further evidence for clinical treatment. Methods Eighty-six patients with chronic atrophic gastritis were selected for diagnosis. The atrophy sites， degree of atrophy， presence or absence of Hp infection， presence or absence of erosion， bleeding point， bile reflux， and pathological histology were observed. Epithelial metaplasia changes. The relationship between the two is discussed by the appearance of the mucosa and the pathological features of the gastroscope. Results There was a statistically significant difference in the degree of atrophy of each syndrome（P<0.05 ）. There was no statistically significant difference in the distribution of atrophy sites of each syndrome （P>0.05）. There was a statistically significant difference in the distribution of concomitant lesions of each syndrome（P<0.05）. The comparison between the two groups showed that the ratio of liver and stomach discomfort with bile reflux was significantly different from other syndromes（P<0.01）， and the proportion of spleen and stomach dampness with erosion was significantly different from other syndromes（P<0.01）. There was no significant difference in the intestinal metaplasia rate of each syndrome type（P>0.05）. The differences between the dysplasia groups of each syndrome type were statistically significant（P<0.05）. There was a certain detection rate for Hp infection of five syndrome types， and there was no significant difference. Conclusion The evolution of the disease may be Liver and stomach disharmony， dampness and heat of the spleen and stomach， weakness of the spleen and stomach， deficiency of stomach yin and blood stasis of stomach， and the condition is gradually aggravated. The detection rate of bile reflux in liver-gastric disharmony was 41.94%， which was significantly higher than that in the other four syndromes. The detection rate of dampness and heat of the spleen and stomach was 60%， which was significantly higher than the other four syndromes.