Objective To observe the changes of endoscopy and pathology of gastric mucosa before and after treatment of chronic atrophic gastritis with erosion in different syndromes and to explore the relationship between TCM syndromes of chronic atrophic gastritis with erosion and the changes of gastric mucosa， which provides evidence for clinical diagnosis and treatment of chronic atrophic gastritis with erosion. Methods 68 cases of chronic atrophic gastritis with erosion was divided into 6 TCM syndrome type： deficiency of spleen and stomach in 18 cases， stagnation of heat in liver and stomach in 16 cases， dampness and heat of spleen and stomach in 12 cases， deficiency of stomach and yin in 9 cases， stagnation of qi in liver and stomach in 8 cases， and blood stasis of stomach in 5 cases. All patients were treated with TCM syndrome differentiation for 3 months. Then compared the changes of gastric mucosa before and after treatment， and analyzed the relationship between the changes of gastric mucosa and the types of syndromes. Results The number of syndrome types was as follows： deficiency of spleen and stomach（26.5%）， stagnation of heat in liver and stomach（23.5%）， dampness and heat of spleen and stomach（17.6%）， deficiency of stomach yin（13.2%）， stagnation of qi in liver and stomach（11.8%）， and blood stasis of stomach（7.4%）. The most common type of mild atrophy of gastric mucosa was deficiency of spleen and stomach（88.9% P<0.001）. The most common type of mild intestinal metaplasia of the gastric mucosa was dampness and heat of spleen and stomach（91.7%， P<0.01）. The most common type of severe atrophy and severe intestinal metaplasia was blood stasis of stomach（100%， 80%， P<0.05）. The most common type of erosion in grade I of gastric mucosa was deficiency of spleen and stomach（77.8% P<0.05）. The most common type of erosion of grade IV was dampness and heat of spleen and stomach（75.0%， P<0.05）. Spleen and stomach deficiency syndrome had the biggest change in the degree of gastric mucosal atrophy after TCM treatment（△=0.94±0.42， P<0.05）. Blood stasis of stomach had the biggest change in the degree of intestinal metaplasia of gastric mucous membrane after TCM treatment（△=1.80±0.45， P<0.05）. Spleen and stomach damp-heat syndrome had the biggest change in the degree of gastric mucosal erosion after TCM treatment（△=1.67±0.49， P<0.05）. Conclusion Chronic atrophic gastritis combined with erosion has a certain correlation with the changes of gastric mucosa before and after TCM treatment， which can provide some basis for clinical diagnosis and treatment of different types of chronic atrophic gastritis with erosion.