Objective:To study the distribution of traditional Chinese medicine (TCM) syndromes,Helicobacter pylori(Hp) infection and pathological changes of gastric mucosa in chronic atrophic gastritis. MethodsThe related data of 338 patients with chronic atrophic gastritis were collected. The distribution of TCM syndromes, Hp infection and pathological changes of gastric mucosa were analyzed.  Results:①The syndrome of deficiency of spleen and stomach was the most common in patients with chronic atrophic gastritis(23.4%), followed by dampness-heat of spleen and stomach (20.7%), stagnation of liver qi and stomach qi(19.2%), deficiency of stomach yin(13.3%), stagnated heat of liver and stomach(12.1%), and blood stasis in stomach collateral(11.2%).② The total Hp infection positive rate of 338 patients with chronic atrophic gastritis was 55.3%, which was highest in dampness-heat of spleen and stomach syndrome (72.9%); different syndromes of chronic atrophic gastritis had statistically significant difference in the rate of Hp infection (P<0.01) .③The total positive rate of gastric mucosa active inflammation was 53.8%, which was highest in dampness-heat of spleen and stomach syndrome(71.4%), The proportion of moderate and severe active inflammation was 37.1% and 27.1% respectively.There were statistically significant differences in the degree of active inflammation of gastric mucosa in different TCM syndromes (P<0.05).④The proportion of moderate and severe gastric mucosa atrophy in deficiency of spleen and stomach syndrome was the highest (43.0% and 27.8%, respectively).The degree of gastric mucosa atrophy in different TCM syndromes was statistically different(P<0.05).⑤There was no statistically significant difference between different TCM syndromes in chronic inflammation of gastric mucosa, intestinal metaplasia, and low-grade intraepithelial P>0.05).  Conclusion:Deficiency of spleen and stomach syndrome is the most common TCM syndrome in patients with chronic atrophic neoplasia (gastritis, which has the higher incidence of moderate and severe gastric mucosa atrophy; dampness-heat of spleen and stomach syndrome is closely related to Hp infection, and the degree of gastric mucosa active inflammation is also more severe.