Objective To observe the distribution laws of TCM microcosmic differentiation syndromes of gastric mucosa in patients with chronic atrophic gastritis and the occurrence of precancerous lesions. Methods A total of170 patients with chronic atrophic gastritis were treated with the examination of painless gastroscopy and confocal laser endoscopy. According to the endoscope observation

they were divided into stomach yin insufficiency type

stasis blocking stomach collaterals type

deficiency cold of spleen and stomach type

spleen-stomach damp-heat type and stagnation of liver-Qi type after microcosmic syndrome differentiation of traditional Chinese medicine. Targeted biopsy was taken on the the glands atrophy to determine the intestinal epithelial metaplasia or intraepithelial neoplasia

the mean optical density of CD34 and Ki67 in gastric mucosa was examined by immunohistochemical method

and at the same time

Helicobacter pylori（ Hp） infection would be judged. Results Among all the cases of chronic atrophy gastritis in this study

according to TCM microcosmic syndrome differentiation

there were 54 cases of stomach yin insufficiency type

28 cases of deficiency cold of spleen and stomach type

22 cases of liver stomach heat type

16 cases of spleen-stomach damp-heat type. There was no significant difference in the Hp infection rate among different types of TCM microcosmic syndrome differentiation（ P > 0. 05）. Intestinal metaplasia rate and intraepithelial neoplasia rate in stagnation of liver-Qi type and spleen-stomach damp-heat type was significantly higher than that in deficiency cold of spleen and stomach type and stomach yin insufficiency type（ P < 0. 05 or P < 0. 01）. The intraepithelial neoplasia rate in stagnation of liver Qi type was significantly higher than that of deficiency cold of spleen and stomach type and stomach yin insufficiency type（ P < 0. 01）. The CD34 average optical density value of stagnation of liver Qi type value was significantly higher than that of liver stomach heat type

stasis blocking stomach collaterals type

deficiency cold of spleen and stomach type

stomach yin insufficiency type（ P < 0. 05 or P < 0. 01）; Pi-Wei damp-heat type and deficiency cold of spleen and stomach type was significantly higher than that in stasis blocking stomach collaterals type and stomach yin insufficiency type（ P < 0. 05）; Ki67 average optical density value in stagnation of liver-Qi type and spleen-stomach damp-heat type was significantly higher than that in deficiency cold of spleen and stomach type

stomach yin insufficiency type and stasis blocking stomach collaterals type（ P < 0. 05 or P < 0. 01）

Ki67 average optical density value in Pi-Wei damp-heat type was significantly higher than that in liver stomach heat type（ P <0. 01）. Conclusion Among TCM microcosmic differentiation of gastric mucosa in chronic atrophic gastritis

excess syndrome is more than deficiency syndrome Among all the microscopic syndromes

Stagnation of liver-Qi Type and spleen-stomach damp-heat type have higher incidence rate of precancerous lesions.