To investigate the traditional Chinese medicine(TCM) syndromes and syndrome elements of chronic atrophic gastritis(CAG)，reveal the medication rules，and thus provide evidence for the standardized differentiation and treatment of CAG.Methods:The relevant articles about the treatment of CAG with TCM were retrieved from China National Knowledge Infrastructure(CNKI)，China Science Periodical Database(CSPD)，and Chinese Citation Database(CCD)，with the time interval from January 1990 to December 2020.The syndromes，syndrome elements，number of cases，and prescription composition were extracted from the literature.The frequency，number of cases，and constituent ratio of CAG syndromes and syndrome elements in the literature in the first 25 years and recent 5 years were analyzed and compared.The frequency of medicines in the prescriptions was analyzed，and finally the association rules analysis and cluster analysis were carried out for the medicines with high frequency.Results:A total of 245 qualified articles were included，involving 42 TCM syndromes.The common syndromes were deficiency of spleen and stomach qi，deficiency of stomach yin，deficiency of spleen and stomach yang，spleen deficiency and qi stagnation，liver-stomach disharmony，dampness-heat of spleen and stomach，and stasis in stomach collateral.CAG mainly affected the stomach，spleen，and liver.The common syndrome elements of CAG were qi deficiency，yang deficiency，heat，yin deficiency，qi stagnation，stasis，and dampness.Compared with the literature of the previous 25 years，the literature in the recent 5 years mainly reported deficiency of spleen and stomach qi，deficiency of stomach yin，and liver-stomach disharmony，and the syndrome elements reported more were qi deficiency，heat，yin deficiency，qi stagnation，and stasis.A total of 260 prescriptions were included，involving 191 Chinese medicines.Atractylodis Macrocephalae Rhizoma(56.54%)，Codonopsis Radix(46.54%)，and Paeoniae Radix Alba(46.15%) were used more frequently.The 30 high-frequency medicines were well clustered into 8 groups.Conclusion:The CAG patients mainly present the TCM syndrome of deficiency of spleen and stomach qi，with the stomach，spleen，and liver affected.The common syndrome elements are qi deficiency，yang deficiency，heat，yin deficiency，qi stagnation，stasis，and dampness.Replenishing qi and invigorating spleen can be taken as the main therapy for CAG，supplemented by regulating qi for relieving stagnancy，clearing heat and removing toxin，activating blood and resolving stasis.