Chronic atrophic gastritis (CAG) is one of the common and difficult to treat clinical diseases. It is characterized by atrophy of the gastric glands, thinning of the mucosa, thickening of the mucosal base, and even intestinal epithelial hyperplasia and atypical hyperplasia, for which there is no good treatment method at home and abroad. This disease is called “gastric gangrene” in Chinese medicine, and Chinese medicine has more obvious advantages in the treatment of CAG. The author combined with his personal experience in clinical practice for many years to discuss the ideas and methods of medication for the treatment of CAG, aiming to provide necessary information and reference for the combination of macroscopic dialectic and microscopic dialectic, and the combination of dialectical and pathological treatment for this disease. 1, from the main symptoms of the treatment, to understand the symptoms of the deficiency, the dialectical use of drugs: CAG disease is located in the stomach, involving the spleen and liver two organs and Shaoyang biliary organs. The initial disease is mainly due to damage to the stomach and yin, and after prolonged disease and spleen, it is mainly due to deficiency of middle energy or deficiency of both qi and yin. The deficiency in the middle is not transported, and the elevation is not in order, then the symptoms of Qi stagnation, blood stasis, heat stagnation, phlegm and dampness, food accumulation and other symptoms follow, and it becomes a deficiency of the original symptoms. This deficiency is mostly Qi deficiency or Yin deficiency or both Qi and Yin deficiency. The symptoms are blood stasis and gas stagnation. The stomach is the internal organs of Qi and blood, to pass down for use, CAG regardless of cold, heat, deficiency, internal stagnation is the commonality of its pathogenesis. Therefore, the treatment of CAG should be to benefit the qi, nourish yin, regulate the qi, unblock the blood channels, pass down the gas as the main method of treatment, pass down the gas to investigate the cause, according to the situation, to avoid the simple attack to drain down. Define the treatment from flatulence: flatulence is one of the most common main symptoms of CAG. Most of them are symptoms of deficiency of the root and symptoms of the symptoms, not without evil and stagnation. For those who are deficient in Qi, the symptoms include feeling of stuffiness in the internal organs, feeling of stagnation after eating, more food, or a feeling of falling and distension, but no pain when pressed, it is advisable to strengthen the spleen and Qi, regulate Qi and stomach, and use Xiang Sha Liu Jun Zi Tang with Jiao Nei Jin and Citrus Aurantium, etc. Glycyrrhiza glabra is sweet in taste, and it is easy to cause fullness in the middle, which can obviously inhibit gastric emptying and small intestine propulsion function, so it should not be used or used sparingly for those who are very full. For stasis and blood stagnation, it is necessary to regulate the Qi and invigorate the Blood, resolve stasis and relieve pain, and use raw Pu Huang, Wu Ling Lipid, Jiuxiang Worm, vinegar Yanhuo, frankincense, myrrh and so on, and add products to nourish the stomach as appropriate, so as not to deplete the right Qi. From the noisy identification of treatment: noisy has a cold and hot distinction, the stomach hunger noisy, like heat and cold, the coating is thin, it is appropriate to warm the middle and stomach, use Huangqi Jianzhong Tang plus yam, lentils, Buddha’s hand and so on. If the stomach is hot and noisy, noisy and dry mouth, red tongue with yellow coating, it is advisable to use warm bile soup with Baihe Wu Yao San or the like to clear heat and stomach, nourish Yin and regulate Qi. For those with liver fire in the stomach, noisy and irritable with acidity, it is advisable to use Wuyi Wan or the like to control liver fire. Those with noisy hunger in the stomach, accompanied by a feeling of fullness and burning pain, dry mouth and bitterness, are suffering from bile fire offending the stomach and loss of harmony and descent in the stomach, mostly accompanied by bile reflux. Bile reflux is one of the pathogenic factors of CAG and one of the main causes of CAG recurrence. In the treatment of CAG with biliary tract infection or duodenal malformation combined with bile reflux, I often use the self-prepared Chai Gui (Si Wei San combined with Chai Hu Gui Zhi Tang) plus Wu Mei, Hawthorn, Stipula and Curcuma with satisfactory results, which can enhance gastric emptying and small intestine propulsion function, resolve blood stasis and disperse knots, loosen knots of gastrointestinal malformation, dredge the liver and bile, and harmonize the stomach and lower the rebellious effect. Appetite: Loss of appetite is also one of the common symptoms of this disease. The author often uses Jiao Sanxian, raw grain buds, fried lycopodium, fried chicken internal gold, etc. to eliminate appetite and stomach, and selects the medicine according to the specific symptoms. The symptoms of loss of appetite, increased pain in the empty stomach, and fullness after eating are mostly due to deficiency of Qi in the spleen and stomach; those who know hunger but do not want to eat, prefer to eat a liquid diet, and eat a rough diet are painful, mostly due to deficiency of stomach yin. Those with abdominal fullness and fear of food are mostly suffering from liver qi offending the stomach or stasis of blood. 2, from microscopic detection to identify treatment, check the pathological changes, identify the disease and use drugs: treatment of CAG, to macroscopic identification and microscopic identification combined. Microscopic detection can accurately detect the pathological changes and provide the basis for the selection of targeted drugs. Especially for some no obvious conscious symptoms, macroscopic evidence “no symptoms to identify” no one, is of great significance. From the detection of Helicobacter pylori (HP) to identify treatment: HP infection is one of the important causes of CAG, drug antibacterial test shows that some heat detoxification drugs, detoxification drugs, Qi drugs, etc. have a killing or inhibiting effect on HP, clinical evidence can be based on the identification of HP infection, the use of some HP-sensitive drugs, a reasonable combination of formula, such as evidence of damp-heat, yellow greasy moss, can choose Huang Lian, Xuan Shen, etc., thin moss For example, if the evidence is damp-heat with yellow greasy moss, Huang Lian and Xuan Shen can be used; if the moss is thin, Jiang Pu Gong Ying and Serpentine can be used; for blood stasis, Dan Shen, Yuan Hu and Panax notoginseng can be used; for qi and yin deficiency, Dang Shen, Wu Mei and Licorice can be used; for dampness and turbidity, Cang Zhu and Hou Pu can be used. Wu Yu and Gui Zhi can be used for those with cold, but also with the bitter cold antiseptic Huang Lian and Baicalin to control their cold and heat. The killing effect of Chinese medicine on HP is slower than western medicine, but with fewer side effects. The course of treatment must be extended to 6-8 weeks and needs to be rechecked one month after HP removal treatment to determine whether HP has been eradicated. Gastric acid analysis of CAG patients often indicates a decrease in gastric acid, which should be used under the premise of dialectical treatment, combined with modern pharmacological research results. For example, umeboshi, hawthorn, schisandra and papaya can increase gastric acid, but umeboshi and schisandra are suitable for those with low gastric acid and insufficient gastric yin, and should also be selected with the addition of sweet and cold products such as sage, raw earth and maitong to guide the production of gastric acid. Hawthorn is used for those with low stomach acid and also food accumulation, chicken naijin, Shen Qu and malt can be added as appropriate to increase the secretion of gastric juice and stomach acid. Papaya is suitable for those who have low acidity and also see phlegm and dampness, and add aromatic and bitter warm products such as patchouli, thick park, half summer and calamus to harmonize the stomach and dissolve dampness. In cold cases with low acidity, umeboshi and hawthorn can be used together with ginger and cinnamon; in hot cases with little acidity, a small amount of ice chips can be added and swallowed to stimulate the gastric mucosa to secrete gastric acid. elevated gastric acid test in CAG patients is seen in those with complicated superficial gastritis, erosive hemorrhagic gastritis, warty gastritis, or gastric and duodenal ulcers; cuttlebone, calcined corrugated seeds, calcined oyster, etc., and in those with heat, gypsum can be used. Gastroscopy and gastric mucosa biopsy: Gastroscopy is an extension of TCM diagnosis, and pathological examination can reveal the current situation and regression more clearly and accurately. If the gastric mucosa is congested and edematous, red and white, mainly white, with filiform vessels visible and little gastric secretion, the stomach is weak, and Huang Qi Jian Zhong Tang with Angelica Sinensis and Buddha’s Hand can be used. If the gastric mucosa is red-white, mainly red, or with red spots and a blue blood vessel network, it is a case of heat and stasis in the stomach, so use Sha Shen Mai Dong Tang with Dandelion, Dan Shen and Di Long. If the gastric mucosa is red and white, with white predominantly, more on the less curved side, the rest is congested and edematous, with erosion and bleeding spots, and a lot of secretions, it is chronic gastritis with superficial + atrophy + erosion, and if HP is positive, it is spleen dampness and heat with stasis and toxicity. Gastric mucosa atrophy, also see scattered elevation, apical depression erosion, accompanied by warty gastritis for phlegm and stagnation, available white flower snake tongue grass, stiff silkworm, raw oyster, penetrating the mountain armor, curcuma longa, hedgehog bark, ephedra, half summer, dandelion, etc. to resolve phlegm and remove blood stasis, detoxification and dispersion, cold and warm use. If bile reflux is also seen, it belongs to bile-heat offending the stomach or liver and stomach disharmony, add and reduce the aforementioned Self-M Four Reverse Chai Gui Tang. If the gastric mucosa is white and dark, with atrophy of the glands, cracked mucosa, blue vascular network clearly visible, little gastric secretion, and slow peristalsis, the stomach is deficient in yin, so use Consistent Decoction with Wu Mei, Hawthorn, and Wu Wei Zi to sour the yin. If the gastric mucosa is gray-green, dendritic vessels are clearly visible, dark red, small blood vessels in the fundus are varicose and stagnant, the gastric mucosa is granular or nodular hyperplasia, or polyp-like changes, pathological biopsy has intestinal hyperplasia or atypical hyperplasia, it is phlegm and stasis blocking the gastric ligament, it is appropriate to invigorate blood circulation and eliminate stasis, soften and disperse the knots, using snake tongue herb, half branch lotus, raw barley, salvia, trigonella, curcuma, perforated nail, stiff silkworm, etc. For elderly patients with moderate-to-severe CAG whose clinical symptoms have disappeared or improved after more than four months of treatment, but no improvement on gastroscopic review, products that nourish the kidneys and nourish blood such as Xian Ling Spleen, Fructus Lycii, Radix Angelicae Sinensis, Radix Paeoniae Alba and Radix Rehmanniae Praeparata can be added to the agent for benefiting Qi, resolving blood stasis and detoxifying toxins. The regeneration and reconstruction of gastric mucosa and restoration of normal function takes 3D5 months, and CAG should be treated with four months as a course of treatment, and timely gastroscopy and pathology should be checked. The treatment of CAG is based on the conventional indexes of blood stasis: blood stasis in the stomach and localized loss of nourishment is an important pathogenesis of CAG. Patients with this disease have significant changes in blood rheology indicators, and their hyperviscosity is particularly evident and correlates with the degree of atrophy. The abnormalities of whole blood viscosity and plasma viscosity are especially obvious and can be used as one of the indicators for the application of blood activating and blood stasis removing drugs. According to the abnormal degree of each index, the type and dosage of blood-activating and blood-stasis-removing drugs can be selected clinically. 3, from the overall concept, the whole body state, decide the medication: CAG patients are mostly middle-aged and elderly, in addition to suffering from CAG, often suffer from other diseases, and the overall concept is an important theoretical basis of Chinese medicine. Therefore, in the treatment of CAG, the patient should also think of other diseases, such as diabetes, hypertension, coronary heart disease, etc., to clarify the body type, comprehensive consideration of medication, to prevent the loss of the other.