Background. Traditional Chinese medicine (TCM) has long been used to treat chronic atrophic gastritis (CAG). The aim of the present study was to evaluate the TCMsyndrome characteristics of CAG and its core pathogenesis so as to promote optimization of treatment strategies. Methods. This study was based on a participant survey conducted in 4 hospitals in China. Patients diagnosed with CAG were recruited by simple random sampling. Exploratory factor analysis (EFA) was conducted on syndrome extraction. Results. Common factors extracted were assigned to six syndrome patterns: qi deficiency, qi stagnation, blood stasis, phlegm turbidity, heat, and yang deficiency. Distribution frequency of all syndrome patterns showed that qi deficiency, qi stagnation, blood stasis, phlegm turbidity, and heat excess were higher (76.7%-84.2%) compared with yang deficiency (42.5%). Distribution of main syndrome patterns showed that frequencies of qi deficiency, qi stagnation, phlegm turbidity, heat, and yang deficiency were higher (15.8%-20.8%) compared with blood stasis (8.3%). Conclusions. The core pathogenesis of CAG is combination of qi deficiency, qi stagnation, blood stasis, phlegm turbidity, heat, and yang deficiency. Therefore, treatment strategy of herbal prescriptions for CAG should include herbs that regulate qi, activate blood, resolve turbidity, clear heat, remove toxin, and warm yang.