Objective Exploring the correlation between the chronic atrophic gastritis (CAG) gastroscopic images and TCM syndrome differentiation, to improve the accuracy of clinical diagnosis of CAG. Methods Articles concerning CAG TCM syndrome differentiation and gastroscopic description were retrieved in CNKI, Wanfang, VIP, CBM, PubMed, EMBase and Cochrane Library databases from their establishment to August 1, 2022. Screening qualified literature, extracting TCM syndromes and gastroscopic images of CAG patients. Then build database after data sorting, use SPSS 20.0 software to analysis the correlation. Results Finally 10 qualified papers were intaked, including 1 562 valid cases, which involve 5 TCM syndromes. According to the frequency of TCM syndrome differentiation, the order is liver-stomach disharmony syndrome, spleen-stomach weakness syndrome, spleen-stomach damp-heat syndrome, stomach collateral stasis syndrome, and stomach Yin deficiency syndrome. The highest detection rate of gastroscopic images is white mucosa, accounted for 47.38% of the total occurrence frequency. The detection rate of white mucosa is the highest in spleen-stomach weakness syndrome. The detection rate of rough mucosa, congested mucosa, edematous mucosa, granular hyperplasia, exposed blood vessels and nodulated apophysis is the highest in stomach collateral stasis syndrome. The detection rate of mucosal hemorrhage and mucosal erosion is the highest in spleen-stomach damp-heat syndrome. The detection rate of flattening folds and grey mucosa is the highest in stomach yin deficiency syndrome. The detection rate of bile regurgitation was the highest in liver-stomach disharmony syndrome. Conclusion There is a correlation between TCM syndrome differentiation and some gastroscopic images, and summarize the rules as follows. It will be considered to be spleen-stomach weakness syndrome or stomach yin deficiency syndrome, when gastroscopic shows white mucosa and flattening folds, but stomach yin deficiency syndrome also shows mucosal gray. It will be considered to be liver-stomach disharmony syndrome or spleen-stomach damp-heat syndrome, when gastroscopic shows bile regurgitation, but liver-stomach disharmony syndrome also shows congested mucosa and edematous mucosa, spleen-stomach damp-heat syndrome also shows mucosal erosion. It will be considered to be stomach collateral stasis syndrome, when gastroscopic shows granular hyperplasia and nodulated apophysis.