A total of 182 patients with chronic atrophic gastritis (CAG) who were hospitalized and treated at the Department of Spleen and Stomach Diseases, Fangchenggang Traditional Chinese Medicine Hospital, from July 2023 to July 2024, were selected. This study was approved by the Ethics Committee of Fangchenggang Traditional Chinese Medicine Hospital, and informed consent was obtained from all participants while they were fully conscious.

Western Medical Diagnosis Criteria: Patients meeting the diagnostic criteria for CAG as outlined in relevant literature [3] .

Endoscopic Confirmation: Confirmed by endoscopy with findings of color changes in the gastric mucosa, glandular atrophy, and visible blood vessels.

Informed Consent: Patients and their families were informed and provided written consent.

1) Patients with severe cardiac, hepatic, or renal insufficiency: such as cardiac insufficiency Class III or above, liver function classified as Child-Pugh C, or renal function with a creatinine clearance rate < 30 mL/min;

2) Patients who have received other treatments within the past 3 months;

3) Patients with suspected malignancy;

4) Patients with drug allergies: those with a history of allergy to traditional Chinese medicine or Western medicine used in this study;

5) Patients who do not comply with medical advice: those unable or unwilling to adhere to the prescribed treatment regimen and follow-up requirements;

6) Pregnant or breastfeeding patients.

All patients included in this study met the diagnostic criteria for chronic atrophic gastritis and were hospitalized. According to the principles of randomized controlled trials in prospective clinical studies, patients were numbered in the order of their inclusion and then randomly assigned to groups using statistical software. The random numbers assigned to each patient remained unchanged throughout the study.

The 182 patients were randomly divided into two groups:

Treatment Group: Received the Jing ethnic prescription.

Control Group: Received conventional treatment.

Conventional medications and treatments were administered based on the patient’s condition:

For heartburn and acid reflux: Aluminum magnesium carbonate (Sichuan Chengdu Pharmaceutical Co., Ltd., Approval No.: H20058566) 10 mg per dose, 3 times/day.

For bloating, nausea, and vomiting: Mosapride citrate (Guangdong Anno Pharmaceutical Co., Ltd., Approval No.: H20203264) 5 mg per dose, 3 times/day.

For Helicobacter pylori (Hp) positive patients: Conventional symptomatic treatment plus quadruple antibiotic therapy:

Rabeprazole capsules (Guangdong Dongguang Pharmaceutical Co., Ltd., Approval No.: H20183466) 20 mg per dose, 1 time/day.

Clarithromycin tablets (Guangdong Dongguang Pharmaceutical Co., Ltd., Approval No.: H20183466) 0.5 g per dose, 2 times/day.

Amoxicillin (Au Mei Pharmaceutical Factory, Approval No.: HC20130014) 1.0 g per dose, 2 times/day.

Potassium citrate bismuth (Jichuan Pharmaceutical Group Co., Ltd., Approval No.: H20043059) 0.6 g per dose, 2 times/day.

Duration of treatment: 14 days.

In addition to the “Control Group Protocol,” the treatment group received the Jing ethnic prescription. The composition and dosage of the herbs in the Jing ethnic prescription are as follows: Hai piao qiao (Cuttlefish Bone) 30 g, Wa leng zi (Calx Gastropodis) 30 g (to be decocted first), Mu li (Calx Ostreae) 30 g (to be decocted first), Ni ding (Sipunculus nudus) 25 g, Shan nai (Kaempferia galanga) 10 g, Tao jinniang gen (Myrtus communis root) 15 g, Nan mu pi (Phellodendron amurense bark) 15 g, Bai shao (Paeonia lactiflora root) 15 g.

Decoction method: Decoct in water and take orally, 1 dose/day, divided into 2 servings in the morning and evening. One course of treatment lasts 4 weeks, and a total of 3 courses of treatment will be administered.

Clinical Cure: Symptoms and signs are basically eliminated, and the reduction in TCM syndrome score is ≥95%.

Significant Effect: Symptoms and signs are significantly relieved, and the reduction in TCM syndrome score is 95% > reduction ≥ 70%.

Effective: Symptoms and signs are somewhat relieved, and the reduction in TCM syndrome score is 70% > reduction ≥ 30%.

Ineffective: No change in symptoms and signs, and the reduction in TCM syndrome score is <30%, or the condition worsens.

Levels of TFF2 and NF-κB in the gastric mucosa were assessed using real-time quantitative PCR before and after treatment, following the instructions in the kit.

Levels of serum IL-6, IL-8, and hs-CRP were measured using ELISA before and after treatment.

Randomization was performed using a random number table to minimize selection bias. To reduce observer bias and its impact on the study results, a single-blind design was adopted. Data were analyzed using SPSS 23.0 statistical software. Independent t-tests and Chi-square (χ²) tests were used to calculate differences between groups, with p < 0.05 considered statistically significant.

To ensure the statistical significance and clinical relevance of the study results, a power analysis was conducted. Based on data from previous studies, the expected effect size for the primary outcome measures (such as TFF2 levels in gastric mucosa, NF-κB levels, and serum levels of IL-6, IL-8, and hs-CRP) was moderate (Cohen’s d = 0.5). Using G*Power software, it was determined that at least 91 patients per group were required to achieve 80% statistical power, with a significance level set at 0.05. The actual sample size was 91 patients per group, meeting the requirements for statistical power.

The overall clinical effectiveness rate in the treatment group was higher than that in the control group, but the difference was not statistically significant (P > 0.05). See Table 1 .

After treatment, TFF2 levels in the gastric mucosa increased and NF-κB levels decreased in both groups. The TFF2 levels in the gastric mucosa of the treatment group were higher than those in the control group, while the NF-κB levels were lower (P < 0.05). See Table 2 .

Note: Compared to Pre-treatment, **P < 0.001.

After treatment, the levels of IL-6, IL-8, and hs-CRP were lower in both groups compared to before treatment, and the levels in the treatment group were significantly lower than those in the control group (P < 0.05). See Table 3 .