Traditional Chinese Medicine in chronic atrophic gastritis and gastric cancer: Mechanisms and pathways

Chronic atrophic gastritis (CAG), a critical precancerous stage of gastric cancer (GC), is characterized by persistent inflammation, oxidative stress, and dysregulated signaling pathways. Traditional Chinese Medicine (TCM), with its multi-component, multi-target approach, has emerged as a promising strategy to intercept the “inflammation-cancer transformation" axis. This review synthesizes recent advances in TCM's mechanisms for treating CAG and GC, focusing on its modulation of key oncogenic pathways, including PI3K/AKT, MAPK, Wnt/β-catenin, NF-κB, JAK/STAT, and TLRs. Bioactive compounds such as curcumin, garcinol, and resveratrol exhibit dual anti-inflammatory and anti-carcinogenic effects by suppressing pathway activation (NF-κB nuclear translocation, β-catenin accumulation) and enhancing apoptosis in premalignant cells. Network pharmacology and preclinical studies validate TCM formulations like Moluodan concentrated pill and Banxia Xiexin Tang, which synergistically regulate overlapping targets to restore gastric homeostasis and inhibit epithelial-mesenchymal transition. Clinical evidence highlights TCM's potential superiority in improving endoscopic pathology scores, reducing Helicobacter pylori infection, and reversing intestinal metaplasia. Despite promising efficacy, limitations including formulation standardization and the need for more rigorous clinical trials require addressing. Future directions emphasize integrating multi-omics technologies, combining TCM with immunotherapy, and optimizing biomarker-driven precision medicine. By bridging traditional knowledge with modern molecular biology, TCM offers transformative potential in gastric carcinogenesis interception.