Abstract: Precancerous conditions and lesions of the gastric mucosa represent critical stages in the gastritis-cancer transformation process. The core pathogenesis lies in the inherent deficiency of the spleen and stomach, impaired transport and transformation functions, and the internal accumulation of dampness and turbidity. Dampness-turbidity, being both a pathological product and a secondary pathogenic factor, can further generate qi stagnation, heat, phlegm, and blood stasis. It combines with the pathogenic factors of H.pylori to form a vicious cycle of deficiency-dampness-toxin, propelling gastric mucosal progression from atrophy and intestinal metaplasia to dysplasia and carcinogenesis. Based on the deficiency-dampness-toxin combined pathogenesis framework and integrating modern medical research, this paper elucidates the pathological basis of gastric mucosal precancerous states and distinct pathological patterns from multidimensional perspectives—including immunity, inflammatory microenvironment, and metabolic disorders—while exploring their correlation with malignant transformation. This contributes to understanding and preventing the inflammation-to-cancer transition in gastric mucosa.