Tan, female, 48 years old, is a cadre. History of hyperthyroidism for more than ten years, first diagnosed on February 23, 2012. She had pain in the neck, panic and palpitations, and hand tremors for more than six months. She has pain in the abdomen, dry mouth, irritability, sweating, wind, hunger, sleeplessness, light red tongue, thin white fur, and astringent and slightly astringent pulse. The thyroid function tests showed that FT3, FT4, TT3 and TT4 were elevated and TSH was significantly decreased. Ultrasound of the thyroid gland showed diffuse enlargement of the thyroid gland, and hyperthyroidism was considered. TCM diagnosis: gall disease. TCM evidence: liver and gall depression and heat, heart and Yang floating over. Western medical diagnosis: hyperthyroidism (Graves’ disease). The disease starts from the patient’s stressful work and poor interpersonal relationships, resulting in excessive mental stress and emotional dysregulation. Consider Shaoyang pivot is unfavorable, liver and gallbladder are heat-depressed, and fire disturbs God and grinds earth. The prescription is Chai Hu, Dragon Bone and Oyster Soup with Gui Zhi Tang: Chai Hu 10g, Scutellaria Baicalensis 10g, Fuxia 15g, Dang Shen 15g, Gui Zhi 10g, Bai Shao 10g, Da Zao 10g, Sheng Long Mu 15g each (first decoction), Yuan Zhi 10g, Sour Jujube 30g, Roasted Glycyrrhiza Glabra 6g. 7 doses with water decoction, one dose per day, divided into two warm doses. The second consultation was held on March 2, 2012. The patient complained of slight improvement in dry mouth, bitterness and night sleep after taking the medicine, recently developed oral ulcers, food intake was acceptable, stool was regulated, tongue was light and fat, moss was thin and white, pulse was string. Considering that the problem still belongs to Shaoyang pivotal mechanism, the above prescription was increased with the following: Chai Hu 10g, Scutellaria Baicalensis 10g, Fuxia 15g, Radix Codonopsis Pilosulae 15g, Radix Ginger 10g, Gui Zhi 10g, Lily 15g, Radix Paeoniae Alba 10g, Rhizoma Atractylodis Macrocephalae 10g, Jujube 10g, Yuan Zhi 10g, Wu Jia Pi 30g, Fu Shen 30g, Roasted Licorice 6g. 7 doses, decoction with water, one dose per day, divided into two warm doses. The third consultation was held on March 9, 201. The patient complained that after taking the medicine, the mouth ulcer did not improve significantly, and still had dry mouth and bitterness, difficulty in falling asleep, easy to wake up after sleep, dizziness, stomach and stool can be regulated, dark red tongue, white smooth coating, and string pulse. Considering that liver and gallbladder fever is combined with damp-heat upwelling, we should imitate Glycyrrhiza diarrhea Heart Soup in Jin Kui Yao (The Essentials of Fox Confusion) to purify damp-heat, together with products to calm the liver and tranquilize dampness: 30g of roasted licorice, 10g of Huang Lian, 10g of Scutellaria, 15g of Fuxia, 10g of dried ginger, 10g of Yuan Zhi, 10g of red ginseng (stewed separately), 10g of Radix et Rhizoma Polygonati (decoction), 15g of Da Zao (decoction first), 10g of jujube, 30g of Fu Shen, and 15g of each of Sheng Long Mu (decoction first). 15g each of Fu Shen, 15g each of Sheng Long Mu (decoction first), 10g of Acorus calamus, 10g of Pei Lan. 7 doses, decoction in water, one dose per day, divided into two warm doses. The fourth consultation was held on March 16, 201. After taking the medicine, the patient developed ulcers on the tip of the tongue, poor sleep at night, wheezing when walking fast, fatigue, vicious cold and fever, and thin pulse strings. The patient is prone to cold and heat, the effect of treatment from damp-heat of liver and gallbladder is not obvious, consider that the middle jiao is out of position and the deficiency fire is inflammation, the treatment is from the middle jiao, attract fire back to the position, the prescription is Rizhong Tang with flavor: 20g of Radix Codonopsis Pilosulae, 15g of ginger, 10g of Atractylodes Macrocephala, 30g of each raw dragon and peony (first decoction), 5g of Huang Lian, 30g of mother of pearl (first decoction), 30g of Fu Shen, 30g of sour dates, 10g of roasted licorice. seven doses, decoction with water, one dose per day. Take it in two warm doses. The fifth consultation was held on March 23, 201. The patient’s tongue ulcer has not decreased after taking the medicine, and he still has poor sleep at night, fatigue, fear of heat, red tongue, thin white fur, and sunken slippery pulse. “The prescription is Glycyrrhiza glabra with Gardenia jasminoides with addition and subtraction: Huang Lian 10g, Gardenia 10g, Tempeh 10g, Fuxia 10g, Ginger 10g, Scutellaria 10g, Radix Codonopsis 15g, Jujube 10g, Roasted licorice 30g. seven doses, decoction with water, one dose per day, divided into Two doses, divided into two warm doses. On the sixth consultation on March 30, 201, after taking the medicine, the patient’s tongue ulcer was slightly reduced, and the lower lip ulcer appeared with white color, night sleep was better than before, still afraid of heat, red tongue, and sunken and slippery pulse. The effect is not to change the formula, the original formula is increased and damaged, adjuvanted with products that penetrate the surface. Radix Glycyrrhiza glabra 30g, Fuxia 10g, Radix ginger 10g, Scutellaria baicalensis 10g, Radix Codonopsis pilosula 15g, Pellitory 10g, Acorus calamus 10g, Huang Lian 10g, Yuan Zhi 10g, Thornbush 10g (later down). Seven doses with water decoction, one dose per day, divided into two warm doses. The seventh diagnosis was made on April 13, 201. After taking the medicine, the patient’s lower lip ulcer improved insignificantly, dry mouth and desire to drink cold water, easy hunger and lack of desire to eat, trembling hands yesterday, fatigue, slightly difficult to fall asleep, easy to wake up, feeling heat in the chest at times, the second stool was regulated, the tongue was light with yellow coating and slightly greasy, the pulse was sunken and smooth. The patient’s condition is recurrent, long-standing illnesses are often mixed with cold and heat, from the dry mouth and desire to drink cold water, heat in the chest, seems to be a real heat, but did not see sweating, easy to hunger but not desire to eat, yellow moss but light tongue, smooth pulse but not count, and the patient sees hand trembling and poor sleep, the wind of the sympathetic yin movement, treatment from the sympathetic yin, imitating Zhong Shi’s Wu Mei Tang treatment of cold and heat mixed disease, the proposed formula is as follows: Wu Mei 30g, 15g of cooked Radix Aconiti (first decoction), 15g of dried ginger, 10g of Gui Zhi, 15g of Dang Ginseng. Gui Zhi 10g, Radix Codonopsis 15g, Huang Lian 10g, Huang Bai 10g, Radix Angelicae Sinensis 15g, Radix Glycyrrhiza Uralensis 10g, Radix Pepper 10g, Radix Sinensis 3g, Bai Xian Pi 15g. 7 doses, decoction in water, one dose per day, divided into two warm doses. The eighth consultation was held on April 27, 2012. The patient complained that the mouth ulcer had long healed after taking the medicine. Present symptoms: mouth is not dry and slightly bitter, night sleep is more stable than before, chest tightness is significantly relieved than before, occasional fever, light tongue with white fur, pulse is slightly stringy and slightly counted. The treatment is to regulate the pivotal mechanism, to promote the palsy and to clear the Yang. The prescription is Xiao Chai Hu Tang with extra flavor: Chai Hu 15g, Baicalin 10g, Fuxia 10g, Radix Codonopsis 15g, Jujube 10g, Gua Gua Shell 30g, Allium 10g, Sour Jujube 30g, Yuan Zhi 10g, Roasted Glycyrrhiza 6g. 7 doses, followed by a good course. Comment: The recurrent oral ulcer in this case went through several twists and turns and finally came under the banner of sympathetic yin disease, which was collected with Wu Mei Tang, which was a coincidence, but also inevitable. The patient in this case has been treated from Shaoyang cardinal unfavorable, liver and gallbladder depression heat and dampness, but the results are poor, Jing Yun: “cold of not cold, is no water also. In the seventh consultation, we combined the symptoms of “pain and heat in the heart”, “hunger and lack of desire to eat”, tremors in the hands and feet, and other symptoms of heat in the heart and stomach and wind movement in the sympathetic yin, and carefully analyzed the symptoms based on the tongue and pulse and the constitution, and concluded that The patient had a mixed pathological mechanism of cold and heat, deficiency and reality, so he was treated with Wu Mei Tang and it worked. Therefore, not all mouth ulcers are fire-heat, and those who can be cured by clearing heat and dipping fire are prone to recurrence. There are also patients with deficiency fire due to the weakening of the kidney yang, and the deficiency yang goes up, so it is advisable to warm the yang and submerge the yang, so that the fire of Long Lei returns to its original position. There is also a deficiency in the middle jiao, insufficient vital energy, the spleen yang is unable to perform its power of warming and transportation, can not live in its original position and float upward, resulting in mouth ulcers, it is appropriate to warm the spleen yang. If you are a person who has a combination of cold and heat in the middle jiao, it is natural to use licorice diarrhea heart soup and half summer diarrhea heart soup. The oral ulcer may seem simple, but the clinical symptoms of the disease are numerous, the condition is like a hemp, such as the four diagnoses are not complete, the disease mechanism is not detailed, can not use the right medicine, to achieve satisfactory results is difficult to imagine. Therefore, when the clinical evidence, we need to bear in mind the famous words of Zhong Shi, “observe its pulse and evidence, know what is wrong, and treat it according to the symptoms”. Only by accurate dialectic, reasonable selection of prescriptions, and proper use of drugs, can we get rid of the disease.