The main pathogenesis of gastroesophageal reflux disease (GERD) is complex. The main pathogenesis is the result of a decrease in the anti-reflux defense mechanism of the esophagus and the attack and action of the reflux on the esophageal mucosa. The longer the reflux exists, the more severe the damage to the esophageal mucosa. Therefore, timely and correct treatment of GERD is of great importance. In the treatment, the idea of combining identification of disease and evidence is highlighted. Identification of disease means combining the current situation of mucosal redness and erosion under gastroscopy to select clinical drugs in a targeted manner; identification of evidence means treating according to the idea of identification and treatment in Chinese medicine. Finally, we formulated the basic treatment for this disease to benefit the qi and strengthen the spleen, harmonize the stomach and lower the rebellion. According to TCM, the spleen is the main organ of transportation and transformation; ascending is healthy; the stomach is the main organ of reception; descending is harmonious. The liver rises with the spleen and the bile descends with the stomach, so that the spleen and stomach can function normally when the organs are in harmony, the nourishment is normal, the elevation is coordinated, and the drainage is regulated. If the elevation of the spleen and stomach is out of order, or due to emotional disorders, excessive thinking, resulting in the liver and gallbladder lose drainage, transverse rebellion against the stomach; poor diet, excessive drinking burn the stomach and internal organs; or suffer from biliary disease, bile evil offend the stomach, damp heat in the obstruction, so that the cloudy yin does not descend, stomach Qi rebellion, resulting in the occurrence of this disease. Professor Gao Zhongying, a famous veteran Chinese medicine practitioner, suggested that the basic etiology of this disease is spleen deficiency, stomach dryness and loss of health in transportation and transformation. The advanced examination methods of modern medicine, combined with the results of gastroscopy and pathological examination, were used as an important basis for treatment and evaluation of clinical efficacy. Treatment method: The treatment group adopted the method of benefiting qi, strengthening the spleen, harmonizing the stomach and lowering the rebellion, which consisted of prunus ginseng, Atractylodes macrocephala, Huang Lian, Cornu Cervi Pantotrichum, cuttlebone, smallpox powder, Chuan Bei, chicken’s inner gold, corrugated cortex, lycopodium, and sempervert. For those with bile reflux, add Citrus aurantium, Yu Jin and Bai Shao; for those with severe acid reflux and red tongue, add Radix et Rhizoma spinosa and Ochre; for those with dry stools, add Rhubarb in wine; for those with liver stagnation, add Radix et Rhizoma Chai Hu and Radix Aromaticus. Take 1 dose daily with water decoction, once in the morning and once in the evening, 0.5h after meals. In the basic formula, prince’s ginseng is a product that strengthens the spleen and benefits, its tonic power is slow, strengthens the spleen and nourishes the stomach. Atractylodes macrocephala strengthens the spleen, dries dampness and benefits Qi, which helps prince ginseng to benefit Qi and strengthen the spleen. The function of the mucous membrane of the esophagus is protected by the use of the herb Radix et Rhizoma Glycyrrhizae. Huang Lian and Wu Ju Ju combine bitter and pungent to clear liver fire and suppress stomach acid, soothe the liver and stomach to control acidity and relieve pain. Radix Panax notoginseng harmonizes the stomach and reduces rebelliousness. Corrugated seeds and Aconite can inhibit gastric juice secretion, reduce total acid excretion and pepsin activity, and have the effect of repairing ulcers. The combination of Chuan Bai Mu and Smallpox Powder can repair the damaged gastric mucosa (or erosion or ulcer) and nourish Yin and generate fluid to improve the evidence of gastric dryness. In clinical application with bile reflux, add Citrus aurantium, Ulva lucidum and Radix Paeonia lactiflora; the combination of the three can relax the liver and bile, reduce abdominal pressure, soften the liver and relieve pain. For those with severe acid reflux and red tongue, add Horticium and Ochre to harmonize the stomach and lower the Qi to reduce esophageal reflux; for those with dry stools, add wine and rhubarb to relieve laxity; for those with liver depression, add Radix Bupleurum and Radix Aromaticus to clear the liver and relieve depression. The whole formula can make the middle jiao healthy and smooth, and the dryness and heat can be cleared and the reflux will stop. Stomach Qi is harmonized and lowered, and the mucous membrane of the esophagus is repaired. This formula is effective in clinical practice because it hits the disease mechanism. Clinical practice proves that the method of benefiting Qi, strengthening the spleen, harmonizing the stomach and lowering rebellion has good efficacy in treating GERD and can significantly improve clinical symptoms.