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Gastroesophageal reflux disease ( GERD ) is a common clinical disease of the upper gastrointestinal tract. According to traditional Chinese medicine (TCM) theory, its pathogenesis is not only closely related to the liver, gallbladder, spleen and stomach, but also to the heart and lung. Based on the theory of “the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized” in Shanghan Lun, our team propose that by adjusting the functions of the heart and lung in the upper jiao, the qi flow of the spleen and stomach in the middle jiao can be restored, which is ultimately conducive to promoting harmonization and descending of the stomach qi in the middle jiao, that is, “clearing the upper jiao with the aim of harmonizing the middle jiao”. If the heart and lung of the upper jiao are malfunctioning, it will easily affect the middle jiao, which is not conducive to the harmonization and descending of the stomach qi, thus easily causing GERD to occur. Further combining clinical practice with relevant researches in western medicine, if the functions of the heart governing the blood vessels and spirit are abnormal or the function of the small intestine is abnormal, the person is prone to esophageal visceral hypersensitivity and small intestinal bacterial overgrowth. Furthermore, if the functions of the lung governing dispersion, descending and respiration are abnormal or the function of the large intestine is abnormal, this may cause esophagogastric junction barrier damage and transient lower esophageal sphincter relaxation. All of these eventually lead to GERD. Therefore, the present paper provides a new direction and theoretical basis for the prevention and treatment of GERD by clarifying the influence of heart and lung on GERD. At the same time, it further enriches the theoretical connotation of “the upper jiao is cleared, the fluid is brought down, and the stomach qi is harmonized”. [ABSTRACT FROM AUTHOR]