Gastroesophageal reflux disease (GERD) is one of the most easily misdiagnosed diseases in Western medicine. Through reviewing the relevant literature in ancient and modern times and combining with his own practical experience, the author considers that there are also many misunderstandings in differentiation of GERD in traditional Chinese medicine. On the one hand, because the clinical manifestations of GERD are very complex, especially lack of typical reflux symptoms in many patients with extraoesophageal manifestations, it may be misidentified as lung, heart, liver and kidney diseases. On the other hand, as some of the symptoms of GERD are very special, such as the typical manifestations of sour regurgitation, heartburn, as well as possible accompanying symptoms such as bitter mouth, dry mouth, bad breath, gingival bleeding, oral ulcers, these symptoms, which appear to have obvious febrile characteristics, may be caused due to spleen-stomach qi deficiency, spleen-stomach deficiency cold or turbid phlegm obstruction in middle energizer. Therefore, in differentiation of the symptoms and signs of GERD, TCM doctors must first make clear the diagnosis of the disease by means of modern medical examination and correctly understand its pathogenesis, and then work out accurate differentiation of the location and nature of the disease, finally giving correct treatment according to the manifestations of the tongue and the pulse and other symptoms as well as the valuable experience accumulated by the ancient and modern physicians.