Summary of case history,　The main complaint was "the skin of both hands became hard for half a year with the end of the left index finger broken for 1 month". The patient was diagnosed with rheumatoid arthritis 6 years ago and took methotrexate tablets and folic acid tablets irregularly. In August 2022, the elasticity of the skin of both hands gradually decreased and the activity was unfavorable, the raynaud phenomenon when it was cold could , and alleviate when it was warm. In February 2023, the distal interphalangeal joint of the left index finger was black, atrophy, ulceration, and decreased sensation. Metronidazole injection and salviorrhiza injection were treated in the local hospital, but the symptoms did not improve. 16/03/2023, partial tissue loss of distal interphalangeal joint of left index finger. Symptoms: swollen hands, hard skin, dark purple color, low skin temperature. The end knuckles of the left index finger were black, atrophied, partially broken and absent, without oozing. Multiple joint pain in the limbs, pain aggravate the temperature was cold. Fatigue, abdominal distension, dull, the color around the eyes is green, urine clear and long, loose stool 2-3 days once. Tongue color is light, dark, green, white and greasy fur, pulse is heavy and weak.,TCM diagnosis,　bi syndrome of skin (cold dampness stays in the spleen,kidney, liver, and cold dampness is difficult on the body surface),Western medicine diagnosis,　overlap syndrome (systemic sclerosis, rheumatoid arthritis),;secondary pulmonary interstitial fibrosis,;mild pulmonary hypertension,;hypercoagulability,;tricuspid valve insufficiency,;hypercholesterolemia,;subclinical hypothyroidism.,Therapeutic methods,　The TCM treatment is oral TCM decoction (Fuzi Guizhi Decoction, Angelica Sini Decoction, Qianyang Fengbei Dan, Buzhong Guizhi Decoction). The Western medicine gives symptomatic treatment such as immune suppression, anti-inflammatory pain, anti-fibrosis, anticoagulation, vasodilation, calcium supplement, acid inhibition and stomach protection.,Clinical outcomes,　remission