Pleural effusion is an excessive accumulation of fluid in the pleural space. The common symptoms associated with pleural effusion may include chest pain, short breathing and cough. It is classified as transudates or exudates. Exudates result from pleural and lung inflammation, tumor, or autoimmune disease. It takes time to search for pathogens before and during diagnosis. In the meantime, treating with traditional Chinese medicine (TCM) can have better outcome compared with western medicine alone for cause unknown pleural effusion. In the TCM, it is termed as the "phlegm-rheum" or the "thoracic retention of fluid" or "excessive fluid in the hypochondrium and epigastrium". Most of them caused by imbalance of hydrostatic and osmotic forces across a semipermeable membrane. This case is a forty-nine-year-old female who had tuberculosis and sicca syndrome suffered from chest pain and dyspnea lasting one and a half months. During recent half year, she was nervous and exhausted from taking care of sick family. After treating with antibiotics and drainage, she still had short and painful breathing. The Chest man consulted our TCM apartment on 2019/07/12. The diagnosis after pattern identification were the evil enter shao yang, phlegm and fluid retention in the chest and qi-blood vacuity. After treatment with Chai Hu Gui Zhi Tang and Wu Lin San for the purpose of support right and eliminating dampness and diuresis, the patient's chest pain relieved in one week and the pleural effusion didn't recur after drainage. This case provides that Chinese medicine have excellent therapeutically effects in remove dampness and phlegm. This case shows the etiology and pathogenesis of pleural effusion, and also reflects the pattern identification and treatment of individual in traditional Chinese medicine.