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  何天心容貌清秀可人,个性叛逆,热心助人,活泼可爱,天不怕地不怕。从父亲所留之医书里学到粗浅的耆黄之术,在民间有『小华陀』之称号。为学正统宫廷医术,决心乔装成男医士,进宫习医。好打抱不平的个性让她结识了假太监张哲三和皇帝朱历,三人一同经历了镇南王叛变和汪公公的迫害,每每都凭自己过人的机智和高超的针灸医术度过难关。平时与张哲三打打闹闹,丝毫不查自己对张哲三的爱意,直到张哲三保护自己而遭砍伤,这才让天心发现,两人早在不知不觉间互相爱慕。被知晓女儿身身分后,皇上屡次为自己解危,但心系张哲三的天心,只能将皇上当成好兄弟,因为那独一无二的爱情,已经给了张哲三。但张哲三却因阴错阳差没当上护卫,而转为太监,但没想到执刀从未失手的净身员刘一刀,当天因为天心配错了药,而头昏眼花,竟然一刀落下刺中张哲三的大腿而非命根子。幸亏刘一刀一时失手,但张哲三从此也成了假太监~小三子。在陪同天心回乡替穷苦民众免费诊疗后,渐对这平时古灵精怪的天心改观,甚至产生好感,屡次不顾性命也要守护天心。因镇南王事件戴罪立功,哲三恢复男儿身,成为御前带刀侍卫,因某次救了游湖溺水的水灵公主,令水灵公主芳心暗许。在得知皇上对天心的爱慕之意,自觉身分配不起天心,便将自身感情隐藏心底,却不知这样若即若离的态度,同时牵动着天心和水灵公主。在得知天心为女儿身的身分后,故意加以隐瞒。天心过人的机智和勇气,不但替皇上拢络了宫中人心,也使皇上逐渐为她倾心。当皇上发现张哲三对天心有情时,不顾太后反对,执意要立天心为后,而三人之间的关系渐渐起了微妙的变化……另一方面,汪公公发现皇上与因有天心、张哲三相助,在朝中势力逐渐巩固,因此便与镇南王密谋伪造天文凶象,企图逼皇上退位。羽翼未丰的皇上,能顾全天心、张哲三,并拿回实权吗?

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