Patient Zhu, female, 69 years old, has a history of diabetes mellitus for 18 years, used to take a variety of oral hypoglycemic drugs, three months ago, due to the difficulty of blood glucose control, changed to use Novolin 30R (22U in the morning and 18U in the evening subcutaneously) combined with Byosubergine (50mg 3 times/day) to control blood glucose. Two years history of hypertension, usually taking Shoubisan (2.5mg/day) to control blood pressure. Three years ago, he was diagnosed with urinary tract infection due to frequent and urgent urination in an outside hospital, and was treated with anti-infective drugs such as ofloxacin, and his symptoms disappeared within a few days, but soon he had another attack due to exertion and other reasons, and repeated several times. A year ago, he was hospitalized because of frequent and painful urination, and was diagnosed with “chronic pyelonephritis” and was discharged after his condition improved. After that, he had many recurrent episodes of frequent urination, urinary urgency, lumbago and weakness due to strain and other reasons, which affected his daily life. Ten days after treatment with cotrimoxazole and ciprofloxacin, the symptoms were reduced and the frequency and urgency disappeared, but there was still mild urinary astringency and no improvement in lumbar acidity and weakness. Three days ago, we checked urine leukocytes ++++, so we came to our department for medical treatment. Urinary tract infection is one of the most common infectious diseases in diabetic patients, and its incidence is about 12%-20%. It is significantly higher in women than in men. It can be divided into upper urinary tract infection and lower urinary tract infection. The former is pyelonephritis (acute, chronic) and the latter is cystitis and urethritis. Lower urinary tract infections can exist alone. In contrast, upper urinary tract infections are often accompanied by lower urinary tract infections. Clinical symptoms may or may not be present. Recurrent urinary tract infections can eventually lead to progressive renal impairment; therefore, early prevention and treatment is extremely important. The mechanism of urinary tract infections complicated by diabetes mellitus is inconclusive and may be related to the following factors: 1) hyperglycemic state; 2) weakened defense mechanism of the body; 3) diabetic vascular complications; 4) abnormal urination; 5) other factors (such as malnutrition, hypoproteinemia, dehydration, acidosis, large fluctuations of blood glucose, etc.). The patient complained of astringent urine, lumbar acidity, weakness, slightly dry mouth, and average appetite. Examination of the patient: body temperature 36.6°C, blood pressure 160/90 mmHg, no abnormalities in cardiopulmonary auscultation, heart rate 98 beats/min, and no positive abdominal physical examination. The tongue is light, the coating is thin and white, and the pulse is thin and weak. Laboratory report: blood WBC5.6×109/L, NE54.6%, L39.5%; urinary Addison’s count WBC3885000/12h, RBC1400000/12h; FPG10.1mmol/L. Ultrasound: both kidneys were normal in size, liver and spleen were not large, gallbladder without stones. Western medicine diagnosis: type 2 diabetic urinary tract infection; Chinese medicine diagnosis: thirst and straining gonorrhea. Diabetes mellitus combined with urinary tract infection, according to its manifestation, belongs to the category of “thirst” and “gonorrhea” in Chinese medicine. The occurrence of this disease is mostly due to prolonged consumption of Qi and Yin, or over-eating of fat and sweet, resulting in damp-heat, which turns into fire and can be easily injected, or external damp-heat and poisonous evil, which can be found in the bladder, or due to depression of the seven emotions, annoying labor and excessive labor, resulting in gonorrhea due to the depression of Qi and fire in the lower jiao. TCM treatment: clear dampness and toxicity, consolidate Qi Heng, and treat both the symptoms and the root cause. The formula is based on the combination of Zhi Kidney Six Flavors Tang, Fu Ling Wan and Tiger Balm San. Chinese medicine prescription: Da Sheng Di 12g, roasted tortoise shell 18g, Dong Bai Wei 15g, Female chasteberry 30g, Mo Shui Lian 30g, made Shou Wu 15g, Fructus Lycii 30g, White Flower and Snake Tongue 30g, Tu Fu Ling 30g, Fu Ling 30g, Dong Qu Zi Zi 20g, Zhi Kidney Pill 6 capsules (packet decoction). The patient’s recurrent urinary tract infections, which occur with straining, belong to the category of straining gonorrhea in Chinese medicine and are related to the deficiency of essence and blood in the liver and kidney. In the treatment of this recurrent refractory urinary tract infection, both the symptoms and the root should be taken into account, on the one hand, tonifying the liver and kidney to treat the root, and on the other hand, distributing dampness and heat to treat the symptoms, which can often yield twice the result with half the effort. In the selection of prescriptions available in the formula are zhi kidney six flavor soup, Fu Cudan, zhi kidney Tong Guan Wan, Tiger Balm, etc.. Drugs such as raw earth, roasted turtle plate, dogwood, Chinese yam, cuscuta, poria, poria, dong quaizi, zedoary, tiger stick, etc.. At the same time, according to the theory of meridians in Chinese medicine, the eight channels of the odd meridians are closely related to the liver and kidney, so we can add some products that can tonify the odd meridians, such as: Astragalus, Angelica, Lock-Yang, Cistanches, Phellodendron, Cinnamon, etc., to improve the clinical efficacy. In clinical practice, while identifying the evidence, some herbs with clear antibacterial effects can be used to improve clinical efficacy, such as Chai Hu, Ze Di, Scutellaria, Fritillaria, Bai Hua Shi Tong Tong Cao, Horsetail, etc. These herbs have certain inhibitory effects on common pathogenic bacteria of urinary tract infection such as Escherichia coli. After one month, the symptoms of urinary astringency disappeared, a little exertion, sneezing and coughing, a little urine leakage, still have waist and knee soreness, tender red tongue, less coating, pulse moistened weak. The formula has been effective, the above plus reduction with the. Chinese medicine prescription: 12g of the big raw earth, 18g of roasted tortoise shell (first decoction), 15g of dogwood flesh, 12g of raw waiyao, 30g of porcupine ling, 12g of cuscuta, 6g of powder danpi, 12g of zedoary, 30g of tiger stick, 0.1g of musk, 1.2g of cinnamon heart (swallow). After a follow-up examination in one month, the symptoms improved significantly, with 4-6/HP leukocytes in the urine on rechecking, and occasional back pain, but coughing or sneezing would not cause leakage of urine. He continued to be treated with herbal medicine for six months. After one year follow-up, the number of episodes of urinary tract infection was significantly reduced, only one episode, and the quality of life improved significantly. The efficacy of Chinese medicine in treating urinary tract infections is certain, with few side effects. Especially for patients with recurrent urinary tract infections, Chinese medicine can not only control the clinical symptoms of patients, but also improve the immune function of the body and reduce or prevent recurrence. In addition, along with herbal treatment, diabetes should be actively treated to bring blood sugar control to the ideal level and prevent the emergence of acute and chronic complications of diabetes. Patients with existing complications should be treated with insulin in a timely manner according to the situation, and try to achieve early diagnosis and treatment for diabetes-induced neurogenic bladder and diabetic nephropathy. Encourage patients to develop good lifestyle and hygiene habits, exercise moderately, do not squat for long periods of time, drink more water, urinate regularly, keep the vulva clean and dry, and prevent impure sexual intercourse. Those with complex factors such as prostate disease, urinary stones, bladder/ureteral reflux, polycystic kidney and urethral anomalies should be actively managed and inappropriate use of urethral devices should be avoided to reduce the chance of retrograde infection. Proper use of antibiotics is also the key to treatment. Commonly used antibiotics include fluoroquinolones (norfloxacin, ofloxacin, etc.), cotrimoxazole and amoxicillin/clavulanic acid, etc. Patients are advised to choose according to the infection under the guidance of their doctors. Bacterial culture of pathogenic bacteria should be done early if possible, and the results of drug sensitivity test should be used to guide the rational selection of antibiotics and avoid blind abuse of antibiotics.