Chronic failure is the final developmental outcome of many kidney diseases including primary glomerular diseases such as chronic nephritis, secondary glomerular diseases such as hypertensive kidney damage and diabetic nephropathy. The incidence of renal failure in the elderly is also higher than that of young people due to the higher incidence of various primary diseases that cause kidney damage, and secondary renal failure is more common, making renal failure an important syndrome that seriously affects the quality of life and even the life of the elderly. Our clinical application of combined Chinese and Western medicine therapy for the treatment of chronic renal failure in the elderly can delay the development of chronic renal failure to uremia for a longer period of time without the need for alternative therapies such as dialysis. I. Etiology and pathogenesis of renal failure in the elderly Renal failure in the elderly is the end of various kidney damage, chronic renal failure belongs to the Chinese medicine “Guange”, “retention of urine”, “deficiency labor Chronic renal failure belongs to the categories of “Guange”, “retention of urine”, “deficiency labor” and “drowning poison” in Chinese medicine, and its pathogenesis is confusing and its symptoms are complicated. Its basic pathogenesis is the evidence of deficiency and symptom. The interplay of deficiency and reality is seen throughout the development of this evidence. Usually, when the disease is stable, it is mainly manifested by the deficiency of Yin, Yang, Qi and Blood and the deficiency of the five organs and the six internal organs; when the kidney failure progresses or at the end stage, it is mainly manifested by the deficiency of evil or mixed with the deficiency. The disease is often triggered by external sensation or exertion or rapidly aggravated by the disease. Early diagnosis is the primary factor for timely treatment and prevention of deterioration of chronic renal failure. However, due to the diverse clinical manifestations of chronic renal failure in the elderly, the disease duration is long, and there are no specific symptoms in the early stage, so there is no obvious pathogenesis of chronic renal failure in the elderly. Clinical chronic renal failure patients rarely see a nephrology clinic in time. The current general physical examination also does not have the project of blood creatinine and blood urea nitrogen. Therefore, most of the patients are not properly diagnosed and treated for a long period of time with the primary disease as the main complaint. Through long-term clinical observation, we found that most elderly patients with chronic renal failure are seen in cardiovascular, endocrinology or even gastroenterology departments for hypertension, diabetes, anemia, heart failure, and even gastrointestinal symptoms. In addition, there are no clear rules for the maternal presentation, and the initial physicians are non-nephrologists, so it is very easy to miss and misdiagnose the disease. Early diagnosis is difficult. Therefore, strengthening training for doctors in related disciplines, raising their awareness of chronic renal failure in the elderly, and adding blood creatinine and blood urea nitrogen to the physical examination program is one of the better ways to detect chronic renal failure early. Chronic renal failure in the elderly is clinically characterized by spleen and kidney Qi deficiency. Patients often appear pale or yellowish in the process of disease development, fatigue and weakness, and even cold and fear of cold, and mostly see the waist and knee weakness, dullness and abdominal distension, light and tasteless mouth, etc.. The author’s previous clinical studies found that spleen and kidney qi (yang) deficiency accounted for 43.0%, qi and yin deficiency accounted for 32.9%, liver and kidney yin deficiency accounted for 5.1%, and yin and yang deficiency accounted for 19.0%, each with evidence of blood stasis, water-dampness, dampness, phlegm-dampness, etc. Our clinical observation is that spleen and kidney qi (yang) deficiency is the most common type of chronic renal failure. At the same time, there are more complications of renal failure in the elderly, and most patients have more serious anemia, heart failure, etc. in the long-term disease process. Third, the prevention and treatment of renal failure in the elderly focus on prevention, the fundamental purpose of treatment is not to cure renal failure, but to use a combination of Chinese and Western medicine to slow down the rate of progression of renal failure, as far as possible to delay the entry of renal replacement therapy. There are more factors affecting the progression of renal failure, such as hypertension in Western medicine, hyperglycemic state in diabetic nephropathy, lupus activity in lupus nephritis, etc. If the existence of renal failure is detected early, targeted therapeutic measures can be used for these primary diseases or aggravating factors, which can completely stop the development of chronic renal failure. If the diagnosis of chronic renal failure is made, an integrated TCM treatment plan needs to be adopted in stages according to its different conditions. For the elderly with chronic renal insufficiency in the compensated or decompensated stage, or even in the renal failure stage, conservative treatment can be adopted. That is, the use of Chinese medicine dialectical treatment, and according to the different complications of the use of appropriate antihypertensive, calcium supplementation, correction of anemia and other symptomatic treatment under the premise of the use of enema and other external treatment methods for integrated treatment. Western medicine can usually be used ACEI drugs such as Lodinexin, Enalapril, ARB drugs such as Dynavin, Coxsulla, etc. Chinese medicines can be used such as Jinshui Bao and Urotoxic Qing. According to the clinical manifestations and evidence analysis of chronic renal failure in the elderly, it is usually divided into the following types of evidence-based treatment. 1, spleen and kidney qi (yang) deficiency, dampness and internal stagnation type: treatment should be to strengthen the spleen and nourish the kidney, the formula is selected from the ginseng and white atractylodes with the addition and subtraction of the right return pill, with: ginseng, poria, atractylodes, yam 12g each, lentil 9g, coix seed, sand, cinnamon 6g each, dulcimer 9g, Chinese wolfberry, dogwood 10g each. easy to catch a cold, add astragalus 15g, atractylodes 10g, wind 9g benefit qi and fix the surface; urine protein amount is large, add gold cherry 20g, cicada 15g. Add 9g of ginger to warm the middle and disperse cold in those with abdominal pain and diarrhea, and 9g of ginger to warm the middle and disperse cold in those with poor appetite and abdominal distension; add 9g of mucuna pruriens and 12g of malt; add 9g of hyssop and 20g of dulcimer to strengthen tendons and bones and relieve pain in those with back pain. The poor defecation, five night diarrhea, plus bone marrow, nutmeg 12g each; frequent nocturnal urination, urine clear long, plus fried yam, gravy 12g each; edema heavy, plus poria 12g, zedoary 9g, poria skin 30g; qi deficiency is very much plus astragalus 9g, codonopsis 12g. 2, liver and kidney yin deficiency type: treatment should nourish the liver and kidney, the formula is selected from the six flavors of Dihuangwan combined with two to pill plus or minus, with: Shu Di 12g, dogwood 9g, yam For dizziness and tinnitus, add 12g of Radix Aconiti, 9g of Radix Paeoniae Alba and 12g of Radix Polygoni; for heartburn and insomnia, add 20g of fried jujube seeds and 12g of nightshade; for headache and vertigo, add 15g of asparagus and 12g of hooked vine; for fever in the hands and feet, add 12g of each of Dictyostelium and Tortoise. 3, Qi and Yin deficiency type: to benefit Qi and nourish Yin, select Ginseng-Qi If you have oedema, add 12g of Dagongpi, 30g of Fucus roots and 30g of Poria bark; if your back and knees are weak, add 20g of Dulcimer and 12g of Dog’s back; if you have dry mouth and tongue, add 20g of Smallpox powder, 15g of Dendrobium and 15g of Qinpi; if you have cough and phlegm, add 12g of Scutellaria baicalensis and 20g of Fisetail. For those with cough and phlegm, add 12g of Scutellaria baicalensis and 20g of Dendrobium fritillariae. 4. Yin and Yang deficiency type: treatment should be Yin and Yang dual tonic, the formula is selected from Jisheng Kidney Qi Pill plus or minus: 9g of Shu Di, 15g of Bacopa monniera, 12g of Cornu Cervi Pantotrichum and Dendrobium, 10g of Cistanches, 9g of Schisandra chinensis, 6g of Cinnamon, 12g of Poria, 10g of Madonnas, 3g of Licorice. For those with heavy yin deficiency, remove Radix et Rhizoma, add 12g of Yam, 9g each of Dan Pi and Radix et Rhizoma. Each of the above types can be combined with Rhubarb capsules in the treatment process, 1 to 2 capsules each time, 2 to 3 times a day, adjusting the dosage according to the number of bowel movements, so that the bowel movements are maintained 2-3 times a day. For those with dampness and vomiting as the main clinical manifestation, the treatment is to clear heat and dampness, harmonize the stomach and lower the turbidity, and the formula is Huanglian Wenzhi Tang with addition and subtraction, using: Chen Pi 10g, Han Xia 12g, Fu Ling 20g, Hovenia 10g, Zhu Ru 12g, Sha Ren 10g, ginger 5 slices, licorice and rhubarb (later) 6g each. For the type with hyperactivity of liver and yang: to nourish yin and subdue yang and quench the wind in the liver, add 30g each of Huai Niu Knee and Dai Ochre (first decoction), 15g each of Sheng Long Bone, Sheng Oyster, Turtle Plate, 15g each of Bai Shao, Xuan Shen and Mai Dong, 6g each of Sheng Mai Ye, 10g of Licorice. For fatigue, add Radix et Rhizoma przewalskii and Radix et Rhizoma maitake 12g each. For enema therapy, use 10g of Radix et Rhizoma rehmanniae, 10g of Radix et Rhizoma rhizoma, 15g of cuttlebone, 15g of dandelion, 15g of honeysuckle and boil 200ml of the liquid with water and keep for enema. 1-2 times daily. For Rhubarb I, the dosage should not be too large for elderly patients. A large number of clinical and experimental studies have confirmed that it has the effect of keeping the bowels open, reducing the absorption of toxins in the intestine, promoting the discharge of uremic pimples, reducing glomerulosclerosis, and having a protective effect on kidney function. Shennong Ben Cao Jing: “Rhubarb is bitter cold, main down blood stasis, cleanse the intestines and stomach, push out the old and the new, pass through the water and grain, regulate the middle and transform food, peace and five organs.” The author’s experience is that the powder can be packed into capsules, with 0.75-3g/d is appropriate, and the water decoction with 15-20g/d is good. Patients usually have loose stools after taking the medicine, and the number of stools is kept at 2-3 times/d. If the number of times is too many, and the abdominal pain and discomfort, the dose of rhubarb should be slightly reduced, and to prevent the disadvantage of deficiency of rhubarb, rhubarb can be used with the medicine based on the identification of the evidence. Of course, we can also use raw rhubarb in water to control the number of bowel movements in appropriate amounts, but the taste is not good. In the case of prolonged illness with blood stasis, especially in renal failure caused by diabetic nephropathy or benign small arteriosclerotic nephropathy, it is essential to invigorate blood and remove blood stasis. Commonly used clinically are benefitting Qi and invigorating Blood, moving Qi and Blood, clearing heat and Blood, tonifying Kidney and Blood, detoxifying and invigorating Blood, etc. Commonly used drugs are: Salvia, Yujin, Zeilan, Angelica, Panax ginseng, etc. Clinical often play a trap to help the healing effect. Patients are educated to use high quality low protein to reduce the source of toxins, but protein intake should not be too low to avoid the loss of positive energy and affect the efficacy. Patients are usually advised to control daily protein intake at 0.5-0.8g/kg body weight on the basis of comprehensive TCM treatment. For uremic patients with severe anuria or blood potassium >6.5mmol/L, hemodialysis or peritoneal dialysis treatment is decisively carried out to avoid patients’ life threatening in the short term in order to buy time for combined Chinese and Western medicine treatment. Elderly patients with chronic renal failure have obvious characteristics and should be given full attention in order to help more elderly patients in clinical practice!