Chronic kidney disease has become a global public health problem with high morbidity and mortality rates, and significantly increases the risk of cardiovascular disease and generates huge medical costs. The combination of Chinese and Western medicine in the prevention and treatment of chronic kidney disease has advantages, but there are also many confusions. The ideas and methods of combining Chinese and Western medicine in the prevention and treatment of chronic kidney disease are: (1) to strengthen research on the optimization of single disease programs; (2) to strengthen research on the development of new drugs with proven efficacy; (3) to strengthen research on the mechanism of action of Chinese medicine in the treatment of kidney disease; (4) to strengthen research on the mechanism of kidney damage and prevention of toxic Chinese medicine; (5) to use the method of systems biology to explore the nature of the kidney; (6) to organize the preparation of the Chronic Kidney disease prevention and treatment guide of combined Chinese and Western medicine; (7) vigorously promote, pay attention to screening and early prevention. Improve the level of diagnosis and treatment of chronic kidney disease by combining Chinese and Western medicine. 1, the harm of chronic kidney disease National Institutes of Health (NIH) statistics show that chronic kidney disease (Chronic Kidney Disease, CKD) accounted for 7% of the U.S. medical population, but accounted for 24% of the total medical budget costs. End-stage Renal Disease (ESRD) requires $65,000 per person per year for dialysis and is expected to cost $29 billion for ESRD in the United States in 2010 [1]. There is no accurate epidemiological data on CKD in China. According to a statistical survey of permanent residents over 40 years of age in Shijingshan area of Beijing in 2005, the prevalence of CKD was 9.4% [2]. Accordingly, it is projected that there are more than 100 million CKD patients and more than 3 million ESRD patients in China. Due to economic conditions, only 60,000 of the 3 million patients receive renal replacement therapy. According to the National Health Insurance Bureau, the annual cost of replacement therapy is 100,000-130,000 RMB per person, and the annual medical cost of just 2% of ESRD patients is 6-7.8 billion, and if all ESRD patients receive replacement therapy, the medical cost will be 300-390 billion. ESRD imposes a heavy economic burden on society and families, and causes lifelong regrets to the patients themselves. Although ESRD cannot be cured at present, it is very important to actively intervene when CKD has not yet progressed to ESRD by combining Chinese and Western medicine. The combination of Chinese and Western medicine is a product of natural penetration of Chinese traditional medicine and Western medicine, and it exists in the medical practice of Chinese hospitals and a considerable part of Western hospitals in China. Many nephrologists are actively exploring the road of combining Chinese and Western medicine in the treatment of kidney disease, such as the famous nephrologist Leleishi, who developed and researched the Chinese medicine extract Leigongteng polysaccharide to provide effective drugs for the treatment of clinical kidney disease; Chen Xiangmei, who was awarded the national “Tenth Five-Year Plan” science and technology research project ” Research on the rules of Chinese medicine evidence and treatment of IgA nephropathy”, which provides scientific evidence for the rules of Chinese medicine evidence and treatment of IgA nephropathy. They are a model of the combination of Chinese and Western medicine in the field of kidney disease. The combination of Chinese and Western medicine has obvious advantages and significant achievements in the field of nephropathy, but there are also some problems and confusions. 2.1 Advantages of combining Chinese and Western medicine in the treatment of CKD (1) Improve clinical efficacy and reduce side effects. Professor Ye Rengao, a famous expert in Chinese and Western medicine combined with nephrology, pointed out that “the combination of Chinese and Western medicine should originate from Chinese medicine, but higher than Chinese medicine; originate from Western medicine, but higher than Western medicine”, which is the goal of the combination of Chinese and Western medicine and the advantage of the combination of Chinese and Western medicine. For example, in refractory nephrotic syndrome, while using prednisone, cytotoxic agents, ACEI, ARB and other treatments, the combined treatment of Chinese and Western medicine such as Lei Gong Doside or Torch Flower Root Tablets and Chinese medicine soup is significantly more effective than simple Chinese medicine and Western medicine. Chinese medicine can also significantly reduce the medical Cushing’s syndrome side effects caused by high doses of hormones, and reduce the gastrointestinal reactions and the suppression of bone marrow and gonads caused by cyclophosphamide (CTX) [3]. (2) Integrated treatment with Chinese and Western medicine. Chinese medicine and Western medicine have their own advantages and disadvantages in the treatment of different stages of the disease, and the combination of Chinese and Western medicine can complement each other’s strengths and weaknesses, so that patients can receive integrated treatment. For example, when IgA nephropathy manifests as simple hematuria, there is no specific treatment in Western medicine, and Chinese medicine soup plus torch flower root or thunder root has better efficacy; when it manifests as moderate proteinuria and hematuria, small doses of hormone, ACEI plus Chinese medicine soup or thunder root can have better efficacy; when there is a large amount of proteinuria, large doses of hormone, ACEI plus Chinese medicine soup, thunder root or torch flower root can be used. In chronic renal failure (Chronic Renal Failure, CRF) stage 1 and 2, oral treatment with Chinese herbal soup, Chinese herbal enema and Chinese herbal fumigation with hypotension to reduce renal “three highs”, etc.; in the uremic stage, replacement therapy is the main treatment, and Chinese herbal medicine with improved nutrition. The combination of Chinese and Western medicine in the treatment of uremia. Therefore, the best integrated treatment can be obtained by combining Chinese and Western medicine at different stages of the disease, each applying its own strengths. (3) The combination of Western medical diagnosis and Chinese medical diagnosis improves the sensitivity of treatment and prognosis of kidney disease. For example, different pathological types of nephrotic syndrome can manifest spleen and kidney yang deficiency, while spleen and kidney yang deficiency in microscopic lesions respond well to treatment and have a good prognosis, while spleen and kidney yang deficiency in focal segmental sclerosis respond poorly to treatment and have a poor prognosis. TCM identification under Western medicine diagnosis has improved the understanding of prognosis of kidney disease in TCM. 2.2 Problems and confusions (1) Combination of Chinese and Western medicine in the treatment of CKD still lacks evidence-based medical evidence. Although there are many reports on the combination of Chinese and Western medicine in the treatment of various kidney diseases, most of them are based on the personal experience of experts and clinical observations of their respective units, and no multicenter randomized double-blind clinical trials with large samples have been conducted, so the objectivity of its efficacy is difficult to determine. (2) The mechanism of its efficacy is still a “black box theory”. The composition of Chinese medicine is complex, and after concoction, compounding, decoction, and metabolism in the body, the changes of the composition are even more unknown. Therefore, it is difficult to examine the efficacy of Chinese medicine with a single indicator, and the mechanism of action is unknown. The mechanism of efficacy is even more unclear when western medicine is added on top of Chinese medicine treatment. Therefore, the efficacy mechanism of combining Chinese and Western medicine in the treatment of CKD can only be explained by the “black box theory”. (3) There is no “Guideline for Combination of Chinese and Western Medicine in Prevention and Treatment of Chronic Kidney Disease” in the industry, so there are no rules to follow for the treatment of CKD by combining Chinese and Western medicine, and there is no authoritative reference and guideline for the clinical treatment of nephrologists combining Chinese and Western medicine, so the safety of doctors and patients is poor. (4) Basic theory research is still confused: Chinese medicine is characterized by evidence-based treatment, and the research of “evidence” is the core of the basic theory of Chinese medicine, which is the bottleneck of the modernization of Chinese medicine. However, no specific objective indexes have been found for the study of “evidence” such as kidney deficiency, and there is still a great distance from the essence of “evidence”. (5) The theory of integrated Chinese and Western medicine has not yet been formed. At present, the clinical practice of Chinese medicine is guided by the “holistic concept” as the leading ideology and the system theory of evidence-based treatment; Western medicine is guided by the “reductionism” as the leading ideology, logical thinking as the characteristic, experimental methods as the main research method, with the help of physics, chemistry, biology and other means. Western medicine is based on “reductionism” and is characterized by logical thinking and experimental methods, with the help of physics, chemistry, biology and other means to guide practice [4]. Chinese medicine and Western medicine are guided by their own theories, and there is no theory of combined Chinese and Western medicine yet, and the formation of a new theory is still a long time away. 3, the combination of Chinese and Western medicine prevention and treatment of chronic kidney disease ideas and methods 3, 1 strengthen the combination of Chinese and Western medicine treatment of CKD single disease optimization program research Chinese and Western medicine combination of treatment of kidney disease reported a lot, the efficacy is also better, but now there is no Chinese and Western medicine combination of treatment of CKD optimization program introduced. The National 11th Five-Year Plan for Science and Technology Support Program has started to fund the research on the clinical optimization plan of Chinese medicine for kidney disease, such as the “Demonstration Study on the Optimization Plan of Chinese Medicine Evidence Treatment for Chronic Kidney Disease Stage 3” led by Professor Wang Yongjun of Hangzhou Hospital of Traditional Chinese Medicine with the participation of 11 hospitals’ nephrology departments and A multicenter prospective clinical study on the integrated treatment of membranous nephropathy in Chinese medicine led by Professor Chen Yiping of Longhua Hospital, Shanghai University of Traditional Chinese Medicine [5]. Their research methods and results will provide a reference for the study of optimal protocols for the combined treatment of CKD by Chinese and Western medicine. In addition, it is recommended that governmental health administration departments, science and technology departments, and enterprises support the study of optimization protocols for combined Chinese and Western medicine for kidney disease in various forms to provide evidence for the preparation of guidelines for combined Chinese and Western medicine for the prevention and treatment of kidney disease, to provide a basis for decision-making by governmental and health administration departments, to provide the most effective methods for industry diagnosis and treatment of CKD, and to improve the level of treatment of kidney disease. When studying the optimized protocol, please pay attention to the following issues: (1) In order to make the clinical trial information transparent and improve the social credibility of the study, please register with the WHO ICTRP-accredited clinical trial registry before starting the clinical trial; (2) In order to optimize the best protocol, please discuss the experience of experts within the collaborative group and solicit outside the collaborative group for Chinese medicine nephrologists, Western medicine nephrologists , renal pathologists, immunologists, pharmacologists, statisticians, medical economics experts, ethics committee, and nursing experts. After the optimization protocol is developed, a multicenter, large sample, randomized controlled blinded clinical trial is conducted to objectively evaluate the efficacy and safety of the protocol. After the results of the first clinical trial are available, the protocol is re-optimized and retested for problems in the clinical trial until a satisfactory protocol is optimized. CRF is a clinical syndrome caused by multiple etiologies, with different etiologies, different mechanisms and rates of progression, and different clinical outcomes and prognoses. Therefore, CRF should be studied optimally according to its primary etiology classification. In addition, primary nephrotic syndrome and chronic glomerulonephritis should also be studied by pathological type for single disease optimization protocols. 3.2 Strengthen research on the development of new drugs with proven efficacy At present, the Chinese patent medicines that have been developed and marketed for the treatment of kidney disease include Leigongteng polyglucoside tablets, nephritis rehabilitation tablets, urinary toxicity clear, nephritis four-flavored tablets and Huangkui capsules, but they are not enough to meet the clinical needs. In order to enrich clinicians’ means of treating kidney disease, to meet the needs of clinical patients, and to expand the influence of combined Chinese and Western medicine in treating kidney disease in the international kidney disease community, research on the development of new Chinese medicines with proven efficacy and safety should be strengthened [6]. The development of new Chinese medicines should pay attention to the following issues: (1) clinical efficacy is the life of a new drug, and only if it is efficacious and safe will it have a long and enduring cycle in the medical market; (2) there should not be too many medicinal flavors in the formula, preferably under 8 flavors, and 4-6 flavors are best. Because too many flavors, the process is complex, the amount of medication, not easy to control costs and patients taking long-term; (3) to master the latest classification of new drugs, according to the different classification of new drugs in pharmacology and toxicology research requirements are not the same, please go to the State Food and Drug Administration’s website in a timely manner; (4) the group of drugs if there is no quality standard of local herbs to do the quality standard of the drug first; (5) the clinical indications of new drugs in Chinese medicine (6) pharmacodynamic study if there is no recognized animal model, self-created animal model should have the relevant expert demonstration; (7) clinical trial protocol should refer to the Guiding Principles for Clinical Trials of New Chinese Medicines, if the principle does not have the disease, the clinical trial protocol should have the relevant expert demonstration; (8) the selection of control drugs, preferably (8) The selection of the control drug should preferably be the most effective Chinese medicine of the same kind, without the same kind of Chinese medicine to choose the recognized effective western medicine, and the control drug is a different dosage form to do double simulation. 3.3 Exploring the essence of kidney by using the method of system biology The core of TCM theory is the diagnosis and treatment, and the study of the essence of “evidence” is the breakthrough of TCM modernization. Since the 1980s, in-depth studies on CAMP, GAMP, endocrine, immune and genetic factors have been conducted on kidney yin deficiency and kidney yang deficiency, and great achievements have been made, but no specific indicators of kidney deficiency have been found. Systems biology is composed of genomics, proteomics, metabolomics, interactomics, phenomics and bioinformatics, etc. Through bioinformatics, the results of horizontal studies of genes, proteins, metabolites and phenotypes are integrated, and the existence characteristics, activity patterns and interconnections of a collection are described dynamically at the overall level using systematic and integrated ideas and means. The most characteristic feature of traditional Chinese medicine theory is the “holistic view” and “discriminatory view”, which coincides with the modern systems biology approach [7]. Therefore, the use of functional genomics and proteomics as the core of the systems biology approach will provide a scientific and objective basis for the study of the nature of kidney deficiency in TCM. 3, 4 Strengthening the research on the mechanism of action of TCM for CKD The research on the mechanism of action of TCM for kidney disease is a hot spot at present, and many nephrologists have done a lot of meaningful work to study the improving effect of the compound or single medicine of kidney treatment TCM on kidney pathology and function, the regulating effect on cytokines and genes, and the search for effective drugs for clinical purposes. Given that Chinese medicine is multi-component, multi-target, multi-pathway and multi-effect, it is difficult to judge whether it is an effective or ineffective ingredient because of its complex composition, and it is also difficult to examine its efficacy with a single indicator, its metabolic pathway is not clear, its half-life is unknown, and its efficacy mechanism is still explained by the “black box theory”. All tonics are taken twice a day, and all proprietary Chinese medicines are taken three times a day. Given the current technical and methodological limitations, such studies will continue for a long time. The systems biology approach described earlier coincides with the multi-component, multi-pathway, multi-target and multi-effect approach of Chinese medicine. However, the technical conditions are relatively demanding, and it is recommended that units in a position to do so use the systems biology approach to explore the efficacy mechanism of TCM in the treatment of kidney disease, for the field of nephrology to draw on. 3,5 To strengthen the mechanism of renal damage and prevention research of toxic Chinese medicines such as aristolochic acid As early as 1964, Wu Songhan et al. reported 2 cases of acute renal failure caused by taking drugs containing guanxi, which were subsequently reported, but the number of cases was small and did not attract attention. in 1993, Vanhe rweghem et al. found 9 cases of interstitial renal fibrosis in women after consuming diet foods with Chinese medicine ingredients, 2 of which were already in ESRD at the time of initial diagnosis. The analysis of their drugs revealed that the diet drugs contained aristolochic acid, which attracted the attention of the medical profession. In China, Professor Chen Yipu and others have made a more in-depth study. The Chinese medicines containing aristolochic acid include Aristolochia, Tian Xian Vine, Qing Mu Xiang, Guan Mu Tong, Guang Fang Ji and so on. Other herbal medicines that cause kidney damage include bitter ginseng, bone marrow, hyssop, neem, celosia, hedgehog, bailey, xiaquan, kunming hayan, houpu, hawthorn, cao wu, croton, junzi, and tu bei mu. Renal damage is manifested by acute and chronic renal failure and fibrosis of the renal tubular interstitium [8]. It has caused worldwide doubts about the safety of herbal medicines, and some even dare not use them. In fact, these cause damage in addition to the drugs themselves, related to excessive doses, prolonged use, and medication not guided by TCM theory. Therefore, it is necessary to study the origin, duration of administration, dosage and compatibility of herbs that may cause kidney damage, prohibit the circulation of drugs that do cause kidney damage such as Guanmutong, Aristolochia and other Chinese medicines and their preparations in the market, further study the mechanisms that may cause kidney damage, find effective prevention and treatment methods, and provide safe and effective Chinese medicines for clinical treatment of kidney disease. 3.6 Organize the preparation of “Guidelines for the Prevention and Treatment of Chronic Kidney Diseases by Integrating Chinese and Western Medicine” Western medicine has the “Clinical Practice Guidelines for Chronic Kidney Diseases and Dialysis” prepared by the U.S. organization, and in 2005, the World Health Organization has started to organize Chinese experts in Chinese medicine to write the “Clinical Guidelines for Chinese Medicine”, hoping that the clinical guidelines will not only meet the international common disease standards, but also reflect the characteristics of Chinese medicine in terms of evidence-based treatment, and become a standardized and The work is still in progress. The biggest problem now is the lack of clinical evidence [9]. It is recommended that the national health administration and the Chinese Society of Integrative Medicine and Nephrology take the lead, with the participation of experts in integrative Chinese and Western medicine and nephrology, Chinese nephrology, Western medicine and nephrology, renal pathology, immunology, medical economics, statistics, epidemiology, nursing, and health decision-making departments from the Chinese Society of Nephrology and the Chinese Society of Traditional Chinese Medicine, to The combination of Chinese and Western medicine is more mature in the treatment of CKD, and the combination of disease and evidence, with recognized diagnostic criteria and efficacy evaluation criteria, and grading of evidence, to provide clinicians with authoritative, practical, and operable guidelines for the prevention and treatment of CKD with the combination of Chinese and Western medicine. 3.7 Increase publicity, emphasize screening and early prevention High prevalence of CKD, high cardiovascular complication and death rates and high medical costs, yet the awareness rate is less than 10%. Some people have never checked their urine in their life and know nothing about whether there are any kidney problems. Therefore, in 2006, the International Society of Nephrology (ISN) and the International Federation of Kidney Funds (IFKF) jointly took the initiative to designate the second Thursday of March as “World Kidney Day”, with the aim of arousing the attention of people from all walks of life to CKD. The Chinese Medical Association’s Nephrology Branch has already launched media campaigns, held lectures and organized screening. Other related societies and government departments are expected to take active actions to increase the publicity, draw the attention of the society, and organize professionals to participate in large-scale urinary routine screening. Early establishment of a method for the widespread clinical use of glomerular filtration rate (GFR) detection in China, and GFR evaluation for inpatients and physical examiners who may cause CKD. Early prevention of factors causing secondary kidney disease such as hypertension, diabetes and gout; active intervention and treatment of existing kidney disease to prevent the progression of kidney damage; prevention of complications such as cardiovascular events in stage 3, 4 and 5 CKD. All Chinese and Western medicine nephrologists take action to make their contribution to the prevention and treatment of CKD.