In clinical practice, we often encounter patients who think that they are suffering from nephritis because of edema, urinary tract infection because of discomfort in urination, kidney deficiency because of back pain, and kidney disease because of kidney deficiency. They do not know that besides kidney disease can cause edema, heart and liver disease, endocrine disease and malnutrition can also cause edema; discomfort in urination can be related to gynecological disease or prostate disease in addition to urinary tract infection; and lumbar pain may not necessarily mean kidney deficiency. From the perspective of Western medicine, in addition to chronic kidney disease, urinary tract infection or stones can cause lumbago, lesions of the thoracic and lumbar spine, peripheral soft tissue lesions and adjacent organ lesions can also cause lumbago, and the clinical management of the same lumbago is distinctly different due to different etiologies. In clinical practice, we often encounter patients who present with anemia or gastrointestinal symptoms but are actually suffering from chronic renal failure after examination. Other patients who present with renal disease as the first symptom are suffering from immune rheumatic diseases or other systemic diseases. If the above situation is not diagnosed through the doctor’s careful examination and differential diagnosis, according to the instructions of some drugs for treatment, often misdiagnosed and mistreated, the lesser will be ineffective, the more serious will delay or even aggravate the disease Therefore, the identification of the disease is the premise of the prescription of drugs, only a clear diagnosis of the disease, a full understanding of the disease regression and prognosis, in order to guide the correct clinical use of drugs. Second, the identification of evidence is the basis for achieving curative effect The identification of evidence is the characteristic and essence of Chinese medicine, the identification of disease is conducive to grasp the etiology, pathogenesis, clinical manifestations of various diseases and their evolution and development, while “evidence” represents a pathological state of the current stage of the disease, is the point of diagnosis and treatment of diseases in Chinese medicine, only accurate identification, according to the evidence Only through accurate identification and treatment can we obtain the expected therapeutic effect. The so-called “identification” means that the various symptoms and signs of the disease collected are analyzed, synthesized and summarized through the four consultations of Chinese medicine: observation, smell, questioning and cutting, and judged to be a certain nature of “waiting”. At present, many commercially available proprietary Chinese medicines are often developed for a certain symptom of a certain disease, such as Huang Kui capsule for chronic nephritis damp-heat evidence; nephritis rehabilitation tablets for chronic nephritis qi-yin deficiency and damp-heat evidence; Bao Ren Kang for the treatment of chronic renal failure blood stasis evidence; urinary toxicity Qing granules for chronic renal failure spleen deficiency dampness and blood stasis evidence; Jin Shui Bao and Bai Ling capsule for various chronic kidney disease partial kidney deficiency evidence, and so on. Therefore, the selection of therapeutic drugs should be based on the doctor’s identification of the disease and the evidence. For patients with complex symptoms, we should use Chinese medicine to treat them. Only in this way can we maximize the advantages of Chinese medicine, instead of ruling one side of a disease or a hundred diseases. Third, out of the “disease is kidney deficiency, kidney disease should be kidney, cautious use of warm kidney and strengthen Yang” and other misconceptions Chinese medicine kidney disease has a broad sense and narrow sense. The broad sense of “kidney disease” refers to a series of diseases in which the pathological changes of the “kidney” are the main pathogenesis. According to Chinese medicine, the kidney is the root of the innate nature and has the physiological functions of growth and development, reproduction, water and fluid metabolism, production of marrow and blood, absorption of qi and warming and moistening of the internal organs, etc. The kidney works in synergy with the lung, the lung, the liver, the three jiao, the bladder and the small intestine to complete the water and fluid metabolism of the human body, and the kidney is closely related to human reproduction, growth and development and aging. Due to the limitations of the anatomical concept of the ancients, the “kidney” here can only be regarded as a comprehensive functional unit. Therefore, the broad sense of Chinese medicine kidney disease actually involves modern medicine urology, reproduction, endocrinology, metabolism, connective tissue and geriatric diseases and other categories. In contrast, “kidney disease” in the narrower sense is the main object of study of various kidney diseases in modern medicine and is limited to the category of kidney disease, which mainly corresponds to the function of “kidney is the master of water and fluid metabolism” in Chinese medicine. As the kidney is the organ of water and fire, it contains the true yin and the Yang, and the kidney collects the essence and the essence transforms into qi, which should be stored and not leaked, so there is an ancient saying that “kidney diseases have many deficiencies”. Kidney deficiency refers to the deficiency of essence in the kidney, which should be identified as yin or yang deficiency. But in fact, not all kidney diseases are deficiency evidence, the so-called “kidney deficiency” refers to the pathological deficiency of essence in the kidney or Yang deficiency, and then refers to a symptom, which is a summary of various symptoms caused by the pathology of kidney deficiency. For example, kidney yin deficiency is manifested as physical weakness, dizziness and whimpering, little sleep and forgetfulness, lumbago, seminal emission, dry mouth, red tongue with little coating and thin pulse, etc.; kidney yang deficiency is manifested as symptoms such as s white face, lumbago, impotence, dizziness and whimpering, fear of cold, frequent urination, pale white tongue and weak pulse. The concept of “kidney disease with deficiency” is derived from the concept of “kidney stores essence”, in fact, both the broad and narrow sense of Chinese medicine kidney disease can be manifested as actual or mixed evidence of deficiency and reality, for the narrow sense of Chinese medicine kidney disease, its onset is more In the narrow sense of TCM kidney disease, its pathogenesis is more “real due to deficiency, and more deficiency from real”, and it is often seen in the course of the disease with real evidence such as water-dampness, damp-heat, phlegm-heat or damp-humidity. For example, in the late stage of chronic renal failure, one can see deficiency evidence such as white face, fatigue, palpitations and shortness of breath, but also nausea and vomiting, chest and abdominal distension, constipation, thick and greasy tongue and other manifestations of dampness and turbidity, the treatment of which should follow the principle of “treating the symptoms when it is urgent”, and the first priority is to remove dampness and drain turbidity from the internal organs, and at the same time to support the positive energy: therefore, one should not think that kidney disease is Therefore, we should not think that kidney disease is kidney deficiency, kidney disease should supplement the kidney, excessive supplementation leads to evil love does not go, and we should not think that supplementing the kidney is to warm the kidney and strengthen Yang, even if the chronic kidney disease should be supplemented from the point of view of identification, to flatten the yin and Yang as the key, the use of Chuan Guan, Mulberry, Du Zhong, Wolfberry, Di Huang, Cornu Cervi Pantotrichum, Xuan Shen and other drugs. It must be recognized that some warm kidney aphrodisiac drugs, such as deer antler, Ba Ji Tian, Xian Mao, Epimedium, sea dog kidney, dog whip, etc., kidney failure patients will aggravate the condition after misuse, such drugs are clinically limited to male infertility or impotence of kidney deficiency patients, should not be confused. Fourth, not blindly follow the “as long as the kidney can strengthen the body anti-aging” said Chinese medicine believes that the kidney is the innate, is the root of life, fully emphasizing the vital position of the kidney in the human body. The kidney is the source of the function of the internal organs of the body, the kidney stimulates the normal physiology of the internal organs of the human body, and the abundance of kidney energy is of great significance to human growth and development, disease prevention, health and longevity. As we say, “if you don’t hide the essence in winter, you will be sick and warm in spring” and “if the five organs are injured, you will be poor and kidney”, so the treatment of protecting the kidney and regulating the body, nourishing the yang in spring and summer, and nourishing the yin in autumn and winter has always been respected. With the improvement of living standards in recent years, health investment has become a major concern, especially for the middle-aged and elderly, and believe that as long as taking kidney medicine that can strengthen the body and anti-aging. But the specific application, but also must be implemented on the basis of evidence, not blindly kidney supplementation. If a person with Yin deficiency is mistakenly using warm kidney products, it can lead to more fire; if a person with Yang deficiency is nourishing Yin and tonifying the kidneys, it will make the Yin cold even worse. Usually, we must follow the principle that Yin deficiency is not dry, not too bitter cold, it is advisable to sweet moisten the agent that benefits the kidney, in order to complement Yin with Yang, so that the deficiency fire descends and Yang returns to Yin, the so-called “strong water master to control the sun”, the representative formula such as Liu Wei Di Huang Wan; Yang deficiency is not cool moist, not too pungent, it is advisable to sweet warm beneficial products, in order to complement Yang with Yin, so that the sinking Yin disperses and Yin The so-called “source of beneficial fire to eliminate yin and shade”, which is represented by Jin Kui Kidney Qi Pill. While tonifying the kidney, attention should also be paid to regulating the function of the stomach and spleen, because the spleen is the origin of the latter, the source of biochemistry of qi and blood, and all kinds of drugs depend on the distribution of stomach qi. For those who are weak in spleen and stomach with reduced food intake, intestinal tinnitus and abdominal distension, loose stools, and a yellowish complexion, they should be complemented with qi to strengthen the spleen, otherwise they will be deficient in tonicity; and for those who are damp and trapped in the middle jiao with celiac puffiness and dullness, and thick tongue coating, they should first transform the dampness and transport the spleen, and then try to tonicity, otherwise they will be greasy and obstruct the stomach, making the dampness even worse. In addition, pay attention to the overall regimen is also very important, in the tonic before the best recommended tonic can do a comprehensive examination, the accompanying organic lesions should be treated, the existence of more health problems using cream can make the treatment more targeted. Five, careful to prevent drug injury to the kidneys Although drugs are used to treat diseases, but the medicinal properties of too cold too hot or toxic, or improper clinical application can lead to kidney damage. The kidney is the main organ of the body to excrete metabolites, the majority of drugs entering the body after metabolism is also excreted through the kidneys. The nephrotoxicity of some western drugs has long been recognized, common ones such as aminoglycoside antibiotics, antipyretic and analgesic drugs, rifampin, cyclosporine A, iodine contrast agents, chemotherapy drug cisplatin, etc., can cause acute renal failure in different ways, especially for some sensitive individuals, including the elderly, chronic kidney disease, and diabetics. Compared with western drugs, people have always thought that the toxic side effects of Chinese herbal medicines are relatively small and can be used with confidence. However, in recent years, with the widespread use of Chinese herbal medicines worldwide and the diversification of their dosage forms, there have been increasing reports of adverse reactions caused by Chinese herbal medicines, and the safety of Chinese herbal medicines has received attention, including the nephrotoxicity of Chinese herbal medicines. In fact, in China, there was a case of acute renal failure caused by “Mouton” as early as l964, which was called “aristolochic acid nephropathy” because the main toxic component of these drugs is aristolochic acid. The drug is called “aristolochic acid nephropathy”. According to expert analysis, the large-scale nephrotoxic damage caused by Guang Fangji and Guanmutong is directly related to the confusion of their Chinese names, which, according to the pharmacopoeia, include “Guanmutong” of Aristolochiaceae, “Chuanmutong” of Mouliangidae and “Mutong” of Mouton family. The difference between “Moutong”, and “Fangji” of Aristolochiaceae, “Guang Fangji”, “Hanzhong Fang” and “Powder Fangji” of Fangji The difference between “Moutong” and “Fangji” is that although it is “Moutong” or “Fangji”, it is actually a completely different herb. The clinical efficacy is also significantly different, and should never be mixed. In the Belgian case, the toxic Guang Fangji was mistakenly substituted for the non-toxic Powdered Fangji in the original prescription, and in the British case, the toxic Guanmutong was substituted for the non-toxic Chuanmutong. Studies have confirmed that herbs containing aristolochic acid components include Guanmutong, Guang Fangji, Hanzhong Fangji, Aristolochia, Tian Xian Vine, Qing Mu Xiang, Bone Seeking Wind, and Zhu Sha Lian. The Chinese patent medicines that may contain the above mentioned ingredients due to the use of herbs are Gentian Diarrhea Liver Pill, Rhubarb Stomach Pill, Stone Drainage Punch, Feminine Fraction Pill, Anyang Refined Cream, Guiding Chi Pill, Fraction Five Gongyan Pill, Ganlu Disinfectant Dan, Pediatric Jin Dan Pill, Tumbling Pill, Deafness Left Magnet Pill, etc. Other medicines with nephrotoxicity such as Zebrano, Centipede, Bee Venom, Cinnabar, Xiong Huang, Lead Dan, Yimu Cao, Hou Pu, Hsiang Hsiang, Lei Gong Vine, The mushroom, three yellow tablets, etc. Therefore, we must strictly grasp the scope of these drugs and use them with caution, and if they are really needed for medical conditions, they should be used under the guidance of experienced physicians. The “herbs have been standardized, as long as the products of regular manufacturers can generally be used with confidence. In summary, the rational use of Chinese herbal medicine is a systematic project involving clinicians, pharmacists and patients at all levels, clinicians and pharmacists should learn from each other, communicate constantly, and collaborate well, and pay attention to the combination of disease identification and evidence identification when dispensing drugs, fully understand the indications and adverse reactions of various drugs, and strengthen the education of patients so that they can actively cooperate with the treatment with the sole purpose of improving The only goal is to improve the efficacy and reduce the side effects, so that patients can benefit to the greatest extent.