Chronic renal failure (CRF) is a syndrome consisting of decreased glomerular filtration rate and its associated metabolic disorders and clinical symptoms caused by various primary and secondary chronic kidney diseases, referred to as chronic renal failure, which is the middle and late stage of chronic kidney disease. It has become a major public health hazard after cardiovascular diseases, tumors and diabetes. There is no nationwide epidemiological data on the incidence of end-stage renal disease in China, based on an epidemiological survey of 200,000 people in Nanjing. In 2007, an epidemiological survey in Xuanwu District of Beijing showed that the prevalence of chronic kidney disease was 13.9% and the rate of abnormal kidney function was 8.7% among people over 18 years old. It is evident that it has become a major disease affecting the health of Chinese nationals. In China, primary glomerulonephritis is the first cause of end-stage renal disease, and in western developed countries, end-stage renal disease is more common as secondary renal disease, and diabetic nephropathy has become the first cause of end-stage renal disease. At present, the trend of end-stage renal disease caused by diabetes and other metabolic diseases in China is increasing year by year. It is generally considered by Chinese medicine practitioners to be within the scope of the ancient literature of Chinese medicine, such as “guan ge” and “deficiency labor”. Most scholars believe that the pathology of this disease is a combination of deficiency of the spleen and kidney, deficiency of evil, and cold and heat. The key to the pathogenesis of this disease is the failure of the spleen and kidney and the retention of dampness and turbidity. Due to the failure of the spleen and kidneys, the two bowels are not in charge, and the function of qi-transformation is severely impaired, so it is difficult for the turbid yin to come out from the lower orifices and be retained in the body. Kidney complex stasis is another important link in the process of chronic renal failure. Infection is often an important factor that triggers the deterioration of the disease. The clinical condition is often characterized by external wind-heat, wind-cold, dampness and heat toxicity, which are also important factors of the actual evil. Diagnostic criteria: (1) Chronic kidney disease for more than 3 months. (2) Glomerular filtration rate (GFR) below 60 ml/min/1.73m2 for at least 3 months (below 50 ml/min in the elderly) (3) Metabolic disorders and clinical symptoms associated with renal failure during the decline of glomerular filtration rate. The above three articles, the first one is the main basis for diagnosis, according to the second article diagnosis should be cautious or strictly grasp. If the third article is available at the same time, the diagnosis will be based more fully. Detailed medical history, careful physical examination and necessary laboratory tests are required to raise the alertness to chronic renal failure to avoid misdiagnosis. Differential diagnosis 1. Differentiation from pre-renal azotemia: renal function can be restored in patients with pre-renal azotemia after 24-72 hours of effective blood volume replenishment, while renal function is difficult to be restored in CRF. 2, and acute renal failure: often based on the patient’s medical history can make the distinction. When the patient’s history is not detailed, the diagnosis of CRF can be analyzed with the help of imaging examinations (such as B-ultrasound, CT, etc.) or nephrographic findings, if both kidneys are significantly reduced, or if the nephrographic findings suggest chronic lesions, the diagnosis of CRF is supported. 3, accompanied by acute renal failure: If the chronic renal failure is mild, while the acute renal failure is relatively prominent, and its course is in line with the evolution of acute renal failure, it can be called “chronic renal failure combined with acute renal failure”, and its management principles are basically the same as those of acute renal failure. If the chronic renal failure itself has been relatively heavy, or its course of aggravation does not reflect the evolution of acute renal failure, then it is called “acute exacerbation of chronic renal failure”. Chinese medicine treatment The basic pathogenesis is spleen and kidney failure, deficiency of evil, mixed cold and heat, and abnormal elevation. Spleen and kidney failure and retention of water and dampness are the key to the pathogenesis of the disease. Therefore, tonifying the spleen and kidney, supporting the righteousness and dispelling turbidity is the main method of treatment for this disease: 1, spleen and kidney qi deficiency, blood stasis and dampness evidence: the face is dull and dark, less energy and weakness, poor appetite and abdominal distension, dilute stool, light mouth without thirst or thirst without desire to drink, waist and knee pain, hands and feet are not warm, frequent nocturnal urination, light and dark tongue with teeth marks or petechiae, sunken and astringent pulse. Benefit the kidneys and slow down the decay of the kidneys by adding reduction. The medicine uses 15g of raw Astragalus membranaceus, 10g of fried Atractylodes macrocephala, 15g of Radix Angelicae Sinensis, 15g of Radix Paeoniae Alba, 15g of Radix Paeoniae Alba, 15g of Chuanxiong Ligustici, 12g of Yimu Cao, 15g of Radix Codonopsis Pilosulae, 15g of Huo Stem, 15g of Su Stem, 9g of Jiao Da Huang, etc. If the complexion is pale, less energy and weakness, poor appetite and abdominal distension, foul-smelling mouth, sticky mouth and bitter mouth, stuffiness in the chest and epigastrium, abdominal distension and dullness, or with fever and irritability, yellow and greasy tongue coating, slippery and numbered pulse. 2, deficiency of spleen and kidney qi, dampness and heat obstruction, treatment is to benefit qi and strengthen spleen, clear heat and dampness, harmonize stomach and stop vomiting. The formula is based on Xiao Chai Hu Tang with addition and subtraction, using 15g of Radix et Rhizoma Polygonati, 10g of Radix et Rhizoma Polygonati, 15g of Radix Scutellariae, 9g of Radix et Rhizoma Ginger, 9g of Pericarpium Citri Reticulatae, 9g of Rhizoma Polygonati. 3, liver and kidney yin deficiency, dampness and turbidity within the evidence: face atrophy, bitter mouth or cold drinks, dry eyes, dry stools, waist and knee pain, dizziness and tinnitus, heat in the heart of the hands and feet, light red tongue, thin shape, no moss or thin yellow moss, thin pulse or thin strings. Qigong Ju Di Huang Wan combined with Er Zhi Wan plus flavor. The medicine uses wolfberry 15 g, chrysanthemum 10 g, raw and ripe earth 12 g, dogwood 12 g, dandan bark 10 g, zedoary 10 g, chasteberry 10 g, dry lotus grass 10 g, yam 10 g, he shou wu 12 g, parasitic 12 g. If heat is obvious, add gentian grass 6 g, mountain gardenia 10 to clear liver fire; if seminal emission and night sweating, add calcined dragon bone, calcined oyster 30 g each to submerge yang and fix astringency. In cases of hyperactivity of liver and yang, we can use Tian Ma and Hooked Vine Tang or Liver Quenching and Wind Quenching Tang. 4.Spleen and kidney deficiency of both qi and yin, stagnation and obstruction: dull face, weakness, soreness and weakness of waist and knees, dry mouth and throat, insubstantial or dry stools, yellow urine, nocturnal urine, pale, dark purple tongue with teeth marks, white and greasy moss, sunken and thin pulse. Ginseng and Astragalus Dihuang Tang with reduction. Ginseng 10g, Astragalus 15g, Radix Rehmanniae 15g, Cornu Cervi Pantotrichum 12g, Poria 15g, Zeligia 12g, Yam 15g, Fructus Lycii 15g, Radix Angelicae Sinensis 15g, Salviae Miltiorrhiza 20g, Rhubarb 9g. (1) Adhere to the etiology of treatment: such as hypertension, diabetic nephropathy, glomerulonephritis, etc. adhere to long-term rational Treatment. The ability to adhere to long-term rational treatment is a very important factor affecting whether these diseases develop into chronic renal failure and the rate of progression of chronic renal failure. (2) Avoid or eliminate risk factors for the rapid deterioration of CRF: recurrence or acute exacerbation of underlying renal diseases, failure to control severe hypertension, acute hypovolemia, acute reduction of local blood supply to the kidney, severe infection, tissue trauma, urinary tract obstruction, etc., failure of other organs (e.g., severe heart failure, severe liver failure), improper use of nephrotoxic drugs, etc. (3) Blocking or inhibiting various pathways of progressive development of renal unit damage and protecting surviving renal units. Blood pressure, blood glucose, urine protein quantification, and GFR decline should be controlled within the “ideal range” (Tables 1 and 2). (4) Dietary therapy: A low-protein, low-phosphorus diet with essential amino acids or alpha-keto acids (EAA/KA) alone or in addition to EAA/KA may be useful in reducing glomerulosclerosis and interstitial fibrosis. Most studies support the effectiveness of dietary therapy in delaying the progression of CRF, but its effect varies among patients with different etiologies and stages of CRF. (5) Others: Active correction of anemia, reduction of uremic toxin accumulation, application of statin lipid-lowering drugs, and smoking cessation are likely to have a protective effect on renal function and are being further investigated.