Diabetic nephropathy (DN) is one of the important chronic complications of diabetes mellitus (DM). Glomerular hyperperfusion and hyperfiltration caused by diabetes leads to glomerular basement membrane thickening, thylakoid expansion and extracellular matrix hyperplasia, which gradually manifests clinically as massive proteinuria, hypertension, hyperlipidemia, edema, and progressive and irreversible renal function impairment. Although modern medicine has obvious advantages in controlling blood sugar, blood pressure and blood lipids, TCM still has certain advantages in controlling proteinuria, improving patients’ symptoms, quality of life and delaying renal function damage. Although medical practitioners have formed a systematic diagnosis and treatment system on the etiology and mechanism of the disease, as well as the theory, method and prescriptions of the disease, quoting the scriptures can certainly be beneficial. However, the crux of the problem is that with the change of social diet and living habits, the intervention of modern medical treatment, and the prolongation of the disease course, how to truly and effectively respond to the current clinical patient’s performance and summarize the clinical treatment experience immediately, so as to effectively improve the clinical efficacy, is a problem we need to seriously consider. I would like to discuss a few points about our experience in the treatment of diabetic nephropathy, and to encourage our colleagues. 1, diabetic nephropathy although there is no “thirst” symptoms, but still because of the “thirst” attributed to “thirst” In view of the clinical manifestations of “thirst” of diabetic patients, generations of medical practitioners on diabetes attributed to In view of the clinical manifestations of “thirst” in diabetic patients, there is basically no objection to the classification of diabetes as “thirst”. As early as in Su Wen? This person must have eaten a lot of sweet food and fat. The fat makes the person hot internally, and the sweet makes the person full in the middle, so the gas overflows and turns into thirst. “Ling Shu? Five changes” cloud: “five organs are soft and weak, good disease elimination.” According to this, the “three elimination” theory of treatment has been used until now and has not crossed its fence. With the progress of medicine, due to the good control of patients’ blood sugar, the number of patients with symptoms of “thirst”, “elimination of food” and “polyuria” has been greatly reduced. Especially in diabetic nephropathy, the clinical complaints are mainly “fatigue, lumbago, foamy urine, edema and dizziness”, which cannot be classified as “thirst”. In order to reflect that this disease comes from “thirst”, modern medical practitioners still define it more from “thirst”. For example, Zhao inherited the thought of Professor Lu Renhe that the clinical stage with edema as the main evidence can be diagnosed as “edema of thirst disease”, while DN renal insufficiency is equivalent to “kidney labor of thirst disease” in Chinese medicine, and DN late stage renal failure uremia, it is “The patient with advanced DN nephrosis and uremia is Guange”. This is of great significance to the understanding of the origin of the disease name. Since Chinese medicine is not good at understanding the cause and primary disease, this concept of combining “identification” and “disease identification” developed on the basis of modern medicine will be helpful to improve the clinical efficacy of Chinese medicine. For example, in “dry syndrome kidney damage”, its clinical manifestation is also “thirst, excessive drinking, polyuria and proteinuria”, if we start from traditional Chinese medicine, it is not too much to diagnose it as “thirst”, but Such a diagnosis can be fatal to the subsequent treatment. 2. Diabetic nephropathy is classified as “thirst”, “urinary turbidity, edema, kidney labor”. The name is lower extinction. As a result, many clinical treatments are also based on the idea of “three eliminations” mentioned above. Clinically, although diabetic nephropathy is developed from diabetes mellitus, the characteristics of the “three eliminations” are not obvious in terms of clinical symptoms or changes in the development of the disease. In the Ming Dynasty, Zhao Xianke’s “Medical Guan? The theory of thirst” said: “…… Therefore, the treatment of thirst, there is no division between the upper and lower, the first treatment of the kidney as an emergency. Chen Shiduo of the Qing Dynasty, “the secret record of the stone room”, “although the evidence of thirst is divided into upper, middle and lower, but the kidney deficiency leads to thirst no different, so the treatment of thirst, the treatment of the kidney is the main, do not have to ask its upper, middle and lower three elimination also”. It can be seen that the fifth edition of the textbook on the “thirst” of the three elimination treatment idea is questionable. According to the clinical manifestations of diabetic nephropathy (from microproteinuria, to massive proteinuria, to edema, to renal insufficiency), we believe that diabetic nephropathy belongs to the “elimination of thirst” of “cloudy urine, edema and kidney labor”: 1. Early stage: attributed to 1. Early stage: it is classified as “thirsty urine cloudiness”, where patients mainly show foamy urine without edema or slight edema, i.e. the clinical stage of microalbumin and massive proteinuria; 2. Middle stage: it is classified as “thirsty edema”, where patients mainly show proteinuria with obvious edema, and the clinical stage of low protein The patient has proteinuria with obvious edema, and the clinical stage is hypoproteinemia; 3. Late stage: it is classified as “thirsty? Kidney labor”, the stage of renal insufficiency. The above ideas are based on clinical understanding and better reflect the pathology and treatment principles of diabetic nephropathy than the “three eliminations”. 3, the spleen and kidney deficiency is the key to the pathogenesis of diabetic nephropathy For the pathogenesis of diabetic nephropathy, there are different views. The early stage of the disease is dominated by the deficiency of both qi and yin, while the middle stage is dominated by the deficiency of yin and yang and the deficiency of spleen and kidney. In the middle stage, the disease mechanism is Yin loss and Yang, and Yang deficiency of the spleen and kidney. From the clinical point of view, we should grasp the main contradiction and manage the complexity of the pathogenesis of diabetic nephropathy, regardless of the early, middle and late stages, the deficiency of both spleen and kidney is the key. The spleen is the master of transportation and transformation, and the essence of water and grain needs the warmth of Yang Qi in the kidney, while the essence of the kidney also relies on the continuous replenishment and transformation of the essence of water and grain in the latter day, so the spleen and kidney nourish each other and serve each other. Deficiency of the spleen and kidneys can lead to deficiency of the spleen and the kidneys, which can lead to deficiency of the spleen and the kidneys. Therefore, spleen and kidney deficiency is the key link in the pathogenesis and evolution of diabetic nephropathy, so clinical strengthening of the spleen and kidney is the basic principle of treatment, such as Astragalus, Radix Codonopsis, Atractylodes, Rhizoma, Rhizoma, Radix et Rhizoma, Radix et Rhizoma, Cortex, Fructus Lycii, Rhizoma, Rhizoma, Rhizoma, Rhizoma, Cuscuta, etc. As for the grasp of nourishing yin, warming yang, benefiting qi and nourishing blood in each phase, it depends on the individual’s experience and power of the taste and quantity of medicine. 4. Blood stasis throughout the diabetic nephropathy Although there is the understanding of diabetic nephropathy with phlegm, stasis and toxicity, but from the long-term clinical evidence and treatment efficacy, blood stasis is the most accepted by the majority of doctors. Blood stasis is not only the main pathological basis of diabetic nephropathy, but also runs through the whole course of diabetic nephropathy. The idea that blood stasis causes thirst has been put forward in the Yellow Emperor’s Classic of Internal Medicine, “Blood vessels do not work and turn to heat, and heat eliminates the skin, so it is an elimination disease”. In recent times, the book “Blood Evidence” proposed that “thirst is caused by stasis of blood in the lining. Clinically, although sometimes diabetic patients do not have stasis of blood to identify, patients with different stages of diabetic nephropathy have blood rheology abnormalities and microcirculatory disorders, the severity of which is often evident with the aggravation of the disease. Therefore, blood stasis has been running through the whole process of the occurrence and development of diabetic nephropathy. 5. With the progression of diabetic nephropathy, treatment should be divided into activating blood, removing blood stasis and eliminating Y. Diabetic nephropathy has a lengthy course, “prolonged disease enters the ligaments”, and qi stagnation and blood stasis, “prolonged disease with many stasis”. Stasis blocks the kidney ligaments and the essence cannot flow freely, often making proteinuria and edema stubborn and difficult to disappear. As the disease progresses, the treatment for blood stasis is different. In the stage of edema (early stage), the main treatment should be to invigorate blood and nourish blood, to regulate the flow of qi and blood, and to unblock blood vessels and channels. In the edema stage (middle stage), the medicine should be used to remove stasis and promote water circulation, such as Yi Mu Cao, Da Huang, Di Long, Tao Ren, San Ling, Curcuma longa, Ze Lan, etc. At the stage of kidney labor (late stage), it should be used to eliminate Y, break blood and disperse knots, with medicines such as Centella asiatica, Rhubarb, Trigonella, Curcuma longa, Chuanjia, leech, etc.