Vancomycin is a glycopeptide antibiotic from Streptomyceso-rientalis or Amycolatipsisorientalis with a unique triple antibacterial mechanism: it inhibits protein synthesis in the bacterial cell wall, alters the permeability of the bacterial cell membrane, and prevents bacterial RNA synthesis. RNA synthesis. Since the 1990s, the incidence of Gram-positive cocci in hospital-acquired infections has gradually increased, even up to 42%-50% in ICU, with Staphylococcus spp. Staphylococci predominate. The majority of patients with staphylococcal infections are resistant to cephalosporins, quinolones, and other antimicrobials, and are only susceptible to vancomycin. Although new antibiotics are being introduced, vancomycin is still one of the most reliable antibiotics against staphylococcal infections. However, the renal function of critically ill patients is often compensated or impaired, and the lack of knowledge about the efficacy and toxicity of vancomycin limits its widespread use in clinical practice, and the renal damage caused by it is one of the factors that increase the mortality of patients. For the prevention and avoidance of vancomycin nephrotoxicity, the following recommendations are made: (1) Based on the patient’s specific situation and laboratory data and other scores, determine whether the patient is at high risk of nephrotoxicity, and for the high-risk group, the dose must be reduced or other antibiotics with less nephrotoxicity should be selected first. (2) Closely monitor the blood concentration, the trough concentration should be controlled at 5-10μg/ml and the peak concentration at 30-40μg/ml. The duration of continuous administration should be shorter than 2 weeks. (3) Be cautious when combining aminoglycoside antibiotics, cyclosporine A, amphotericin B, etc., and be especially careful with tachyphylaxis. The above recommendations do not solve many problems: (1) vancomycin as the first choice or even the only antibiotic for drug-resistant Staphylococcus aureus, there is no substitute for its current status, and either reducing the dose or changing the drug means that the control of the primary infection may be lost, resulting in bad consequences; (2) blood concentration testing is not very meaningful in reality, and when the blood concentration exceeds the standard, nephrotoxicity is mostly shown long ago. Vancomycin nephrotoxicity mostly appears on the 4th day of drug use, and stopping the drug within 2 weeks does not play a substantial role in the prevention of nephrotoxicity; (3) once the renal function is damaged, even if the risk of timely discontinuation of the drug, renal damage can not be completely restored, often leaving long-term proteinuria phenomenon, renal function abnormalities under the stress state every easy to reappear, renal damage undoubtedly increases the difficulty of treatment to increase the rate of death, is a difficult problem in the use of vancomycin. At present, there are fewer studies in China, but more experiments in animals abroad. At present, we mainly focus on oxidative damage, using tempol and other antioxidants to intervene in the animal model of vancomycin renal damage, observing urinary LDH and other oxidative damage indicators and renal tubular pathological changes, verifying its efficacy and mechanism. The formation of hydroxyl groups may play an important role, so iron chelators can prevent the formation of hydroxyl groups and thus play a protective role against kidney injury, and other free radicals such as peroxides may also cause kidney injury directly or through the generation of hydroxyl groups. At present, Chinese medicine has been widely recognized for the treatment of vancomycin kidney injury, among which Cordyceps sinensis (3-5g/d) plus blood-activating drugs have more certain efficacy, but due to the price and production, clinical application is limited, while the application of the adult formula is quite little research, and the efficacy is not guaranteed. Theoretically, this content is also a blank state, no evidence-based content is proposed, and the treatment also simply follows the method of tonifying the kidney and invigorating the blood, which is basically the state of treating the disease, so there is considerable room for research in the theory and treatment. 1, according to the pathology of microscopic identification, such as the existence of renal tubular necrosis, kidney edema phenomenon, can be identified as phlegm, dampness and blood stasis, in combination with the patient’s back pain, edema and other manifestations of kidney Yang deficiency, can be identified as kidney Yang deficiency as the basis, phlegm, dampness and blood stasis as the standard, the treatment can be tonifying the kidney and warming Yang, phlegm, dampness and disperse stasis, each has its own priorities, so that there is evidence for the identification and treatment, rather than according to the disease speculation, the loss of the fundamental Chinese medicine The characteristics of Chinese medicine. As long as it can achieve comparable efficacy and can be used as a substitute for Cordyceps, it will be successful; we can also learn from foreign research methods and use a single Chinese medicine or a single formula to intervene in animal models to observe and compare its ability to protect or reverse oxidative damage to the kidney. To find the more ideal antioxidant in Chinese herbal formulas. In conclusion, vancomycin renal damage is a common pharmacogenic injury, both Chinese and Western medicine are far from enough research in this area, and further research on it has far-reaching significance in theoretical agent clinical guidance.