Abstract： Prof. LI Zhenhua， a Chinese medicine master， believes that the basic pathogenesis of chronic renal failure includes five aspects， which are deficiency， turbid， stasis， toxin and debilitation. Deficiency is mainly spleen- kidney yang deficiency and liver- kidney yin deficiency； turbid is caused by spleen- kidney yang deficiency， internal retention of phlegm rheum and water- dampness， and retained dampness turbid in the body； stasis， which is due to deficiency and obstructs kidney collaterals， runs through the whole course of the disease；toxin is due to pathological products，such as phlegm turbid and blood stasis， stagnating in and sticking to the body for a long time， micro accumulation of concretions being formed，turbid toxin being accumulated in the body，kidney collaterals being damaged by toxin，and turbid toxin syndrome being caused； debilitation is due to the intention of dampness turbid and kidney function failure. The disease is a syndrome of deficiency in the origin and excess in the superficiality，the decline of kidney qi being the root cause and dampness turbid， blood stasis and stasis toxin being the symptom. The complex of deficiency， turbid， stasis， toxin and debilitation is the pathogenesis of the disease. Supplementing the spleen and kidney should be the root cause of the treating principle， and dispelling dampness and directing the turbid downward， invigorating blood and dispelling stasis， and detoxifying and eliminating toxin as the symptom. Because of the complicated pathogenesis of chronic renal failure， we should pay attention to the pathogenesis， combine the whole and the part， treat both the interior and the exterior，and great effects can be achieved.