Abstract：Senile pruritus（SP）is a common skin disease in the elderly，characterized by paroxysmal skin itching without obvious primary lesions. Based on the theory from the Huang Di Nei Jing（The Yellow Emperor's Inner Classic） that "all pain，itching，and sores are ascribed to the heart，"and combined with Director CHEN Xinsheng's clinical experience， this study deeply explores the pathogenesis and treatment strategies for SP. By analyzing the heart's functions in governing fire， blood vessels， and spirit， it is found that the impairment of the heart's physiological functions is the etiology and pathogenesis of SP. Excessive heart fire and imbalance between water and fire are the initial factors，insufficient heart blood or blood stasis are important developmental factors，and disturbance of the spirit is the key link. Clinically，different treatment methods such as nourishing yin and reducing fire，nourishing yin and blood， promoting blood circulation and unblocking vessels，and calming the heart and relieving itching are adopted according to different syndromes. Corresponding prescriptions are used with modifications based on syndrome differentiation， supported by case studies.