Abstract：Based on HUANG Yuanyu's theory of circular movement of one qi，this paper proposes that the core pathogenesis of chronic kidney disease-associated pruritus （CKD-aP） lies in the disturbance of qi circulation due to dysfunction of the middle earth （spleen-stomach） and decline of kidney foundation. As the disease progresses， pathological transmission occurs： depression of liver wood on the left pathway transforms into wind； failure of lung metal to descend on the right pathway leads to turbid yin obstruction； and eventually disharmony between heart and kidney with imbalance of yin and yang ensues. Therapeutically， the emphasis is placed on strengthening and transporting the central axis，primarily using modified Huangya Decoction plus Shenqi Dihuang Decoction to cultivate earth and boost the origin. Stage-specific treatments are applied according to the evolution of pathogenesis： for liver depression with wind stirring，Dayu Decoction is modified to soothe the liver and relieve constraint；for lung congestion with turbid obstruction， Xiaqi Decoction is modified to descend metal and guide turbidity； for heart-kidney disharmony，Tianhun Decoction plus Huanglian Ejiao Decoction is modified to communicate yin and yang. By restoring the physiological state of circular movement of one qi， qi movement becomes regulated， the skin is nourished， and pruritus is naturally alleviated， providing a new approach for the diagnosis and treatment of CKD-aP in traditional Chinese medicine.