Chronic renal failure is a syndrome composed of a series of symptoms or metabolic disorders that occur in all primary or secondary kidney damage.Clinically,it is mainly characterized by abnormal urine,water metabolism disor-ders,and electrolyte imbalances.According to traditional Chinese medicine theory,the spleen's transport and transformation function requires the warm and steaming of kidney yang to generate qi,blood,and essence.The kidney essence must rely on the nourishment of the spleen's transport and trans formation essence to prevent biochemical stagnation.Chronic renal failure is often caused by spleen and kidney deficiency,which is related to various factors such as congenital deficiencies,irregular diet,internal injuries to the seven emotions,prolonged illness without treatment,and excessive sexual activity that deplete the vital energy.Therefore,treatment should focus on nourishing the spleen and kidneys throughout the process.Black Rehmannia Pill is a common self-prepared traditional Chinese medicine,which uses Atractylodes macrocephala as the ruler,Rehmannia glutinosa as the minister,jujube as the accompaniment,and dried ginger as the agent.It is often used in modem medicine alone or in combination with Western medicine to treat chronic renal failure,and its efficacy is quite good.This article reviews the mechanism of Black Rehmannia Pill in improving chronic renal failure from the aspects of adjusting gastrointestinal hormone disorders,strengthening intestinal mucosal barrier,regulating intestinal microbiota disorders,regula-ting brain gut axis interaction,protecting renal function,and correcting renal anemia,in order to provide reference for the re-search and clinical application of this drug.