Chronic renal failure (CRF), as the end-stage of various chronic kidney diseases, involves complex pathological mechanisms such as renal fibrosis and inflammatory responses, making it one of the difficult clinical diseases. The "Hengfa" theory founded by National Master of Traditional Chinese Medicine Yan Dexin takes "regulating qi and blood, balancing yin and yang" as the core, emphasizing the prevention and treatment of diseases by balancing the circulation of qi, blood, and body fluids in the body. Modern studies have shown that the imbalance of macrophage polarization status (M1/M2 type) plays a key role in the process of renal fibrosis in CRF, and Hengfa prescription (Gushen Xiezhuo Decoction) may improve CRF pathological damage by regulating macrophage polarization and inhibiting the inflammationfibrosis cascade reaction. Starting from the core connotation of the Hengfa theory and combining with the molecular mechanism of macrophage polarization, this paper systematically discusses the correlation between the two in the diagnosis and treatment of CRF, providing new ideas for the integrated traditional Chinese and western medicine treatment of CRF.