Medical dialogue systems (MDS) have emerged as crucial online platforms for enabling multi-turn, context-aware conversations with patients. However, existing MDS often struggle to (1) identify relevant medical knowledge and (2) generate personalized, medically accurate responses. To address these challenges, we propose MedRef, a novel MDS that incorporates knowledge refining and dynamic prompt adjustment. First, we employ a knowledge refining mechanism to filter out irrelevant medical data, improving predictions of critical medical entities in responses. Additionally, we design a comprehensive prompt structure that incorporates historical details and evident details. To enable real-time adaptability to diverse patient conditions, we implement two key modules, Triplet Filter and Demo Selector, providing appropriate knowledge and demonstrations equipped in the system prompt.Extensive experiments on MedDG and KaMed benchmarks show that MedRef outperforms state-of-the-art baselines in both generation quality and medical entity accuracy, underscoring its effectiveness and reliability for real-world healthcare applications.