Myelodysplastic syndromes (MDS) are common blood disorders that occur mostly in the elderly and are characterized by (1) impaired development and maturation of bone marrow hematopoietic cells, or pathological and ineffective hematopoiesis, causing hematopoietic failure, resulting in a decrease in red blood cells, white blood cells, and platelets, and clinical anemia, fever, and bleeding. (2) Proliferation of bone marrow malignancy cells with a high risk of transformation to acute leukemia. Because the concept of this disease is abstract and obscure; the clinical staging is numerous, and the natural course and prognosis of each patient are very different; the measures, methods and medications used for treatment are also very individualized. Therefore, patients often have many misunderstandings, which are described below. Myth 1: MDS is pre-leukemia and will eventually turn into acute leukemia. It means that there are a few patients with leukemia who have a longer period or stage of anemia beforehand. As for pre-leukemia, it refers to the presence of hematologic abnormalities of an indeterminable nature for a period of time before the appearance of leukemia, and thus it is said that pre-leukemia is a retrospective diagnosis made after the onset of leukemia. a significant proportion of patients with MDS, especially those with RCMD type and RAEB type, can transform into acute leukemia as their disease progresses, and these patients can be called pre-leukemic. In addition, some myeloproliferative disorders such as true erythroblastosis, primary myelofibrosis, and primary thrombocythemia also convert a small number of patients to acute leukemia. there are 3 types of MDS in general: 1) about 1/3 of patients develop acute leukemia, some patients enter the acute leukemia stage within 2 years, while some patients develop acute leukemia after 5-10 years, or even longer. Most patients will gradually develop bone marrow hematopoietic failure and transform to acute leukemia ② Long-term MDS state without developing into leukemia; ③ A few patients have improved or disappeared clinical symptoms after treatment, and the blood and bone marrow images basically returned to normal or improved significantly. It can be seen that MDS is not all pre-leukemia, only those patients whose disease progresses into acute leukemia can be called pre-leukemia in part. Nor do all patients with MDS develop and evolve into acute leukemia, especially some low-risk patients, such as refractory anemia (RA), refractory anemia with ringed iron granulocytes (RARS), MDS with simple 5q- and other types, have a very low chance of transforming into acute leukemia, or even remain in the MDS stage for a long time with little or no development of leukemia. 2. Myth 2: Why does each patient is treated differently and with different measures? In clinical work, many patients have the question: Why are the treatments and measures different when our diagnoses are all MDS? This question can be addressed from the following aspects. MDS is not a single disease, but a group or class of diseases with abnormal development of bone marrow hematopoietic cells, and the treatment for different types of MDS must be different. These include refractory hematocrit with unilineage pathogenic hematopoiesis (RCUD), refractory anemia with ringed iron granulocytes (RARS), refractory hematocrit with multilineage pathogenic hematopoiesis (RCMD), refractory anemia with primocytosis-1 (RAEB-1), refractory anemia with primocytosis-1 ( RAEB-2), MDS-unclassified (MDS-U), MDS with simple 5q-. ② The natural course and prognosis of MDS patients are highly variable, so these factors should be taken into account in treatment. The more commonly used prognostic systems for MDS are the International Prognostic Score System (IPSS) and the WHO Staging Prognostic Score System (WPSS.) The IPSS score system classifies disease into low risk, intermediate risk-1, intermediate risk-2, and high risk groups. The WPSS classifies disease into very low risk group, low risk group, intermediate risk group, high risk group, and very high risk group. In general, current MDS treatment is based on risk groupings to determine treatment options and strategies. Treatment for patients with MDS in the relatively low-risk group includes supportive therapy (component blood transfusion, hematopoietic factor therapy), immunomodulators, and demethylation therapy, and chemotherapy and hematopoietic stem cell transplantation are generally not recommended. Patients in the relatively high-risk group require high-intensity therapy, including demethylation, chemotherapy and hematopoietic stem cell transplantation, but high-intensity therapy has a high rate of treatment-related complications and morbidity and mortality and is not suitable for all patients. (iii) MDS is a disease with a wide age span. In China and Asia, there is a tendency for the age of onset to be younger. There are a few clinical cases of MDS in children and adolescents, and some MDS in adults, but most of them are still diseases of the elderly. Therefore, when formulating treatment plans and measures, in addition to the prognostic score of MDS patients, a comprehensive assessment should be made by combining the patient’s age, physical condition, comorbidities and concomitant diseases, willingness to treat and compliance, etc., to select an individualized treatment plan to suit each patient and prevent over and under treatment.3. Myth 3: MDS has no specific treatment and is incurable. Although the disease is currently a refractory blood disorder, with the in-depth understanding of the pathogenesis, the development of new drugs, and the progress of clinical research, the efficacy of MDS has been greatly improved and improved compared to the past, many patients have been given the opportunity to be cured, and some patients are able to survive for a long time, both in terms of survival or quality of life have been significantly improved. Thalidomide, ralidomide and demethylation drugs (decitabine, azacitidine) therapy are recognized as emerging agents for the effective treatment of myelodysplastic syndromes. Ralidomide has unique efficacy in MDS with simple 5q- patients; the demethylating drugs decitabine and azacitidine can effectively prolong the time to transformation to acute myeloid leukemia, prolong overall survival, and significantly improve the quality of life of patients with myelodysplastic syndrome; supportive therapy can relieve patients from anemia, bleeding, and infection caused by hematocrit through blood transfusion and cell growth factor therapy Low-intensity therapy can stimulate normal residual hematopoietic stem cells and improve the hematopoietic efficiency of diseased hematopoietic clones by using immunosuppressive drugs. These measures and methods have greatly improved the therapeutic effect of MDS. In clinical practice, we combine the above-mentioned stratified treatment with active intervention of Chinese herbal medicine to identify the disease by “marrow toxicity and labor”, and treat the disease by tonifying the kidney and strengthening the spleen, nourishing the blood and promoting blood production, taking into account detoxification and anti-cancer. On the basis of this, we classify the disease into three types: spleen and kidney yang deficiency, liver and kidney yin deficiency, and internal heat toxicity, and apply treatment methods such as warming the spleen and kidney, nourishing the liver and kidney, and clearing heat and detoxification respectively, and often receive satisfactory results. In particular, our treatment based on decitabine + arsenious acid or compound Huang Dai tablets is particularly effective in high-risk patients. In conclusion, although the drug treatment of MDS has a slow onset of action, as long as we establish the concept of long-term adherence to treatment, the majority of patients can obtain good results. In the present era, the concept of “MDS is an incurable disease” has passed.