Myelodysplastic syndrome (MDS) is a group of malignant clonal hematopoietic stem cell disorders characterized by refractory qualitative and quantitative abnormalities of blood cells and a high risk of developing acute leukemia, which is highly heterogeneous. The International MDS Risk Analysis Symposium in 1997 proposed the MDS Prognostic Score System (IPSS), which divides MDS into low-risk, intermediate-risk-1, intermediate-risk-2 and high-risk groups. This score and risk classification system has been universally recognized and adopted internationally, and has actually become a staging system that best reflects the clinical prognosis of MDS patients and is extremely helpful in guiding the treatment of MDS patients [1]. The pathogenesis of this disease is not well understood at home and abroad, and domestic treatment of this disease is given with differentiation-inducing agents, chemotherapy, immunosuppressive agents, androgens and supportive therapies, but the efficacy is unsatisfactory, with large individual variability and more toxic side effects. Chinese medicine has good clinical efficacy in the treatment of MDS, and has obvious advantages in improving symptoms, improving the quality of survival, and reducing toxic side effects of treatment. According to the clinical manifestations, MDS belongs to the categories of “deficiency labor”, “blood evidence”, “accumulation” and “acute labor” in Chinese medicine. According to Chinese medicine, MDS develops due to the weakness of the body’s vital energy and the invasion of evil toxins, and the interaction of internal and external factors. The patient’s congenital deficiency of endowment, or the internal injury of the seven emotions, poor diet, excessive labor, damage to the liver, spleen, kidney and essence, resulting in the imbalance of yin and yang, qi and blood, and the dysfunction of the internal organs. Due to the heterogeneity of MDS and the polymorphism of clinical manifestations, we use Chinese medicine typology to identify and treat MDS according to IPSS typology, and the clinical results are obvious, which are introduced as follows. 1. Low-risk MDS (IPSS low-risk/medium-risk-1): This type is mostly seen in RA, RARS, RCMD, RCMD-RS, 5q-syndrome type of MDS, with a median survival time of 3-5 years and a longer transformation time into acute leukemia. This type of MDS belongs to the category of “deficiency labor” and “blood evidence” in Chinese medicine, and the disease is located in the kidney and spleen. The importance of spleen and kidney deficiency in the development of deficiency labor is emphasized. The production of blood depends on the coordination of the functions of the five viscera, of which the spleen and kidney are the most closely related. The spleen is the source of Qi and blood; the kidneys are the source of the congenital organs, the main bone and marrow producer and the main essence collector, and the essence and blood have the same source. The strength of the spleen and kidney determines the strength and weakness of the vital energy, and the coordination of the functions of the spleen and kidney plays an important role in the production of essence and blood, and when the spleen and stomach are healthy, there is a source of biochemical energy and blood; when the kidney essence is sufficient, the marrow is nourished and the blood production function is normal. Insufficient congenital endowment or acquired internal injuries may lead to deficiency of the spleen and kidneys, resulting in clinical symptoms such as fatigue, dizziness and palpitations, lumbago, and lack of color. The clinical symptoms include fatigue, dizziness, palpitations, lumbago, and lack of color. Clinically, these patients can be divided into three types: spleen and kidney yang deficiency, spleen and kidney yin deficiency, and spleen and kidney yin and yang deficiency. In cases of spleen-kidney yin deficiency, dry mouth and desire to drink, dry stools, hot flashes and night sweats, flushed face, red tongue and dry texture, little coating, thin pulse, commonly used to strengthen the spleen and nourish the kidneys, such as Zuo Gui Wan, Da Teng Yuan Decoction, Qi Ju Di Huang Wan, and Zeng Yu Tang, commonly used drugs such as Fructus Chasteberry, Shu Di, Cornu Cervi Pantotrichum, Shou Wu, Roasted Turtle A, Huai Shan Yao, Prince Ginseng, Sheng Di, Mai Dong, etc.; in cases of spleen-kidney yin-yang deficiency, the above two symptoms can be combined. The above two types of symptoms can be combined, the clinical evidence of medicine can be used according to the Yin deficiency and Yang deficiency focus on different and appropriate choice. In order to obtain the effect of “yin gets yang to rise, and the source is inexhaustible” and “yang gets yin to help, and the biochemistry is endless”, a small amount of warming yang is added to the main formula of nourishing yin, and a small amount of nourishing yin is added to the main formula of warming yang. Modern research proves that kidney tonics can stimulate bone marrow hematopoiesis, induce hematopoietic cell differentiation, and improve the body’s immune function and stress capacity, as well as benefit the qi and strengthen the spleen. Evil toxins are important pathogenic factors of MDS, including various pathogenic substances that can have toxic effects on the body, such as the six sexes, epidemic toxins, drug toxins, etc. Whether these evil toxins can cause disease depends to a large extent on the strength of the body’s positive qi, especially the functional status of the spleen and kidneys. “If the righteous qi exists within the body, the evil cannot dry up; where the evil comes together, its qi will be deficient”. In low-risk MDS, although the positive qi is deficient, it can still fight against the evil toxin. We often combine western drugs such as androgens or the immunosuppressant cyclosporine to stimulate bone marrow hematopoiesis in the treatment of low-risk MDS, with good results. 2. High-risk MDS (IPSS intermediate-risk-2/high-risk type): This type is mostly seen in the RAEB type of MDS, which is still a problem in medical circles at home and abroad because of the high proportion of primitive cells, rapid transformation of acute leukemia, short survival time and great difficulty in treatment. High-risk MDS belongs to the categories of “deficiency labor”, “blood evidence”, “accumulation” and “acute labor” in Chinese medicine. At this stage, the patient’s positive energy is gradually declining, the evil toxin is advancing, depleting the Yin and blood, and increasing anemia can be seen; the toxin is embedded for a long time, and the disease gradually develops. Evil toxin is a pathological reflection of the deficiency of the spleen and kidney and the dysregulation of the internal organs. Evil toxin is a pathological product of the pathogenesis of MDS, appearing at any stage of the pathogenesis of MDS, and at the same time can be used as a pathogenic factor to aggravate bleeding and induce infection, forming a vicious circle with numerous changes and difficult to heal. The internal attack of evil toxins, which remain in the body, may affect the transformation of qi and blood, or cause disturbance of blood and delusion, or accumulate in the internal organs, or block the meridians, resulting in all kinds of evidence. Qi and blood deficiency, blood deficiency, blood veins and collaterals are not full, Qi deficiency, blood flow is not smooth, or Qi deficiency, blood deficiency, or blood heat forced blood delusion, blood overflow outside the veins, long time marrow sea stasis, blood stasis does not go, then new blood is not born. Therefore, in the treatment of high-risk MDS, we should emphasize the use of herbs to clear heat and detoxify the blood, invigorate blood circulation and remove stasis, and at the same time, supplement with products that strengthen the spleen and kidney, so as to eliminate evil without harming the righteousness, and help the righteousness to facilitate the elimination of evil. Commonly used herbs to detoxify and remove blood stasis, such as white flowered snake tongue herb, half branch lotus, small thistle, zhebei mother, trigonella, curcuma longa, wood steamed bun, fried danpi, danshen, jingtian panax ginseng, tiger cane root, stellaria, etc., should be used in large doses, together with products that strengthen the spleen and kidney, benefit qi and nourish blood, so that both the symptoms and the root can be applied and complement each other, so that the poison can be removed and the evil can be retreated, and the qi and blood can grow. A large number of experimental studies have shown that the drugs for clearing the evil toxins have the effects of inhibiting the abnormal proliferation of bone marrow, adjusting the immune function of the body, inducing the growth of differentiated hematopoietic stem cells, promoting the apoptosis of leukemia cells and accelerating the metabolism of bone marrow microcirculation, thus facilitating the normal hematopoiesis of MDS bone marrow. Because of the high risk of transformation of high-risk MDS into acute leukemia, the clinical treatment is usually combined with Chinese and Western medicine, Chinese medicine combined with Western chemotherapy, induction of differentiation therapy, etc., which can achieve better results. 3, urgent is to treat its symptoms: “urgent is to treat its symptoms” means that when the heat and toxicity are in full bloom, blood heat is delusional and manifests obvious bleeding and fever, because the condition is relatively urgent and progresses rapidly, we should quickly cast the agent of clearing heat and detoxifying, cooling the blood and stopping bleeding to treat the symptoms first, commonly used Rhizoma Dihuang Tang, Huang Lian Detoxification Tang, Qing Fei Defeated Poison Tang, Ten Ash San and other formulas plus and minus, commonly used drugs are The commonly used drugs are water hyacinth, raw earth, danpi, red peony, jiao mountain gardenia, cyperus, white foxglove, small thistle, Xianhecao, Jingtian Sanqi, fried yellow cypress, forsythia, antelope horn and so on. If there is also internal Qi blockage, you can add typhoid fever diarrhea heart soup, taking the meaning of “diarrhea of the heart is diarrhea of fire, diarrhea of fire is to stop the bleeding”, the bottom of the kettle is drawn, diarrhea of heat to stop the bleeding. The clinical evidence can be combined with blood transfusion, anti-infection, hormone and other treatments to quickly control the disease, until the heat and toxicity are removed, the fever subsides, and the bleeding is controlled, and then the later treatment is planned. At the beginning when the fever subsides and the blood stops, most of the symptoms are deficiency, often accompanied by coughing and phlegm, nasal congestion and runny nose, fever and sore throat, etc. At this time, it is appropriate to get rid of the external evil first, so that the evil can be removed and the right can be restored. We should use products to dispel cold, promote lung dispersal, dispel phlegm, disperse wind-heat and detoxify the throat as appropriate. This type of evidence is mostly a deficiency, the spleen and kidney qi and blood deficiency, and often have a tendency to bleeding, so do not use too much spicy emanation sweat, bitter cold diarrhea heat, harsh drugs, so as not to hurt the yin and consume the qi, blood consumption and blood, the clinical evidence is often used Jing Fang defeat poison, Yin Qiao San, Xiao Chai Hu Tang, three wo Tang, two Chen Tang and other additions and subtractions, commonly used drugs are fried wind, sizzling ephedra, almonds, orris, Qian Hu, scutellaria, system of half a summer, forsythia, plate of blue root The most common drugs used are fried fangfeng, sizzling ephedra, almonds, orris, scutellaria, scutellaria, semen, forsythia, panax notoginseng, dandelion, psyllium, fried heliotrope, etc., and supplemented with products that benefit the spleen and nourish the kidneys and blood, so that the evil is removed without harming the right. 4. The stomach is the sea of water and grain, the main intake and ripening, to descend for and, like to moisten but not dry, the spleen is the main transport and transformation, the spleen is the main clear, like to dry but not wet, the spleen and stomach for the pivot of the qi up and down, where food, drugs are not through the stomach intake, ripening, and the maintenance of human life activities, all rely on the water and grain essence of Qi and blood and Yin essence, and the water and grain essence of the transformation, and can not be separated from the spleen and stomach to play a normal transport function. Therefore, in the clinical evidence should pay great attention to protect the stomach qi, because MDS generally has a long duration of illness, the spleen and stomach deficiency, long-term medication is easy to hurt the spleen and stomach, once the spleen and stomach injury, the qi and blood biochemical source, the kidney essence lost water and grain essence filling, therapeutic drugs are difficult to work, the blood production function can not be restored, the so-called “stomach qi, a hundred drugs difficult to administer”. Therefore, among the prescriptions for strengthening the spleen and tonifying the kidney, clearing the evil toxins and activating blood circulation to remove blood stasis, we always add products that regulate qi to help transport and harmonize the stomach to resolve dampness, so as to achieve tonification without congestion and diarrhea without harming the middle, often taking Xiang Sha Liu Jun Zi Tang with addition and subtraction, such as Han Xia, Chen Pi, Cardamom Seed, Fried Citrus Aurantium and Perilla Leaf. In summary, the basic pathogenesis of MDS can be summarized as “deficiency of spleen and kidney as the root cause and internal stagnation of stasis and toxin as the symptoms”, that is, deficiency of positive energy is blamed on the two organs of spleen and kidney, and internal stagnation of evil energy is attributed to two causes of stasis and toxin. We use the formula of strengthening the spleen, tonifying the kidney, activating blood circulation and detoxifying the toxin as the main treatment for MDS, and have observed more than 100 clinical cases, with an overall efficiency of more than 76% [2] [3]. The current WHO typing of MDS and the IPSS system have more advantages than FAB typing in determining the prognosis of MDS, and the combination of TCM evidence-based treatment and Western medicine in the treatment of MDS does have better efficacy, so it is imperative to combine TCM evidence-based treatment with the latest typing of MDS and to conduct multicenter, controlled clinical trials to further develop a reasonable and recognized treatment plan, and at the same time to further develop TCM In the meantime, experimental studies on the targets of TCM such as immune regulation, differentiation induction, apoptosis promotion, and hematopoietic stimulation should be carried out, so that experimental studies and clinical trials can be closely integrated to further optimize the treatment protocols of TCM for MDS.