Patient: In March 2000, he turned to qigong practice because he was anxious due to a bad job, and in September he developed hallucinations and hallucinations, and at that time some of his thinking and behavior were governed by hallucinations. He was hospitalized for 4 months, and his condition improved. Six months later, he reduced his medication (clozapine) to a maintenance dose of 2 tablets/day. Two years later the voices reappeared, immediately added some medication and the voices disappeared again. The sound would come back after the medication was reduced. This goes back and forth. Especially in the last two years, probably due to work stress, the amount of clozapine had to be increased to 14 tablets/day to reduce or suppress the voices, but it did not completely eliminate them. The patient is able to work normally and has normal intelligence and cognition. At present, he can also recognize and judge correctly what he hears (mostly cursing or judgmental male voices). He has been taking clozapine and hepatoprotective drugs (biphenyldiphenhydramine), but repeatedly, the hallucinations cannot be cured. Dr. Jiang has rich experience in this difficult disease, I would like to ask three questions: 1, increase the dosage of drugs seems to be able to stop the hallucinations for a period of time, and when they appear again, they have to be even greater, so the vicious cycle continues, the patient will become Is there any good solution? 2. On the Internet, some people do not support the use of western medicine (because of the side effects), but suggest the use of Chinese medicine, saying that Chinese medicine can prevent recurrence. 3. There are a few cases of this disease that can be cured, and I wonder under what circumstances it can be cured? The first thing is that there are obvious problems with the treatment of this patient. The main problem is the lack of treatment, which is a common problem in the treatment of schizophrenia. Usually, as in this case, once the effect of treatment appears, the medication is quickly reduced and maintained at a very low dosage. In this way, schizophrenia recurs, and the difficulty of treatment increases with each recurrence of schizophrenia, requiring a larger amount of calcium for treatment and a poorer outcome. The more likely it is to be completely cured, the more likely it is to require lifelong medication, and the more certain symptoms can no longer be cured, and the more social functioning deteriorates. Therefore, the key to the treatment of schizophrenia is still the principle of “adequate dosage and adequate course of treatment”. Specifically, the dose of anti-schizophrenic drugs chosen should be sufficiently large and should last for 4-6 weeks. Observe the efficacy of the treatment. Once effective, they must be maintained at high doses for at least 6 months. Long-term maintenance therapy (5-10 years or lifelong medication) should be at a high dose rather than a low dose. The minimum dose should not be lower than the therapeutic window of the drug (200 mg/day for clozapine). For the current second-generation antipsychotics, many experts at home and abroad believe that the maintenance dose can be the same as the acute phase, i.e., no reduction in maintenance, because of the low side effects and high safety level, compared to a highly disabling disease like schizophrenia. Specifically in this case, the use of clozapine has created a huge obstacle to further treatment (clozapine should not be used as much as possible, and should not be used as a last resort. There are many reasons for this, so I won’t go into detail here.) . For this case, there are two options; 1, continue to use clozapine, increase the dosage to 400-500mg / day, 4-8 weeks to judge the effectiveness, and then continue to use more than 6 months. Later, due to the side effects of the drug, the dosage can only be reduced to maintain, but preferably not less than 200mg/day. 2. Switch to a second-generation antipsychotic drug with fewer side effects (Quetiapine – Seroquel), which is widely used at home and abroad. The dose should be gradually increased to 600-800mg/day. After 4-8 weeks of judging the effectiveness, this high dose will be maintained for a long time. At the same time, clozapine can be maintained at 50-25mg/night (according to a lot of experience at home and abroad, it is difficult to stop clozapine once it is used. Otherwise, it will cause serious attacks of the disease.) The above views are for reference only. Therapeutic use must be carried out under the guidance of a specialist, and the patient’s side effects should be closely observed. In addition, there is no evidence that TCM is beneficial in treating schizophrenia! Do not let this delay the treatment of your loved one’s illness. The key to curing schizophrenia is early diagnosis and treatment, and controlling the disease at once. No relapse and few relapses. Social functioning is intact, with no symptoms. Continuous treatment for more than 5-10 years. Schizophrenia is a biological disease, not a psychological disease, and therefore cannot be treated only with so-called psychotherapy. The core of treatment is antipsychotic drugs. Psychotherapy can only be an adjunctive tool. Diagnosis and treatment of psychiatric disorders must be carried out in a regular psychiatric hospital. If necessary, the diagnosis and treatment plan can be clarified and decided at several famous specialized hospitals in China. Mental health centers at the provincial level have improved rapidly in recent years and are also available.