Restless legs syndrome (RLS), also known as Ekbom syndrome, usually presents with extreme discomfort in both lower extremities during sleep at night, forcing the patient to keep moving the lower extremities or walking on the floor, resulting in severe sleep disturbances. Although the disease is not life-threatening, it seriously affects the quality of life of patients. Foreign epidemiological data show that the prevalence is 1-10% of the total population, and the prevalence in China is estimated to be around 1.2-5%, common in middle-aged and elderly people. It is a more common disease, and its incidence is much higher than other neurological diseases, such as multiple sclerosis, Parkinson’s disease or Alzheimer’s disease. I. Classification There are two major categories: primary and symptomatic. 1. Primary restless legs syndrome The cause of this type is unknown, and a few patients have a family history. 2. Symptomatic restless legs syndrome RLS is also secondary to other diseases and is commonly caused by the following: uremia, iron deficiency anemia, folic acid deficiency, pregnancy, rheumatoid arthritis, Parkinson’s disease, multifocal neuropathy, metabolic diseases, and medications. II. Clinical manifestations Clinical features are a spontaneous, unbearably painful abnormal sensation occurring in the lower extremities. It is most common in the gastrocnemius muscle, and can occasionally occur in the thighs or upper extremities, usually symmetrically. Patients often complain of a tearing, creeping, tingling, burning, painful or itchy sensation deep in the lower extremities. Patients have an urgent and intense feeling of needing to move and this leads to hyperactivity. Symptoms occur at rest and can be partially or completely relieved by activity. Normally, symptoms become intense at night while lying in bed and peak after midnight, forcing patients to kick their legs, move their joints or massage their legs, often describing “not having a comfortable place to put their legs.” In severe cases, the patient has to get up and walk constantly to get relief. As a corollary, most patients experience periodic movements of sleep (PMS), a stereotypical, repetitive flexion of the legs that occurs during REM sleep and wakes the patient. As a result of nocturnal sleep disorder, the patient suffers from severe daytime sleepiness and reduced work capacity. III. Diagnosis and differential diagnosis Diagnostic criteria: The International Restless Legs Syndrome Study Group (IRLSSG) has developed a minimum diagnostic criteria consisting of four symptoms. 1. Abnormal sensations: Indescribable discomfort in the limbs leads to a strong desire to move the limbs, mainly the lower limbs. These abnormal sensations often occur deep in the limbs rather than on the surface, such as the skin. 2. Motor symptoms:The patient cannot sleep and keeps moving the limbs to relieve the abnormal sensations. The main manifestations are walking back and forth, constantly shaking or flexing and extending the lower limbs, or rolling around in bed. 3. The symptoms are aggravated at rest and can be temporarily relieved by activity. 4. The symptoms are aggravated at night and reach a peak late at night. The causes of restless legs syndrome are complex and unknown in Western medicine, but the following factors are thought to be related to its development. 1, genetic factors Ekbom (1960) believes that the onset of RLS is related to genetic factors, 43% of his reported patients have similar diseases in their relatives, and there are several families with dominant inheritance. 2. Local ischemia theory RLS mostly occurs at quiet rest, and it can also develop after working in cold environment for a long time, and the symptoms can often be relieved after activity, pressing, pounding local muscles or applying vasodilators. Some patients’ limb hemograms also show reduced blood flow. Based on the above facts, many scholars believe that this disease is due to the local tissue blood circulation disorder, resulting in tissue hypoxia and metabolite accumulation. 3. Endocrine factors RLS is also common in pregnant women. Jolivet (1953) reported that 27% of pregnant women had RLS. 4, metabolic and nutritional disorders Serious RLS is mostly complicated by diabetes, uremia, ethanol poisoning, carcinoma, hypercholesterolemia and hematoporphyria, so it is thought that it may be a metabolic peripheral neuropathy caused by metabolic disorders. It is also thought to be related to anemia and iron deficiency. In 77 cases of this disease reported by Ekbom (1966), 1/4 of the serum iron was below normal; Aspenstrom (1964) reported that 42% of 80 patients with iron deficiency found in health examination had RLS; Behrman (1955) confirmed that the discomfort of patients with this disease improved significantly after oral or injection of iron. 5.Other etiologies Partial venous thrombosis and varicosities in the lower extremities, partial gastrectomy, taking phenothiazines and barbiturates, and having psychiatric factors such as anxiety or depression have all been reported to have some relationship with this disease. In terms of pathogenesis, TCM believes that restless leg syndrome is closely related to the liver, which is the master of tendons and blood collection. If liver blood is insufficient, the tendons and veins are not nourished, and discomfort such as limb soreness and numbness may occur. The common clinical causes of TCM are: 1, deficiency of qi and blood, old age and weakness, or long illness, depletion of qi and blood, or after blood loss, deficiency without recovery, or weakness of the spleen and stomach, unable to transport water and grain to biochemistry of qi and blood, resulting in deficiency of qi and blood, unable to warm the four ends, poor blood flow and produce abnormal sensations such as soreness, numbness, burning. 2.Liver and kidney deficiency Insufficient innate endowment, or old age deficiency, or long term disease loss of nourishment, or excessive room labor, resulting in liver and kidney deficiency, tendons and muscles lose nourishment and produce abnormal sensations such as soreness, numbness, swelling and pain. 3.Blood stasis blocking the ligaments Old age, physical weakness, or Yang deficiency, or chronic illness, or emotional disorders, or bruises and trauma lead to dysfunction of the internal organs, and poor blood flow, resulting in blood stasis, blocking the vasculature and producing deep discomfort in the limbs. 4, dampness paralysis, weakness, old age and physical decline, lack of vitality, couples are not dense, not solid, or because of dampness, wading in water and rain, etc., cold and dampness invasion, cold stagnation lead, dampness agglutination does not change, resulting in poor blood flow; or because of dampness and heat to move the order. 5, cold and dampness for a long time into heat people feel this evil, blocking the meridians, tendons and muscles lose moisten and produce soreness and discomfort and other abnormal feelings. V. Treatment of restless legs syndrome Restless legs syndrome is a common clinical disease of restless legs, especially serious at night or before going to sleep, the conventional treatment of restless legs syndrome includes Chinese and Western medicine treatment, etc.: 1. General treatment Before going to bed, wash the feet with warm water, or wash the lower limbs with mugwort water. Massage the local muscles. 2, symptomatic treatment If anemia is present, correct the anemia. If the attack occurs during pregnancy, the symptoms can disappear after delivery. 3.Medication â‘´Inositol 1g, take it once a night. (2) Use vasodilators, such as niacin, scopolamine 5mg for treatment. 1 time daily. (3) Use dopaminergic drugs or dopamine agonists, such as methyldopa 125-250mg, Sinemet 125mg, once a day. Less commonly used in China. Dobutamine 0.0625mg,3 times a day, gradually increase the amount. (4) Antispasmodics such as carbamazepine or sodium valproate, both 0.1g, once before bedtime. (5) Use vitamin B1 100mg, vitamin B2 50mg, alternately injected in the body surface area of the commission, Chengshan or along the peroneal nerve stem, one point of the affected limb once a day, 5 days as a course of treatment. From the perspective of traditional Chinese medicine, the basic etiology and pathogenesis of restless leg syndrome is the deficiency of the righteousness and the love of the evil, the unfavorable local meridians, and the loss of nourishment of the muscles and tendons, which are mainly reflected in the following aspects: (1) the entry of external evil into the middle: the onset of paralysis of the lower extremity meridians due to the lack of solidity of the guard qi, the feeling of wind and cold and other external evil, and the incompletion of the evil qi. (2) Dampness paralysis (2) Paralysis by dampness: if the diet is not in order, excessive labor, emotional disorders, drug injury, etc., resulting in the loss of spleen health, dampness, stagnation of the lower jiao, or over time dampness into heat, dampness and heat down to infiltrate the muscles and tendons, resulting in the onset of the meridian qi. (3) Blood stasis and obstruction: deficiency of meridian qi, astringent stagnation of yin and blood, disharmony of Ying and Wei, stasis and obstruction of the veins and channels in the lower extremities, or prolonged illness, unfavorable meridian qi, stagnation of qi and blood stasis. (4) Liver and blood deficiency: liver yin deficiency, blood does not glorify the meridians, tendons and veins lose nourishment and develop. (5) Kidney weakness: Mostly due to long-term illness and old age, kidney deficiency, or deficiency of yin essence, and the onset of disease due to deregulation of the meridians; or weakness of kidney qi, internal movement of water qi, and rebellion of qi. In Chinese medicine, patients need to be treated according to their specific conditions, such as dispersing cold and dispelling dampness if they feel wind, cold and dampness, activating blood circulation and removing stasis if blood vessels are stagnant, and tonifying liver and kidney if liver and blood are insufficient. In addition to taking medication, acupuncture can also be used to assist in the treatment, which will achieve twice the effect with half the effort. Body acupuncture (a) Acupuncture points Main acupuncture points: 2 groups: 1, arm middle; 2, blood sea, Yanglingquan, Sanyinjiao, Taixi. Supporting points: foot San Li, Wei Zhong, Cheng Shan. Location of arm middle points: inner forearm, midpoint of the transverse wrist and elbow, between the two tendons. (B) Treatment: Take only one set of main points, and add matching points if the effect is not good. In the middle of the arm, the needle is inserted 2.5-4.0 cm, and the needle is removed after 3 minutes of twisting and tonicity. Foot Sanli, Yanglingquan, Chengshan, Blood Sea, and Zhizhong are stabbed straight 1-1.5 inches, so that the needle sensation is transmitted upward or downward; Taixi is stabbed obliquely 0.5-1 inch upward, so that the needle sensation is transmitted upward, and the above points are twisted and tonicized after obtaining qi, and the needle is retained for 10 minutes. 7 times is a course of treatment, with an interval of 3-5 days. Pick treatment plus acupuncture point injection (a) Acupuncture points Main points: Huanjiao, Chengfu, Yinmen, Fengshi, Zhizhong, Guiyang, Huiyang, Chengjian, Chengshan. Supporting acupuncture points: A-Ye acupuncture point. Location of the A-Ye point: take the point on the line from the point in the middle of the committee to the heel of the foot. (B) Treatment: Combination of picking and acupuncture point injection. The main acupuncture point is treated by picking 2 points each time, after routine disinfection and local anesthesia, piercing the skin with a picking needle, picking up the skin face, pulling and swaying it, with a pulling frequency of about 30 times/min. After picking with sterile cotton ball compression to stop bleeding, with a small piece of sterile gauze applied externally and fixed with adhesive tape. Acupoint injection solution: 6ml of 5% angelica injection, 2ml of rheumatism injection, 200mg of VB1 injection, 1000mg of VB12 injection, 2mg of dexamethasone injection, and 4ml of 2% procaine, mix the above solution and take 2 to 3 points of the ayurvedic point for acupoint injection. The above method are every other day 1 time, 10 times for a course of treatment. The two methods can be applied separately or combined. Warm acupuncture plus head acupuncture (a) Acupuncture points Main acupuncture points: Ah Yes point, Foot San Li, Feng Long, San Yin Jiao, Blood Sea, Wei Zhong, Yang Ling Quan. Supporting points: foot transport sensory area, sensory area (upper 1/5). (b) Treatment: Main acupuncture point alone or a combination of main and supporting points. At the main point, use the warm needle method, pierce with a 28-gauge 1.5-2 inch needle and perform a twisting and lifting technique after obtaining the qi, tonic method or flat tonic and flat diarrhea method, insert a section of moxa about 1.5-2 cm long on the needle handle, or pinch an olive-sized moxa ball and light it from the small end, the former burning a strong, the latter must be 2-3 strong. Burn out the ashes and remove the needle. With the same milli-needle point, about 15-30 degrees angle with the scalp along the skin into 3cm, after reaching the length, twist quickly, twist frequency of 200 times / min, twist amplitude should be large, require forward and backward to make the needle 2 ~ 3 turns each. Retain the needle for 30 minutes, every 3 to 5 minutes twist 1 time. The above method is generally 1 time every other day, 7 times for a course of treatment, the course of treatment interval of 3 to 5 days. Acupuncture (I) Acupuncture points Main acupuncture points: 3 groups: 1) Foot San Li, Cheng Shan, Jie Bone; 2) Yang Ling Quan, Xie Xi, San Yin Jiao; 3) Wai Qiu, Wei Zhong, Ba Feng. (II) Treatment Each time a group of points is taken, after entering the needle, the patient is made to have a sore and heavy or slight radiating sensation locally or in the calf, then a flat tonic and flat diarrhea technique is applied, the needle is left for 30 minutes, and after the needle, a moxa stick is used for mild moxibustion for 5 minutes, to the extent that the skin is flushed. Once a day, 10 times as a course of treatment. Six, the general care of restless legs syndrome Restless legs syndrome patients in addition to adhere to drug treatment, in ordinary life some attention is also very important, in life need to pay attention to the following matters: 1, first of all, it is necessary to maintain a good state of mind. Depression and anxiety can aggravate the symptoms of restless legs syndrome. 2, to rationalize life and work. Because the symptoms of restless legs can also appear during the day when they are stationary, patients should pay more attention to the environment they are in and take appropriate protective measures. For example, in theaters and theatres, it is best to choose seats adjacent to the aisles when flying, so that you can stand or walk at any time when the symptoms appear, in order to reduce discomfort. 3, adjust the way of sleep. The symptoms of restless legs syndrome mainly occur in the evening and during nighttime sleep, so intentionally delay sleep until sleepy and then rest, avoid reading scary and stimulating texts or videos before going to bed, you can do some appropriate exercise before bedtime, especially for the legs. 4, pay attention to temperature changes. Most patients feel that cooler weather and humid climate will aggravate the symptoms of restless legs syndrome, so the night sleep should be kept warm environment. 5, avoid exposure to stimulating substances nicotine, caffeine and other substances have the function of excitement of the nervous system, these may aggravate the symptoms of restless legs syndrome. Seven, restless legs syndrome exercise Many people have developed the habit of good static and bad movement for many years, suffering from restless legs, but some patients say that since they know they suffer from restless legs, every day at least adhere to jogging 4 kilometers, how the legs more difficult at night? Elderly friends should pay attention, adhere to exercise, develop good habits, pay attention to strengthen the leg exercise, such as walking, jogging, squatting, kicking legs, etc.. Help to improve the symptoms of restless legs, but must be moderate, not too fatigue. At the same time, every day early in the morning or before bedtime after washing the feet with the hands rub the heart of the feet until hot and red, to help improve the blood circulation and nutritional status of the legs, to prevent numbness, cold and other symptoms of ischemia. Secondly, pay attention to a balanced diet, eat less meat dishes and more vegetarian dishes. Having a smoking habit should be quit, and also prevent passive smoking to reduce the harmful effect of nicotine on blood vessels. Medically speaking, light patients generally do not need treatment, but should pay attention to avoid fatigue, cold and trauma, and not to take the above-mentioned drugs with triggering effects; if they suffer from anemia, diabetes and other diseases, they should be actively treated. In severe cases, prompt medical attention is required.