To observe long-term efficacy on Realgar as the main scheme in the treatment of myelodysplastic syndrome with multilineage dysplasia(MDS-MLD).Methods:A total of 130 patients with MDS-MLD admitted in Xiyuan Hospital of China Academy of Chinese Medical Sciences from August 2007 to April 2015 were retrospectively analyzed and collected as subjects.These patients were treated by Qinghuang Powder(containing Realgar and Indigo Naturalis)and decoctions and herbs of supplementing spleen and kidney for 36 months at least.Peripheral blood neutrophils(ANC)，hemoglobin(Hb)and platelet count(PLT)were taken as observation indicators and calculated before and after the treatment，then the improvement of hematology before and after the treatment was assessed，and efficacies in different groups of genetics were compared.Results:In the 130 patients，rates of complete remission，hematological improvement，stability and disease progression were 13.84%(18 cases)，61.54%(80 cases)，18.46%(24 cases)and 6.15%(8 cases)respectively; count differences in the ANC，Hb and PLT of MDS-MLD patients before and after the treatment were statistically significant(P<0.01); comparison on efficacy in three-line blood cells of peripheral blood showed statistically significant differences in the hematological improvement between Hb and ANC，as well as Hb and PLT(P<0.01)，but there was no statistically significant difference in the hematological improvement between ANC and PLT(P>0.05); there was no statistical significant difference in the hematological improvement in different groups of genetics(P>0.05).Conclusion:Realgar as the main scheme can improve peripheral blood in patients with MDS-MLD and has a better effect on erythroid cells.