Lumbar disc herniation is a common cause of low back pain. There are many ways to treat this disease, each with its own characteristics, and some therapies can be used in place of each other or in conjunction with each other, but the important thing is to grasp the mechanism and indications in order to achieve the best results. In the past 20 years, the emergence of needle knife therapy combines the strengths of Chinese and Western medicine, in the treatment of a variety of chronic soft tissue injury disease has achieved satisfactory results, in the treatment of lumbar disc herniation has also obtained more satisfactory results. Generally speaking, it is difficult for needle knife to enter into the vertebral canal and make a direct action on the herniated disc, but needle knife can effectively relieve some parts of the lumbar and leg pains and make the lumbar and leg pains relieve or disappear, which is confirmed by clinical practice. According to the author’s clinical experience of the needle knife, that the needle knife treatment of lumbar disc herniation can be at least from the following three aspects. 1, needle knife can be corrected through the lumbar spine joints and lumbar nerve after the pathological changes to lift the lumbar pain lumbar disc and its corresponding pair of lumbar spine joints after the “trinity”, constituting a functional unit. After lumbar disc herniation, the intervertebral space becomes narrow, the upper and lower articular synapses are shifted wrongly, and the diameter of the intervertebral foramina decreases both upward and downward and the anterior and posterior diameters of the foramina, so that the nerve roots are easy to be squeezed. At the same time, it can also cause the lumbar posterior joint dysfunction and lead to injury. Evidence suggests that simple mechanical compression of the nerve root only causes numbness in the innervated area of the nerve root, but only when accompanied by aseptic inflammation around the nerve root, typical low back pain occurs. These inflammations can be caused by traumatic synovitis resulting from trauma to the posterior lumbar joints. Posterior lumbar joints are synovial joints, and like other synovial joints, the injury can cause inflammatory reactions such as congestion, edema, and fluid accumulation, and the formation of chronic synovitis can lead to synovial membrane hypertrophy, hyperplasia, and contracture. One of the thinking points of needle knife treatment of lumbar disc herniation is how to make the nerve root and the surrounding aseptic inflammation be effectively controlled. Clinically, it can be seen that patients with asymptomatic lumbar disc herniation, or patients with symptoms of low back and leg pain relieved or disappeared after treatment, may have symptoms recurring or aggravated due to “flashing waist”, but the herniated disc did not aggravate on imaging examination. In addition, some patients with herniated discs that are calcified and have little possibility of further herniation may experience symptoms due to lumbar injury. Injury to the postvertebral joint at the herniated disc and secondary aseptic inflammation is one of the major causes of lumbar disc herniation symptoms. The lumbar spinal nerve exits the intervertebral foramen and divides into three branches, namely, the spinal branch, the anterior branch and the posterior branch. The posterior branch travels posteriorly and divides into the posterior medial branch and posterior lateral branch through the bone fiber foramen to the medial edge of the transverse intervertebral muscle. The posterior medial branch is thinner, and after the posterior branch branches out, it goes around the lateral edge of the superior articular process, enters the osteofibrous canal between the mastoid process and the paracentral process, and goes behind the vertebral plate, and distributes in the structures on the medial side of the posterior articular line, such as the interspinous muscle, the multifidus muscle, the ligamentum flavum, the posterior articular capsule, the supraspinatus ligament, the interspinous ligament, and so on. After lumbar disc herniation, the wrong displacement of the upper and lower articular processes can make the posterior medial branch of the lumbar nerve twisted and pulled, and the acute inflammatory stimulation around the posterior joints and the adhesion and contracture caused by chronic inflammation can make the posterior medial branch of the lumbar nerve pressurized and stimulated, resulting in low back pain. If the posterior lateral branch of the lumbar nerve is involved, it can cause lumbar hip pain. Since the posterior lumbar joints and the nearby posterior medial and lateral branches of the lumbar nerve are located in a safer place, it is easy for the needle knife to reach and operate, therefore, starting from the posterior lumbar joints and the posterior medial and lateral branches of the lumbar nerve is one of the aspects of the treatment of lumbar disc herniation by the needle knife. 2, needle knife can be used to reduce the tension of the nerve root by loosening the lumbar intervertebral foraminal fibrous septum and the attachment of the nerve root fibrous bundle. The lumbar spinal nerve root leaves the dura mater to the intervertebral foraminal foramen to pass through a bony fibrous tube, which includes two parts, i.e., the lateral saphenous fossa and the foramen magnum that extends outwardly and downwardly from it. Inside the foraminal canal, there are not only nerve roots, intervertebral arteries and veins, but also some fibrous compartments composed of connective tissue. The fibrous septum attaches to the root of the transverse process and the intertransverse ligament at the outer portion of the foramen ovale, dividing the outer portion into upper and lower foramina, and the lumbar nerve root passes through the lower foramen. The area of intervertebral foramen and nerve root seems to be a big difference, especially in the longitudinal direction than the transverse direction, which seems to have a larger space for movement, but in fact, the intervertebral foramen is keyhole shaped, and the effective space is very small, coupled with the fibrous septum in the intervertebral foramen, the nerve root is fixed in a narrower aperture, especially in the lower lumbar vertebrae, the fibrous septum is in a low position and thick, which hinders the nerve root’s The lumbar nerve roots are transmitted from the dural sac to the lumbar spine. The lumbar nerve root emanates from the dural sac and is encircled by the dural sheath sleeve. On the medial side, the sheath sleeve is attached ventrally to the posterior longitudinal ligament and the posterior periosteum of the vertebral body by Hofmann’s ligament, and on the lateral side, the nerve root is attached externally to the external foramen by a fibrous fascia. These attachments of the nerve root are also the cause of tension injury to the nerve root when the lumbar disc herniation prevents the nerve root from avoiding. Using needle and knife to cautiously loosen the fibrous septum and nerve root fibrous band attachment near the root of transverse process of lumbar vertebrae and the outer mouth of intervertebral foramen can relax the over-distracted nerve root and relieve the low back and leg pain. 3.Acupuncture and knife therapy can loosen the secondary nerve compression points to eliminate lumbar and leg pain. The causes of lumbar disc herniation leading to lumbar and leg pain are various, but mechanical compression is still considered to be the most important aspect. It is reasonable to assume that lumbar disc herniation is a nerve compression injury. Scholars at home and abroad have noticed that, in addition to the corresponding clinical symptoms caused by the proximal side of a nerve compression or injury, it can also make the distal side of the nerve to the compression injury susceptibility to increase the original does not cause nerve damage compression and pulling, which can make the nerve compression injury, and is called the nerve double card syndrome. It is also possible to see multiple compression injuries to a single nerve, which can be called nerve polycarp syndrome. It is currently believed that the mechanism of this type of lesion is the obstruction of neuraxial flow due to compression. From the clinical point of view, there is a “Doka” mechanism in lumbar disc herniation. From the clinical manifestations, lumbar disc herniation caused by neuralgia, not along the entire nerve root fibers to a balanced degree of pain, but to its branches of the pathway is easy to pressure for the pain of common, such as ① lumbar spinal nerve posterior branch and the posterior medial branch of the pathway of the transverse processes of the root and paramedian – mastoid interosseous fibrous tube is easy to pressure, the clinical production of lumbago and lumbar paravertebral pressure pain. ② L4, L5, S1 nerve root fibers form the superior gluteal nerve, and the superior gluteal nerve is prone to be compressed after crossing the upper edge of the sciatic foramen and reflexed upward, clinically, gluteal pain and gluteus medius muscle tension and tenderness of the bundles. The superficial peroneal nerve crosses the surface of the fibula obliquely and is easily compressed, resulting in numbness and pain on the lateral side of the calf. For lumbar disc herniation, the above three parts of the compression is a common cause of low back pain, can be understood in this way, the herniated disc on the nerve root compression is the primary compression, and the latter of the three parts of the compression can be understood as secondary compression. When the primary compression and secondary compression affect the nerve axial flow to a certain extent, clinical manifestations appear. In patients with lumbar disc herniation, if the nucleus pulposus is removed at an early stage, the disappearance of low back pain symptoms after the operation is often more complete. For patients with longer duration of disease, after nucleus pulposus removal surgery, many patients have some residual symptoms, and the above three parts are more common, which is called post-surgical syndrome, often making the operator feel regretful for not knowing the reason. This can be explained from the point of view of neural Doka syndrome. In the early stage of lumbar disc herniation, the secondary compression point is manifested as acute neuritis, and after the removal of the disc as the cause of the primary compression, the pathological axial flow is corrected, and the nerve fiber resistance to pressure is corrected, and the secondary compression sign disappears accordingly. In the case of lumbar disc herniation of long duration, the secondary compression point is characterized by chronic inflammatory changes, local adhesions, hyperplasia, and scar formation. Although the primary compression is lifted, the secondary compression point is not lifted due to its own pathological changes and local nerve compression. Experimentally, it was proved that the axial flow was bi-directional, the upper compression could affect the lower axial flow, and the lower compression could also affect the upper axial flow. Correction of the upper compression can improve the lower axial flow, and correction of the lower compression can improve the upper axial flow. The effectiveness of non-surgical treatment of lumbar synostosis has been clinically proven, and its mechanism is multifaceted. If explained from the above mechanism, it can be thought that methods such as acupuncture, tuina, physiotherapy, body therapy, etc. have the effect of improving axial flow, increasing the tolerance of nerve fibers to the compression, thus preventing or reducing the formation of secondary compression points, and further improving the axial flow of the whole nerve fiber, which reduces or disappears the clinical symptoms. In the past 10 years, the authors have tried to treat more than 300 cases of lumbar synostosis and nearly 100 cases of post-surgical lumbar synostosis with needle-knife as the main treatment to loosen the secondary compression points, and have obtained satisfactory curative effects. From the mechanism of nerve Doka injury, it can be concluded that the treatment of lumbar synostosis by releasing the secondary compression points is not a simple cure for the symptoms of lumbar synostosis. Needle knife therapy can be used in various types and stages of lumbar disc herniation, the important thing is how to determine the patient’s specific pathological changes, and develop a corresponding treatment program.