I. Pathogenesis Lumbar disc degeneration is the basic pathogenesis of lumbar disc herniation. The lumbar intervertebral disc is one of the earliest degenerating organs in the human body, and its degeneration begins at about 20 years of age as an irreversible natural process that occurs with age. The degenerated disc has a reduced ability to resist pressure due to degradation of the proteoglycans in the nucleus pulposus and a reduction in polymerized water; the collagen composition of the annulus fibrosus is altered so that its ability to resist tension is reduced. The combination of the two causes the disc to reduce or lose its mechanical function of load absorption and stress dispersion. Based on the degeneration of the biochemical composition, the reduction or loss of biomechanical function leads to a series of changes in the annulus fibrosus such as fissures, fractures and even ruptures, which eventually leads to the protrusion of the nucleus pulposus, compression and irritation of the spinal cord and nerve roots, resulting in symptoms and signs of back and leg pain. As a result of this pathological change, the intervertebral disc becomes less elastic and resistant to pressure. Mild, repeated crushing injuries cause different degrees of tearing of the annulus fibrosus, forming a weak point from which the nucleus pulposus eventually protrudes. It is more common in males than females, and the age of onset is mostly middle-aged and elderly, which may be related to the fact that males are more involved in physical labor (especially underground work in mines) and degenerative disc degeneration; it is more common in the L 4/5 and L 5/S 1 discs, which may be related to the weight bearing of L 4/5 and L 5/S 1. The pathologic type is degeneration: mostly without clinical symptoms and signs. The decrease of water content in the disc is seen on MRI scan, and deformation or calcification is seen on CT. The degeneration type is an early change and is usually not confused with the protrusion type. Bulging: Bulging is a physiologic degeneration with a relaxed but intact annulus fibrosus and a crinkled nucleus pulposus that appears as the annulus fibrosus uniformly extending beyond the edge of the vertebral body endplate. Generally, there are no clinical symptoms, but sometimes recurrent low back pain can occur due to narrowing of the spinal space, instability of the vertebral segment, and secondary changes in the articular eminence, and rarely radicular symptoms. If combined with developmental spinal stenosis, it is manifested as spinal stenosis and spinal decompression should be performed. A bulging disc is a degenerative disc that decreases in height, with the peripheral annulus fibrosus symmetrically exceeding the normal physiological limits of the vertebral endplate edge. Theoretically, a bulging disc is a physiological degenerative process, and in the absence of other pathological factors, bulging may not produce symptoms. Data show that asymptomatic herniated discs are up to 30% of the population by CT, symptomatic ones are about 2%, and those requiring surgery are about 10% to 20% of the symptomatic ones. Most patients with lumbar disc herniation can recover with non-surgical treatment. Protrusion: The nucleus pulposus protrudes into the spinal canal through the fissure of the annulus fibrosus without rupture of the posterior longitudinal ligament, and the imaging shows a limited protrusion of the disc into the spinal canal, which may be asymptomatic, with some patients showing typical neurogenic symptoms and signs. This type can be relieved by conservative methods such as traction and bed rest, but the recurrence rate is high due to the poor healing ability of the fibrous annular fissure. Minimally invasive intervention is required when necessary. Extrusion: complete rupture of the annulus fibrosus and posterior longitudinal ligament, protrusion of the nucleus pulposus into the vertebral canal, with obvious symptoms and signs, extrusion is difficult to heal spontaneously, and the effect of conservative treatment is relatively poor, most of which require minimally invasive intervention or surgery. Free type (seqestration): the prolapsed nucleus pulposus is not connected with the corresponding intervertebral disc, and can be free to the upper or lower segments of the spinal canal and intervertebral foramen, etc. Its clinical manifestations are persistent nerve root symptoms or spinal stenosis symptoms, and a few may appear cauda equina syndrome, and this type often requires surgery. Conservative treatment is the basic treatment of LDH, and about 80% of LDH can be relieved or cured by conservative treatment. The aim of conservative treatment is to accelerate the decompression of inflammatory edema in the lumbar disc herniation lesions and irritated nerve roots, so as to reduce or relieve the irritation and compression of the nerve roots. Conservative treatment is mainly suitable for: 1, young, first attack or short duration of disease; 2, those whose symptoms can be relieved by themselves after rest; 3, those without spinal stenosis on X-ray examination. Conservative treatment for herniated disc includes absolute bed rest, continuous traction, physiotherapy, massage, massage, oral anti-inflammatory and pain-relieving drugs, and focal injection therapy, etc. The role of focal injection therapy is to reduce the inflammatory response of the nerve root, which has an efficiency of 76% for herniated type and only 26% for bulging type. Generally, the regular conservative treatment for 6-8 weeks has no effect on the consideration of other methods. 1, absolute bed rest, the most important. 2, can traction, but the initial traction can aggravate the clinical discomfort, to correctly understand it. 3.Local physiotherapy and hot compress. 4.Non-steroidal pain medication, hormonal drugs can be added appropriately in the acute stage, the effect is better, usually 3 days that is, but now many people do not advocate the application of hormones. 5.If the above methods are not effective, epidural closure or sacral canal treatment can be done. 6, avoid physical labor during the recovery period Chinese medicine conservative treatment 1, correct the cause of the patient (such as: poor sitting posture), 2, orthopedic massage > acupuncture (available nerve root electroacupuncture) > the usual patient practice (lumbar back muscle training) 3, severe cases can be epidural anesthesia + hormone after the large massage 4, water Chinese medicine internal and external application Hello, everyone, the body is the capital of the revolution, I hope you work hard at the same time can pay attention to their I hope you can pay more attention to your own body at the same time, healthy and healthy, if once the body has any discomfort, remember to treat early ha.