Xu Moumou, male, 42 years old. Main cause of lumbar pain, can not do a large bending movements, sedentary, standing or get up in the morning after the activities are limited, lumbar pain aggravated by labor and occasionally to the right lower limb radiating distension for more than 10 months, has been to a number of hospitals to do the MRI, CT, according to the lumbar 4/5, lumbar 5 sacral 1 intervertebral disc herniation treatment, the effect is not ideal. He was introduced to our clinic by a friend. After questioning, palpation, reading the film and communicating with the patient in depth, I gave the diagnosis of “third lumbar transverse herniation syndrome”. Lumbar disc herniation” was excluded. The patient felt that half of the symptoms had disappeared after one treatment with three-pronged needle puncture, fire cupping and acupuncture, and recovered from 10 successive acupuncture treatments. This is a case of “third lumbar transverse herniation syndrome” misdiagnosed as “lumbar disc herniation” in my clinic. Because the former doctor only considered the diagnosis of MRI and CT and the similar clinical manifestations of “third lumbar transverse herniation syndrome” and “lumbar disc herniation”, he did not pay attention to distinguish the small differences in the Cosmos, which led to the misdiagnosis and the patient remained untreated for more than 10 months. Therefore, it leads to misdiagnosis and the patient remains untreated for 10 months. According to the survey, the reason why a considerable number of patients with “lumbar disc herniation” remain untreated is not because they have not found the right treatment, but because they have been misdiagnosed. The phrase “knowing the constant and reaching the change” comes from “Huangdi Neijing – Diagnosis Method”. It refers to the understanding of things through the mastery of the general law, and then understand the specificity of things, so as to achieve the purpose of comprehensive understanding of things. First of all, we should figure out a few medical terms. In the CT or even MRI report, you will often see the words “lumbar disc bulge”, “lumbar disc herniation”, “lumbar disc prolapse”. What do the words “bulging”, “herniated” and “prolapsed” mean? Then there is “herniated disc”. A “lumbar disc bulge” refers to the degeneration and relaxation of the intervertebral disc, with the peripheral annulus fibrosus uniformly exceeding the edge of the vertebral body endplate, and the disc bulging backward in the sagittal plane of the MRI. “Lumbar disc herniation” refers to localized rupture of the annulus fibrosus of the intervertebral disc, with the nucleus pulposus protruding through the annulus fibrosus fissure and forming a limited bulge in the vertebral body posteriorly into the spinal canal. Herniated discs can occur in up to 30% of the normal population. A “lumbar disc prolapse” is a complete rupture of the annulus fibrosus in which the degenerated and fragmented nucleus pulposus prolapses from the annulus fibrosus fissure and crosses the posterior longitudinal ligament to reach the epidural space. “Lumbar disc herniation, also known as lumbar disc fibrous ring rupture or lumbar disc nucleus pulposus prolapse, refers to the lumbar intervertebral disc degeneration, due to some reasons lead to the fibrous annulus rupture partially or completely, together with the nucleus pulposus and outward expansion, compression of the nerve roots and the spinal cord, resulting in simple lumbar pain, simple sciatica, or simple low back pain and sciatica, or simple low back pain and sciatica. Lumbago and sciatica coexist, or cauda equina compression is the typical manifestation. Symptoms may be relieved when resting, but the pain is aggravated when bending, squatting, coughing and straining. The pain is most common in the buttocks and thighs, and the abnormal sensation is most common in the calves. Lumbar disc bulging, herniation, and prolapse are all pathological changes caused by degenerative disc changes, and only differ in the degree of pathological changes. In contrast, lumbar bulging discs can be cured from a pathological point of view (the bulging can disappear in CT and MRI examinations), while lumbar herniated discs and prolapsed discs can only be cured from a clinical point of view (the disappearance of symptoms, but the herniation and prolapsed discs are still present in CT and other imaging examinations). After learning about lumbar disc herniation, let’s talk about the common conditions that are most likely to be misdiagnosed as lumbar disc herniation in clinical practice. In addition to the previously mentioned third lumbar transverse process syndrome, conditions such as gluteal epiphyseal nerve entrapment syndrome, ischemic necrosis of the femoral head, interspinous ligament strain, gynecological pelvic conditions, and lumbar spine tumors and verrucous lesions are also relatively common. It is not uncommon for third lumbar transverse process syndrome to be misdiagnosed as lumbar disc herniation in clinical practice. This is because the third lumbar vertebra is located in the middle of the lumbar spine, its transverse process is the longest, with a large backward curvature, and many muscles and fascia of the lumbar dorsal and abdominal regions are attached to it, forming the hub of lumbar spine activities and stress center, which is easily damaged by the pulling of muscles and fascia, and is prone to be pulled and abraded when the lumbar spine flexes anteriorly and bends to the opposite side, which will lead to pain and numbness of the innervated area. It may involve the anterior branch and cause radiating pain to the hip and anterior thigh, and in a few cases, to the perineum. If it is gluteal epithelial nerve entrapment syndrome, its clinical manifestations are lumbar pain and buttock pain, which can spread to the thighs and cochlear fossa, but seldom involves the calf; there are obvious pressure points under the margin of the iliac crest outside and above the posterior superior iliac spine, and sometimes striated, nodular or small lipomatous tumor-like pathologic reaction can be detected; it can be accompanied by gluteal muscle spasms. Closure of the affected area can immediately eliminate the pain. There are no signs in the lumbar region, and the straight leg raising and strengthening tests are negative, so it is possible to exclude lumbar disc herniation as long as you are attentive. According to the statistics, among the cases of ischemic necrosis of the femoral head misdiagnosed or omitted, those misdiagnosed or omitted as lumbar intervertebral disc herniation accounted for about 48.33%. Ischemic necrosis of the femoral head can be manifested as hip and knee pain, pain or functional limitation of passive activities of the hip joint, positive straight back elevation test, no neurosensory abnormalities and tendon reflex abnormalities, if you don’t carry out a detailed hip examination to understand the functional activities of the hip joint such as hip flexion, internal rotation, external rotation and so on, the hip and knee pain is very easy to be misinterpreted as lumbar intervertebral disc herniation. Interspinous ligament strain is also one of the common causes of low back pain, generally manifested as lower back pain and weakness when bending over, difficulty in straightening and localized pain after bending over. Taking the affected area closed can make the symptoms disappear. As the pelvic organs are innervated by the visceral branch of the sympathetic nerve trunk composed of the 1st and 2nd sacral ganglia, the upper part is connected to the lumbar region, and the lower end is on the anterior side of the tailbone. When the pelvic organs appear abnormal lesions stimulate the nociceptive afferent nerve fibers, through the sympathetic nerve trunk and traffic branch into the posterior root and a section of the spinal cord, the stimulus will be transferred, diffused to the section of the spinal cord and nerve roots innervated by the lumbar skin, fascia and other tissues, can make the dural sac in the edge of the neural foramen of the attachment to the dura mater to produce tension, the cauda equina nerve located in the dura mater is subjected to tension and then produce indirect compression of the symptom. This is the reason why so many gynecological diseases are misdiagnosed as lumbar disc herniation in clinical practice. Tumors and neoplastic lesions have been repeatedly reported to be misdiagnosed as lumbar disc herniation, and intradural tumors with radicular pain as the first symptom are as high as 57.5%. Radicular pain is mostly caused by nerve sheath tumors, and radiculopathy below the thoracolumbar level may manifest as lumbago or lumbar-leg pain. When a single nerve root is involved, it may be very similar to the clinical manifestation of lumbar disc herniation, which is relatively difficult to differentiate clinically. For the above mentioned diseases, such as the third lumbar transverse process syndrome, gluteal epiphyseal nerve compression syndrome, interspinous ligament strain, etc., these traditional acupuncture treatment, and usually pay attention to the patient to rest, avoid overwork can be cured in a very short period of time. Ischemic necrosis of the femoral head, lumbar spine tumors and tumor-like lesions with mild symptoms can be supplemented by acupuncture, for the longer course of the disease, life and living affected by the person should consider surgery and other related symptomatic treatment. For gynecological pelvic diseases only need to take the appropriate conventional drug treatment will soon be cured.