I. Concept of disease name: lumbar disc herniation is mainly characterized by pain in the lower back with radiating pain in the lower limbs. Coughing, sneezing, and forceful defecation can aggravate the symptoms, and walking, bending, and standing with knees extended also aggravate the pain, and the pain is relieved when resting in bed with hips and knees flexed, and the radiating parts of the lower extremities feel numb in those with longer disease duration. The disease mostly has a history of lumbar trauma of varying degrees. (1) Sacral pain or pain radiating to the buttocks and the posterior lateral aspect of the lower limbs, which can be aggravated by coughing, sneezing and forceful defecation. (2) Restriction of lumbar activities, walking, bending, standing with knees extended also aggravate the pain, and the pain is relieved when resting in bed with hips flexed and knees bent, and for longer duration of the disease, the radiological parts of the lower extremities may feel numb, and the nerve roots may experience hypoesthesia in the innervation area under pressure for a long time; the reflexes are weakened and the muscles are atrophied. (3) Central type prominence can appear numbness of the perineum, defecation disorder and other manifestations of cauda equina syndrome. 2. The pain is very strong when moving, and slow when lying down. 3.Prompting factors: Most patients have a history of lumbar weight bearing, improper exertion, trauma, chronic strain or cold and dampness. Most patients have a history of chronic low back pain before the onset of the disease. 4, physical examination; (1) crestal scoliosis, lumbar physiological curvature disappeared, the lesion site vertebral spine and the affected side have pressure pain, and radiation to the lower limbs, lumbar activity is limited. (2) Sensory hypersensitivity or dullness in the affected innervated areas of the lower limbs, and muscle atrophy in those with long duration of disease. The straight leg raise or strengthening test is positive, the flexion neck test is positive, the knee and Achilles tendon reflexes are weak or absent, and the dorsiflexion of the bunion is weak. 5, imaging: (1) X-rays: crestal scoliosis, or loss of lumbar physiological curvature, the lesion may narrow the vertebral space, adjacent vertebral body edge with osteophytes. (2) MR or CT examination can show the vertebral body, intervertebral disc, crestal medulla, and nerve roots. It has important clinical significance for the diagnosis of the disease. Chinese and Western medicine diagnosis Chinese medicine diagnosis: lumbar disc herniation Western medicine diagnosis: lumbar disc herniation Chinese medicine diagnosis 1, blood stasis evidence: lumbar leg pain like thorns, pain has a fixed place, light day and heavy night, lumbar plate stiffness and kung fu, pitch and tilt rotation is limited, painful place refuses to press, dull purple tongue, or petechiae, pulse string or astringent. 2.Cold-damp evidence: cold pain in the waist and legs, unable to turn sideways, pain does not decrease when lying down, aggravated by cold and cloudy rain, cold limbs, light tongue, white or greasy coating, sunken and tight or moist pulse. 3. Damp-heat evidence: pain in the lumbar region, weakness of the leg, pain with heat, increased pain in hot or rainy days, pain decreases after activity, vicious heat and thirst, short and red urine, yellow and greasy moss, moist pulse or stringiness. 4. Liver and kidney deficiency: lumbar pain, weakness of legs and knees, worse with labor and less with lying down, white face with Yang deficiency, unheated hands and feet, lazy speech, cold waist and legs, or impotence, premature ejaculation, women with thin belt, light tongue, sunken pulse, dry throat with Yin deficiency, thirst, flushed face, tiredness, sleeplessness, dreaminess or spermatorrhea, women with yellowish taste and odor, red tongue with little coating, thin pulse. 5, Western medicine differential diagnosis 1, acute lumbar sprain: a history of lumbar sprain, mostly seen in young adults. Severe pain on one or both sides of the lumbar region, restricted activity, inability to turn over, stand firm and walk, and often maintain a certain forced position to reduce pain. The lumbar muscle and gluteal muscle spasm, or can be palpable strips of hard mass, strain site has obvious pressure points, the crest physiological curvature changes. x-ray examination can be identified. 2, lumbar spinal stenosis: a history of chronic low back pain, some patients have a history of trauma. Most occur in manual workers over 40 years of age, long-term recurrent lumbar pain and intermittent claudication, lumbar pain is relieved in forward flexion and aggravated in back extension, leg pain is mostly bilateral and can alternate, lumbar pain or numbness and weakness when standing and walking, pain and claudication gradually aggravate, rest holds improvement, severe cases can cause frequent urination or difficulty in urination, lower limb muscle atrophy, weakened tendon reflexes, positive lumbar hyperextension test, lumbar spine x-ray Lumbar spine X-ray, cremasteromyelography, CT or MR examination have important diagnostic significance. 3, lumbar spine tuberculosis: the main manifestations are lower back pain, light or heavy, restricted movement, spinal pressure and percussion pain, positive pick-up test, lesion irritation of nerve roots, can cause nerve root irritation signs or conduction dysfunction. The abscesses of the lumbar muscle on one or both sides can be felt on palpation of the abdomen, and sometimes abscesses can also appear in the femoral triangle or outer thigh or lumbar triangle. there are particularly positive findings on X-ray examination (cavities and dead bone). 4. Intravertebral canal and cauda equina tumor: when the tumor compresses the nerve root and crestal medulla, it may also cause symptoms similar to the nerve root, cauda equina or crestal medulla compression of lumbar disc herniation, which can be identified with the help of CT or MR. (a) Indications for non-surgical treatment: 1. Patients with first attack and short duration of disease. 2. 2. Patients with long duration of disease but with mild symptoms and signs. 3. Patients with small prominence by special examination. 4.Patients who cannot perform surgery due to systemic diseases or local skin diseases. 5.Patients who do not agree to surgery. (2) Indications for surgical treatment: (1) Patients with severe symptoms that affect life and work, and who have been ineffective for 6 months after regular non-surgical treatment; or patients with severe symptoms that cannot be treated by traction, massage and other non-surgical therapies. (2) Those with extensive muscle paralysis, sensory loss and cauda equina damage (such as saddle area sensory loss and urinary and fecal dysfunction), and those with complete or partial paraplegia. Most of these patients have a central protrusion, or a ruptured nucleus pulposus that has broken off into the spinal canal, resulting in extensive compression of the nerve roots and cauda equina, and should be operated as soon as possible. (3) In patients with severe intermittent claudication, most of them have spinal stenosis at the same time, or X-ray and CT images show spinal stenosis, and non-surgical treatment is not effective, so early surgery is recommended. (4) In cases of combined lumbar isthmus discontinuity and crestal spondylolisthesis, surgical removal of the diseased nucleus pulposus tissue and simultaneous fusion of the contralateral vertebral plate and interspinous bone graft should be performed. (5) For young and middle-aged patients with recurrent attacks, the indications for surgery may be relaxed in order to restore their working ability as soon as possible. The indications for surgery should be strictly controlled for elderly and frail patients. (3) Non-surgical treatment routine: 1. General treatment (1) Early complete bed rest, lying on a hard bed, with a lumbar brace brake. (2) late can be appropriate to put on lumbar protection flat slow walking, walking that bed rest, should not be long walking, long standing, sitting, should not go up and down stairs, should not be weight bearing, avoid wind and cold, warmth, waterproof moisture, general patients must be bed rest for more than one month, bed must be done in bed leg exercises, massage, etc., to prevent disuse muscle atrophy, keep the bowels open. (1) Blood stasis: the formula is based on the formula of Peach-Hong Huiwu Tang with the addition and subtraction of Angelica Sinensis 10 Safflower 10 (first decoction) Huai Niu Qi 15 Tao Ren 10 Red Peony 15 Chuanxiong 10 Xuan Hu 25 Shanjia 15 Wu Zhi Snake 15 Lao He Cao 15 Tendrils 30 Tian Qi 15 (2) Cold and dampness: the formula is based on the formula of Paralysis Tang with the addition and subtraction of Solanum 10 Gentiana 15 Angelica Sinensis 10 Chuanxiong 10 Hai Feng Vine 30 Mulberry 15 Hossein 3 Wei Ling Xian 15 Scorpion 6 Centipede 2 (3) Dampness and heat: the formula is reduced by Si Miao San, plus Atractylodes 6, Phellodendron 15, Niu Qi 15, Job’s Tears 30, Dioscorea Z 30, Datura 15, Loxodendron 30, Lonicera 30, Mufangji 15, Di Long 15 (4) Liver and kidney deficiency: Yang deficiency: the formula is reduced by Right Return Pill: Radix Rehmanniae 15, Cornu 15, Yam 15, Wolfberry 15, Cuscuta 15, Dulcus 15, Deer horn gum 15 (closed), Angelica 30, All Dog’s Crest 15. The formula for yin deficiency is reduced by Zuo Gui Wan: Radix Rehmanniae 30, Radix et Rhizoma 15, Cornu Cervi Pantotrichum 15, Fructus Lycii 16, Semen Cuscutae 15, Gum Kernel 15 (closed), Tortoise Board 20, Chuan Niu Qi 15, Fructus Rooster 30, Radix Paeoniae 30, Glycyrrhiza Glabra 6, Radix et Rhizoma Mulberry 16. 3. Chinese medicine and western medicine treatment Treatment principles: reduce local pressure, edema, anti-inflammatory and pain relief, treatment of the original disease, bed rest, avoid weight bearing and excessive lumbar activity. If necessary, surgery should be performed. (1) In early stage of severe local swelling and pain with obvious symptoms, the following measures can be taken: dexamethasone 10mg iv drip qd; neuroleptic 3ml iv qd; Wanluo tablets 25mg po qd; rapid-acting bone healing agent 25ml po qod; bone spur spirit topical application. (2) Longer duration of the disease, the lower extremity of the radiological parts of the sensory numbness, the following measures can be taken: neuroleptic 3ml iv qd; Micropod 500ug po tid; quick-acting bone healing agent 25ml po qod; bone spur spirit topical external paste. 4, acupuncture treatment (1) general rule: take the lesion intervertebral disc up and down the two vertebral body of the crest point or bladder meridian dorsal points with the affected lower extremity of the foot sun bladder meridian and foot Shaoyang bile meridian points mainly, 4 to 6 points per day, flat tonic and flat diarrhea, stay acupuncture half an hour, 6 times for a course of treatment, rest a day, and then renew the next course of treatment; for wind-cold type and physical weakness can be applied moxibustion box moxibustion, warm acupuncture; stasis of blood heavy and muscle spasm pain obvious Electric acupuncture is applied. (2) Acupuncture points: Huatuo pinched crest point, Huanjiao, Yinmen, Yanglingquan and Kunlun of the lumbar spine. For blood stasis, add Taichong; for cold-damp and damp-heat, add Yinlingquan and Foot Sanli; for liver and kidney deficiency, add Kidney Yu and Guan Yuan; for yin deficiency, add Sanyinjiao and Tai Xi. 5.Physical therapy: (1) lumbar traction. Adopt the British AKRON automatic traction bed, with the affected side in supine position, continuous traction, weight 50-70Kg, time 30 minutes, once a day. (2) Adopt TQ-98B vaporized medicinal liquid fumigation machine to treat the lumbosacral region. The temperature is suitable for the patient to tolerate, once a day. 6.Tui-na treatment: Treatment principle: relaxing tendons and channels, activating blood circulation, relieving blood stasis, loosening adhesions, and regulating tendons. Acupuncture points: lumbar Yangguan, large intestine Yu, ring jumping, Zhizhong, Chengshan, Yanglingquan. Main techniques: rolling, pressing, kneading, point pressure, top pushing, wrenching, etc. Operation method: (1) Method of pressing and kneading by following the path: with the patient in prone position, use rolling, pressing and kneading techniques to apply 3 —-5 minutes to the bladder meridian on both sides of the patient’s crest and the posterior and lateral sides of the buttocks and lower limbs, with the lumbar region as the focus. Then press the lumbosacral region from top to bottom along the crest with overlapping palm pressure with both hands, repeated 2 —-3 times. To relieve the spasm of the lumbar back muscles. (2) Plucking and stretching and pushing method: the patient is in prone position, first use the thumb or elbow tip to press the lumbar Yangguan, Kidney Yu, Juzhong, Huanjiao, Chengfu, Zhizhong and Aye points to relieve spasm and relieve pain. Then tug and stretch the unilateral lower limbs or bilateral lower limbs according to the actual situation, and then use the thumb to push or elbow tip to press the affected area (opposite to the direction of the protrusion). Tendon adjustment method: The patient lies on his side, and the doctor uses the lumbar oblique traction method, once on each side (or unilateral use of lumbar oblique traction method according to the actual situation). Then in supine position, use forced straight leg elevation to pull the sciatic nerve and N nerve, and then shake the hip joint. (3) Finishing manipulation: the patient is in the prone position, and the physician applies rolling, holding, kneading and flicking manipulation along the lumbar region and the distribution area of the sciatic nerve on the affected side for 3 to 5 minutes, then rubs the affected area with heat and ends the manipulation treatment. Seven, lumbar disc herniation recovery period commonly used rehabilitation exercises are as follows: 1, supine knee: supine position, both knees, hip flexion, hands on the knee to make it as close as possible to the abdomen, buttocks as far as possible to lift off the bed (be careful not to arch the back away from the bed), for a few seconds, repeated several times. 2, arch bridge: supine position, bilateral elbow flexion, hip and knee flexion, with the head, elbows, feet five points of support, for the movement of the abdomen and waist into an “arch bridge” for a few seconds or longer, repeated several times. 3.Straight leg raise: supine position, put both hands naturally on both sides of the torso, slowly lift both lower limbs or one lower limb, knee joint as straight as possible to raise, repeatedly. 4, prone swallow fly: the patient lying prone on the bed to collapse the waist, head up, arms force back extension, legs to the knee as the fulcrum back lift as swallow fly style, for a few seconds or more, repeated several times. 5, left and right lateral bending: standing position, feet apart and shoulder width, hands forked waist or up to hold the pillow, for waist left and right lateral bending activities, lateral bending to the maximum extent for a few seconds, repeated several times. 6, rotating waist: standing position, feet apart and shoulder width, hands forked waist, along the waist axis left and right swing rotation, the amplitude from small to large, alternating with and against several times. Functional exercise must be gradual, exercise intensity varies from person to person.