Low back pain type disorders are the most common clinical condition, accounting for one-fifth of surgical outpatient visits and half of orthopedic outpatient visits according to some hospitals. Some scholars estimate that on average, there will be one patient with low back pain per person in a family of five. Some experts also point out that low back and leg pain is experienced by everyone in their lifetime and directly endangers people’s health. Every year in the United States, between seventy and one million people are hospitalized for low back pain, and about 200,000 of them receive surgical treatment. This shows that low back pain is a disorder that cannot be ignored. There are many causes of low back pain, except for a few patients who suffer from acute trauma, most of them are caused by chronic strain, degeneration, hyperplasia and disc herniation. In addition, osteoporosis, spinal cord tumors and other diseases can also cause low back pain. The lesion site is often more soft tissue, bone and joint lesions are second, vascular disease is rare. The diagnosis of the site of pain is generally not difficult and can be determined by medical history, physical examination and various diagnostic instruments. Treatment is often a combination of etiologic and symptomatic treatment, and the goal of treatment is to relieve or alleviate pain. Treatment is mainly conservative, with a few cases requiring surgery. Classification of low back pain There are many ways to classify low back pain, and this chapter combines the site of onset and causative factors to classify. 1. Soft tissue low back pain: low back pain caused by soft tissues such as paraspinal dorsalis muscle, supraspinal, interspinous ligament and transverse process ligament. It can be divided into traumatic: such as lumbar soft tissue injury and contusion; inflammatory: such as myofibrositis and fasciitis; strain: such as lumbar strain and lumbar transverse synovial syndrome; compression: such as pear-shaped muscle injury syndrome; 2. osteoarticular lumbago: refers to the vertebral column bones and joints, which produce lumbago for some reasons. External injury: such as synovial imbrication, misalignment and fracture of the small joints of the spine; inflammatory: such as dense osteitis, ankylosing spondylitis: degenerative: such as degeneration and hyperplasia of the small joints of the lumbar vertebrae; structural instability: such as disconnection of the isthmus of the lumbar vertebrae, lumbar spondylolisthesis, scoliosis, etc. 3, endogenous lumbago: refers to the lumbago caused by some causes in the spinal canal. Such as lumbar intervertebral disc herniation, spinal stenosis, spinal canal tumor, etc. 4, other causes of low back pain: visceral disease reflex low back pain. In addition, ancestral medicine believes that kidney deficiency and wind-cold-dampness invasion can also cause low back pain. Why is it easy to suffer from low back pain? The lumbar vertebrae are located between the thoracic vertebrae, which have little mobility, and the sacrum, which is fixed in the pelvis, and are the hub of the district trunk activities. Because of upright walking, the lumbar spine is sometimes the center of the spinal column weight-bearing, and the load it bears is greater than other parts of the spine. Any activity of the lumbar spine will produce a shift in the center of gravity, which causes a change in the moment of force, producing shear forces in the lumbar region, as a small tree over-swaying, it will be bruised. The lumbar spine is also prone to such phenomena in a state of poor posture. When the lumbar spine in an instant excessive flexion or rotation, the shear force will rapidly increase, which can destroy the lumbar balance, resulting in instability, and then damage the lumbar muscles, ligaments, joints and other tissues, and in serious cases can cause intervertebral disc fiber destruction and disc prolapse. The flexion and extension, rotation and other activities of the lumbar region are often repeated in the daily life of each person, so whenever walking, labor, weight-bearing, sports and other activities, it is easy to cause acute and chronic injury to the lumbar muscles, ligaments, small intervertebral joints and intervertebral discs, resulting in back pain and even leg pain. Treatment of low back pain There are many treatment methods for low back pain, and different treatment methods should be selected according to the clinical situation. 1, the treatment of acute stage (1) bed rest, internal or external use of Chinese and Western medicine pain relief and antispasmodic drugs. Cold compress or local closure can be applied to the painful point. (2) Apply orthopedic manipulation to rectify the protruding disc, intervertebral joint or sacral joint subluxation, release the small intervertebral joint embedment, and restore the internal and external balance of the spine. (3) Acupuncture and massage to relieve tendons, dissipate blood stasis, and relieve pain. 2.Treatment of chronic lumbar and leg pain (1) Measures to relax the tendons, activate blood circulation and move the qi: internal use of lumbar pain Ning capsules, external use of traditional Chinese medicine, acupuncture and massage, various closed therapies, various physical therapies such as electricity, heat and magnetic ultrasound. (2) Measures to strengthen the waist and kidneys and nourish the tendons and bones: traditional Chinese medicine, acupuncture and moxibustion, body therapy. (3) Measures to remove wind, dry dampness and disperse cold: internal consumption of lumbago Ning capsules, acupuncture and moxibustion and various heat therapies. (4) Reset and decompression measures: various traction, manual reset, to rectify the protruding disc, correct vertebral misalignment, open the vertebral space, expand the intervertebral foramen to reduce or eliminate nerve root compression. (5) Acupuncture and sacral therapy: for inflammatory adhesion lesions inside and outside the spinal canal, sacral therapy and acupuncture therapy can be used respectively. (6) Supportive and protective measures: Wearing various lumbar circumferences or using wide belts. (7) Intervertebral disc aspiration surgery and nucleolysis therapy: this therapy can be used for patients with heavy disc herniation and long and poor results of conservative treatment. (8) Surgery is required for those who are ineffective in applying the above treatments. The etiology and pathogenesis of low back pain Chinese medicine believes that low back pain is not external to the feeling of external evil, bruises and injuries, old age and physical weakness, etc.. In the process of understanding the whole process of low back pain, the understanding of the etiology and pathogenesis cannot be ignored, because the process of identification and treatment is the process of identifying the cause and examining the cause and treatment. 1, due to long living in wetlands, sweating too much after labor or labor sweat when the wind, braving rain and water, wet and cold clothing and other feelings of cold and damp evil. The cold nature of the stagnant collection of lead, damp evil sticky stagnation does not change, resulting in the waist and leg meridians obstructed, qi and blood does not run smoothly, and thus the occurrence of waist and leg pain. 2.Dampness and heat cross-steaming season, feeling the dampness and heat of the evil, obstructing the meridians, causing back and leg pain. 3, bruises and blows, improper body position, improper exertion leads to lumbar injury vein Qi and blood stagnation, stasis of blood stasis and occurrence of back and leg pain. 4, congenital endowment deficiency, acquired disorders, long term illness, physical weakness, old age and physical decline, indiscipline in sexual intercourse, to kidney meridian deficiency, no to moisten the meridian and occur back and leg pain. The key to the above causes is kidney deficiency, wind, cold, damp and heat paralysis often due to kidney deficiency and tolerance. On the contrary, even if you feel external evil, you will not have back and leg pain. In addition, strain sprain is related to bruising, if the essence of the kidney is insufficient, the injury is also easy to recover. Identification of low back and leg pain Identification is the premise of treatment, and only by correct identification of low back and leg pain can we better guide the clinical use of medicine. 1.Identify the deficiency and reality of low back and leg pain: the identification of low back and leg pain should first distinguish whether it is deficiency or reality. If the pain is caused by cold-damp, damp-heat or blood stasis, it is clinically characterized by rapid onset, short duration, severe pain and refusal to press; if it is caused by kidney essence deficiency, it is clinically characterized by slow onset, long duration, recurrent attacks, and happy to press, it is deficiency; if the evil is detained for a long time and damages the essence in the kidney, it can turn into a real evidence in deficiency. 2. Identify the site of lumbar and leg pain: the so-called lumbar and leg pain in Chinese medicine refers to pain on one or both sides of the waist, or in the middle. Since the foot solar bladder meridian passes through the lumbar region and the legs, lumbar pain can be complicated by the legs. Low back pain is predominantly on both sides, and it is relieved by pressing, and it is worse by straining, most of which are lumbar muscle or kidney diseases. To have severe pain on one side, adverse onset of activity, or a history of flash and contusion injury, most acute sprains. Pain occurs in the middle of the waist, bending unfavorable, most spinal lesions. 3, identify the nature of pain in the lumbar leg pain: lumbar leg pain soreness and swelling heavy turbidity is real, both cold sensation for cold damp, both burning sensation for pain such as pins and needles difficult to turn the side for blood stasis. Soreness and weakness of the waist and knees, which are worse with labor, are mostly kidney deficiency. Low back and leg pain is rheumatism if it attacks or worsens every time due to climate change. Chinese medicine for low back and leg pain 1. Cold and damp type: cold pain in the lower back and legs, soreness, swelling and heaviness, attack or aggravation in rainy days, white and greasy coating, sunken and sluggish pulse. The treatment is to disperse cold and dampness, warming the meridians and clearing the channels, and to take Lumbago Ning Capsules orally. The main ingredients of Lumbago Ning capsule are strychnine and scorpion, which have the function of dispersing nodes, reducing swelling and relieving pain; turtle worm, Chuan Niu Knee and frankincense, which have the function of activating blood circulation and resolving blood stasis, renewing tendons and connecting bones. It is suitable for cold-damp type and blood stasis type lumbago, and can also be used for kidney yang deficiency type lumbago with kidney tonics. 2. Damp-heat type: low back and leg pain, with heat sensation in the painful area, yellow and greasy coating, moist pulse. Treatment is to clear heat and dampness, soothe the tendons and open the channels. Add and subtract Si Miao Wan and combine with Lumbago Ning Ning capsule for oral use. 3.Blood stasis type: stabbing pain in the main part, pain with a fixed location, causing leg pain, dark purple tongue or petechiae, and astringent pulse. Treatment should be to activate blood circulation, resolve blood stasis, regulate qi and relieve pain. It can be taken orally with Lumbago Ning capsules. 4.Kidney deficiency type: soreness and weakness of the waist and knees with heavy pain, unrelenting, preferring to press and be soft, more so in case of labor. For Yang deficiency, the hands and feet are not warm, the tongue is light with white fur, and the pulse is sunken and thin. In the case of Yin deficiency, the hands and feet are hot, the tongue is red with little moss, and the pulse is thin. Treatment: For Yang deficiency, tonifying the kidney yang is recommended, with the addition and subtraction of Right Return Pill and oral administration of Lumbago Nimble Capsules. For those with Yin deficiency, use Zuo Gui Wan plus or minus, and combine with Lumbago Ning capsule orally. Massage, chiropractic, acupuncture for low back pain 1, massage, also known as “massage”, is a method to prevent and treat diseases by applying pressure, massage and other techniques to certain parts of the body surface under the guidance of the basic theory of Chinese medicine. This method is widely used in the prevention and treatment of various clinical diseases because of its comprehensive effects of unblocking the meridians, reducing swelling and pain, slipping joints, and adjusting the qi and blood functions of the internal organs. The method can be used to identify the evidence of lumbar small joint disorder, acute lumbar injury, chronic lumbar muscle strain, degenerative spondylitis and lumbar intervertebral disc herniation in lumbar and leg pain. 2, chiropractic therapy is generally often used to divide the tendon flicking, pressure combing and other rectification techniques act on the brawn of the spine, so that the sick vertebrae back to normal, so as to achieve the purpose of treating spinal injuries and other diseases, lumbar and leg pain in the disc herniation, certain injuries such as paraplegia can identify the use of this method. 3, acupuncture therapy mainly refers to body acupuncture therapy, is the use of milli-needles as acupuncture tools, through the body 14 meridians on the acupuncture points applied to certain methods of operation, in order to achieve the purpose of treating related diseases. This therapy is widely used, with two-way regulation, many similar back and leg pain can identify the use of this method.