Lumbar disc herniation is a disease caused by degeneration of the lumbar disc, rupture of the fibrous ring, and protrusion of the nucleus pulposus, which compresses and stimulates the nerve roots, cauda equina, or spinal cord at the corresponding level, causing symptoms and signs such as low back pain, radiating pain in the lower extremities, or having bladder and rectal dysfunction. It is referred to as lumbar herniation. 1. The diagnosis of lumbar disc herniation is based on 1. There is often a history of lumbar trauma, chronic strain injury or cold and dampness, and most patients have a history of chronic lumbar pain before the onset of the disease. Xuzhou City Hospital of Traditional Chinese Medicine Department of massage Si Jingfu 2, the age group and gender differences in the onset of the disease are becoming less and less obvious, except for the high incidence of young adults, the elderly and children are not uncommon. 3.The incidence of herniated discs in lumbar vertebrae 4 and 5 or lumbar vertebrae 5 and sacral vertebrae 1 is the highest and can account for more than 90%. 4, recurrent episodes of low back pain or radiating lower limb pain, generally more serious in the acute phase, pain increases when coughing, sneezing or stool and other abdominal pressure increases, bed rest may reduce. Lower limb muscle strength loss or muscle atrophy may occur in those with long duration of disease. Central disc herniation may cause cauda equina compression syndrome. 5. Lumbar stiffness, restricted movement, loss of physiological curvature or even kyphosis, lumbar scoliosis, and pressure pain or radiating pain next to the spinous process corresponding to the herniated disc space. Straight leg raise test and strengthening test are positive. Sensory, motor and reflex changes in the affected innervated area help in the diagnosis of herniation localization. If the cauda equina nerve is compressed, there may be a loss of the piriform reflex and piriform reflex. 6. Lumbar spine frontal and lateral radiographs show changes in physiological arc, narrowing of the lesion gap, osteophytes, etc., and exclude changes such as fractures and bone destruction. CT of the lumbar spine can clearly diagnose and localize, suggesting the direction, shape and degree of protrusion, the size of the vertebral canal morphology, and signs such as articular synovial joint hyperplasia. 7. For refractory patients, further MRI examination can be performed to fully display the overall situation of the lumbar spinal canal and disc herniation, providing details such as whether there are occupying lesions in the spinal canal, whether the herniation prolapses, whether it invades under the posterior longitudinal ligament and the cauda equina nerve and spinal cord injury. Second, the classification of symptoms of lumbar disc herniation Chinese medicine symptoms 1, qi stagnation and blood stasis: lumbar and leg pain like needles, pain with a fixed location, light day and heavy night, lumbar plate stiffness, difficulty in tilting and turning sideways, refusing to press at the painful place. The tongue is purple and dark, or there are petechiae, and the pulse is tight or astringent. 2.Cold dampness offends the waist: cold pain in the waist and legs, unfavorable turning, pain does not decrease when lying down, pain is aggravated by cold and rainy weather, and the limbs are cold. Pale tongue, white or greasy coating, sunken and tight or moist pulse. 3. Damp-heat offending the waist: pain in the waist, weakness of the legs, heat sensation in the painful area, increasing pain in hot or rainy days, decreasing pain after activity, vicious heat and thirst, short and red urine. The coating is yellowish and greasy, and the pulse is moist or stringy. 4. Liver and kidney deficiency: pain in the lower back, weakness in the legs and knees, worse with exertion, pain decreases when lying down. Yang deficiency is white, the hands and feet are not warm, less breath and lazy speech, the waist and legs are cold, or impotence, premature ejaculation, women with thinning of the belt; the tongue is light, the pulse is sluggish. In the case of Yin deficiency, dry throat and thirst, flushed face, tiredness, sleeplessness, excessive dreaming, or seminal emission, yellowish and foul-smelling belt in women; red tongue with little coating, thin pulse. Modern medicine typing 1, central type: the protrusion is located in the anterior posterior center of the spinal canal, mainly stimulating and compressing the cauda equina nerve, clinical manifestations are lumbar and leg pain, numbness in the perineum and urinary and bowel dysfunction. 2.Lateral type: The herniation is located in the lateral side of the spinal canal and the nerve root is extruded, mainly causing radicular irritation or compression symptoms. 3. Extremely lateral type: the herniated material moves to the anterolateral side of the spinal canal, or even enters the lateral wall of the spinal canal or the root canal, mainly causing radicular pain. The treatment plan of lumbar disc herniation 1, evidence-based treatment Apply rolling and pressing methods to the lumbar region and the affected lower limbs, and do lumbar traction and lumbar lateral oblique traction; also do moderate passive straight-leg elevation of the affected lower limbs, etc. 2.Other therapies. Bed rest: The acute attack should be strictly bed rest for 1 to 2 weeks while conservative treatment, after which appropriate activities can be done under protection. Acupuncture: Applicable to all patients, the key acupuncture points are Kidney Yu, Large Intestine Yu, Ji, Huatuo Pinnacle, Huanjiao and Guizhong. Traction: combined with bed rest, bedside pelvic traction, traction weight 15-20Kg, 1~3 times a day, 0.5~1 hour each time, 3~4 weeks as a course of treatment. Electric mechanical bed traction, traction weight less than one-third of the patient’s body weight, 1 to 2 times a day, each time 20 minutes, 3 to 4 weeks for a course of treatment. A small number of patients have a tendency to aggravate back and leg pain after traction, so traction treatment should be stopped. Closure: intervertebral foramen nerve root or sacral fissure closure therapy or lumbar epidural closure therapy is commonly used. Drugs: non-steroidal anti-inflammatory drugs, short-term dehydrating agents or hormonal drugs can be used for severe symptoms. Chinese herbal medicine can also be used to activate blood circulation and remove blood stasis. 3.Complication treatment Aggravation of symptoms: Push-up treatment should be stopped immediately and bed rest should be given. Treatment with dehydrating agents or hormonal drugs can be used, as well as herbal medicine for activating blood circulation and removing blood stasis. Anesthesia accident: If anesthesia accident occurs during the closure, deal with it according to the operation routine. Skin breakage: If skin breakage occurs at the treatment site, the manipulation should be stopped to take anti-infection and other measures. Precautions for lumbar disc herniation 1. When pushing treatment, the posterior extension trigger method or stilt stepping method should not be used for those with huge herniation or calcification, cauda equina nerve compression, or secondary spinal stenosis. 2.It is recommended to inform patients of the possible hazards before using spinal canal closure therapy. 3.The lumbar girth can be used for protection during conservative treatment, but it should not be used for a long time. 4, chronic patients should lie on a hard bed and carry out functional exercises for the lumbar back muscles. 5.Avoid sitting for a long time, avoid sitting on the sofa and low stool; avoid shock to the lumbar region, heavy work or strenuous exercise; avoid violent coughing or sneezing, keep the bowels open. 6. If the symptoms of radioactive lumbar pain do not improve or even worsen after more than half a year of regular conservative treatment, or if the symptoms are serious and there is clear nerve root conduction dysfunction, especially the muscle strength is obviously weakened and affects working life, or if there is cauda equina pressure and urinary and faecal dysfunction, surgery should be recommended. Fourth, the efficacy assessment of lumbar disc herniation 1, cure: lumbar and leg pain disappears, straight leg elevation more than 70 degrees, can resume the original work. 2.Improved: lumbar and leg pain is reduced, and the function of lumbar activity is improved. 3.Not cured: symptoms and signs are not improved.