Lumbar disc herniation is one of the most common diseases that cause back and leg pain. The degeneration of the lumbar disc tissue is the basis of the disease. Under the action of strain and trauma, the degenerated lumbar disc fibrous ring ruptures and the nucleus pulposus protrudes, compressing and stimulating the lumbosacral nerve root or cauda equina nerve, resulting in a series of symptoms such as low back pain and radiated pain in the lower limbs. The disease is mostly seen in young adults, more men than women. The site of onset is the lumbar 4, 5 and lumbar 5 sacral 1 intervertebral discs. Lumbar disc herniation belongs to the category of paralysis in Chinese medicine, which is usually thought to be caused by wind, cold, dampness or blood stasis paralyzing the meridians, and the evidence of kidney deficiency may appear in those with prolonged onset or vegetative deficiency. 1. Diagnosis 1.1 Clinical manifestations 1.1.1 Symptoms: Low back pain and lower limb radiating pain are the typical symptoms of the disease, which may appear simultaneously or sequentially. Low back pain is usually confined to the lower back, and lower extremity radiating pain is usually unilateral. If the disc herniation is central or the herniation is large, bilateral lower extremity pain may appear. The pain can be aggravated by coughing, sneezing, defecation and other movements. 1.1.2 Signs 1.1.2.1 Lumbar deformity: lumbar stiffness, reduced physiological curvature of the lumbar spine, loss of lumbar curvature or even lordosis; lumbar scoliosis; restricted lumbar movement. 1.1.2.2 Pressure pain: pressure pain and radiating pain in the spinous process space and paraspinal process of the lesioned segment, pressure pain at the exit of the sciatic nerve on the affected side, N fossa, etc. 1.1.2.3 Nerve root pull test: straight leg raise test, straight leg raise strengthening test, healthy leg raise test, femoral nerve pull test, and flexion neck test may appear positive. 1.1.2.4 Intraspinal pressure increase test: abdominal pressure test, jugular vein compression test may show increased low back pain or lower extremity radiating pain. 1.1.2.5 Neurological impairment: nerve root or cauda equina nerve damage due to lumbar disc herniation may result in corresponding motor, sensory and reflex weakening, urinary and faecal and sexual dysfunction. When the lumbar 4 nerve root is damaged, the anterior thigh is painful or with hypoesthesia, and the knee reflex is weakened or disappeared. When the lumbar 5 nerve root is damaged, the anterolateral calf and medial dorsalis pedis are hyperalgesia and hypoesthesia, and the dorsal extension force is reduced. When the sacral 1 nerve root is damaged, the pain and touch sensation near the outer ankle and the lateral side of the foot are diminished, and the ankle reflex is weakened or disappeared. 1.2 Auxiliary examination 2.2.1 X-ray film: Lateral convexity of the lumbar vertebrae and narrowing of the lumbar space on the affected side can be seen in the orthopantomograph; in the lateral film, there are often manifestations such as narrowing of the involved vertebral space, osteophytes on the upper and lower edges of the vertebral body and disappearance of the anterior convexity of the lumbar physiological curve. It can also help to exclude other bony lesions. 2.2.2 CT: Not only can it clearly show the degree of protrusion, but also accurate localization. 2.2.3 MRI: It clearly shows the degree of protrusion, the type of protrusion at the site and the displacement of the protrusion in the spinal canal, and can determine the degree of disc degeneration. 1.3 Diagnostic criteria? 1.3.1 Recurrent episodes of low back pain combined with radicular lower limb pain. The pain increases when the abdominal pressure increases. 1.3.2 Paraspinal pressure pain and radiating pain at the herniated disc space 1.3.3 Restriction of lumbar spine movement, change of lumbar spine physiological curvature, positive straight leg raise test, positive straight leg raise strengthening test, positive femoral nerve pull test in lumbar 3 and 4 disc herniation. 1.3.4 Lower limb muscle atrophy, muscle weakness, sensory impairment, and abnormal tendon reflexes. 1.3.5 Imaging examination: X-ray shows reduced or absent physiological anterior convexity of the lumbar spine, narrowing of the intervertebral space (anterior narrowing and posterior widening), and other bony lesions can be excluded, and CT or MRI shows disc herniation consistent with clinical manifestations. Two or more abnormalities in items 1-4 of the diagnostic criteria, plus item 5 will confirm the diagnosis of lumbar disc herniation. 1.4 Differential diagnosis 1.4.1 Lumbar spinal stenosis: low back and leg pain with intermittent claudication, with heavy symptoms but few signs. 1.4.2 Lumbar osteoarthropathy: the age of onset is mostly after 50 years old, and the pain is aggravated by exertion or rainy days, with lumbar stiffness in the morning and slightly reduced after activity. Straight leg raising test is mostly negative. 1.4.3 Pyriform muscle syndrome: no lumbar symptoms and signs, pain in the buttocks, pressure pain at the pyriform muscle, positive pyriform muscle tension test. 1.5 Typing: According to the pathological changes and imaging manifestations, there are four types: ① bulging type. ②Protruding type. ③Prolapsed free type. ④Transosseous protrusion type. 2. Identification 2.1 Blood stasis evidence: there is often a history of trauma, pain is obvious, pain like pins and needles, pain has a fixed location, refusal to press, dark tongue, string pulse. 2.2 Wind-cold evidence: cold pain in the lower back and legs, fear of cold and evil wind, aggravated by cold, pale tongue, white fur, tight pulse. 2.3 Damp-heat evidence: pain and malignant heat, aggravated by heat or dampness, thirst and urination, yellow and greasy coating, tight pulse. 2.4 Kidney deficiency: soreness and weakness of the waist and legs, worse after exertion. In Yang deficiency, the face is white, less breath and lazy speech, the hands and feet are not warm, the tongue is pale, and the pulse is sunken and thin. In Yin deficiency, the throat is dry and thirsty, tiredness and fatigue, distraction and insomnia, the tongue is red with little moss, and the pulse is thin. There are also other types of treatment such as phlegm and stasis evidence, which can be applied according to the condition. 3. Treatment 3.1 Medication 3.1.1 Chinese medicine internal treatment: According to the results of identification, choose suitable prescriptions and medicines. 3.1.1.1 Blood stasis evidence Treatment: Promote blood circulation, dispel blood stasis and relieve pain. Formula: Body pain and stasis removal soup with addition and subtraction. Peach kernel 9g, safflower 6g, angelica 9g, Chuanxiong 12g, myrrh 6g, gentiana 9g, dolichosperm 9g, licorice 6g. Commonly used Chinese medicine: Root Pain Punch, 8g each time, 3 times a day. 3.1.1.2 Wind-cold evidence Cure: warming the menstruation and dispersing cold to relieve pain. Formulation: Duluxiang Yansheng Tang with addition and subtraction. Duluxiang 9g, Fusheng 12g, Eucommia 12g, Niubizi 12g, Weilingxian 9g, Hosin 3g, Fangfeng 6g, Chuanxiong 12g, Angelica 9g, Licorice 6g. Commonly used traditional Chinese medicine: Yixing Kidney Pill, 8g each time, 3 times a day. 3.1.1.3 Damp-heat evidence Treatment: Heat and dampness to relieve pain. Formulation: Si Miao Wan plus or minus. Radix Achyranthes bidentatae 12g, Coix lacrymae 12g, Atractylodes lacrymae 9g, Phellodendron cypress 6g, Fructus bidentatae 12g, Lonicera japonica 12g, Dulcis ligustici 9g, Chuanxiong rhizome 12g. 3.1.1.4 Kidney deficiency. Treatment: Tonify yin and yang, tonify liver and kidney. Formulas: Jin Kui Kidney Qi Pill for Yang deficiency and Liu Wei Di Huang Pill for Yin deficiency. Clinically, the corresponding Chinese medicine can be used according to the results of the diagnosis, and other prescriptions can be applied according to their own experience. 3.1.2 Western medicine internal treatment usually applies non-steroidal anti-inflammatory and analgesic drugs, such as nabumetone, sodium diclofenac, etc. COX-2 selective inhibitors have less side effects than traditional NSAIDS, such as meloxicam, etc. The application of NSAIDS should pay attention to their side effects on the gastrointestinal tract and kidneys. Those with severe radicular symptoms can apply mannitol and glucocorticoids intravenously for a short period of time, and oral or intramuscular injection of B vitamins can help restore neurological function. 3.1.3 Topical medicine treatment Topical Chinese medicine can be applied to the painful parts of the waist and lower limbs according to the condition. 3.2 Manual therapy: including ordinary tui-na manipulation and anesthesia tui-na manipulation. If the effect of general massage is not good, massage treatment under intervertebral foramen anesthesia or intravenous anesthesia can be considered. Lumbar spine activity manipulation should be done with caution for central, free type herniation or huge nucleus pulposus herniation. Patients with severe osteoporosis, fracture, infection, bleeding disease and other diseases are prohibited from manipulation. 3.3 Surgical treatment 3.3.1 Indications: Recurrent episodes of pain; those who are not effective after 3 months of systematic non-surgical treatment; or those with severe pain, surgical treatment is feasible, and those with symptoms of cauda equina damage should be operated as early as possible. Those with obvious lumbar instability should undergo lumbar spine fusion at the same time. 3.3.2 Contraindications: those who have infected foci; those who cannot tolerate surgery due to organ insufficiency; those who have social and psychological factors affecting the efficacy. 3.3.3 Surgical modalities: including laminectomy, laminectomy, decompression, and various minimally invasive interventions (including percutaneous disc aspiration, laser radiofrequency ablation, chemical fusion, etc.). 3.4 Other treatment 3.4.1 General treatment: Rest in a hard bed during the acute pain period and wear a lumbar brace for protection during activities. After the pain is relieved, the functional exercise of the lumbar back muscle can be strengthened. 3.4.2 Traction therapy: the pelvic traction method is commonly used. Choose the appropriate weight according to the patient’s weight, body mass and condition, and the traction weight should start with a small dose. Traction is not recommended for central, free type herniation or huge nucleus pulposus herniation. Traction should be done carefully for those with obvious pain, lumbar muscle tension and lumbar scoliosis. 3.4.3 Closure: Epidural closure, sacral canal closure, intervertebral foramen closure and pain point closure can be applied according to the condition. Combined with diabetes, infectious disease, bleeding disease, liver and kidney insufficiency is prohibited to do closure. The effect of closure is not good in the case of prolapse type, free type protrusion or combined lumbar spinal stenosis. 3.4.4 Chinese medicine ion introduction therapy 4. Efficacy evaluation criteria 4.1 Excellent: Symptoms are relieved, lumbar spine mobility, straight leg raising test and neurological function are restored, and the original work and life can be resumed. 4.2 Good: partial remission of symptoms, partial improvement of lumbar spine mobility, straight leg raising test and nerve function, and unable to resume the original work and life. 4.3 Poor: The treatment is ineffective or the symptoms worsen, and the relevant signs do not improve.