I. Overview of lumbar herniation and conservative treatment. 1, the concept of lumbar disc herniation: refers to the lumbar intervertebral disc degeneration, under the action of external forces, the fibrous annulus rupture partially or completely, alone or together with the nucleus pulposus, cartilage end plate to the outward protruding, irritation or compression of the sinus nerve and nerve root caused by lumbar and leg pain as the main symptom of a lesion. Pathogenesis: mechanical compression, inflammation. 3, the principle of conservative treatment: eliminate the stimulation of inflammatory substances, lifting the intervertebral disc on the nerve root stimulation, accelerate the repair of the damaged fibrous ring. Second, clinical case observation. The patient is male, 23 years old, from Heze, Shandong Province. On January 17, 2011, due to “lumbago with right lower limb numbness and pain for 1 year, aggravated for 3 days”, he was admitted to the Spine and Orthopaedic Department of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine as an outpatient with “lumbar intervertebral disc protrusion” for systemic treatment. On March 20, 2010, the patient went to the outpatient clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine for treatment of lumbar pain accompanied by numbness and pain in the right lower limb without any obvious triggers 10 months ago. Dr. Hao Yanke, deputy director of the Department of Spine and Orthopaedics, diagnosed “lumbar intervertebral disc herniation” after physical examination, X-ray, CT, MRI and other imaging tests. Chinese medicine diagnosis is “paralysis”, cold and damp obstruction type. Outpatient prescription: Mecobalamin, Lumbar Palsy Capsules, Qizheng Pain Relieving Paste, Qingpeng Cream, and instructed the patient to strictly follow the instructions of the medication to take or use externally. And educate the patients to get down as little as possible during the initial pain period, more bed rest, daily in bed for lumbar and dorsal muscle function exercise, the number of times from less to more. The lumbar back muscle exercise could be continued. The patient underwent MRI on the day of consultation, and the sagittal MRI, T2W1 showed: (Above are two cross-sections in the MRI. It clearly shows that the signal change of lumbar 4 and 5 intervertebral discs is obvious, the discs are protruding backward, and the corresponding dura mater is compressed. The brightness of the nucleus pulposus in the intervertebral discs was significantly reduced, and the signal shadow was disorganized and discontinuous). The patient himself and his parents described the history of the present illness. After the patient went home from the outpatient clinic, he strictly followed director Hao’s medical advice, rested in bed, insisted on taking oral medication Mecobalamin and lumbar paralysis capsule for one and a half months, insisted on applying Qingpeng ointment externally to the painful area for half a month, and insisted on applying Qizheng pain-eliminating paste externally for 20 days. After the symptoms significantly reduced, can work normally, life can be simple exercise, such as jogging, and even upward slight jumping, the height of about a dozen centimeters. Adhere to the lumbar back muscle exercise, exercise continued after the reduction of symptoms, but irregular. After conservative treatment, the symptoms of lumbar disc herniation were significantly relieved, and pain, numbness and other symptoms basically disappeared. Three days before this visit, the patient experienced worsening of symptoms without any obvious triggers, so he urgently came to our hospital for hospitalization. The outpatient examination showed straightening of the physiological curvature of the lumbar spine, lumbar 4/5 spinous process tenderness, and a positive straight leg raising test of 20 degrees on the right side.On January 17, 2011, MRI was taken in the outpatient clinic, and the sagittal MRI and T2W1 showed the following: (The above are the two cross-sections in the MRI. It clearly shows signal changes in the lumbar 4 and 5 intervertebral discs with posterior disc protrusion and dural compression. The brightness of the nucleus pulposus in the intervertebral disc is reduced compared to the upper and lower discs.) Third, conservative treatment discussion. 1, according to the comparison of the MRI sagittal slice T2 before and after two times, it was found that the signal of the nucleus pulposus tissue of the patient’s lumbar 4/5 intervertebral disc in the current admission examination, there was a more obvious brightening, and the boundaries between the bright and dark areas were no longer obvious. As to the reason for the obvious change of the nucleus pulposus in T2, i.e., the “rehydration” of the degenerated nucleus pulposus, it is thought that there are two directions to think about. First, medullary tissue is an elastic jelly substance composed of aminoglycans, mineral salts, water, and cells. Because of its water content accounts for about 80%, its plasticity is strong, and the patient’s lumbar protrusion fiber ring is not completely ruptured. After taking medication and functional exercises, the function and structure of the nucleus pulposus and surrounding tissues improved significantly, resulting in “rehydration” of the nucleus pulposus, which is a good sign of development. However, at present, there is no large sample of evidence-based medical reports to prove that the “rehydration” of the nucleus pulposus is a good direction of regression after conservative treatment or not, and its specific mechanism is not yet clear. The second point is that the signal enhancement and improvement is an artifact. The second MRI was taken on the third day of the patient’s sudden pain, according to the principle that the nucleus pulposus has the ability to cause inflammation, which can cause an inflammatory response in the tissue. After the patient’s lumbar protrusion, the structure of the fibrous ring is bound to be pulled, this unexplained stimulation, in fact, the fibrous structure of the edema due to inflammation. MRI showed an increase in the water component that may be due to inflammation caused by the fibrous ring edema. 2. Conservative treatment in this case alone can still achieve good results. Characteristics of the case: The patient is a young male with typical symptoms of lumbar disc herniation with lumbar and leg pain radiating to the right lower limb. Chinese medicine diagnosis is “paralysis”, cold and damp blockage type. Therefore, he was treated with a combination of Chinese and Western medicine. Drug therapy: Micaobao (methylcobalamin) is a nutritive peripheral nerve drugs; lumbar paralysis through the capsule, blood circulation and eliminate blood stasis, eliminate wind and dampness, qi and pain, for blood stasis and stagnation of qi, veins and channels blocked due to lumbar pain of proprietary Chinese medicines; Qizheng pain plaster, efficacy of activating blood circulation and eliminating blood stasis, reduce swelling and relieve pain; Qingpeng cream, pain relief and swelling, with anti-inflammatory, analgesic, swelling, activating blood circulation and elimination of blood stasis, improve microcirculation and antibacterial effect. Resting and braking can lift the muscle contraction force and intervertebral ligament tension on the extrusion of the intervertebral disc, in a state of rest is conducive to intervertebral disc nutrition, is conducive to the peripheral venous return to eliminate inflammatory edema, and is conducive to the repair of the damaged annulus fibrosus. The exercise of lumbar dorsal muscles can promote the expansion of capillaries in the lesion area, increase blood flow, accelerate metabolism, and have a role in exudation and edema, and can also loosen the adhesion of the nerve root, and have the role of analgesia, for the patients with bulging discs, lumbar dorsal muscle exercise may make some of the protruding nucleus pulposus to return to the body. This is the basic principle on the conservative treatment of this case. Through clinical observation, it can be combined with acupuncture, traction, pain point closure and other treatments. 3. Indications for conservative treatment. Non-surgical treatment is the first choice for lumbar disc herniation, and most of them can achieve good results. The indications are: initial onset, short duration of the disease, long duration of the disease but the symptoms and signs are mild, special examination shows that the herniation is small, and the patients who can not implement the surgery or do not accept the surgery. Regarding the “indications”, whether they are surgical or non-surgical indications, or indications for the choice of surgical methods, clinicians do not have a strict grasp of the indications, which is due to a variety of reasons, but we must face this problem squarely. Currently, lumbar disc herniation belongs to the category of pain disorders that can be cured, and the way to cure is mostly surgical treatment. Surgical treatment is mostly elective surgery, such as unilateral plate invasive decompression nucleus pulposus removal. However, emergency surgery is needed in the following cases: combined with incomplete paralysis of the lower limbs, combined with cauda equina syndrome or spinal conus syndrome, severe pain that cannot be relieved by drugs.