1.Manipulative therapy: suitable for non-central type huge protrusion, not accompanied by cauda equina dysfunction. (1) prone massage method ① kneading method: the patient is lying down, the operator stands beside him, with the thumbs and palms of both hands from the shoulders along the spine on both sides of the foot solar bladder meridian route from top to bottom, kneading spinal tendons, over the Cheng Fu point and then change to kneading, down to the Yinmen, the commission of the middle and over the Chengshan point, repeat 3 times. ② pressure method: the operator crossed his hands, the right hand on the top, the left hand on the bottom, with the palm of his hand from the 1st thoracic vertebrae, along the Vertebra down to the lumbosacral area, the left hand in the pressure slightly to the side of the foot to exert force, repeated 3 times. Then use the thumb to press the points of lumbar yangguan, vital gate, kidney yu, chi room, jusi, huanjiao, chengfu, and zhongzhong. ③ Rolling method: the operator in the dorsal lumbar ducal and foot solar bladder meridian, from top to bottom to implement the rolling method, until the lower limbs below the Chengshan point, repeated 3 times. Focusing on the lower back can be repeated several times. Traction and compression method: the patient lies prone, both hands hold the head of the bed, an assistant in front of the bed to pull the patient’s armpits, an assistant to pull the two ankles, to the two ends of the extraction and traction for about 10 minutes, the operator stood on the side of the patient with the thumb or palm pressure on the paravertebral pressure points. The force of pressure can be light or heavy. (5) Traction and shaking method: the patient lies prone, holding the head of the bed with both hands, the operator stands on the patient’s foot side, holding the patient’s ankles with both hands, shaking up and down on the basis of forceful traction, and rubbing and pressing the lower lumbar area with the palm of the left hand, and repeating this procedure for 2 to 3 times. (6) Prone leg method: the operator presses the waist with one hand, and holds the patient’s opposite knee with the other hand, so that the lower limb is stretched back as far as possible, and the hands are alternately exerted at the same time, so that a popping sound can be heard, and the left and right are each done once. (7) Prone shoulder method: the operator presses the waist with one hand, the other hand grasps the shoulder, the shoulder will be pulled to the back of the extension position can not be stretched back, push the waist of the hand suddenly pressed down hard, sometimes can be heard popping sound, left and right each for 1 time. (8) push the waist and pull the leg method: the patient lying on the side, the operator pushes the waist forward with one hand, the other hand holds its ankle and pulls it backward, such as pulling the bow to make the waist overstretching, and rhythmically loosening and tightening shaking the waist. ⑨ oblique trigger method: the patient lying on the side, the healthy side of the lower limb straight, the other lower limb flexion on the opposite side of the upper calf. The operator stands behind the patient, one hand holding the patient’s iliac bone after the outer edge, the other hand holding the patient’s shoulder in front, while pulling the shoulder back, pushing the iliac bone forward, so that the lumbar twist, sometimes can be heard or felt “click” sound. ⑩ roll and shake leg extension method: the patient lies on his back, both hips and knees flexed, so that the knee as close as possible to the abdomen. The operator holds the two knees with one hand, holds the two ankles with one hand, rotates and rolls the waist, and then pulls the two lower limbs hard to straighten them. (2)The three-step method of pulling and bouncing under anesthesia The therapy needs to be carried out only after the patient has been in intermittent traction for 10 to 15 days, and it needs to be safer with epidural anesthesia, after the anesthesia, the pulling and bouncing reset method is carried out. The patient lies supine, two assistants hold the patient’s two ankles and both sides of the armpits, for the confrontation of the pulling and stretching, and then will be affected by knee flexion and hip flexion, for clockwise rotation of the hip joint 3 to 4 circles, and then the lower limb for straight leg elevation test, the first affected limb, after the healthy limb, and in the highest position when the ankle dorsiflexion, for a total of three times. The patient should lie on the healthy side (if central herniation, the less symptomatic side), the healthy limb should be close to the bed and straightened, and the patient should be flexed as much as possible. The operator faces the patient, an elbow push shoulder back, an elbow pressure hip and thumb pressure lesion gap on the superior spinous process (if the spinous process is skewed to skew the spinous process shall prevail), staggered elbow force, adjusting the line of force, when the line of force conduction to the thumb and a sense of impedance when a sudden force, and smell the “khah-thump” sound at the same time there is a sense of joint loosening under the thumb can be. The patient is lying prone. ③Patient prone, the patient will be fixed on the electric traction bed with tension monitor, so that the lesion gap of the abdomen is suspended, the traction weight according to the patient’s tolerance level is set to overweight 10% -30%, continuous traction for 10-15 minutes after the implementation of the elastic reset. The operator stands on the affected side (central herniation standing on the side of the heavier symptoms), a hand palm root pressure on the corresponding lesion segments of the spinous process gap, the middle finger is facing the direction of the spine (or up or down), the other hand tiger’s mouth superimposed on the back of the wrist, the elbow joints straighten, to the vertical vertical abdominal continuous elasticity (elasticity process, the patient is asked to open his mouth to breathe, do not close the air), the pressure of 30-50kg (computerized traction machine can display the pressure of elasticity), frequency is 30-50kg (computerized traction machine can display the pressure of elasticity), and the pressure of 30-50kg (computerized traction machine can display the pressure of elasticity), frequency is 10-15 minutes after continuous traction. Kilograms), the frequency is 120 times / min, at this time the traction force remains unchanged, the patient, such as no adverse reaction, continuous elastic pressure for about 10 minutes that is to stop the maneuver, and gradually reduce the weight of the traction to the computer shows that the traction force is 0, remove the traction. During the implementation of manipulation under anesthesia, attention should be paid to the reaction to anesthesia. There may be back pain and abdominal distension on the day of the operation. After the implementation of the above manipulation treatment patients need to be absolutely bedridden for three days, straight turn over, lying down with a homemade lumbar cushion under the waist, the height of not less than 2cm, in order to maintain the lumbar curvature. And the application of 20% mannitol 250ml drip once a day for three days. After three days of absolute bed rest, the patient bed lumbar and dorsal muscle exercise, limb activities for 1-2 hours, measured blood pressure is normal, wear a waist circumference out of bed activities, pay attention to maintain the correct posture, to avoid sudden bending. (3) Rotary reset maneuver The patient sits on a square stool, with the feet separated by a shoulder width. Take the right lower limb pain as an example, the operator stands on the right rear side of the patient, the right hand through the patient’s right armpit to the back of the neck, with the palm of the hand to press the back of the neck, the thumb down, the remaining four fingers to support the left side of the neck, and at the same time the patient will be asked to step on the ground with both feet, the hips are seated and do not move, and the operator’s left thumb pushes and holds the distorted lumbar spinous process on the right side of the pressure and pain. An assistant stands facing the patient, clips both legs and assists in fixing the patient’s left thigh with both hands, so that the patient can maintain a seated position during repositioning. The operator then presses the patient’s neck with the right hand, causing the upper body to flex forward by 60 to 90° and then continue to bend to the right side, rotating the patient’s torso posteriorly and medially at maximal lateral bending. At the same time, the left thumb to the left top of the lumbar spinous processes, at this time can be felt under the fingers of the vertebral body slightly wrong movement, there is a “click” sound. Finally, the patient returns to sitting, and the operator uses the thumb and index finger to straighten the ligament and lumbar muscle from top to bottom. Traction therapy Pelvic traction is one of the most commonly used means of traction. Traction can be divided into artificial traction, mechanical traction. Artificial traction: the use of special pelvic traction belt, through the pulley at the head of the bed for traction, traction weight is generally about 5 to 12 kg per side, each 30 to 60 minutes, 1 to 2 times a day. In addition, the chest and pelvis can be used against traction, this method is based on the pelvic traction and chest traction belt to form a confrontation traction, traction time and weight with the pelvic traction. Generally, it takes 2 to 3 weeks for this traction to be effective. Mechanical traction: that is, with the help of special traction bed for traction, commonly used traction devices are: self-control pulse traction therapy bed, vibration traction bed, vertical automatic control traction device. 3, three-dimensional chiropractic: make the patient lie down on the reset bed, so that the lesion of the intervertebral located in the junction of the two boards, the thoracic back fixed on the cephalothoracic board, the pelvis is fixed on the buttock-leg board, before and after the tight rope, the thoracic back and pelvic fixation belt and fixed belt tightened. Beforehand, according to the patient’s height, weight, gender, age, lesion site and lesion degree to determine the data, the traction distance, into the angle direction, into the number of angles and rotational direction, rotation and other data into the computer, the computer control automatically complete a variety of actions. At the same time of instantaneous fixed-distance and rapid angular traction in a certain angular state in a fixed direction, fixed-angle rotation synchronization, the medical practitioner and then with the manipulation of the lesion of intervertebral applying the top push or pressure force, in 1/3 of a second can be completed in the spinal intervertebral three-dimensional change of a key treatment. Indications: patients with central and paracentral lumbar disc herniation. Contraindications: patients with spinal tuberculosis, severe osteoporosis, severe visceral diseases, severe physical weakness, pregnant women, bleeding tendency, compression of the cauda equina incontinence, fusion of the lesion intervertebral or the formation of bone bridges. 4, drug therapy Western medicine: (1) acetylsalicylic acid (aspirin) is the most commonly used analgesic, the role and slow, for a variety of neuralgia and arthralgia. Aspirin is currently available in a variety of enteric solvent forms that are less irritating to the stomach. This drug is prohibited for long-term use in large quantities, but relatively safe. Gastric ulcer patients should be used with caution. (2) non-steroidal analgesics such as anti-inflammatory pain, ibuprofen, anti-inflammatory spirit, etc., analgesic effect are stronger than aspirin, anti-inflammatory and anti-rheumatic effect is also stronger. They have some side effects, such as headache, nausea, vomiting, skin rash and gastrointestinal reactions, on the blood and liver, kidney function also has a certain effect, need to be taken under the guidance of a doctor. In order to reduce the adverse reactions, some drugs appeared in new dosage forms, such as anti-inflammatory pain suppositories, ibuprofen’s enteric slow-release agent fenbid, etc.. (3) Central muscle relaxants, such as chlorothalonil, have a role in relieving muscle pain. (4) For patients with lumbar disc herniation in the acute stage, as their spinal nerve root edema is obvious, causing severe pain and even secondary arachnoid adhesion, oral or static steroids can be used, supplemented with diuretics or dehydrating agents to eliminate nerve root edema. (5) Neurotrophic drugs such as vitamin B1 are also often used in some compound prescriptions. Herbal medicine: Blood stasis type Treatment: Promote blood circulation and eliminate blood stasis, regulate qi and stop pain. The main formula: Body Pain and Blood Stasis Expelling Tang plus subtractions. Cold-dampness type treatment: warming menstruation and dispersing cold, dispelling dampness and relieving pain. Main prescription: Wu Tou Tang with additional subtractions. Wind-dampness treatment: dispelling wind and dampness, promoting paralysis and clearing the channels. The main formula: add and subtract Duhu Sheng Tang. Kidney-Yang deficiency: warming and tonifying the kidney-Yang, activating the channels and muscles, strengthening the tendons and bones. Main formula: Right Returning Drink plus subtractions. Kidney Yin deficiency: nourishing Yin and tonifying the Kidney, relaxing the channels and activating the collaterals, strengthening the tendons and bones. Main prescription: Zuo Gui Drink with addition or subtraction. Chinese patent medicine: lumbar pain capsule, Jinwu Bone Tong capsule, external treatment: Tongluo pain relief cream, Yunnan Baiyao Cream 5, Chinese medicine fumigation therapy Generally, intelligent Chinese medicine fumigation treatment bed is used for patients to perform lumbar Chinese medicine fumigation therapy. Specific operation: before each fumigation, patients first add 200-500ml of decocted Chinese medicine liquid into the medicine tank of Chinese medicine fumigation bed, then turn on the power supply and heat it up, when the thermostat shows the temperature is 58±2℃, then support the patients to lie on their backs on the fumigation bed, take the bending-knee supine position with the waist overhanging above the fumigation holes, and the back can be fumigated with the disposable single padding. Patients were treated once a day in the morning and afternoon, for 35±5 minutes. Continuous treatment for 15 days for a course of treatment. 6, Pingle show tendon Dan kneading medicine Pingle show tendon Dan kneading medicine is a traditional Chinese medicine external treatment method in external medicine, Chinese medicine is profound, external drugs have cream, pill, Dan, bulk and other kinds of, show tendon Dan is one of the bulk, it is crushed by more than ten kinds of traditional Chinese medicine into a loose form, filtered, processed and become, and its important ingredients are blood exhaustion, pearl, ice and so on more than ten kinds of. It can help to soothe tendons and activate blood, separate adhesions, facilitate joints, regulate qi and stop pain and so on. In the process of clinical application, you can firstly shake the medicine containing Zhanjindan evenly, then stick a small amount of Zhanjindan powder with the thumb, take the corresponding reaction points or acupoints of the disease, and apply it on them to do the kneading technique. There are three types of medicine kneading, one is acupoint kneading, the second is kneading at joints, and the third is kneading at pain points. The method is to stick a little powder with the thumb, apply it to the reaction point and perform the kneading maneuver. It is characterized by gentle rotation on the skin, in order not to drive the skin under the finger to the degree; the direction is along the clockwise direction; kneading the range of medicine is the size of a nickel coin is appropriate. The frequency is 1 to 3 times a day, 60 to 100 turns each time, 10 days for a course of treatment. Its mechanism of action is through the abdomen of the thumb in the affected area rotating friction, this physical stimulation can make the local skin temperature rise, the pores open diarrhea, disease escape, and then the powder through the open diarrhea of the pores directly to the place of disease. Depending on the speed of the kneading technique and the size of the force, the medicine can reach different parts of the body. Therefore, according to the patient’s specific condition, different locations, the use of appropriate kneading techniques, can make the drug to reach the subcutaneous, muscles, fascia, ligaments, bones and joints and other parts of the body, so that the drug to achieve the maximum effect. In the lumbar disc herniation kneading medicine, you can choose lumbar yangguan, kidney, ring jump, commission, hanging bell, taixi and other parts of the kneading medicine treatment. 7, acupuncture treatment Acupuncture therapy clinically applied mainly based on the basic theories of traditional Chinese medicine, especially the theory of meridians and acupoints. Chinese medicine believes that the human body has twelve meridians, twelve meridians, eight odd meridians and fifteen collaterals, which run through the human body, with the role of the surface and the inside, through the upper and lower, the line of qi and blood, camping yin and yang. Acupuncture and moxibustion treatment, is directly on the acupoints, through the meridian conduction and reaction, to adjust the body’s nutritional qi and blood and viscera function, cure the disease. Acupuncture applied to lumbar intervertebral disc herniation, it is also based on the motherland medical knowledge of lumbar intervertebral disc herniation caused by back and leg pain, take points according to the meridian, identification and treatment, especially through the adjustment of the two meridians through the lumbar back of the blood and blood and yin and yang, blood, blood, blood circulation and blood stasis, soothing and clearing the channels and to achieve the therapeutic purpose. The following can be used: Kidney Yu, Large Intestine Yu, Waist Ah Yes Point, and Commission Zhong. Other commonly used points are: Huanjiu, Huizhong, Chengshan, Ashansanli, Jiezhong, Ah Yes, etc., once a day, 10 times for a course of treatment. Moxibustion is an important part of acupuncture therapy, it is the meridians, internal organs and other theories as a guide, the use of mugwort and other flammable drugs, in the acupuncture points or the affected area burning fumigation, can be over the warmth of the effect of the meridians to achieve the therapeutic purpose. Moxibustion can warm through the meridians, dispel cold, blood circulation, dissipate blood stasis and swelling, lift the gas, lead the gas downward, on the stagnation of blood stasis, wind, cold and damp paralysis caused by low back and leg pain, have a better therapeutic effect. There are many kinds of moxibustion, in the treatment of lumbar intervertebral disc herniation, in addition to needle handle moxibustion combined with acupuncture, but also can be used alone moxa roll moxibustion, take the kidney Yu, large intestine Yu, Chichibian, ring jump, Chengfu, Yinmen, Commission, Yanglingquan and other acupuncture points, each time to choose 3 to 4 points, each acupuncture point each moxibustion for 15 to 20 minutes, once every other day, 15 to 20 times for a course of treatment. 8, closed and sacral therapy pain points or nerve root closed properly selected can achieve better therapeutic effect, hard external or sacral therapy is also not lost as an effective pain relief therapy of intravertebral lesions. There are two types of closure therapy, one is intradural closure and the other is nerve root closure. As the name suggests, intralesional closure involves injecting medication directly into the spinal canal, while nerve root closure involves injecting medication around the nerve roots. The injected drugs are mainly adrenal glucocorticoids plus local anesthesia. Under the action of hormone, it can reduce and eliminate the aseptic inflammation and edema of the nerve root; the anesthetic drug is for pain relief, anesthetizing the nerve to make it less sensitive. Steps of sacral therapy: the patient lies in prone position, the lower abdomen is padded with pillows, so that the head and legs are lowered and the sacrococcygeal area is protruded. After routine skin disinfection, spread the hole towel, in aseptic operation, with No. 7 or No. 9 infusion needle in the sacral cleft, and the skin was 70 ~ 80 ° puncture into the needle, when the feeling of a sense of emptiness that is, the puncture is successful. When there is no blood or cerebrospinal fluid, and there is no excessive resistance to the injection, the drug mixture can be injected. The volume of drug injection is generally 40-70 ml. It is required to push the drug with a certain speed and give a certain strength to achieve the purpose of loosening the adhesion around the epidural space and nerve root with the help of the volume of the drug and the pressure when injecting. Commonly used injections are: 25mg of Chuangyan Shusong, 0.25% Lidocaine 5ml, Vitamin B1 100mg, Vitamin B12 200mg, 0.9% saline 10-50 ml. Sacral injection treatment once every 5-7 days, for the treatment of the right, and puncture to give the correct drug, usually a treatment can be effective, 3-5 times for a course of treatment. After systematic conservative treatment, patients should wear suitable waist circumference for fixation. If there are still clinical symptoms after conservative treatment, patients can continue to rest in bed for a few days. When lying in bed, the patient should put pads under the waist and pay attention to the lying posture. 10, other treatments Small knife therapy is a new treatment method developed on the basis of acupuncture and closed therapy. The needle knife is a surgical instrument that is used to loosen the pain points of patients with lumbar and leg pain by extensive peeling and loosening to loosen the adhesion and reduce tension and pressure, thus relieving the clinical symptoms of a therapy. Hook knife therapy is a kind of “sickle”-like medical instruments, after local anesthesia, to carry out extensive subcutaneous muscle and tendon release at a certain depth, to release the intervertebral dynamic imbalance caused by the bone or soft tissue causes of intervertebral disc herniation, such as adhesion, scarring, contracture, joints and other minor misalignments, to restore the stability of the internal environment, so as to improve the clinical symptoms. It is a kind of therapy to improve clinical symptoms. Hydro-needle knife therapy, that is, on the basis of needle knife, extensive peeling and loosening of the pain points of patients with low back and leg pain, and then injected into the local anesthesia drugs plus hormone drugs, to play the role of anti-inflammatory and pain relief. Injections and Zichuan therapy, i.e., the corresponding drugs such as saffron, angelica, hormones, etc. are injected into the painful areas or around the nerve roots to improve the inflammatory stimulation, thus relieving the symptoms. Embedded Thread Therapy is a therapy that uses specific instruments to inject or place sheep’s intestines into specific acupuncture points and areas, utilizing them for continuous stimulation, thus providing a continuous therapeutic effect. The method of applying artificial or natural physical factors to the organism to prevent and treat diseases is called physical therapy, or physiotherapy for short. It has analgesic effect, anti-inflammatory effect, loosening adhesion, softening the role of scarring, excitation of nerves and muscles. Laser therapy, infrared therapy: their main role in the human body is the thermal effect, mechanical effect, photochemical effect and electromagnetic effect of four aspects, mainly through the role of radiant heat, so that the organization of heat, accelerate blood circulation, promote metabolism, strengthen tissue nutrition, while reducing the excitability of the nerve endings, anti-inflammatory, analgesic, relaxation of muscle spasm effect. Electrotherapy, ultrasound therapy, wax therapy, magnetic therapy, vinegar iontophoresis, external drug belt can be chosen to apply. 11.Surgical treatment For those who have serious symptoms and images of work and life, for those who can not accept traction manipulation therapy, for those who have relapsed even though conservative treatment is effective, or for those who are ineffective in conservative treatment, and for those who are accompanied by damage to the cauda equina nerve, surgical treatment should be used. Generally, single- or double-window surgery is used. It can be divided into lumbar disc nucleus pulposus removal, lumbar discoscopic nucleus pulposus removal, percutaneous lumbar discectomy, nucleus pulposus dissolution, and ozone intervention.