[Definition] A disease caused by degeneration of the lumbar intervertebral disc, rupture of the annulus fibrosus, and protrusion of the nucleus pulposus to compress or stimulate the nerve roots and cauda equina, resulting in lumbar and leg pain as the main manifestation. It is commonly found in the L4-5 and L5-S1 spaces. The cause of this disease is trauma, strain and injury, lack of kidney qi, weakness of essence and loss of nourishment of tendons and veins, and wind, cold, dampness and heat, which cause obstruction of the meridians, stagnation of qi and blood, and pain. Spiritual pivot・beginning of all diseases: “is the reason for the deficiency of evil in the people also …… stay and do not go is transmitted to the loss, in the loss of the time, the six meridians do not pass, the limbs are limb pain lumbar spine is strong.” The source of diseases on the waist and foot pain waiting: “kidney deficiency, by the wind evil for, labor injury is kidney deficiency, deficiency is subject to the wind and cold, wind and cold and right qi cross, so the waist and foot pain.” Second, modern medicine: internal causes: ①, congenital developmental abnormalities of the intervertebral disc. ②, degeneration of the intervertebral disc nucleus pulposus water content reduction, elasticity and resistance to load decreases. External causes: ①, a more serious trauma. (ii) Repeated multiple mild traumas and accumulated injuries. ③, cold stimulation. Pathological changes】 l. Pre-protrusion scar-like connective tissue of the nucleus pulposus, repeated injury, thinning of the degenerative fibrous ring, and production of fissures, the patient may have lumbar discomfort or pain, without radiating lower limb pain. 2.Protrusion stage The nerve root undergoes acute traumatic inflammatory reaction, congestion, edema, coarsening and extreme sensitivity. 3.Late stage of herniation ①.Protrusion fibrosis and calcification. ②, the entire disc degenerates, the fibrous ring crumples, the vertebral body hardens beneath the vertebral body, the edge of the bone proliferates, and a bone superfluous is formed. ③, nerve root adhesion, degeneration, atrophy, loss of movement and sensation in its innervation area. ④, hypertrophy of the ligamentum flavum as a secondary lesion. ⑤, degeneration and hyperplasia of the intervertebral joints due to narrowing of the intervertebral space and increased compensatory loading of the intervertebral joints after disc herniation. ⑥.Secondary spinal stenosis. Classification】 Classification according to the direction and location of the herniation 1. Paracentral type herniation: The herniation is located on the posterior lateral side of the intervertebral disc, compressing the nerve root and causing radiated leg pain. (1) Root and shoulder type: The protrusion is located in the outer front of the nerve root (shoulder), squeezing the nerve root to the posterior medial side, and the spine is mostly bent to the healthy side and protrudes to the affected side. (ii) Root and internal organs type: the protrusion is located in the inner front of the nerve root (axilla), and the nerve root is squeezed posteriorly and laterally, and the spine is bent toward the affected side and protrudes toward the healthy side. ③, root front type: the protrusion is located in the front of the nerve root, the nerve root is squeezed to the posterior side, the physiological protrusion of the spine disappears, the anterior and posterior activities are restricted, and there is no scoliosis deformity. 2, central type protrusion ①, partial central type: partial to one side, mainly compressing one nerve root and cauda equina nerve or both sides, but one side is lighter and one side is heavier. Orthocentral type: located in the center, compressing nerve roots and cauda equina nerve on both sides. The nerve roots on both sides and the cauda equina are compressed. Clinical manifestations] I. Symptoms and signs 1. Low back pain and radiating leg pain Features: ①. Radicular radiating pain. ②. Pain is related to abdominal pressure. ③. Pain is obviously related to activity and body position. 2. Limping: The affected limb cannot take steps and bear weight normally, and often needs to walk with the help of crutches. 3.Lumbar muscle spasm, spinal deformity and activity restriction. 4. Interspinous paraspinal pressure pain and radiating pain. 5, neurological impairment. (1) Motor: Atrophy of the muscles innervated by the affected nerve. Sensory: sensory hypersensitivity, hyperalgesia or loss of sensation may occur in the distribution area of the affected nerve root. Reflexes: L4-5 posterior tibial muscle L5-S1 Achilles tendon L3-4 knee. Common examination methods and signs 1. straight leg raise test (lasegue sign) 2. straight leg raise test 3. neck flexion test 3. auxiliary examination 1. X-ray examination: lumbar spine frontal and lateral radiographs ①. lumbar spine shape change: scoliosis deformity, reduction or disappearance of physiological anterior convexity, serious retroversion. ②, change in the width of the intervertebral space: the intervertebral space may become narrower and the intervertebral disc may degenerate. ③, osteophytes on the upper and lower edges of the anterior and posterior vertebral bodies, with lip-like protrusion. ④, small articular protrusion hypertrophy and sclerosis; secondary changes of disc degeneration or protrusion. 2.CT can clearly show the site, size, shape and displacement of nerve roots and dural sac of the herniated disc, as well as hypertrophy of the vertebral plate and ligamentum flavum, hyperplasia and hypertrophy of the small joints, and narrowing of the spinal canal and lateral saphenous fossa. MRI can show the intervertebral disc, the nerve and the epidural fat around the nerve in more detail. (1) Problems to be solved 1. To confirm that the low back pain is caused by disc herniation, to identify and exclude tuberculosis, tumor, spondylolisthesis, spina bifida and other disorders. 2.Determine the plane of protrusion and locate it clearly. 3.Determine the type of herniation. 4.The presence of combined diseases, spinal stenosis, and spondylolisthesis. (1. History of lumbar trauma, strain or wind-cold, and most of them have a history of chronic lumbar pain. 2.Lumbar pain combined with radiating pain of the lower extremities, radiating to the calf or foot, and the pain is aggravated by increasing abdominal pressure. 3. There are obvious pressure points between the spinous process and radiation to the lower limbs at the same time. Straight leg raise and strengthening test are positive. 4. Changes in sensation, movement and reflexes in the affected innervation areas of the lower limbs. Myasthenia gravis may appear in those with long duration of disease. CT shows the location and degree of disc herniation. Differential diagnosis】 1.Sacroiliac joint strain: no obvious radiological pain, no muscle strength, sensory and reflex changes, pressure points in the sacroiliac joint, not in the spinous process. 2, pear-shaped muscle syndrome hip pressure pain, hip muscle atrophy, no spinous process pressure pain, pear-shaped muscle tension. 3, lumbar spine tuberculosis tuberculosis symptoms: hypothermia, night sweats, wasting, accelerated blood sedimentation, X-ray bone destruction, narrowing of the vertebral space. 4.Vertebral canal tumor Intra-vertebral canal tumor, extra-vertebral canal tumor. Progressive aggravation, not related to lumbar activities, rest can not be relieved. MRI can be identified. 5, lumbar spinal stenosis intermittent claudication, slow bending pain, more symptoms, less signs. Treatment】 I. Conservative treatment 1. (2) Longer duration of disease, but less severe symptoms and signs. (3) Smaller protrusions by imaging. (4) Those who cannot perform or do not agree to surgery. 2.Methods: (l), tendon manipulation: traction and pressure method, trembling waist method, oblique trigger method. (2), fixation methods: absolute rest on a hard bed, do not sit or stand for urination and defecation: 2-3 weeks later, under the protection of the lumbar girth to move in bed. (3), pelvic traction: for the first attack and the acute phase of recurrent attacks. (4).Practice activities: Feiyan dotted water, supine bridge, three-point or five-point support method, etc. (5) Drug treatment: ①, dialectical treatment a. Liver and kidney deficiency type: Soreness of the back and legs, weakness of the knees, worse after exertion, relieved by lying down. In case of Yang deficiency, the face is florid, the hands and feet are not warm, little breath and lazy speech, the waist and legs are cold, the tongue is pale, the pulse is sunken and thin, the treatment should be warming and tonifying the kidney yang, and the formula should be added and reduced with Right Return Pill or Tonic Kidney and Tendon Soup. In cases of partial Yin deficiency, the face is flushed, the throat is dry, tiredness and weakness, distress and insomnia, dreaminess, red tongue with little bitterness, thin pulse, the treatment is to nourish Kidney Yin. b. Invasion of external evil type: cold pain in the lumbar region, heavy, unfavorable turning, pain does not decrease when lying down, aggravated by cold, cold extremities, pale tongue with white fur, sunken and tight pulse, treatment is to disperse cold and remove dampness, warming the meridians and clearing the channels. The formula is Qiangwu Shengshi Tang or Douwuxiaosheng Tang, plus or minus. In cases of damp-heat, burning pain in the waist and legs, weakness of the legs, aggravated by heat or rain, malignant heat, thirst and inability to drink, short and red urine, yellow and greasy moss, moist pulse. c. Qi stagnation and blood stasis type: stabbing pain in the lower back and legs with fixed location, refusal to press, light day and heavy night, stiffness in the lumbar region, unfavorable tilting and turning, dark tongue and tight pulse. The treatment is to activate blood circulation, resolve blood stasis and promote blood circulation. (ii) Chinese medicine: Take internal lumbar pain nin, static dose of safflower injection, and so on to activate blood circulation and remove blood stasis. (③) External medicine Local hot compresses of Chinese herbs, external use of Qizheng pain ointment, etc. ④.Western medicine For mild symptoms, use Fenbid, Lunanbet, etc.; for severe symptoms, use dehydration therapy (20% mannitol 250ml once a day, stop after three days). (6), acupuncture therapy: commonly used kidney Yu, ring jump, Cheng Fu, Yin Men, Wei Zhong, Yang Ling Quan, Hou Xi, Tai Chong. Choose 3 to 5 acupuncture points each time. (7), other therapies: physical therapy with Chinese medicine penetration, microwave heat therapy, etc. (2) Surgical treatment Indications: ①, at least three months of strict non-surgical treatment is ineffective. (2) Those who have incomplete paraplegia symptoms. (③) Those with combined spinal slippage. (iv) Those who cannot undergo non-surgical treatment for other reasons, provided that there is a clear protrusion compressing the nerve root confirmed on imaging.