Lumbar disc herniation, also known as lumbar disc rupture nucleus pulposus herniation. It is a lesion characterized by low back pain caused by the rupture of the nucleus pulposus under the action of external forces after the degenerative degeneration of the lumbar intervertebral disc, and is accompanied by symptoms such as radiating pain of the sciatic nerve. Typology: From clinical practice, pathological changes and CT, MRI findings, the following typology can be made: (a) bulging type: degenerative degeneration of the intervertebral disc, degenerative relaxation of the fibrous ring, softening, thinning, to the surrounding is uniformly bulging but still intact, called bulging disc. This type of patient can have back pain or discomfort, more than no radioactive lower extremity pain, this type does not require surgical treatment. Conservative treatment is more effective. (B) bulging type: rupture of the inner layer of the fibrous ring but the surface layer is intact, limited bulging due to the high pressure of the nucleus pulposus, the bulge is smooth and hemispherical. After conservative treatment such as traction, massage and rest, it can be flattened and reduced, and most cases can be cured by non-surgical treatment. (C) Rupture type: The fibrous ring has ruptured, and the protruding nucleus and fibrous ring are only covered by the dilated part of the posterior longitudinal ligament or fibrous membrane, and the protrusions are irregular, sometimes cauliflower-like or fragmented. In cases with long duration of the disease, the protrusions tend to adhere to the surrounding tissues. Surgery is often required for those with severe compression symptoms. Conservative treatment is not recommended for this type, especially not massage treatment. (iv) Free type: The ruptured and protruding disc tissue or fragments leave the location of the protrusion and free into the spinal canal, which can compress the cauda equina nerve resulting in loss of sensory movement below the plane of the protrusion. This type is less common and often requires surgery. Identification and treatment: According to the initial typing, after determining the conservative treatment, identification and treatment can be performed according to the theory of traditional Chinese medicine. This disease should belong to the category of “low back pain” in Chinese medicine. Low back pain, also known as “lumbar spinal pain”, refers to a condition in which the main symptom is pain in the lumbar spine or the paraspinal area due to poor circulation of qi and blood in the lumbar region caused by external sensation, internal injury or contusion and flash. The evidence of lumbago has been discussed in ancient literature. The Su Wen – Pulse Essence of Microscopic Theory contains: “The waist is the house of the kidney, if it cannot be shaken, the kidney will be exhausted”, which firstly put forward the close relationship between the kidney and waist diseases. According to the circulation of the meridians, the book “Su Wen – Treatise on Stabbing Waist Pain” describes the symptoms of waist pain caused by the diseases of the three yin and three yang channels and the eight odd meridians, and introduces the corresponding acupuncture treatment. The Jin Kui Yao Yao (The Essentials of the Golden Horoscope) and the Five Organs Wind-Cold Accumulation Disease Pulse Evidence and Treatment says: “The disease of the kidney is the body weight, cold in the waist, like sitting in water …… cold pain below the waist, the abdomen is heavy as with 5,000 money, Gan Jiang Ling Jie Tang is the main one.” Discusses the onset, symptoms and treatment of cold-damp lumbago. The “Treatise on the Origin of Diseases and the Causes of Low Back Diseases” believes that lumbago is due to “deficiency of the kidney meridian and the wind and cold taking advantage of it”, and “strain and damage to the kidney, moving and injuring the meridians, and invasion by wind and cold, and blood and qi fighting, so lumbago is also painful.” In terms of pathogenesis, it emphasizes factors such as kidney deficiency, wind and cold, strain and injury to the kidney, fall and injury to the waist and sleeping on wet ground, etc. It is called sudden onset lumbago, and repeated attacks that do not heal for a long time are called long lumbago. Danxi Xinfać»Lower Back Pain” says: “Low back pain is caused by damp heat, kidney deficiency, blood stasis, contusion and flash, and phlegm accumulation”. The Seven Pines Rock Collection – Low Back Pain points out: “However, there is a distinction between deficiency and reality in pain, and the so-called deficiency is the deficiency of the spirit of the two kidneys and blood. The so-called real, not the kidney family from the real, is the two waist meridians and blood vessels in the invasion of wind, cold and damp, flashing and frustration of gas, the waist in the cavity for the dampness, phlegm, blood stasis, stagnation, impassable and pain, when according to the pulse evidence to identify and understand and divided treatment of.” The common causes and deficiencies of low back pain are summarized. Zhang’s Medical General” and “Rhinoceros Candle on the Origin and Flow of Miscellaneous Diseases” summarize the discussions on low back pain by medical practitioners in the past generations and summarize them as wind low back pain, cold low back pain, kidney deficiency low back pain, qi stagnation low back pain, stasis low back pain, etc., making the identification and treatment of low back pain more systematic. For the treatment of low back pain, Li Yongcui of the Qing dynasty pointed out in the “Evidence and Treatment of Huixi and Lumbago” that “the treatment is only to nourish the kidney first, and then follow the evil seen in order to administer the treatment, and treat the symptoms if the symptoms are urgent, and treat the origin if the origin is urgent, it is appropriate to dredge the evil stagnation and manage the meridians and tunnels for the first pain, and it is appropriate to nourish the true essence and nourish the blood and qi for the long pain.” This treatment principle of distinguishing the symptoms from the root is of great clinical significance. Classification of symptoms: 1. Cold and dampness pain in the lumbar region, with unfavorable rotation, gradually worsening, and the pain does not diminish when lying down, but worsens on cold and rainy days. Pale tongue, white and greasy coating, sunken and sluggish pulse. Summary of the evidence: Cold and dampness close and obstruct qi and blood, resulting in unfavorable meridians. Treatment: Dispersing cold and dampness, warming the meridians and clearing the channels. Representative formula: Ganjiang Lingzhu Tang with addition and subtraction. This formula has the effect of warming the middle, dispersing cold and resolving dampness, and is applicable to the evidence of pain in the lumbar spine caused by cold and dampness blocking the meridians. Commonly used drugs: dry ginger, cinnamon stick, licorice, hyssop to warm the meridian and disperse cold, pass the ligament and relieve pain; poria, atractylodes to strengthen the spleen and permeate dampness; eucommia, mulberry, sequestra to strengthen the kidney and waist. It is more common in the north, more common in winter, aggravated by cold and rainy days, with obvious history of cold and dampness. With Chinese medicine fumigation, Chinese medicine iontophoresis, TDP, cupping effect should be better. 2. Damp-heat evidence Pain in the lower back, heavy and hot, aggravated by summer humidity and cloudy rainy weather, may be relieved after activity, heavy body sleepiness, short and red urine. The moss is yellow and greasy, and the pulse is moist or stringy. Summary of symptoms: Dampness and heat suppress the flow of Qi, and the tendons and veins are not relaxed. Treatment: Clearing heat and relieving dampness, soothing tendons and relieving pain. Representative formula: Si Miao Wan plus reduction. This formula is used for clearing damp-heat, soothing the tendons, relieving pain, and strengthening the lumbar spine. Commonly used herbs: Atractylodes macrocephala, Phellodendron, Semen Coix seeds to clear damp-heat in the lower jiao; papaya and Lobelia vine to soothe tendons and relieve pain; Chuan Niu Knee to open tendons and veins, induce downward movement of medicine, and strengthen the lumbar spine. It is not common. However, as the standard of living improves and the diet becomes greasy, dampness and heat become stagnant in the lumbar region, resulting in poor meridians and lumbago. Foshan Hospital of Traditional Chinese Medicine “yellow water” should be inspired. 3.Qi stagnation and blood stasis Low back pain like stabbing, pain at a fixed place, pain refuses to be pressed, light day and heavy night, the lighter the inconvenience of pitching up and down, the heavier the inability to turn side to side. The tongue is dark purple, or with petechiae, and the pulse is astringent. Some patients have a history of fall and flash. Summary of evidence: Stasis of blood, paralysis of the meridians, pain if it does not pass. Treatment: Invigorate blood circulation, resolve blood stasis, promote circulation and relieve pain. Representative formula: Body Pain and Stasis Removal Soup with Addition and Reduction. This formula has the effect of invigorating blood, promoting blood circulation and relieving pain, and is suitable for trauma to the lumbar region with blood stasis blocking the blood vessels, resulting in lumbar pain like thorns. Commonly used herbs: Radix Angelicae Sinensis, Chuanxiong Rhizoma, Tao Ren and Hong Hua invigorate blood circulation to remove blood stasis and dredge the meridians; Radix Aromaticus, Myrrh, Wu Ling Li and Di Long move Qi and blood, pass through the channels to relieve pain, remove blood stasis and eliminate swelling; Niubizi invigorate blood circulation to remove blood stasis, induce downward movement of medicine and strengthen the lumbar spine. The labor factor is dominant and most patients are due to this evidence. All kinds of treatment methods are applicable to this evidence, mostly applying blood activating and stasis relieving drugs, and our “pain relieving and swelling dan” is applicable. 4.Deficiency of liver and kidney. Vague pain in the lumbar region, soreness and weakness, lingering. Pale tongue and thin pulse. Summary of symptoms: Kidney deficiency, unable to moisten the lumbar spine. Treatment: Nourish the kidneys and moisten the tendons. Representative formula: Zuo Gui Wan and Right Gui Wan with addition and reduction. This formula nourishes the kidneys and strengthens the waist and spine. Commonly used drugs: Shu Di Huang, Fructus Lycii, Cornu Cervi Pantotrichum, Yam, Tortoise Gum to nourish kidney yin; Cinnamon, Radix et Rhizoma, Deer horn Gum, Eucommia, Semen Cuscutae to warm kidney yang. Most of them have the manifestation of deficiency. Our “Bone Ning Wan” is suitable. Acupuncture and moxibustion: acupuncture points of the foot and sun bladder meridian are the main points. The acupuncture points are mainly the acupuncture points of the foot solar bladder meridian, such as the Wei Zhong, Kidney Yu, Large Intestine Yu, Waist Yang Guan, Da Zhong, Low Back Pain, and Ah Yes. For cold and damp lumbago, moxibustion of Dazhi should be added to warm the Yang and disperse the cold; for stagnant lumbago, moxibustion of Diaphragmatic Yu should be added to activate blood circulation and remove stasis; for kidney deficiency lumbago, moxibustion of Zhanmen should be added to benefit the kidney and strengthen the lumbago. Tuina: operation: (1) prone relaxation. First relax the lumbar muscles to promote blood circulation in the lumbar region. Gun, kneading, shoulder movement method is equal to the waist and the affected lower limbs back and forth application, to the waist treatment is the main. (2) Antispasmodic and pain relieving, raising the pain threshold. Pointing, pressing or plucking method is applied to the acupuncture points, and the degree of “getting qi” is the degree. (3) Enlarge the intervertebral foramen, adjust the posterior joint, and release the position between the protrusion and the nerve root. Do lumbar oblique tug method and other tug methods, once on each side (first on the affected side and then on the healthy side) (4) widen the lumbar intervertebral space, reduce the pressure in the intervertebral disc, do lumbar extraction and extension method (manual or mechanical traction), do shaking and pulling method or lumbar extraction and extension method, leg extraction and lumbar pressure method. (5) Promote the recovery of lumbar nerve root function, using gun, kneading, pinching, rubbing method, etc. to promote blood flow in the lumbar and lower limb parts, so that the damaged nerve root function can be restored. Traction: The main method is pelvic traction, which is suitable for patients in the acute stage of the first attack or recurrent attacks as well as for patients with severe disease. The patient lies supine on the traction bed, and after the lumbar iliac region is tied with a traction belt, traction is performed with 10 kg of weight on each side for 30~60 minutes each time, 1~2 times a day, 7~10 days as a course of treatment. Clinical evidence preparation: 1. Make good use of blood-activating and stasis-transforming drugs. Blood-activating and stasis-transforming drugs can be used for different types of low back pain, but the selected drugs and dosage should be different for different stages of the disease. In the first acute stage, small doses of Angelica sinensis and Rhizoma Chuanxiong are often used to nourish the blood and blood and warm the meridians; in the period of relative remission, the dose and effect of blood-activating drugs can be increased; in the case of prolonged low back pain and repeated recurrence, blood-activating and stasis-clearing drugs can be combined with wind-clearing drugs, such as peach kernel, safflower, panax notoginseng, curcuma longa, gadfly, leech, beehive, whole scorpion and centipede. 2. The clinical evidence emphasizes comprehensive treatment. According to the condition, acupuncture, tuina, traction, closure, cupping, physical therapy, acupoint injection, Chinese medicine fumigation, Chinese medicine iontophoresis and other methods are used to help the treatment and recovery of the disease. It can be combined with the internal consumption of Chinese medicine and proprietary Chinese medicine with the effect of activating blood circulation and removing blood stasis, reducing swelling and relieving pain, and the static drip of seven leaves, mannitol, dexamethasone and other drugs to relieve neuroedema, as well as topical drugs such as ointment. 3. The general treatment sequence is to relax the surrounding muscles and tissues, apply the main treatment means, and then relax the surrounding muscles and tissues at the end. The main treatment means include acupuncture, tui na, traction, and acupoint injection. Other treatments such as physiotherapy, herbal fumigation, herbal iontophoresis and cupping can be used as relaxation tools. Preventive care: Patients should rest in a hard bed during treatment, and the symptoms can be basically relieved after 3 weeks of strict bed rest. After clinical cure by treatment, do not bend the waist significantly within 1 to 3 months to prevent triggering the disease. Reduce the weight on the waist, do less heavy physical work, and avoid too much strain. In winter, pay attention to the lumbar region to keep warm, do not suffer from cold to prevent triggering the disease; in the summer season, when it is hot and humid, you should also avoid sleeping outdoors at night, greedy for cold and like to be cool. Avoid sitting and lying on wet ground, wading in the rain or sweating out of the body should change clothes and wipe the body. Use waist brace to avoid lumbar injury. Commonly used methods are flying swallow, arch bridge, or standing position for lumbar forward bending, back extension, side bending and hanging on the double bar back and forth leg swing exercises. Active participation in sports such as swimming, taijiquan, or lumbar self-massage can help the recovery of lumbar disc herniation.