31.What diseases should be distinguished from lumbar disc herniation? There are more diseases that manifest as lumbar disease combined with sciatica and femoral neuralgia, which are not easy to distinguish clinically and are easily misdiagnosed and mistreated. Therefore, differential diagnosis is very important. The main differential diagnosis points are briefly described as follows; (1) Bone development abnormalities. (1) Lumbosacral cryptoschisis: the 1st sacral vertebra and the 5th lumbar vertebral arch do not heal, is the most common congenital anomaly of the lumbosacral part of the spine, the incidence of which has no precise statistics, about 16.8% to 35.7% of the normal population. Those with severe cryptoschisis are prone to chronic lumbar disease due to strain and occasionally sciatica, and can also be combined with lumbar disc herniation with the level of protrusion in the upper interspace. Simple lumbosacral cryptoschisis can be identified by lumbar spine x-ray. If there are obvious signs of nerve root localization, the possibility of lumbar disc herniation should be considered. ②Arthrosynovial deformity: deformity of the small interlumbar articular processes, especially asymmetry of the small articular surfaces on both sides of lumbar 5 and sacral 1, is one of the causes of lumbosacral pain. Generally the disease is confined to the lumbosacral region, and it is mostly a symptom of lumbosacral strain. If typical sciatica occurs and there is a localized neurological functional disorder, it should be regarded as a lumbar intervertebral disc herniation, not just a small joint deformity. (2) Lumbar joint lesions and strain. (1) Sacroiliac joint tuberculosis: sacroiliac joint tuberculosis can have similar symptoms to lumbar disc herniation, and there are three points of differentiation: a severe pain when turning and strong positive “4” test in patients with this disease; b sacroiliac joint film can be differentiated; c accelerated blood sedimentation. ② Sacroiliac joint trauma: straight leg raising test can be positive in sacroiliac joint trauma. Differentiation points: a history of acute trauma; b positive pelvic compression and separation test, strong positive “4” test; c in case of fracture, X-rays can show the displacement of pelvic bones. ③ Sacroiliac arthritis: including rheumatoid, sclerosing and septic arthritis, all present with low back pain. However, it is usually limited to the sacroiliac joint area. In addition, the inflammatory symptoms of septic arthritis, strong positive “4” test, positive pelvic separation squeeze test, and X-ray can be distinguished. Sclerosing arthritis is mainly identified by x-ray. (3) Spinal tuberculosis. Spinal tuberculosis is usually only low back pain, such as bone destruction, cold abscess posterior protrusion can appear similar to the symptoms and signs of lumbar disc herniation. It can be distinguished by x-ray. (4) Tumor. (1) Intraspinal tumor: there are two kinds of intradural and extradural. The clinical manifestations are similar to those of central lumbar disc herniation, with neuroradiological pain, urinary and fecal dysfunction, and positive straight leg raising test bilaterally. If the tumor is on one side, it is also similar to unilateral lumbar disc herniation. The differential diagnosis mainly relies on spinal canal imaging. (2) Extradural tumor: the symptoms of nerve involvement are not obvious, and pain and activity disorder are its characteristics. x-ray can differentiate. (5) Chronic degeneration and strain of the spine. (1) Lumbar spine osteoarthropathy: refers to degenerative changes of the vertebral body edges and articular cartilage. There are hypertrophic spondylitis, osteoarthritis, vertebral hyperplasia, bone redundancy, etc. The main symptoms and signs are low back pain, some can cause leg pain, restricted movement or stiffness. x-ray can see narrowing of the vertebral space or osteophytes. Degeneration of articular cartilage can be secondary to lumbar disc herniation. ② degenerative lumbar spondylolisthesis: its symptoms are mainly lumbar pain, posterior extension pain is heavy, which can hold the posterior thigh pain, but leg pain is lighter than lumbar disc herniation. x-ray can see heavy degeneration of small articular synapses and degenerative hyperplasia at the edge of the vertebral body of posterior slip. ③Lumbar spinal stenosis: lumbar spinal stenosis is one of the common diseases leading to lumbar leg disease. The key points of differentiation are as follows: a. The sciatic nerve is involved in this disease, and the sensory weakness and muscle weakness are not obvious, and the distribution of the nerve area is not typical. b, Vertebral canal imaging can show stenosis and spread to the entire one vertebral body of the spinal canal. c, Venography for lumbar disc herniation can be differentially diagnosed from this disease. d, CT or MRI imaging is the best differential method, but is not necessary. Small joint syndrome. A syndrome in which lower back pain and sciatica are the main symptoms caused by disorders of the small joints of the lumbar spine. The main points of differentiation are; the disease is dominated by lumbar pain, while sciatic nerve symptoms are not very typical, lumbar pain may suddenly worsen, and turning is difficult, physiological pronation exists, and straight leg raising test is normal. (7) Transverse process syndrome of the third lumbar vertebra. The third lumbar transverse process is the attachment point of thicker ligaments, which often causes low back pain due to stress injury. The key points of differentiation are: the location of lumbar pain in this disease is high (near the third lumbar vertebra), the pressure point is 5-6 cm from the midline (the pressure point of lumbar disc herniation is 2-3 cm outside the midline), the sciatic nerve pain area is blurred, and there is no sensory or motor impairment. Pear-shaped muscle syndrome. Pear-shaped muscle syndrome accounts for 1.02% of lumbar leg disease, and the key points of differentiation are: ① Pear-shaped muscle tension test is mostly positive. The pain is aggravated by passive lower limb internal rotation, or automatic lower limb external rotation. (3) Local anesthesia of the pear-shaped muscle area can make the pain disappear, while there is no change in lumbar disc herniation. (9) Hypertrophy of the ligamentum flavum. The ligamentum flavum thickens and calcifies due to long-term strain degeneration and loss of elasticity, compressing the dural sac and nerve roots, and symptoms similar to those of lumbar disc herniation can occur. However, this disease produces nerve root symptoms when the waist is posteriorly extended, while lumbar disc herniation produces nerve compression symptoms when the waist is anteriorly flexed, which is the opposite of the two. How does TCM recognize lumbar disc herniation? Chinese medicine believes that the waist is the capital of the kidney. Therefore, the evidence of lumbar pain is most closely related to the kidney. The kidney is the master of bone, generates marrow and is connected to the brain, which physiologically indicates that the physiology and pathology of the spine are necessarily related to the kidney. The “Treatise on the Origin of Diseases and Low Back Pain” believes that “there are five diseases of low back pain: one day of Shao Yin, Shao Yin kidney. Injured by the Yang of all things in July, is to lumbago; two wind paralysis, wind and cold on the waist, is to pain; three said kidney deficiency, service injury kidney, is to pain; four faint waist, fall down injury waist, is to pain; five said sleeping and lying wet, is to pain.” The “Danxi Xinfa Lumbago” states, “Lumbago is dominated by damp heat, kidney deficiency, bruising, contusion, and phlegm accumulation.” These above statements summarize the etiology of lumbago. The “Treatise on the Origin of the Diseases and the Causes of Low Back Pain” also analyzed the pathogenesis of low back pain and concluded that, except for “cum lumbago” caused by sudden injury and damage to the waist, all other low back pain is related to “deficiency and loss of kidney qi”. For example, “rheumatism lumbago” is “strain injury to kidney qi, the meridians are deficient, or because lying wet when wind, and wind-dampness take advantage of the deficiency in the kidney meridians, and blood and qi hit so lumbago”; “stroke lumbago” is “People with strain and injury have a deficiency of kidney qi, and the kidney is the main waist and feet, and its meridian through the kidney ligament spine, the wind and evil take advantage of the deficiency, and then into the kidney meridian, so suddenly suffer from lumbar carbuncle.” It is pointed out that even if it is sudden lumbar pain, the origin is still related to kidney deficiency. The Source of Miscellaneous Diseases Rhinoceros Candle on the Source of Waist and Navel Diseases clearly states: “Waist pain, essence deficiency and evil guest disease. …… kidney deficiency its origin also, wind-cold damp-heat phlegm drink, gas stagnation blood stasis flash setback its standard also.” The above understanding of Chinese medicine on the etiology and pathogenesis of lumbago a evidence and the understanding of Western medicine on the etiology and pathogenesis of lumbar disc herniation are basically the same. According to the characteristics of lumbar intervertebral disc herniation, its etiology and pathogenesis can be summarized as follows: ① Kidney essence deficiency loss, tendons and bones lose nourishment: all kinds of lumbar pain, kidney energy deficiency exhaustion as the root of the disease. This view is consistent with the etiopathology of lumbar disc herniation, and a large amount of information shows that lumbar disc herniation occurs on the basis of the degeneration of the original intervertebral disc. The fact that some patients clinically deny or cannot recall a history of previous trauma or other medical history is a strong indication. The body is endowed with weakness, combined with overwork or room strain too much, or old age and physical decline, resulting in the loss of kidney essence, not to moisten the tendons and bones to intervertebral disc degeneration, and the gradual development of the disease. ② Falling and flashing, stagnation of qi and blood: falling and trauma, or improper force or strong weight-bearing in the lumbar region, injury to tendons and bones, stagnation of qi and blood in the meridians in the lumbar region and the development of lumbago. According to the statistics of patients operated for lumbar disc herniation in the affiliated hospital of Qingdao Medical College, 58.89% of the patients were injured due to fall and flash. It proves that fall and flash is an important cause of lumbar disc herniation. Of course, there are essentially two kinds of causes: one is the degeneration of the intervertebral disc on the basis of the original deficiency of kidney energy, which is induced by the fall and flash, which accounts for the vast majority of patients with lumbar disc herniation, and the other is the serious fall and flash, which causes the lumbar disc to lose the protection of the muscles and ligaments of the lumbar back and causes the lumbar disc to herniate, which is a very small number. Clinically, serious spinal fractures, vertebral compression of more than 1/3 to l/2, but also few intervertebral disc fibrous ring rupture, so that the intervertebral disc into the spinal canal, only a very few cartilage plate rupture, so that the intervertebral disc into the spinal canal protrusion. ③ cold damp dip, blocking the meridians: living in a cold and wet place, or sitting and lying in a cold and wet place, or wading in the rain, body labor sweat, wet and cold clothing, Wei Yang first loss, cold and damp evil take advantage of the void and enter. The cold nature of the stagnant collection, wet nature of sticky and heavy, blocking the meridians, Qi and blood do not run smoothly and develop for lumbago. If the cold and dampness are depressed for a long time and turn into heat, they can also block the meridians, stagnate the qi and blood and cause lumbago. Cold is a yin evil, most likely to damage the body’s Yang Qi, Yang Qi is damaged, losing its normal role of warming Qi, then there is a cold evidence of Yang Qi decline. This is a vicious circle. Kidney Yang is the essence of Yang Qi, long illness and kidney, kidney Yang is damaged, and the development of cold back pain. The cold and dampness are accompanied by long depression and heat, which is also its change. According to some statistics, patients with lumbar disc herniation originally had no other medical history, but a history of cold accounted for 3.34%, which is the same as the understanding of this disease in Chinese medicine. In short, Chinese medicine believes that the key to the occurrence of lumbar disc herniation is the deficiency of kidney energy and the loss of nourishment of tendons and bones. The cause of the disease is the fall, flash or cold and dampness. The blockage of meridians and veins and the poor flow of qi and blood are the pathogenesis of pain. If the pain is caused by a serious fall or injury, it is related to injury to tendons and flesh and stagnation of blood stasis. 33.How to identify the evidence of lumbar intervertebral disc herniation in Chinese medicine? Lumbar intervertebral disc herniation is the name of a disease in Western medicine, and there is no corresponding disease name in Chinese medicine. According to the clinical manifestations of lumbar disc herniation and its pathology, the disease is located in the lumbar spine and meridians. The main clinical manifestations of the disease are; lumbar pain and pain in the buttocks and lower limbs in the area of sciatic nerve distribution. The lumbar region is the capital of the kidney, and the kidney is the master of bone and marrow, so the disease is located in the lumbar spine and its origin is in the kidney. The degenerative lesion of the lumbar intervertebral disc is the pathological basis of lumbar intervertebral disc herniation, and the degenerative lesion of the lumbar intervertebral disc is related to heredity, physique and acquired strain. The bone marrow is coherent and is produced by the kidney essence. The congenital deficiency, the acquired loss of nourishment and the strain damage result in the loss of kidney essence and the loss of nourishment of bone marrow and tendons. This theory of Chinese medicine is in line with the understanding of Western medicine. Therefore, kidney essence deficiency is the root of the disease, is the internal cause, is the basis and basis of identification, lumbar intervertebral disc herniation can be due to the fall and flash, cold and damp evil and the onset of clinical symptoms, this is the external cause, is the standard evidence, so when identifying the evidence must identify the symptoms, must not be confused. As for the pain in the buttocks and lower limbs caused by nerve root compression by lumbar intervertebral disc herniation, the origin of the disease is in the waist and the location of the disease is in the meridians. In the Ling Shu Ben Zang, it is said that “the meridians are the ones that move blood and blood and yin and yang, moisten the tendons and bones, and benefit the joints.” The meridians have the role of transmitting and injecting qi and blood to nourish the organs and tissues, defend the body against external evil, so regardless of internal and external factors leading to the meridians qi and blood does not pass then pain, then cause pain in the circulation of the meridians, so the disease because of the root, the meridians qi and blood for the pathogenesis, pain for the symptoms. The purpose of identification is to understand the cause, nature and location of the disease and the prevalence of evil to guide the treatment, which is the basis of treatment. Therefore, from the practical point of view of clinical treatment, the identification of the disease should focus on the identification of the cause of the disease and the identification of the meridians. The identification of the cause of the disease is applicable to the internal treatment of drugs and also guides the identification of the meridians; the identification of the meridians is applicable to the external treatment of acupuncture, moxibustion, massage, etc., which is guided by the identification of the cause of the disease and also complementary to the identification of the cause of the disease. (1) Etiological evidence. (1) Deficiency of kidney essence, loss of nourishment of tendons and bones: soreness and weakness of the back and legs, painful, rubbing and pressing, heavy with labor, light with rest, often recurrent. There may be deafness and tinnitus, sluggish movement, impotence and loss of use of the feet. If it is accompanied by insomnia and dreaminess, fever in the heart, hot flashes and night sweats, red cheek and dry throat, red tongue with little fluid and thin pulse, it is a deficiency of kidney yin; if it is accompanied by cold fear and cold extremities, especially in the lower extremities, and less abdominal constriction. The face is white, the tongue is light and white, the pulse is sunken and weak, for partial kidney yang deficiency. ② stumbling and flashing, stagnation of qi and blood: pain in the lower back and legs like thorns, pain has a fixed place, light is inconvenient to stoop, heavy is unable to turn to the side because of the pain, and the pain refuses to press. If the disease is long-standing, the disease is slightly slow, and does not heal after a long time; or it may come and go, and increases sharply in case of strain or flash and contusion, or the face is sallow, the lips and nails are blue and purple, the tongue is light purple or purple and dark, or there are petechiae spots and petechiae, and the pulse is thin and astringent or sunken; if the disease is new, it is caused by acute fall and flash and contusion, and the disease is severe, the pain is like an awl and a knife, or the lumbago is slightly hot, the light is limping with the waist, the heavy is unable to move, the face is frowning in pain, the tongue is light purple or there is no change, and the pulse is stringent, tight or sunken. (3) Cold and warm internal invasion, blocking the meridians: cold pain in the lower back and legs, unfavorable turning, slow movement, aggravated by cold and dampness, slightly slowed by warm and dry, although lying down and resting the pain is difficult to significantly reduce or even aggravate, the history of the disease is generally long and gradually aggravated, the tongue is light with white greasy coating, the pulse is sluggish, sunken or moistened. In the case of cold, the pain is intense and the tendons and veins are constricted; in the case of damp, the body is heavy and the skin is unkind. If the above evidence of cold and dampness is prolonged, it can turn into damp-heat, which is a variation of cold and dampness, and the pain can be aggravated by heat and dampness, but may be relieved by activity, short urination, red tongue with greasy coating, and moist pulse. In short, this disease is mainly evidenced by back and leg pain. As stated in the “Evidence of Back Pain”, “there is wind, cold, heat, contusion, blood stasis; there is qi stagnation, phlegm accumulation, all of which are also symptoms; kidney deficiency is also its root.” It can be seen that kidney deficiency is the pathological basis for the occurrence of the disease, and is also the key to the identification of evidence. Kidney deficiency is the cause, while fall, flash and cold-dampness invasion are the causative factors and the symptoms. The symptoms should not be confused with the root cause, and the root cause should not be reversed. Of course; this disease is seen in the clinic, often with the symptoms, deficiency and reality, cold and heat mixed. Kidney deficiency for a long time. Flash, feeling external evil and the onset of the disease; and fall and flash, feeling external evil, strain for a long time can also damage the kidney yuan, the cause of the disease evidence for each other as cause and effect. Therefore, the clinical evidence should be distinguished from the primary and secondary symptoms, priority and urgency, so as not to lose its appropriate. (2) Meridian identification. Human meridians are internally connected to the internal organs, externally connected to the limbs, the meridian system can regularly reflect a number of symptoms. According to these symptoms, the clinic can determine where the disease occurs in the meridians, organs and bowels, so as to further explore the cause of disease, location, nature of disease, deficiency and its development trend. As the Ling Shu Wei Qi says: “Those who can distinguish the twelve meridians of yin and yang will know where the disease is born.” The main evidence of lumbar disc herniation is back and leg pain, according to its specific parts of pain, can be identified from the following meridians: ① foot Yangming stomach meridian: a. Circulation site: “Ling Shu meridians” cloud: “stomach foot Yangming veins, …… from the mouth of the stomach, down through the abdomen, down to the qi street in and together, below the thigh, against the fujia, down the knee bin. The branch of it, the lower Lian three inches and other, the lower into the middle finger outside; its branch, other tarsal, into the big finger between, out of its end.” b, the evidence of disease: “Ling Shu meridians and veins” cloud: “knee Bin swelling disease, following …… the stock, Fu Hare, liver external Lian, foot on the tarsus are pain, the middle finger do not use.” The Su Wen prick lumbago chapter cloud: “Yang Ming people lumbago. Can not Gu, Gu if there are seen, good grief.” ② foot sun bladder meridian: a, circulation parts: “Ling Shu meridians” cloud: “bladder foot sun veins.” …… its straight …… hold the ridge against the waist, into the brawn, contact the kidneys belong to the bladder. Its branch, from the waist under the ridge through the hip, into the slap; its branch, …… “hold the ridge inside, over the thigh pivot, follow the thigh outside from the back of the Lian down to close the slap, the following through the kick inside, out after the outer ankle, following the Jing bone, to the outer end of the little finger.” b, the evidence of disease: “Ling Shu meridians” cloud; spinal pain waist like folding, thighs can not be bent, slap like a knot, kick like a crack, …… is the main tendon by the sick, …… item back waist torso kick feet are pain, the little finger do not use.” “Suwen prick back pain chapter” cloud, “the foot sun pulse people waist pain, leading to the collar and back of the tailbone like heavy.” “The Xie vein (referring to the part of the foot solar bladder meridian that divides into two branches from the collar and descends to the torso) causes lumbago, pain leading to the shoulders, the eyes uttering, and sometimes urination.” “The Dissolving Vessel causes pain in the lower back like leading a belt, often like a broken back, and good fear”. “Hengluo’s vein (the vein outside the Sun of the foot, crossed out of the middle of the waist, from the thigh outside the back of the Lian down into the part of the slap) makes the waist painful, can not be lifted, lifting is afraid of falling, get to lift heavy injury waist, Hengluo is extinct, bad blood returns to it”. “flying Yang’s vein (foot sun other luo) people waist pain, pain on the Friesian, and even then sad to fear”. ③ foot Shaoyang bile meridian: a. Circulation parts: “Ling Shu meridian” cloud: “bile foot Shaoyang pulse. …… follow the wakefulness, out of the qi street, around the hair interval, horizontal into the thigh loathing,; its straight …… down the thigh loathing in, the following by the thigh Yang, out of the knee outside the Lian, before the lower outer auxiliary bone, straight down to the end of the extremity of the bone, before the lower out of the outer ankle, following the foot tarsus, into the little finger between the second finger; its branches, the The branch of the branch, not on the tarsus, enters between the big fingers, follows the big fingers inside the manifold bone and out of its end, also through the claw nail, out of the three hairs.” b, the evidence of disease; “Ling Shu Jing Yin” cloud; “is the main bone by the sick, …… chest and ribs thighs outside the knee to the tibia extremity of the ankle before and all the joints are pain, the little finger secondary finger not used.” The Suwen stabbing lumbago chapter cloud: “Shaoyang people lumbago, such as pricking its skin with a needle in the, circumnavigating the can not stoop, can not Gu.” “The vein of the same yin (foot Shaoyang other complex), makes the lumbar pain, pain like a small hammer living in it, Fries swelling.” “The vein of the flesh (foot Shaoyang vein, out of the Yang auxiliary point at) makes the lumbar pain, can not cough, cough Cai tendon contraction urgent”. ④ Foot Conjugate Yin Liver meridian: a. Circulation parts; “Ling Shu meridian” cloud: “liver foot Conjugate Yin vein, starting from the big toe bush hair occasion, up through the foot tarsal upper Lian, go to the inner ankle one inch, the upper ankle eight inches, cross out after Tai Yin, up slap the inner Lian, follow the femoral Yin into the hair in …… to the small abdomen … …”. b. Evidence of disease: “Ling Shu Jing Yin” cloud: “is moving is sick lumbar pain can not stoop”. Suwen prick back pain chapter cloud: “the pulse of the sympathetic yin people waist pain, waist in like Zhang crossbow string”. ⑤ Foot Shaoyin kidney meridian: a, circulation parts: “Ling Shu meridian” cloud: “kidney foot Shaoyin vein, starting from under the little finger, oblique go foot heart, out of under the Rangu, after following the inner ankle, don’t enter the heel, above the kick, out of the slapped inner Lian, on the femur inner back Lian, through the spine belongs to the kidney contact bladder”. b. Evidence of disease: “Ling Shu meridian chapter” cloud: “pain within the back of the spine and femur, impotence and sleepiness, heat and pain under the feet.” Su Wen, Stabbing Waist Pain Chapter cloud: “Chang Yang’s vein (foot Shao Yin vein, out of the Fuyao point) makes the waist pain, pain leads to the Ying, the eyes are lucid, and even then it is reflexive, the tongue is tired and cannot speak.” In addition, back and leg pain is also related to the Foot Taiyin Spleen Meridian, the Governor’s Vessel, Yang Wei, and the Yang Stilt Vessel. The clinical evidence should also be flexible in identifying the evidence. The above meridian identification is the outline of the identification of low back and leg pain of the ancients. As for lumbar intervertebral disc herniation, this identification should be used as a guide to analyze the clinical evidence specifically and to round out the machine and live the method. (6) In order to make the meridian identification more relevant to clinical practice, the clinical manifestations of lumbar disc herniation in different parts are introduced as follows for reference: a. Clinical manifestations of unilateral lumbar disc herniation in different parts: lumbar 3 to lumbar 4 disc herniation, lumbar: nerve root compression: lumbar back, sacroiliac, hip, anterolateral thigh, anterolateral calf pain, anteromedial calf numbness, knee extension weakness. Lumbar 4 to lumbar 5 disc herniation: lumbar: nerve root compression ‘pain in the lumbar back, sacroiliac region, hip, posterior lateral aspect of the thigh and calf, numbness in the lateral aspect of the calf or dorsal mother toe of the foot, occasional foot drop, weakness in dorsal extension of the mother toe. Lumbar 5 to sacral 1 disc herniation: sacral, nerve root compression: pain in the lumbar back, sacroiliac region, hip, thigh and posterior lateral aspect of the calf; numbness in the posterior lateral aspect of the calf and dorsal aspect of the lateral three toes, occasional plantar flexion of the foot and weakness of toe flexion. b. Clinical manifestations of central type lumbar disc herniation, involvement of the cauda equina nerve, pain in the low back, bilateral posterior thighs and calves, numbness in the bilateral thighs, posterior calves, plantar and defensive areas of the feet, weakness or numbness of the bladder and rectum and rectal sphincter, to dysfunctional bowel movements. From the above clinical manifestations of lumbar intervertebral disc herniation, it can be seen that the meridian identification of this disease should be based on the foot sun bladder meridian, followed by the foot shaoyang gall bladder meridian and foot yangming stomach meridian. Once a lumbar disc herniation is diagnosed, it needs to be treated with appropriate methods. Both modern medicine and traditional Chinese medicine have many methods for the treatment of lumbar disc herniation, each of which has its own characteristics and advantages. In summary, they can be divided into the following four categories: (1) conservative treatment, also known as non-surgical treatment. (2) Surgical treatment. (3) Minimally invasive treatment, also known as interventional treatment. These include the following ① chemonucleolysis, ② percutaneous discectomy (PLD), ③ percutaneous laser discectomy (PLDD), ④ percutaneous plasma ablation myeloplasty, ⑤ endoscopic discectomy (MED), etc. (4) Reconstruction methods. The aim is to reconstruct the physiological function of the disc, allogeneic disc transplantation, artificial disc replacement, application of artificial nucleus pulposus technology, and gene therapy strategies for delaying or reversing disc degeneration, etc. 35.What are the advantages and disadvantages of conservative treatment of lumbar disc herniation? Various non-surgical treatment methods are often used in clinical practice, including rest on a rigid bed, lumbar perimeter braking protection, oral or topical anti-inflammatory and pain relief, traction and manipulation, acupuncture treatment, Chinese and Western medicines to activate blood circulation and remove blood stasis, lumbar back muscle exercises, local heat physiotherapy, etc. Non-surgical treatment mainly provides favorable conditions for self-repair by improving local microcirculation, promoting the metabolism and excretion of inflammatory reactive substances, correcting the disordered state of small joints of the lumbar spine, and adjusting the mechanical balance through the above means. And use its pathological regression characteristics to improve the efficacy. However, non-surgical treatment has its limitations because it cannot completely release the mechanical compression of nerve roots, expand the narrowed spinal canal and nerve root canal, and release nerve root adhesions, etc. Clinically, bed rest during the acute period and functional exercise during the recovery period are also non-operative treatments. The key is to master the indications. Reasonable combination of various methods and staged treatment can help improve the efficacy. However, disc herniation is the end of disc degeneration, and the current therapies are unable to stop disc degeneration. 36.What is the role of manual therapy for lumbar disc herniation? The principle of manual therapy for lumbar disc herniation: (1) the effect on blood circulation: it can promote the expansion of capillaries at the lesion site, increase blood flow, and speed up metabolism, which is conducive to the repair of the lesion tissue. (2) Effect on lymphatic system: It can accelerate the lymph flow and enhance the absorption of edema. (3) Effects on joints, muscles, ligaments, etc.: It plays the role of restoration and antispasmodic to joint misalignment and soft tissue spasm. The effects of manual therapy for lumbar disc herniation are: (1) Promoting the absorption of inflammatory transmitters and inflammatory cells, and the decreasing of edema. (2) Adjusting the relationship between the position of the lumbar disc and the nerve root and restoring the asymptomatic pathological compensatory state of nerve root compression. (3) It can promote the partial retraction of the herniated lumbar disc. (4) Release the nerve root adhesions. (5) Release muscle spasm, correct lumbar lordosis, spinous deviation and small joint disorder, and restore the normal anatomical sequence of the lumbar spine. (6) Analgesia and increase tissue pain threshold. (7) Promote intervertebral disc rupture and absorption. 37.Can lumbar spine traction treat lumbar disc herniation? Due to the mechanical compression of the herniated nucleus pulposus in lumbar disc, nerve root congestion, edema and ischemia, increased capillary permeability and plasma extravasation lead to the proliferation of fibrous tissue in the nerve root and aseptic inflammation, which leads to local adhesions of the nerve root, scarring and thickening of the outer membrane as the compression time continues. Lumbar traction can restore the normal physiological curvature of the lumbar spine, adjust the intervertebral space and intervertebral foramina, reduce the pressure in the lumbar intervertebral disc, change the relationship between the protruding disc and the nerve root, and relieve the symptoms of irritation or compression on the nerve root, so as to reduce or relieve the symptoms. 38.Can bed rest treat lumbar disc herniation? When doctors propose bed rest for patients with lumbar disc herniation, patients often have great doubts about it: can simply lying in bed cure lumbar disc herniation? In fact, bed rest is a traditional and effective method of treating lumbar disc herniation. The degeneration of the spine is inextricably linked to weight bearing. Strict and scientific bed rest removes the main factors that further develop the lumbar spine pathology in the first place, creating the necessary conditions for the recovery of the disease. When lumbar disc herniation develops, the local soft tissues have different degrees of strain, aseptic inflammation and muscle spasm, and a large amount of lactic acid, histamine, CO2 and other pathogenic substances accumulate in the tissues, stimulating sensory nerves and producing pain. Lying on a padded wooden bed can make the lumbar muscles, ligaments, joint capsule and other soft tissues get sufficient relaxation and rest, relieve spasm, promote blood circulation, transport away pain-causing substances, and also avoid aseptic inflammation aggravated by activities. This can significantly reduce pain and restore function. In addition, after vigorous traction or tui-na treatment, bed rest is also generally required for a period of time to protect the lumbar region and consolidate the therapeutic effect. In conclusion, the bed rest method is simple, without any side effects, and although the course of treatment is longer, the curative effect is indeed. Many patients with herniated discs can be treated with this method. 39.What should I pay attention to when taking bed rest to treat lumbar disc herniation? The use of bed rest to treat lumbar disc herniation is relatively simple and can be performed at home without much expertise. However, there are still many problems that should be paid attention to in bed rest, and if they are not solved properly, the efficacy of the treatment cannot be guaranteed. (1) Bed rest requires a hard bed. Soft bed to sleep muscles are not fully relaxed prone to chronic strain injury, while the flat hard bed is very stable, can make the spine straighten to relax the muscles. The so-called flat hard bed is specifically a thin mattress or mat on a wooden bed, a harder brown bed can also be. (2) patients lying on their backs, can add another thin pad in the waist or make the knees and hips to maintain a certain degree of flexion, so that the muscles can be fully relaxed. Prone position, the mattress should be flat, so as to avoid excessive back extension of the waist. You can also choose to lie on your side, and some patients can also choose to feel pain relief when kneeling in the prone position, in short, the best position to reduce the symptoms. (3) Bed rest should be strictly adhered to. Even after the symptoms are relieved for a period of time wearing a waist brace to get out of bed, you can not make any flexion waist action. If the patient cannot insist on bed rest due to inconvenience, it will affect the therapeutic effect. (4) The most difficult thing to adhere to in bed rest is to urinate and defecate in bed. If the patient can not accept the flat position to defecate, can support the crutches or be assisted to go down to the toilet. Do not sit up in bed to defecate, because then the waist is excessively forward-flexed, the intervertebral disc is more likely to posterior protrusion. During bed rest, patients with lumbar disc protrusion (bulge) may encounter some situations that require getting out of bed, how to get out of bed to avoid excessive lumbar activity and reduce the burden on the back? When the patient gets out of bed in supine position, the body is first carefully laid to the healthy side, i.e., the healthy side is underneath, both knees are semi-flexed, and the hand located above is held against the bed board, while the elbow joint below is used to support the semi-flexed upper body, with the force of these two fulcrum points, the patient will sit up more easily, and then use the hand to support the bed board, and use arm strength to make the body leave the bed, while the semi-flexed hip and knee joints are moved to the side of the bed, and then use crutches and other Then use crutches and other supports to support standing. Getting up according to the above method can make the trunk move as a whole, thus reducing the lumbar flexion, lateral flexion, lateral rotation and other movements, which will not cause pain or discomfort in the lumbar region. If the patient has difficulty getting out of bed alone, he or she can get out of bed in the same way with the help of family members. (5) Bed rest time, traditional bed rest requires more than 3 weeks and is absolute bed rest, the current general view is that the bed rest time should be determined by the extent to which it can reduce the patient’s pain, generally two to three weeks is appropriate. Of course, after a period of bed rest, such as with massage, acupuncture, physiotherapy and other methods of comprehensive treatment, will achieve better results. 40.What is the role of waist circumference for patients with lumbar disc herniation? Many patients with lumbar disc herniation have used lumbar apron, some of them have worn lumbar apron under the guidance of doctors, some have purchased and worn it by themselves, and they do not necessarily know much about the role of lumbar apron and how to wear it. In fact, the lumbar girth is one of the commonly used orthopedic braces, and its main role is braking and protection. (1) braking role. The lumbar girth is generally made of leather or canvas lined with steel or bamboo pieces, and is worn above the lower rib arch, below the iliac crest, and tightened in front. Therefore, when the lumbar circumference is worn, the activities of the lumbar spine, especially the forward flexion activities will play a limiting role, so that the local tissues of the lumbar spine can get relatively adequate rest, relieve muscle spasm, promote the recovery of blood flow, dissipate pain-causing substances, so that the inflammatory reaction around the nerve roots and intervertebral joints can be reduced or disappeared. (2) Protective effect. Since the lumbar girth can strengthen the stability of the lumbar spine, when patients with lumbar disc herniation start to move on the ground after bed rest or traction treatment, they often wear a lumbar girth to strengthen protection, so that the amount and range of activities of the lumbar spine can be limited to a certain extent to consolidate the pre-treatment effect. In addition, because there are many types of lumbar circumference, there are drug lumbar circumference, magnetic therapy lumbar circumference, etc., they can be supplemented with Chinese medicine ion introduction, magnetic therapy and other functions in addition to the braking and protection function, patients can also be flexible according to the condition of the choice.