Traditional Chinese Medicine Treatment of Lumbar Intervertebral Disc Herniation

      1. Acupuncture and moxibustion treatment

　　Acupuncture and moxibustion (Moxibustion and Moxibustion) is an external treatment commonly used in Chinese medicine.

　　It is widely used in the prevention and treatment of lumbar disc herniation, and has been widely accepted, with small efficacy, economic safety, and few adverse reactions.

　　(1) Efficacy: analgesia, sedation, anti-inflammatory, detumescence, regulation of muscle and ligament status, and enhancement of spinal stability.

　　(2) Point selection based on syndrome differentiation and commonly used points

　　① Acupoint selection based on syndrome differentiation: mainly including eight principles of syndrome differentiation and meridian syndrome differentiation.

　　② Common acupoints: Baihui, Shuigou, Qihai, Guanyuan, Ganshu, Shenshu, Dachangshu, Yaoyangguan, Jiaji, Ciliao, Zhibian, Huantiao, Chengfu, Fengshi, Weizhong, Yinling Spring, Yangling Spring, Zusanli, Fenglong, Fengshi, Chengshan, Sanyinjiao, Xuanzhong, Kunlun, Taixi, Taichong, Houxi, Waiguan, Hegu, Zhongzhu.

　　③ Common acupuncture methods: ① filiform needle; ② Electroacupuncture; ③ Water acupuncture: also known as "acupoint injection" is a therapeutic method of injecting Chinese herbal medicine or western medicine into corresponding acupoints.

　　Common Chinese herbal medicine preparations:

　　I. Compound Angelica Injection (1ml is equivalent to 0.5g of raw Chinese medicine Angelica, Safflower, Ligusticum chuanxiong, respectively); It can promote blood circulation, replenish blood and regulate menstruation; The injection volume of each acupoint is 2-4ml.

　　II. Salvia miltiorrhiza injection (1ml is equivalent to 1.5ml of crude drug), compound salvia miltiorrhiza injection (Salvia miltiorrhiza, Dalbergia odorifera); It can promote blood circulation, remove blood stasis, regulate menstruation, relieve pain, nourish the heart and calm the nerves; The injection volume of each acupoint is 2-4ml.

　　III. Paeonol injection (1ml is equivalent to 6mg of paeonol); It can dispel wind and relieve pain, remove dampness and diuresis, clear heat and detoxify, and calm nerves; The injection volume of each acupoint is 2-4ml.

　　Ⅳ. Chuanxiong injection (1ml is equivalent to 0.1g of crude drug); It can promote qi and blood circulation, dispel wind and relieve pain; The injection volume of each acupoint is 2ml.

　　V. Kusnezoff root injection (1ml contains 1mg of free total alkali); It can remove rheumatism, dispel pathogenic cold and relieve pain; Inject 0.5ml into each acupoint.

　　Common Western Medicine:

　　I. Vitamin B1 injection 50mg/piece, 100mg/piece; Function: to maintain the normal function of nerves, for vitamin B1 deficiency, neuritis; The amount of acupoint injection is 50-100mg each time, with strong needle sensation.

　　II. Furathiamine hydrochloride injection (new B1) 20mg/piece; The effect is faster and longer than that of vitamin B1 injection. It is used for various neuralgia and neuritis.

　　Ⅲ. Vitamin B12 injection 0.1mg/tube, 0.5mg/tube; It is used for metabolism of sugar, protein and fat, anemia, neuritis, malnutrition, etc; Point injection 0.1mg each time.

　　Ⅳ. Mecobalamin injection 0.5mg/branch; Its function is to promote the synthesis of nucleic acid and protein, the formation of axon and myelin sheath, improve the excitability of nerves, and improve anemia; It acts on peripheral neuropathy and giant cell anemia; Point injection 0.5mg each time.

　　Cobamamide adenosine injection 0.5mg/branch; Its role is to promote nucleic acid synthesis, the formation of nerve myelin sheath, widely participate in folic acid, protein, fat metabolism, promote the development and maturation of red blood cells, improve nerve excitability and improve anemia.

　　V. Procaine hydrochloride injection 0.5% 20ml/piece, 1% 20ml/piece, 2% 20ml/piece; Its function is to inhibit nerve fiber conduction and expand blood vessels. 0.5% - 1% solution for acupoint injection is generally used for nerve block with 2% solution. 1-2 ml each time, drug sensitivity should be done.

　　④ Moxibustion: including moxa stick moxibustion and moxa stick moxibustion.

　　⑤ Small needle knife therapy.

　　2. Massage therapy

　　(1) Indications

　　ⅰ. The time of the first attack is short (usually 3 months).

　　ⅱ. The symptoms and signs are mild, and the symptoms are simple low back pain, or the radiation pain in the lower limbs does not exceed the knee joint, or ankle joint. There is no strong positive result in straight back and head up test (head up more than 30 °). Millgram test did not show strong positive.

　　Ⅲ. Syndrome of blood stasis or cold dampness

　　Iv. Imaging examination. The CT or MRI findings were single segment, or not multiple segments, but the clinical manifestations were mainly single segment damage, without some obvious stenosis of nerve root canal and calcification of protrusions; The protrusion of lumbar intervertebral disc or lumbar intervertebral disc and central protrusion are less than 5 mm, and there is no obvious effect on cauda equina as a nervous system symptom, or the protrusion of axillary type posterolateral protrusion is less than 5 mm, or the suprashoulder type lateral focal protrusion with a wider main spinal canal.

　　v. Systemic disease or local skin disease without operation

　　(2) Contraindication

　　1. The disease history is long, recurrent and delayed (>6 months).

　　Ii. The symptoms and signs are severe, and the low back pain and lower limb radiation pain are obviously better than the ankle joint with straight leg raised.

　　ⅲ. The syndrome belongs to liver and kidney deficiency, damp heat type.

　　Iv. Imaging examination. CT or MRI showed that the lumbar intervertebral disc was prolapsed, the lumbar intervertebral disc and its center had a large protrusion of more than 5 mm with decreased sensory function in the saddle area, or an axillary posterolateral protrusion was more than 5 mm, or the protrusion was calcified, in the nerve protective tube, the yellow ligament had significantly improved hypertrophy, the facet joint had proliferated to the lateral recess, the intervertebral disc yellow ligament tissue space was relatively narrow, and the protrusion had serious adhesion with the nerve root.

　　v. Patients with severe lumbar spinal stenosis, lumbar spondylolisthesis, lateral recess stenosis and spinal bone changes are all contraindications.

　　(3) Massage technique

　　It mainly includes thigh method, kneading method, pushing method, kneading method, pressing method, pointing method, grasping method, pulling method, hitting method, lower limb shaking method, vibration method, stretching method, bending pulling method, pulling and shaking method, straightening leg lifting method, footlight method, and waist bending method.

　　(4) Staged treatment

　　Acute stage: one week after onset, it is easy to relieve acute pain.

　　Ii. Recovery period: within one month of onset, promote the return of nucleus pulposus and remove adhesion.

　　Ⅲ. Sequela stage: one month after the onset, it is easy to promote qi and blood circulation, and strengthen the stability of the spinal structure.

　　3. Small needle knife therapy

　　This therapy is a new therapeutic technique combining acupuncture and surgery.

　　It is most suitable for various chronic tissue injuries, some joint diseases, and has recently been used to treat intervertebral disc herniation without nucleus pulposus compression.

　　(1) Selection of small needle knife

　　The needle knife is divided into type I, type II and type III. Soft tissue lesion type ⅰ, bone lesion type ⅱ and ⅲ.

　　(2) Needle entry direction

　　ⅰ. Fixed point and direction: general pain point and acupuncture point.

　　The discovery method is:

　　1 tenderness point, 2 passive muscle traction causes pain, 3 active muscle force to complete a certain action causes pain point.

　　Positioning, marking and general disinfection.

　　It is better that the knife edge line is parallel to the big blood vessels, nerves and muscle fibers. If the muscle fibers are different from the nerves and blood vessels, it depends on the direction of the nerves and blood vessels.

　　ⅱ. Puncture: For patients with superficial lesions, press to separate before puncture, and then quickly enter the needle to reach the diseased tissue.

　　For patients with deep lesions, first pass through the skin, then slowly approach the lesion, and timely ask the patient whether there is acid swelling, whether it indicates that the lesion has been reached, and then perform surgery.

　　ⅲ. Surgical treatment: longitudinal dissection, transverse dissection, incision dissection, muscle fiber cutting, and acupoint dissection.

　　4. Medication

　　(1) Traditional Chinese Medicine Therapy

　　Traditional Chinese medicine has obvious advantages in the treatment of lumbar disc herniation. It is not only widely available and economical, but also has analgesic, anti-inflammatory, anti adhesion and other effects.

　　Chinese medicine soup, Chinese medicine, external ointment, lotion, fumigant.

　　TCM's understanding of lumbar disc herniation: First, liver and kidney deficiency; The second is to feel external evils; Third, chronic strain; Fourth, fall and drag injury; Fifth, congenital malformation.

　　Prescriptions and Medicines

　　① Dialectical treatment: follow the principle of "cold is hot, hot is cold, deficiency is tonic, and reality is catharsis".

　　The dialectics of lumbar disc herniation should first deal with strain and reality.

　　It is better to expel pathogenic factors and dredge collaterals in case of acute treatment of excess syndrome. According to the different treatment of cold dampness, damp heat and blood stasis, the treatment should be divided.

　　Deficiency syndrome is a kind of chronic disease that occurs repeatedly, which belongs to kidney deficiency. It is better to warm and replenish kidney qi.

　　Because it is easy to feel external evils for kidney deficiency, and the evil qi will remain and damage the kidney easily, therefore, it is also necessary to mix the information of deficiency and reality with some situations, so that it is appropriate to cure and eliminate evils and strengthen the right. After eliminating evils, it is necessary to regulate and replenish kidney qi.

　　I. Cold dampness syndrome

　　Treatment: dispel cold and dehumidify, warm meridians and dredge collaterals.

　　Prescription: Ganjianglingshu Decoction or Duhuosheng Decoction

　　Add and reduce: severe pain, severe fear of severe cold plus aconite, black, grass, pain for a long time without more breaks, dog ridge, tendon, cloning and stretching grass, spatholops. Pain spots wander or joint pain, and wind evil can be cut with live parasitic soup alone (12 grams of Notopterygium, Angelica, Achyranthes bidentata, 6 grams of cinnamon, Chuanxiong, papaya, Sichuan, Frankincense, Fangfeng, Weiling, 10 grams)

　　II. Damp heat syndrome

　　Treatment: heat clearing, dehumidification and pain relieving

　　Prescription: Jiawei Ermiao Powder (12g each of Atractylodes, Cortex Phellodendri, Papaya, Achyranthes bidentata)

　　Addition and subtraction: severe pain, plus frankincense and myrrh. If you are thirsty, add ointment, anemarrhena and birth place.

　　Ⅲ. Blood stasis syndrome

　　Treatment: invigorate blood circulation and remove blood stasis, regulate qi and relieve pain with drugs

　　Prescription: Huoluo Xiaoling Danhua (12g each for Angelica, Salvia, Frankincense, Wuyao, 10g each for Ligusticum chuanxiong)

　　Ⅳ. Kidney deficiency syndrome

　　Treatment: invigorate the kidney and strengthen the waist. Yang deficiency with kidney warming, Yin deficiency with yin nourishing

　　Prescription: Yin Deficiency Yougui Pill; Yin Deficiency Zuogui Pill.

　　② Commonly used proprietary Chinese medicines for the treatment of lumbar disc herniation: papaya pill, Shufeng Dingtong pill, Xiaohuoluo pill, Jinshu Huoxue pill, Qian Hu pill, Liuwei Dihuang pill, Jinkui Shenqi pill, Duzhong Bu Shen Jing, Compound Danshen dripping pill, Qili San, Sanqi pill, Dahuoluo pill, Bitongning, Xuefu Zhuyu capsule, Guifu Dihuang pill capsule, Tianma pill.

　　③ External Chinese medicine

　　I. Application

　　Commonly used, such as safflower oil, Guyouling spray, Pain Spray, etc.

　　In addition, the residue of traditional Chinese medicine can also be used for external application, or the research end of traditional Chinese medicine (Radix Aconiti Praeparata, Frankincense, Myrrh, Angelica pubescens, Safflower, etc.) can be applied to the affected area with ethanol.

　　II. Paste

　　Zhenjiang Cream, Oriental Blood Circulation Cream, Musk Bone Strengthening Cream, Wind Chasing Cream, Damp Pain Relieving Cream, Dog Skin Cream, etc

　　III. Fumigation

　　Ⅰ. Fumigation and cleaning of traditional Chinese medicine bags: crush 30g/10g of safflower, frankincense, myrrh, papaya, fangfeng, ginger and asarum respectively, put them into cloth bags, put them into a pot, wash them for 30-60min, and take them out to apply hot compress to the affected part.

　　II. TCM fumigation or hot spring bath

　　Iii. Iontophoresis or penetration of traditional Chinese medicine

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