Chinese medicine treatment of lumbar disc herniation ideas and 11 methods

Modern medicine believes that intervertebral disc degeneration is the basic cause of fibrous ring rupture nucleus pulposus protrusion. Acute or chronic injury is the main external cause of disc herniation. On the basis of disc degeneration, some kind of factors that can induce a sudden increase in intervertebral pressure can lead to nucleus pulposus herniation. Common triggering factors include increased abdominal pressure, lumbar posture, sudden weight bearing, pregnancy, and cold. In some patients, there is no obvious cause for the onset of the disease, may be due to long-term poor posture, sedentary labor caused by lumbar muscle spasm.

Identification of ideas

I. Definitive diagnosis

2. Clinical Symptoms Lumbar pain and lower extremity pain, numbness is the main symptom. In severe cases, there may be obstacles to urination and defecation, and abnormal perineal and perianal sensations.

3. Physical signs lumbar activity is limited, paravertebral percussion pain and may be accompanied by the same side of the lower limbs radiating, straight leg raising test and strengthen the test is positive, tendon reflexes are abnormal, skin sensory abnormalities, muscle strength is weakened.

4. Auxiliary examination X-ray examination of the orthopedic film can show lumbar scoliosis, the intervertebral space becomes narrower or unequal, the affected side of the gap is wider; the lateral film shows the lumbar physiological anterior curvature reduced or disappeared in the occurrence of disc herniation of intervertebral spinal intervertebral space is wider than in front of the posterior side of the CT, MRI can clearly show the image of the herniation of the intervertebral disc, through the tomography reflects the state of the dura mater and nerve root compression. CT and MRI can clearly show the image of herniated disc and reflect the state of dural sac and nerve root compression through tomography, which is the most commonly used examination method for diagnosing this disease. In addition, according to the distribution range of abnormal EMG, it can determine the damaged nerve root and the degree of influence on the muscle.

Second, the identification of treatment

Most patients with lumbar disc herniation through the regular conservative treatment, lumbar and leg pain symptoms can be relieved, or even disappeared, the effect of conservative treatment is not obvious, can be considered to minimally invasive surgical treatment, if necessary, the feasibility of open surgery, in short, according to the patient's condition to decide the specific program.

1. Chinese medicine

According to the occurrence and development of the disease, the diagnosis and treatment, clinically divided into qi stagnation blood stasis type, cold and damp paralysis type, damp and hot injection type, qi and blood deficiency type, liver and kidney deficiency type.

2. Chinese medicine external treatment

Chinese medicine external treatment methods include Chinese medicine external application, plaster, fumigation, ionic introduction, etc. The drugs can be absorbed through the skin, directly to the focal point of the disease, and play a role in reducing inflammation and alleviating the pain symptoms of the purpose. We often take Chinese medicine internally while applying three-color paste externally, with Chinese medicine fumigation, Chinese medicine tattoos and other treatments.

Chinese medicine fumigation prescription: Chuanwu, Caowu, Tiannanxing, Angelica tail, safflower, cinnamon sticks, Kaempferia, pine knots, comfrey, mulberry branches, Haitongpi, Weilingxian, sumac and so on. This formula has the effect of activating blood and relaxing tendons, warming the meridians and opening up collaterals. It can also be treated with Chinese medicine acupoints according to the patient's physique.

3. Acupuncture therapy

According to the site of radiating pain, it is recognized as Foot Sun Meridian and Foot Shaoyang Meridian. The main points: foot solar meridian formula: waist pinch ridge, ring jump, rank side, commission in the middle, Yanglingquan, Chengshan, Kunlun. Foot Shaoyang meridian formula: waist pinch ridge, ring jump, Yanglingquan, Hangzhong, Qushu. Supporting points: (1) wind-cold dampness with lumbar Yangguan, Fengshi; (2) dampness and heat with Yinlingquan, Quchi, Xingmai; (3) qi and blood stagnation with diaphragm Yu, Sea of Blood; (4) deficiency of the liver and kidney with the foot Sanli, Qihai, Guanyuan, Sanyinjiao.

4. Auricular acupoint treatment

The lumbar pain is obvious, limitation of lateral activities, both sides of the sacrospinal muscle spasm, the first auricular acupoint treatment, the forefinger and the thumb finger abdomen pressure, pulling the upper part of both sides of the ear wheel, may be appropriate to twisting, each time to press 30s, to press the patient to feel the pain, but can tolerate it, and the ear wheel to the feeling of distension and heat is appropriate. This method has the function of dredging the meridian qi, relieving lumbosacral pain and muscle spasm, and improving lumbosacral activities.

5. Acupuncture Therapy

(1) Position the patient in prone position, abdominal pillow.

(2) The site of the corresponding lumbar disc herniation compression of one side of the nerve root.

(3) fixed point lumbar vertebral body interspinous take a point, spinous process on the side of the midline 0.5cm to take a point, 3 4cm and then take a point, according to the western medical surgical requirements to be sterilized, laying towels, wearing sterile gloves and disposable masks, hats.

(4) The operation of the selection of No. 3, No. 4 needle knife each 1, in turn, respectively, aligned with the above three points for needle knife loosening, decompression, stripping and other surgical treatment. During the operation, strict attention should be paid to the depth and direction of the needle and the patient's feeling. If there is a sense of electric shock, stop entering the needle or reversing the direction of the needle or out of the needle to stop the treatment.

Needle-knife therapy on the one hand, through the role of the "needle", dredge the meridians and channels, adjusting the blood; on the other hand, through the "knife" of cutting, loosening and other physical stimulation can regulate the blood vasoactive substances, improve the local circulation disorders, metabolism, and thus improve the quality of life of the patient. The physical stimulation through the "knife" cutting, loosening and other physical stimulation can regulate the blood vascular active substances, improve the local circulatory disorders, metabolism, thus promoting the local pathological tissue edema and hematoma dissipation and absorption; at the same time, the needle knife can promote the blood and oxygen supply around the lumbar intervertebral discs, provoking and triggering the body's own immune response that is the natural absorption.

6. Manipulation

Lumbar spine manipulation is one of the most commonly used manipulation techniques in the treatment of lumbar disc herniation. The mechanism of massage therapy may be through the expansion of local capillaries, increase blood flow, accelerate the metabolic rate, to achieve the purpose of facilitating the repair of diseased tissues, in the lymphatic system can also accelerate lymphatic reflux, promote the absorption of edema.

Indications for manual acupressure: ①First attack, short duration of the disease (within 6 months); ②No cauda equina compression symptoms; ③Systemic diseases or local skin diseases, can not be operated on; ④No progressive motor dysfunction of the lower limbs; ⑤ Chinese medicine identification of qi stagnation and blood stasis. Specific techniques: kneading, pushing, pressing, dialing, flexion and pulling, wrenching, straight leg raising.

However, it is important to be careful to choose the heavy hand massage or stilt method, easy to cause nerve root adhesion, plate proliferation and sclerosis, hypertrophy of the ligamentum flavum, or even nerve root fibrosis, contusion, violent massage resulting in the rupture of the fibrous ring, the nucleus pulposus prolapse, manifested in the cauda equina nerve injury and nerve root irritation symptoms worsened.

7. Guiding method

Shi's "washing, combing, kneading, rubbing, loosening, pressing, turning, grinding, squatting, mo, spitting, adjusting" twelve words of permaculture, internal regulation of qi, blood, internal organs and external strengthening of the muscles and bones, to support the positive and eliminate evil. The "twelve words of health" can play a role in regulating the balance of local and systemic muscle strength, improve blood circulation, eliminate inflammation of the small joints and improve appetite, regulate the mood of the patient, etc., can be used as a prevention and treatment of lumbar disc herniation daily exercise methods, in order to achieve the elimination of disease, prolonged life purpose.

8. Physical therapy

Physical therapy, including ultrashort wave, electrotherapy, magnetotherapy, thermotherapy, laser therapy, etc., has the effect of improving the blood circulation of the affected tissues and promoting the absorption of inflammation. In the acute stage, the use of ultrashort wave, microwave and other high-frequency electrotherapy, the chronic stage should use low-frequency pulsed electrotherapy, meridian guide leveling, computerized intermediate-frequency electrotherapy.

9. Traction

The role of traction: ① lumbar traction can widen the intervertebral space traction can make the adhesive tissue, spastic ligaments and joint capsule gradually open, in the intervertebral space widening at the same time, the lateral saphenous fossa of the spinal canal volume increased, the ligamentum flavum stretched out, the disc yellow space and the nerve root and the dural membrane of the relative space increased. ② Restore the normal sequence of the lumbar spine: traction will be placed in a physiological position of the patient's waist, with the increase in traction time, small joint disorders, scoliosis and other lumbar spine sequence of bad phenomena gradually return to normal; in traction, the waist is in a balanced and relatively stable state, to facilitate the reduction and elimination of local congestion, oozing, edema and other inflammatory reactions. ③ Traction can make muscle spasm reduce or disappear.

10. Sacral closure combined with four-step release maneuver

Sacral closure is a fast and effective therapy. It can be used in conjunction with this method for patients with obvious symptoms. Prof. Shi Qi pointed out that to ensure safety, sacral canal closure therapy should be completed in a routine operating room. The patient takes the prone position, the lower abdomen is slightly elevated, the location of the sacral cleft is felt first, and then sterilized and laid surgical towel. With 1% lidocaine solution to do local infiltration anesthesia, with epidural puncture needle puncture, in the ligament that breaks through the sacral cleft into the sacral canal when there is a feeling of resistance disappearance, and then the epidural catheter through the inner lumen of the syringe slowly inserted into the lumbosacral epidural lumen, generally inserted into the epidural cavity of the lumbosacral region, generally inserted into the 10 15cm has been enough, back to the bloodless fluid and can be observed to have a beat at the end of the catheter to confirm that the insertion of the catheter is in place, can be slowly injected into the formulated The combination of 2% lidocaine solution 5 ml + saline 40 ml + Choyan Shusong 20mg or Depo-Proxon 1mg, ***35 50 ml. Requirements for 3 4 times at intervals slowly injected, and pay close attention to the patient's response, the injection is observed for a few minutes, there is no special discomfort can be carried out after manipulation therapy. At the end of the sacral closure and then with the four-step release maneuver: pulling and stretching downward pressure method, lateral lying oblique trigger method, straight leg elevation hip and knee flexion and extension method, hanging shake waist method.

If selective nerve root block can be used in combination with the four-step release maneuver, the effect is more precise.

11. Surgery

Surgery to strictly grasp the indications, the main indications for surgery: ① history of more than 3 months, strict conservative treatment is ineffective or conservative treatment is effective, but often recurring and heavier pain; ② the first attack, but the pain is severe, especially in the lower limbs, the patient is difficult to move because of the pain and sleep, in a forced position; ③ the first attack, but the pain is intense, especially in the lower limbs, patients are difficult to move because of the pain, and sleep. (ii) the first attack, but the pain is severe, especially in the lower limbs, the patient is difficult to move and sleep because of the pain, and is in a forced position; (iii) the appearance of a single nerve root paralysis or combined with the cauda equina nerve compression paralysis, accompanied by muscular atrophy, muscle strength; (iv) combined with spinal stenosis. Surgery is often used, such as simple nucleus pulposus removal, intervertebral foramenoscopy, lumbar posterior incision decompression and internal fixation.

This article is selected from The Ideas and Methods of Identifying Common Orthopedic and Traumatic Diseases in Traditional Chinese Medicine, People's Health Publishing House, edited by Mo Wen and reviewed by Shi Qi. People's Health Chinese Medicine Editorial Organization.