# Medical Data Analysis of Lumbar Disc Herniation Patients after Traditional Chinese Medicine Rehabilitation Intervention Lumbar Function Recovery

Authors: Liu Yan; Wang Chenni; Liu Fang; LiyueYang
Journal: Applied Bionics and Biomechanics
 (2022)

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## Abstract

In order to study the efficacy of TCM rehabilitation for lumbar disc herniation, it is suggested to compare the effects of hot compress, ordinary sandbag, or hot compress with traditional Chinese medicine. A total of 79 patients with Qi stagnation and blood stasis syndrome in a traditional Chinese medicine hospital who met the diagnostic criteria of LDH and the syndrome classification in the diagnostic efficacy criteria of traditional Chinese medicine were selected. The subjects were randomly divided into groups A, B, and C: group A (26 cases) was the sandbag hot compress dry pregroup and received the simple sandbag hot compress scheme; group B (26 cases) was a simple traditional Chinese medicine hot compress intervention group, which received traditional Chinese medicine hot compress scheme; group C (27 cases) was the intervention group of traditional Chinese medicine sandbag combined with hot compress and received the scheme of traditional Chinese medicine sandbag combined with hot compress. In addition to the different hot compress media used, other aspects remained the same among the three groups. The treatment time of each hot compress was 40 min, twice a day for 2 weeks. A total of 14 cases fell out during the intervention process, and 65 subjects completed the intervention process. The experiment showed that there was no significant difference among the three groups (P>0.05). The test results were confirmed.


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## Body

## 1. Introduction

Lumbar disc herniation is a common orthopaedic disease. It is a clinical syndrome with low back and leg pain as the main symptom caused by intervertebral disc degeneration, rupture, and kyphosis compressing the spinal cord or nerve [1]. The surgical treatment effect of lumbar disc herniation is remarkable, but some patients will relapse due to adhesion, compression, and other reasons after operation, and the pain and muscle strength of the waist, hip, or lower limb will be reduced again. The success of surgery depends not only on exquisite surgery but also on postoperative rehabilitation and nursing. Timely and correct rehabilitation treatment and perfect nursing after surgery can prevent adhesion and compression of nerve roots, promote functional recovery, shorten rehabilitation time, and reduce recurrence rate, as shown in Figure 1 [2]. Postoperative rehabilitation and nursing can promote blood circulation, reduce tissue edema, improve muscle function, promote wound healing, prevent postoperative complications, and improve the success rate of operation. By increasing the traction of the lumbar nerve roots, it can significantly reduce local adhesion, increase the activity of nerve roots, and reduce the pressure on nerves. It can strengthen the strength of the lumbar and abdominal muscles and ligaments, restore the flexibility of the lumbar and back, improve the supporting effect of the spine, and restore its stability. Early, reasonable, and systematic rehabilitation exercise after operation can stimulate neuronal synapses, improve the recovery of neurological function, reduce dysfunction and pain, reduce the incidence of postoperative low back and leg pain, effectively prevent disease recurrence, shorten the length of hospital stay, significantly reduce the economic burden of patients, and make patients recover as soon as possible [3].Figure 1
Flow chart of lumbar rehabilitation.


## 2. Literature Review

Ye et al. found that LDH is a disease mainly characterized by low back pain and radiation pain of the lower limbs caused by the rupture of the fibrous ring of the lumbar intervertebral disc, protrusion of the nucleus pulposus, and compression of the nerve root, blood vessel, spinal cord, and cauda equina due to lumbar disc degeneration or external force [4]. Ilves et al. found that those with mild symptoms can have symptoms such as low back pain with radiation pain of the lower limbs, and those with severe symptoms will have a series of clinical comprehensive symptoms such as heavy weakness of lower limbs, abnormal sensation, sensory disturbance in saddle area, claudication, and even defecation dysfunction. The prone site is the lower lumbar intervertebral disc, accounting for about 97% of the total incidence. Among them, the intervertebral disc protrusion between the 4th and 5th lumbar vertebrae accounts for about 65%, followed by the intervertebral disc protrusion between the 5th lumbar vertebrae and the 1st sacral vertebrae [5]. Djuric et al. believe that LDH tends to occur at the age of 20-40, and more men than women. With the development of economy, the progress of society and the change of people’s life and work style, the age of onset of the disease is becoming younger and younger [6]. Li et al. believe that due to its long course and easy repetition, it seriously affects the daily life and work of LDH patients, brings huge pain and certain economic burden to patients, and also causes psychological and mental pressure to patients [7]. Hu et al. found that the basic pathological factor of LDH is the imbalance between inorganic and organic components in the intervertebral disc, and the acute and chronic injury of the waist, the increase of intervertebral disc pressure caused by long-term fixed sitting posture, lumbar puncture, genetics, age, etc. may induce LDH. In addition, long-term cold stimulation, pregnancy, and other factors may also induce LDH [8]. Somay and Karaarslan found the mechanism of LDH. With the continuous development of modern medicine and the deepening of clinical practice, researchers gradually realized the complexity of the causes of pain. The pain caused by LDH is not only caused by mechanical compression, but also the inflammatory response and autoimmune response of the body play an important role in causing patients’ lumbar pain. The microcirculation disorder caused by local ischemia and hypoxia around the lumbosacral also affects the course of the disease to a certain extent [9]. Harada et al. believe that in general, the local or systemic manifestations of LDH are caused by the interaction and joint influence of four mechanisms: mechanical compression, body inflammatory response, autoimmune response, and local microcirculation disorder [10]. There is no record of “lumbar disc herniation” in Chinese medicine, but the disease syndromes such as “low back pain,” “low back and leg pain,” “leg thigh wind,” and “arthralgia” are closely related to the disease. Wind cold, damp cold, and other external evils taking advantage of the deficiency are the external causes of the disease. In addition, Kravtsov et al. found that falling strain and overwork are the traumatic factors of the disease. Traditional Chinese medicine classifies it into the category of low back and leg pain, which can be divided into three categories: trauma, exogenous wind cold and dampness evil, and visceral injury. According to these three causes, TCM divides it into four syndrome types: blood stasis syndrome, cold-damp syndrome, damp-heat syndrome, and liver-kidney deficiency syndrome [11]. Yang and Xu believe that at present, the common traditional Chinese medicine treatment methods for LDH include acupuncture, massage, cupping, hot compress, and moxibustion because the traditional Chinese medicine treatment methods have the advantages of stable and accurate effect, low cost, and low side effects, they have a great advantage in the clinical treatment of LDH patients, although surgical treatment is irreplaceable in modern medical treatment. However, due to its large trauma, high risk, a certain proportion of recurrence rate and other factors, it is not the preferred recommended scheme. Traditional Chinese medicine believes that the main symptoms of LDH are low back and leg pain, adverse activity, and unkind skin. Patients with liver and kidney deficiency, cold and wind-damp pathogens invade the meridians, Qi stagnation and stasis, meridian obstruction, pain [12]. Therefore, it strengthens the liver and kidney, disperses wind and dispels cold, activates blood and removes blood stasis, clears the collaterals, and relieves pain. Rasi et al. found that there are many traditional Chinese medicine treatment methods for LDH, such as acupuncture, massage, cupping, hot compress, and moxibustion. Among them, hot compress treatment is the most widely used [13]. There are many hot compress treatment methods, including dry heat methods such as baking lamp irradiation and salt bag hot ironing, but the damp heat method is more common. Some apply the wet compress of traditional Chinese medicine liquid to the affected area, or put it into the traditional Chinese medicine bag after soaking the traditional Chinese medicine with yellow rice wine, and apply it to the pain point after steaming. On the one hand, traditional Chinese medicine wet hot compress uses heat as a kind of stimulation, which is transmitted to the central nervous system together with local pain impulse, interfering with each other and weakening the feeling of pain; it can also improve the blood supply, nutrition, and metabolism of the low back muscles, ligaments, fascia, and nerve roots; at the same time, it can increase the local skin temperature, cause vasodilation, widen the gap between capillary endothelial cells, and increase the permeability after local skin thermal stimulation. Warm stimulation can also activate the phagocytosis of reticuloendothelial system, promote the metabolism of various substances, stabilize mood, regulate autonomic nerve function, improve the function of motor nerve, and improve the pain threshold. On the other hand, the active ingredients in traditional Chinese medicine have the effects of dispelling wind and dispersing cold, reducing swelling and pain, relaxing muscles, and activating collaterals. The drugs for warming meridians and dispersing cold, promoting blood circulation and removing blood stasis are effectively absorbed. After the sensory nerve endings are stimulated, they directly cause further expansion of blood vessels through axonal reflex, which can effectively relieve the symptoms of low back and leg pain. The application of traditional Chinese medicine sandbag combined with hot compress is to take into account that the sand has the physical characteristics of long heat storage and slow heat dissipation, so it can make more full use of heat in application. At present, it is not clear whether the different methods of heat application of traditional Chinese medicine have the exact effect or the synergistic effect of heat application of traditional Chinese medicine, but it is not clear whether the different methods of heat application of traditional Chinese medicine have different clinical effects. Through a randomized controlled study, this study applied simple sandbag hot compress, traditional Chinese medicine hot compress, and traditional Chinese medicine sandbag combined hot compress to patients with LDH. By observing the curative effect of each scheme, we can clarify the curative effect difference of three different hot compress methods and explore whether there is synergy between traditional Chinese medicine and sandbag heat.


## 3. Method

In fact, there are many subjective ways to evaluate an image, for example, ITU-TRec. The internationally recommended P.910 method is a subjective assessment of multimedia use; ITU-R bt.500-11 is a subjective method for assessment of television images [14, 15]. The subjective quality scoring method (MMOs) is one of the methods we think is more recognized. It allows a large number of observers to judge the image after observation and make corresponding summary. Absolute evaluation is to grade the image directly according to visual perception, which is divided into five levels, including quality scale and obstruction scale. Most people will choose the quality evaluation, while more professional scholars use the obstruction method. Relative evaluation is that the observer classifies the quality of the image, compares them with each other, and gives their own score. This paper still selects the absolute evaluation in the subjective evaluation as the evaluation standard. See Table 1 for details.Table 1
Subjective evaluation of images.
Subjective evaluationImage quality characteristics1Very serious obstruction of viewing2Hinder viewing3A slight hindrance to the viewer4Do not hinder viewing5There is no deterioration in image qualityAn objective way to evaluate image quality is to evaluate the image using the corresponding formula and its result. The more traditional objective evaluation methods are mean square error (MSE) and peak signal-to-noise ratio (PSNR).Mean squared error method: Determines the quality of an image by taking the corresponding value from the mean squared value of the difference between the pixels of the starting image and the distorted image. The calculation formula of mean square error is shown in formula (1).
(1)MSE=∑i=1M∑i=1Nfi,j−f∧i,j2M×N,whereM and N are the length and width of the image, the pixel value of the original image before the absolute value, and the pixel value of the degraded image after the absolute value [1, 16]. Another method, peak signal-to-noise ratio (PSNR), is an important measure of image quality. As you can see from the formula, it is the ratio of all signal to all noise. The expression to derive the PSNR is shown in the expression (2).
(2)Snr=101og2552×M×N∑i=1M∑j=1Nfi,j−f∧i,j2,where 2552 is the maximum value of 8bit representation and I is the central position of these numbers, reorder the M numbers according to the size order, and replace the numerical value in the middle with GI. The formula is expressed as formula (3):
(3)gi=Medfx,⋯,fi,⋯,fx+m−1.In the two-dimensional signal, set a sequence {xn} and take a two-dimensional filter window. After sorting the two-dimensional data of the image in the median filter, take the sorted central data to replace the original central data according to the working mode of the median filter. The median filtering of multidimensional data is shown in equation (4).
(4)gi=MedxnA.Mean square error is often used to measure the quality of image restoration because of its simple mathematical calculation. The formula shows that the higher the mean square error, the worse the image restoration quality; the lower the result, the higher the image restoration rate. Conversely, the lower the PSNR value, the better the image restoration effect. The smaller the PSNR, the higher the image restoration effect [2, 17]. These two methods of objective evaluation are good and bad, but they are often regarded as better methods of objective evaluation of images, so this paper takes this method as a reference.A total of 154 LDH patients were admitted to the Chinese herbal medicine hospital.


### 3.1. Diagnostic Criteria of Western Medicine

Refer to the relevant provisions in the guidelines for clinical diagnosis and treatment prepared by the Chinese Medical Association in 2009:(1)
He suffers from chronic back pain, acute back pain, and leg pain. Lower extremity or lower extremity pain spreads along the lumbosacral nerve, and leg pain is more severe than back pain(2)
Two of the following four signs appear along the nerve distribution area: muscle atrophy, paresthesia, muscle weakness, and reflex changes;(3)
Signs: the lumbar spine is bent or the body position is limited, and the activity is obviously limited. Straight leg elevation test was positive, femoral nerve traction test or nerve root tension test was positive;(4)
Imaging examination includes the location and degree of lumbar disc herniation and the degree of spinal canal compression (X-ray film, CT, MRI, etc.).


### 3.2. TCM Syndrome Standard

Refer to the symptom classification in the standard for diagnosis and curative effect of TCM diseases.


### 3.3. Qi Stagnation and Blood Stasis Syndrome

Most of them have chronic diseases, and the symptoms of low back pain worsen when they are tired. It is generally a tingling pain in the waist, with a fixed place and a tense traction texture. If you refuse to press the pain, it is difficult to bend down or even turn your side. The night is heavy and the day is light. The tongue is dark purple, with ecchymosis on the tongue coating, and the pulse string is tight or slippery.


### 3.4. Cold Dampness Syndrome

Low back and leg pain presents a sense of emphasis, acid, or numbness, the disease location is cold, the activity is limited, and it is difficult to pitch. Pain or aggravation of symptoms in rainy days. The limbs are cold, the tongue is light, the moss is white and greasy, and the pulse string is tight or soft.


### 3.5. Damp-Heat Syndrome

Low back pain, soft legs, fever, and pain, increased pain in hot or rainy days, reduced pain after activity, thirst, short and red urine. Red tongue, yellow coating, greasy, few pulses or filaments.


### 3.6. Liver and Kidney Deficiency Syndrome

Slow onset, dull pain, sour or weak feeling in the waist and legs, aggravating when tired, like rubbing and pressing. There are often mental fatigue, cold limbs, spermatorrhea, or leucorrhea. The tongue is light and fat, and the pulse is heavy or weak.Inclusion criteria are as follows:(1)
All the candidates met the diagnostic criteria of lumbar disc herniation in the clinical diagnosis and treatment guidelines prepared by the Chinese Medical Association in 2009 and were diagnosed by CT or MRI(2)
Age > 20 years old, informed consent(3)
Patients with Qi stagnation and blood stasis syndrome according to the symptom standard of the diagnostic efficacy standard of traditional Chinese medicineExclusion criteria are as follows:(1)
Have serious heart, liver, lung, kidney, and hematopoietic system diseases, accompanied by lumbar fracture, lumbar spondylolisthesis, and tumor. Tuberculosis and other diseases, combined with severe osteoporosis, mental disorders, or any other contraindications to hot compress(2)
Pregnant and lactating womenExit criteria are as follows:(1)
Allergic constitution: allergic reaction to traditional Chinese medicine(2)
Patients with severe pain during hospitalization should consider surgical treatment(3)
Those who are unwilling to continue relevant treatment for any reasonThe subjects were LDH patients hospitalized in a traditional Chinese Medicine Hospital Affiliated to a medical university. During this period, there were 154 patients with LDH, excluding 29 patients who were not suitable for hot compress treatment, 25 patients who were unwilling to accept the test, 2 patients with traditional Chinese medicine allergy, 6 patients who changed to surgery due to aggravation of pain, and the other 92 patients signed informed consent. A total of 13 cases were included in the study due to different reasons [18, 19]. A total of 26 patients received simple sandbag hot compress, 26 patients received simple traditional Chinese medicine hot compress, and 27 patients received traditional Chinese medicine sandbag hot compress. In the course of treatment, due to the ineffective effect, 14 other treatment methods were added at the request of patients, and 4 cases were terminated for special matters. The final number of patients in group A, B, and C who completed the intervention was 21, 22, and 22, respectively, a total of 65. The specific flow of the screening process of the research object is shown in Figure 2.Figure 2
Selection and determination process of research objects.This study is a randomized controlled trial. 79 patients who met the selection criteria were randomly divided into 3 groups: A (simple sandbag hot compress group), B (simple traditional Chinese medicine hot compress group), and C (traditional Chinese medicine sandbag combined hot compress group). The JOA Low Back Pain Scale scores were collected before the intervention (T0), 1 week after the intervention (T1), 2 weeks after the intervention (T2), and 4 weeks after the intervention (T3). Combined with the improvement rate of JOA low back pain score, the curative effect and NRS score of low back and leg pain were determined. Referring to the relevant literature, for the main index JOA low back pain scale score, the minimum clinical significance change value is 4 points, and the estimated standard deviation is 6 points. Using two-sided test,C=0.05, β=02, at least 18 cases in each group; considering the shedding rate of 10% during the experiment, at least 20 cases in each group are required. In this study, among 154 patients with LDH treated in a traditional Chinese medicine hospital, more than 60 subjects were recruited to ensure that there were no less than 20 cases in each group, and 79 cases were actually recruited.Group A (simple sand bag hot compress group): put 1.5 kg fine sand in35cm×30cm cotton cloth bag, sew the bag mouth to prevent sand leakage, soak the sand bag in clean water until the sand is wet, steam it in the steamer for 30 min, and then take it out (or microwave oven high fire for 15 min). Lay a waterproof plastic film on the bed, and lay the sand bag on the film to pave it. On the one hand, prevent the sand bag from wetting the clothes and quilt, on the other hand, wrap it with film to save heat. Due to the thermal effect (the temperature is 78-82°C after the sandbag is steamed in the steamer for 30 min), enough cloth shall be added between the sandbag and the patient’s skin to prevent scalding. Maintain the temperature at 38°C-42°C. The patient shall take the supine position, place the waist above, and then wrap the film on the waist cloth to store heat. Twice a day, at 8 a.m. and 2 p.m. for 40 minutes each time.Group B (simple traditional Chinese medicine hot compress group): the drugs used were traditional Chinese medicine formulas with the effects of promoting blood circulation, removing blood stasis, and relieving pain, including 20 g Duhuo, 20 g Gouji, 20 g Shenjincao, 20 g Tougucao, 20 g Achyranthes bidentata, 15 g chuanxiong, 20 g safflower, 15 g turmeric, 15 g wormwood leaf, and 10 g Asarum. Add 1000 ml hot water to boil, soak the towel in the boiling hot water, then screw the towel dry until the temperature reaches 38-42°C, and apply it to the waist with heat, so as to be warm and comfortable without scalding the skin. Since the temperature of hot water towel is maintained at 38-42°C for 6-8 min, it needs to be replaced every 5 min to ensure the curative effect, twice a day, 40 min each time. In order to ensure the temperature effect of hot compress as much as possible, count one hot compress towel on the patient’s waist and prepare two towels for replacement.Group C (traditional Chinese medicine sandbag hot compress group): the same traditional Chinese medicine and equal weight fine sand were evenly mixed and placed in a35cm×30cm cotton cloth bag, and the bag mouth was sutured to prevent the leakage of traditional Chinese medicine. The method was the same as that in group A. Several problems to be explained in the treatment method are as follows: (1) choose to use 1.5 kg fine sand. On the one hand, it can maintain the temperature at 38°C to 42°C for a long enough time to ensure the treatment. On the other hand, 1.5 kg fine sand is put into a 35cm×30cm cloth bag to avoid discomfort in the treatment process [15, 20]. (2) The application of 35cm×30cm cloth bag is not only large enough to more effectively treat waist diseases, but also not too large to burn the unexpected skin of waist diseases. (3) The types and corresponding functions of traditional Chinese medicine: Angelica pubescens has the effects of dispelling wind, overcoming dampness, dispersing, and relieving pain; dog ridge has both the power of dispelling evil and the power of tonifying. It can be applied to the symptoms of low back pain, strong spine, inability to pitch, weakness of the feet and knees, whether it is arthralgia for a long time or deficiency of the liver and kidney; ginseng has the functions of dispelling wind, dispelling cold, removing dampness and swelling, and relaxing tendons and activating collaterals. For wind-cold-dampness pain, muscle spasm, carbuncle U5. Skull grass has the functions of relaxing tendons and activating collaterals, expelling wind and dampness, promoting blood circulation, and relieving pain. Achyranthes are used to promote blood circulation, eliminate congestion, strain the liver and kidneys, strengthen muscles and bones, and treat back and knee pain and muscle and bone weakness. Chuanxiong has the effect of promoting blood circulation, dispelling wind, and relieving pain. Safflower has the effect of dispersing blood stasis and relieving pain; turmeric has the effect of breaking blood, promoting Qi, clearing the meridian, and relieving pain; wormwood leaf activates collaterals, warms the meridian and activates blood, relieves pain and disperses cold, and plays a great role; Assalm has the effect of dispelling wind dispelling cold, warming the meridian, and relieving pain [21, 22].The scale evaluates the subjective symptoms, clinical signs, daily activities, and bladder function, so as to comprehensively judge the effect of treatment improvement. The full score is 29. The greater the score, the lighter the symptoms of LDH, and vice versa.PercentimprovementofJOAbackpainscore=beforeandaftertreatment/totalscore−beforetreatment∗100%.(1) Clinical treatment: symptoms such as low back and leg pain are relieved, and the improvement rate is >95%. (2) Significant effect: the symptoms such as low back and leg pain basically disappear without affecting daily life or work (60%improvement<95%). (3) Effective: low back and leg pain other symptoms are relieved, and the ability to participate in work decreases (25<improvementrate<60%); (4) Ineffective: no improvement in low back and leg pain symptoms, improvement rate <25%.All measurements are shown as standard deviation of the meant unless otherwise stated. Record statistics, number of cases and add percentages. SPSS 18.0 was used for statistical analysis. We compared the baseline data of the three groups of subjects before intervention. The chi-square test was used to measure the variance of the data and one-way analysis of census data. Repeated-measure analysis with two variance factors was used to compare the observed indicators before and after the intervention in the three groups. P<0.05 was statistically significant. The technical route is shown in Figure 3.Figure 3
Technical roadmap.The 65 patients who received the intervention ranged in age from 19 to 85 years old, with an average age of55.1±15.6 years. Among them, 33 were male and 32 were female. Complications included 21 hypertension, 9 diabetes, and 6 heart disease. We compared the baseline data of the three groups. Variance and chi-square test showed that there was no significant difference in each index among the three groups (P>0.05). See Table 2 for details.Table 2
Sociodemographic data and disease-related data of patients in the three groups.
ProjectTotal number (65)Group A (n=21)Group B (n=22)Group C (n=22)F/χ2Age55.1±15.651.9±17.456.4±16.856.8±12.40.650.53aGender2.990.22bMale3350.8%361.9%1254.5%836.4%Female3249.2%838.1%1045.5%1463.6%BMI24.6±3.424.1±2.324.3±3.125.2±4.40.740.48aCourse of disease0.280.99b< 6 months2944.6%942.9%1045.5%1045.5%6-12 months1320.0%523.8%418.2%418.2%>12 months2335.4%733.3%836.4%836.4%Diseased segment0.970.91bL4-L51320.0%523.8%313.6%522.7%L5-S11827.7%523.8%731.8%627.3%L4-S13452.3%1152.4%731.8%1150.0%See Table3 for the comparison of JOA low back pain scale scores and scores of various dimensions among and within the three groups at different time points.Table 3
JOA lower abdominal pain scores and scores of each dimension of the three groups at different time points.
GroupingT0T1T2T3FPJOA low back pain scoreA10.33±3.4812.81±3.16∗∗16.90±2.8∗∗20.67±2.96∗∗149.41<0.001B10.05±3.0513.32±2.85∗∗17.59±3.23∗∗20.91±2.22∗∗115.64<0.001C11.45±2.6015.27±2.51∗∗a19.77±3.37∗∗a23.82±2.87∗∗ab130.81<0.001F1.304.534.889.20P0.2790.0150.011<0.001Subjective symptom scoreA2.24±1.253.23±0.94∗∗4.52±1.O8∗∗5.76±0.62∗∗77.48<0.001B2.41±1.143.91±0.68∗∗4.32±1.29∗∗5.82±0.66∗∗99.35<0.001C2.32±1.293.55±1.22∗∗5.18±0.91∗∗a6.18±0.73∗∗99.81<0.001F1.912.343.682.47P0.2250.1050.0310.093Clinical sign scoreA3.67±0.733.71±0.723.95±0.50∗∗4.19±0.51∗∗8.32<0.001B3.86±0.353.91±0.294.03±0.764.10±0.512.64<0.001C3.17±1.014.27±1.03∗∗b4.82±0.96∗∗5.45±0.80∗∗b29.25<0.001F1.744.210.493.82P0.3040.0190.6090.028Daily activity scoreA3.43±2.754.95±2.87∗∗7.29±2.17∗∗9.76±2.36∗∗80.92<0.001B3.73±2.555.50±2.48∗∗8.23±2.31∗∗10.14±2.03∗∗61.59<0.001C3.32±2.907.59±1.62∗∗ab9.73±2.31∗∗a12.22±1.95∗∗ab74.31<0.001F1.344.534.899.20P0.2430.0010.0030.001Three interventions were effective in the treatment of LDH. The difference in clinical efficacy among the three groups was statistically significant (P<0.05), and the improvement rate of group C was higher than that of groups A and B. Tables 4 and 5, detail 5.Table 4
Comparison of JOA low back pain score improvement rate among the three groups after intervention.
GroupingABCX2PJOA improvement rate0.56±0.100.57±0.110.7±0.1813.110.002Table 5
Comparison of curative effects of three groups after intervention.
GroupingClinical treatmentRemarkable effectEffectiveInvalidGroup A08130Group B08140Group C01570After the intervention, the pain NRS score of the three groups was improved compared with that before the intervention. Among them, the effect of traditional Chinese medicine sandbag combined with hot compress was better than sandbag hot compress and traditional Chinese medicine hot compress. See Table6 for details.Table 6
NRS pain scores of three groups at different time points.
GroupingTOT1T2T3FPGroup A7.14±0.656.10±0.615.10±0.763.10±0.7280.95<0.01Group B7.14±0.645.68±0.764.10±0.762.13±0.6861.58<0.01Group C6.85+̲0.725.25±0.853.89±0.881.85±0.8374.28<0.01F1.246.929.9414.04P0.2970.002<0.001<0.001Due to the composition of traditional Chinese medicine and the thermal effect of hot compress, local scalds, rashes, blisters, itching, and other phenomena may occur during hot compress. The following is the description of adverse reactions during experimental hot compress. The symptoms of patients are mild, which does not affect the treatment of hot compress. See Table7 for details.Table 7
Number of adverse events during the three intervention methods.
GroupingGroup AGroup BGroup CScald101Erythema011Dermatitis010


## 3.1. Diagnostic Criteria of Western Medicine

Refer to the relevant provisions in the guidelines for clinical diagnosis and treatment prepared by the Chinese Medical Association in 2009:(1)
He suffers from chronic back pain, acute back pain, and leg pain. Lower extremity or lower extremity pain spreads along the lumbosacral nerve, and leg pain is more severe than back pain(2)
Two of the following four signs appear along the nerve distribution area: muscle atrophy, paresthesia, muscle weakness, and reflex changes;(3)
Signs: the lumbar spine is bent or the body position is limited, and the activity is obviously limited. Straight leg elevation test was positive, femoral nerve traction test or nerve root tension test was positive;(4)
Imaging examination includes the location and degree of lumbar disc herniation and the degree of spinal canal compression (X-ray film, CT, MRI, etc.).


## 3.2. TCM Syndrome Standard

Refer to the symptom classification in the standard for diagnosis and curative effect of TCM diseases.


## 3.3. Qi Stagnation and Blood Stasis Syndrome

Most of them have chronic diseases, and the symptoms of low back pain worsen when they are tired. It is generally a tingling pain in the waist, with a fixed place and a tense traction texture. If you refuse to press the pain, it is difficult to bend down or even turn your side. The night is heavy and the day is light. The tongue is dark purple, with ecchymosis on the tongue coating, and the pulse string is tight or slippery.


## 3.4. Cold Dampness Syndrome

Low back and leg pain presents a sense of emphasis, acid, or numbness, the disease location is cold, the activity is limited, and it is difficult to pitch. Pain or aggravation of symptoms in rainy days. The limbs are cold, the tongue is light, the moss is white and greasy, and the pulse string is tight or soft.


## 3.5. Damp-Heat Syndrome

Low back pain, soft legs, fever, and pain, increased pain in hot or rainy days, reduced pain after activity, thirst, short and red urine. Red tongue, yellow coating, greasy, few pulses or filaments.


## 3.6. Liver and Kidney Deficiency Syndrome

Slow onset, dull pain, sour or weak feeling in the waist and legs, aggravating when tired, like rubbing and pressing. There are often mental fatigue, cold limbs, spermatorrhea, or leucorrhea. The tongue is light and fat, and the pulse is heavy or weak.Inclusion criteria are as follows:(1)
All the candidates met the diagnostic criteria of lumbar disc herniation in the clinical diagnosis and treatment guidelines prepared by the Chinese Medical Association in 2009 and were diagnosed by CT or MRI(2)
Age > 20 years old, informed consent(3)
Patients with Qi stagnation and blood stasis syndrome according to the symptom standard of the diagnostic efficacy standard of traditional Chinese medicineExclusion criteria are as follows:(1)
Have serious heart, liver, lung, kidney, and hematopoietic system diseases, accompanied by lumbar fracture, lumbar spondylolisthesis, and tumor. Tuberculosis and other diseases, combined with severe osteoporosis, mental disorders, or any other contraindications to hot compress(2)
Pregnant and lactating womenExit criteria are as follows:(1)
Allergic constitution: allergic reaction to traditional Chinese medicine(2)
Patients with severe pain during hospitalization should consider surgical treatment(3)
Those who are unwilling to continue relevant treatment for any reasonThe subjects were LDH patients hospitalized in a traditional Chinese Medicine Hospital Affiliated to a medical university. During this period, there were 154 patients with LDH, excluding 29 patients who were not suitable for hot compress treatment, 25 patients who were unwilling to accept the test, 2 patients with traditional Chinese medicine allergy, 6 patients who changed to surgery due to aggravation of pain, and the other 92 patients signed informed consent. A total of 13 cases were included in the study due to different reasons [18, 19]. A total of 26 patients received simple sandbag hot compress, 26 patients received simple traditional Chinese medicine hot compress, and 27 patients received traditional Chinese medicine sandbag hot compress. In the course of treatment, due to the ineffective effect, 14 other treatment methods were added at the request of patients, and 4 cases were terminated for special matters. The final number of patients in group A, B, and C who completed the intervention was 21, 22, and 22, respectively, a total of 65. The specific flow of the screening process of the research object is shown in Figure 2.Figure 2
Selection and determination process of research objects.This study is a randomized controlled trial. 79 patients who met the selection criteria were randomly divided into 3 groups: A (simple sandbag hot compress group), B (simple traditional Chinese medicine hot compress group), and C (traditional Chinese medicine sandbag combined hot compress group). The JOA Low Back Pain Scale scores were collected before the intervention (T0), 1 week after the intervention (T1), 2 weeks after the intervention (T2), and 4 weeks after the intervention (T3). Combined with the improvement rate of JOA low back pain score, the curative effect and NRS score of low back and leg pain were determined. Referring to the relevant literature, for the main index JOA low back pain scale score, the minimum clinical significance change value is 4 points, and the estimated standard deviation is 6 points. Using two-sided test,C=0.05, β=02, at least 18 cases in each group; considering the shedding rate of 10% during the experiment, at least 20 cases in each group are required. In this study, among 154 patients with LDH treated in a traditional Chinese medicine hospital, more than 60 subjects were recruited to ensure that there were no less than 20 cases in each group, and 79 cases were actually recruited.Group A (simple sand bag hot compress group): put 1.5 kg fine sand in35cm×30cm cotton cloth bag, sew the bag mouth to prevent sand leakage, soak the sand bag in clean water until the sand is wet, steam it in the steamer for 30 min, and then take it out (or microwave oven high fire for 15 min). Lay a waterproof plastic film on the bed, and lay the sand bag on the film to pave it. On the one hand, prevent the sand bag from wetting the clothes and quilt, on the other hand, wrap it with film to save heat. Due to the thermal effect (the temperature is 78-82°C after the sandbag is steamed in the steamer for 30 min), enough cloth shall be added between the sandbag and the patient’s skin to prevent scalding. Maintain the temperature at 38°C-42°C. The patient shall take the supine position, place the waist above, and then wrap the film on the waist cloth to store heat. Twice a day, at 8 a.m. and 2 p.m. for 40 minutes each time.Group B (simple traditional Chinese medicine hot compress group): the drugs used were traditional Chinese medicine formulas with the effects of promoting blood circulation, removing blood stasis, and relieving pain, including 20 g Duhuo, 20 g Gouji, 20 g Shenjincao, 20 g Tougucao, 20 g Achyranthes bidentata, 15 g chuanxiong, 20 g safflower, 15 g turmeric, 15 g wormwood leaf, and 10 g Asarum. Add 1000 ml hot water to boil, soak the towel in the boiling hot water, then screw the towel dry until the temperature reaches 38-42°C, and apply it to the waist with heat, so as to be warm and comfortable without scalding the skin. Since the temperature of hot water towel is maintained at 38-42°C for 6-8 min, it needs to be replaced every 5 min to ensure the curative effect, twice a day, 40 min each time. In order to ensure the temperature effect of hot compress as much as possible, count one hot compress towel on the patient’s waist and prepare two towels for replacement.Group C (traditional Chinese medicine sandbag hot compress group): the same traditional Chinese medicine and equal weight fine sand were evenly mixed and placed in a35cm×30cm cotton cloth bag, and the bag mouth was sutured to prevent the leakage of traditional Chinese medicine. The method was the same as that in group A. Several problems to be explained in the treatment method are as follows: (1) choose to use 1.5 kg fine sand. On the one hand, it can maintain the temperature at 38°C to 42°C for a long enough time to ensure the treatment. On the other hand, 1.5 kg fine sand is put into a 35cm×30cm cloth bag to avoid discomfort in the treatment process [15, 20]. (2) The application of 35cm×30cm cloth bag is not only large enough to more effectively treat waist diseases, but also not too large to burn the unexpected skin of waist diseases. (3) The types and corresponding functions of traditional Chinese medicine: Angelica pubescens has the effects of dispelling wind, overcoming dampness, dispersing, and relieving pain; dog ridge has both the power of dispelling evil and the power of tonifying. It can be applied to the symptoms of low back pain, strong spine, inability to pitch, weakness of the feet and knees, whether it is arthralgia for a long time or deficiency of the liver and kidney; ginseng has the functions of dispelling wind, dispelling cold, removing dampness and swelling, and relaxing tendons and activating collaterals. For wind-cold-dampness pain, muscle spasm, carbuncle U5. Skull grass has the functions of relaxing tendons and activating collaterals, expelling wind and dampness, promoting blood circulation, and relieving pain. Achyranthes are used to promote blood circulation, eliminate congestion, strain the liver and kidneys, strengthen muscles and bones, and treat back and knee pain and muscle and bone weakness. Chuanxiong has the effect of promoting blood circulation, dispelling wind, and relieving pain. Safflower has the effect of dispersing blood stasis and relieving pain; turmeric has the effect of breaking blood, promoting Qi, clearing the meridian, and relieving pain; wormwood leaf activates collaterals, warms the meridian and activates blood, relieves pain and disperses cold, and plays a great role; Assalm has the effect of dispelling wind dispelling cold, warming the meridian, and relieving pain [21, 22].The scale evaluates the subjective symptoms, clinical signs, daily activities, and bladder function, so as to comprehensively judge the effect of treatment improvement. The full score is 29. The greater the score, the lighter the symptoms of LDH, and vice versa.PercentimprovementofJOAbackpainscore=beforeandaftertreatment/totalscore−beforetreatment∗100%.(1) Clinical treatment: symptoms such as low back and leg pain are relieved, and the improvement rate is >95%. (2) Significant effect: the symptoms such as low back and leg pain basically disappear without affecting daily life or work (60%improvement<95%). (3) Effective: low back and leg pain other symptoms are relieved, and the ability to participate in work decreases (25<improvementrate<60%); (4) Ineffective: no improvement in low back and leg pain symptoms, improvement rate <25%.All measurements are shown as standard deviation of the meant unless otherwise stated. Record statistics, number of cases and add percentages. SPSS 18.0 was used for statistical analysis. We compared the baseline data of the three groups of subjects before intervention. The chi-square test was used to measure the variance of the data and one-way analysis of census data. Repeated-measure analysis with two variance factors was used to compare the observed indicators before and after the intervention in the three groups. P<0.05 was statistically significant. The technical route is shown in Figure 3.Figure 3
Technical roadmap.The 65 patients who received the intervention ranged in age from 19 to 85 years old, with an average age of55.1±15.6 years. Among them, 33 were male and 32 were female. Complications included 21 hypertension, 9 diabetes, and 6 heart disease. We compared the baseline data of the three groups. Variance and chi-square test showed that there was no significant difference in each index among the three groups (P>0.05). See Table 2 for details.Table 2
Sociodemographic data and disease-related data of patients in the three groups.
ProjectTotal number (65)Group A (n=21)Group B (n=22)Group C (n=22)F/χ2Age55.1±15.651.9±17.456.4±16.856.8±12.40.650.53aGender2.990.22bMale3350.8%361.9%1254.5%836.4%Female3249.2%838.1%1045.5%1463.6%BMI24.6±3.424.1±2.324.3±3.125.2±4.40.740.48aCourse of disease0.280.99b< 6 months2944.6%942.9%1045.5%1045.5%6-12 months1320.0%523.8%418.2%418.2%>12 months2335.4%733.3%836.4%836.4%Diseased segment0.970.91bL4-L51320.0%523.8%313.6%522.7%L5-S11827.7%523.8%731.8%627.3%L4-S13452.3%1152.4%731.8%1150.0%See Table3 for the comparison of JOA low back pain scale scores and scores of various dimensions among and within the three groups at different time points.Table 3
JOA lower abdominal pain scores and scores of each dimension of the three groups at different time points.
GroupingT0T1T2T3FPJOA low back pain scoreA10.33±3.4812.81±3.16∗∗16.90±2.8∗∗20.67±2.96∗∗149.41<0.001B10.05±3.0513.32±2.85∗∗17.59±3.23∗∗20.91±2.22∗∗115.64<0.001C11.45±2.6015.27±2.51∗∗a19.77±3.37∗∗a23.82±2.87∗∗ab130.81<0.001F1.304.534.889.20P0.2790.0150.011<0.001Subjective symptom scoreA2.24±1.253.23±0.94∗∗4.52±1.O8∗∗5.76±0.62∗∗77.48<0.001B2.41±1.143.91±0.68∗∗4.32±1.29∗∗5.82±0.66∗∗99.35<0.001C2.32±1.293.55±1.22∗∗5.18±0.91∗∗a6.18±0.73∗∗99.81<0.001F1.912.343.682.47P0.2250.1050.0310.093Clinical sign scoreA3.67±0.733.71±0.723.95±0.50∗∗4.19±0.51∗∗8.32<0.001B3.86±0.353.91±0.294.03±0.764.10±0.512.64<0.001C3.17±1.014.27±1.03∗∗b4.82±0.96∗∗5.45±0.80∗∗b29.25<0.001F1.744.210.493.82P0.3040.0190.6090.028Daily activity scoreA3.43±2.754.95±2.87∗∗7.29±2.17∗∗9.76±2.36∗∗80.92<0.001B3.73±2.555.50±2.48∗∗8.23±2.31∗∗10.14±2.03∗∗61.59<0.001C3.32±2.907.59±1.62∗∗ab9.73±2.31∗∗a12.22±1.95∗∗ab74.31<0.001F1.344.534.899.20P0.2430.0010.0030.001Three interventions were effective in the treatment of LDH. The difference in clinical efficacy among the three groups was statistically significant (P<0.05), and the improvement rate of group C was higher than that of groups A and B. Tables 4 and 5, detail 5.Table 4
Comparison of JOA low back pain score improvement rate among the three groups after intervention.
GroupingABCX2PJOA improvement rate0.56±0.100.57±0.110.7±0.1813.110.002Table 5
Comparison of curative effects of three groups after intervention.
GroupingClinical treatmentRemarkable effectEffectiveInvalidGroup A08130Group B08140Group C01570After the intervention, the pain NRS score of the three groups was improved compared with that before the intervention. Among them, the effect of traditional Chinese medicine sandbag combined with hot compress was better than sandbag hot compress and traditional Chinese medicine hot compress. See Table6 for details.Table 6
NRS pain scores of three groups at different time points.
GroupingTOT1T2T3FPGroup A7.14±0.656.10±0.615.10±0.763.10±0.7280.95<0.01Group B7.14±0.645.68±0.764.10±0.762.13±0.6861.58<0.01Group C6.85+̲0.725.25±0.853.89±0.881.85±0.8374.28<0.01F1.246.929.9414.04P0.2970.002<0.001<0.001Due to the composition of traditional Chinese medicine and the thermal effect of hot compress, local scalds, rashes, blisters, itching, and other phenomena may occur during hot compress. The following is the description of adverse reactions during experimental hot compress. The symptoms of patients are mild, which does not affect the treatment of hot compress. See Table7 for details.Table 7
Number of adverse events during the three intervention methods.
GroupingGroup AGroup BGroup CScald101Erythema011Dermatitis010


## 4. Experiment and Analysis

In this study, the average BMI of the subjects is about 26, which is higher than the normal level and belongs to the overweight range. Because the lumbar intervertebral disc bears the strength of the human trunk and upper limbs, overweight or obesity will lead to additional burden and increase the incidence of LDH. At the same time, due to the anatomical position of the lumbar intervertebral disc, it has a large angle relative to the horizontal plane. It is the central segment of the shear force of physical activity, with the largest load and the most activity. The diseased segments have single segments, such as L4-L5 and L5-S1. If multiple segments occur, they are mostly concentrated on L4-S1. According to Thelander’s research, young and middle-aged patients with LDH account for about 4% of all the affected population. Many other studies also show that there are more middle-aged and elderly patients and fewer young patients. However, due to the improvement of living standards, increasing sedentary living habits and bad posture, the incidence of LDH in young people is increasing year by year. Most patients with LDH have a long course of disease, of which the course of more than 10 years accounts for one third. LDH is a chronic disease. Generally, the lumbar intervertebral disc begins to degenerate after the age of 20, and there will be obvious degenerative changes after the age of 30, resulting in lumbar disc herniation, and then, the symptoms of lumbar disc herniation such as low back and leg pain will take a certain time [11, 23]. Of course, there are also young patients with initial acute attack, pain and carbuncle, who are in urgent need of hospitalization. In addition to the younger and younger onset, some research reports believe that trauma and muscle strain are the main causes of the disease.This study conducted a two-week hot compress intervention study on patients with LDH and compared the low back pain scores at 1 week, 2 weeks, and 4 weeks after the intervention, to study the effect of three methods: sandbag hot compress, traditional Chinese medicine hot compress, and traditional Chinese medicine sandbag on the comprehensive score of low back pain in patients with LDH, including subjective symptoms, clinical signs, and daily activities. The study set the sandbag hot compress group as group A, the traditional Chinese medicine hot compress group as group B, and the sandbag traditional Chinese medicine combined hot compress group as group C. The results showed that the total score of JOA low back pain, subjective symptoms, clinical signs, and daily activity scores of the three groups were significantly higher than those before the intervention (P<0.05). At the same observation point at 1 week, 2 weeks, and 4 weeks after the intervention, the total score of low back pain and the scores of three dimensions in group C were significantly higher than those in group A and group B (P<0.05); in terms of subjective symptom scores, group C was higher than the other two groups 2 weeks after intervention (P<0.05), but there was no significant difference between the groups 1 week and 4 weeks after intervention (P>0.05); 1 week and 4 weeks after intervention The clinical symptoms in group C were significantly higher than those in groups A and B (P<0.05). There was no significant difference in this dimension score between 2 and 3 weeks after intervention (P>0.05). After the intervention, the pain NRS score of the three groups was improved compared with that before the intervention. Among them, the effect of traditional Chinese medicine sandbag combined with hot compress was better than that of simple sandbag hot compress and traditional Chinese medicine hot compress. The improvement rate of JOA score of lumbar carbuncle under the scoring standard of comprehensive curative effect of lumbar carbuncle disease in the three groups was P<0.05, with statistical difference [28].In this study, the comparison of the total score of lower back carbuncle and the scores of three dimensions showed that the three groups of patients increased significantly 1 week, 2 weeks, and 4 weeks after the intervention compared with those before the intervention, which showed that simple sandbag hot compress, simple traditional Chinese medicine hot compress, and traditional Chinese medicine sandbag combined hot compress had certain effects on the treatment of LDH, and traditional Chinese medicine sandbag combined hot compress was better than simple sandbag hot compress and traditional Chinese medicine hot compress. Modern medicine believes that the symptoms of LDH are mainly caused by mechanical compression of lumbar nerve root, inflammatory changes around the nerve, and ischemia caused by microcirculation disorder. In the treatment, we can improve microcirculation, eliminate neuroedema and inflammatory reaction, and then achieve the purpose of treatment. Simple sandbag heat can effectively improve the blood supply of low back muscle and nerve root, increase local nutrition, and promote metabolism. Thermal action can also expand skin capillaries, increase hemodynamics and metabolic speed, promote tissue nutrient absorption, and increase cell permeability, so as to promote the elimination of tissue edema and the absorption of inflammatory substances, in addition, it can also reduce nerve and muscle tension to alleviate muscle spasm and pain: under the action of heat, the sweat gland secretion of the body increases and the sweat discharge increases, so that the blood is concentrated, and the water of the tissue enters the blood vessel to promote the absorption of tissue exudate, which is conducive to the regression of swelling and reduce pain, so as to play a therapeutic role. Sand has the characteristics of slow heat dissipation and long heat storage time, which can play a more efficient thermal role, so it has a better effect on alleviating the symptoms of LDH. Traditional Chinese medicine hot compress can also alleviate the symptoms of LDH. First, it is due to local stimulation: the external use of traditional Chinese medicine can dilate local blood vessels, improve the nutritional status of blood circulation and surrounding tissues, so as to improve circulation, and reduce inflammation and analgesia; the second is the direct penetration of drugs: for external use, traditional Chinese medicine can directly penetrate the skin and directly reach the focus. The drug intensity of the affected part is high, so it can play a good role in promoting blood circulation and removing blood stasis, activating carbuncle channels and collaterals, dispelling wind and dehumidification, detumescence, and pain. The third is the regulation of meridians and the distribution of viscera: meridians are an important part of human tissue and a unique system for communication between the outside and the inside, up and down. It is externally connected with the skin muscle and internally connected with the five Zang and six Fu organs. The traditional Chinese medicine is externally applied to the affected areas and acupoints. Various drugs play their role in regulating yin and Yang Qi and blood of the Zang and Fu organs, supporting the right and expelling evil through the stimulation of acupoints and the conduction of meridians, so as to achieve the purpose of treating diseases. Fourth, the function of skin absorption: the skin is the largest barrier of the human body, with large area and many pores. In addition to resisting external evil, it also has the functions of excretion, absorption, and metabolism. The effective components of traditional Chinese medicine are absorbed by the skin through penetration and enter the human body to play a role. Most of the traditional Chinese medicines used in the treatment of LDH are products that promote blood circulation and remove blood stasis, clearing away heat and moistening dryness, dispelling cold, and relieving pain. The combination of Chinese herbal sandbags and hot compresses involves mixing sand with herbs. On the one hand, the heat can be fully utilized to maximize the thermal function. On the other hand, traditional Chinese medicine can penetrate into the skin with the help of heat and act on the local part, giving full play to the role of traditional Chinese medicine in promoting blood circulation, promoting Qi, relieving pain, relaxing muscles, and activating collaterals, so as to make it more significant in alleviating the symptoms of low back pain. For the safety problem in the process of this study, the cloth bag outsourced during the treatment process shall be checked in advance to prevent scalding caused by leakage of traditional Chinese medicine and fine sand after loading in the process of hot compress; before hot compress, the operator first tests whether the heat is appropriate with his own hand. Spread out the sandbag with uniform thickness and moderate height, and select an appropriate number of dry cloth pads; in the process of hot compress, as the temperature gradually decreases, the patient is instructed to remove the pad layer by layer according to the temperature, so that the patient can achieve continuous hot compress effect; for the elderly patients who feel sluggish, the operator needs to strengthen the inspection, carefully check the sandbag and ask if there is any discomfort: when the patient has redness, rash, blister, itching, and other phenomena after hot compress or in the process, the treatment shall be suspended immediately, and the bedside physician shall be notified to make necessary symptomatic treatment according to the symptoms in time.


## 5. Conclusion

During the study, it was found that the compliance was generally good, and the reasons were as follows: (1) wet compress treatment not only had a definite effect and could effectively alleviate the symptoms of pain and numbness but also increased the comfort of patients due to its warm physical effect; (2) the hot compress operation is noninvasive and painless, and the patients are happy to accept it; (3) the operation method of hot compress treatment is simple and easy to implement clinically: (4) the price of traditional Chinese medicine is low, which is easier for patients to bear economically. At the same time, the state vigorously develops and supports traditional Chinese medicine technology and medical insurance policy, which provides a strong guarantee for the implementation of hot compress treatment: (5) relevant health guidance is carried out in the process of hot compress treatment, which improves patients’ understanding and recognition of traditional Chinese medicine. Thus, the satisfaction and compliance of patients are increased. In this study, the hot compress method is simple and practical, with small side effects, low medical expenses, good curative effect, high acceptance of patients, easy collection of patients, smooth experimental process, and basically achieved the expected purpose. However, there are also the following problems: (1) due to the complex pathogenesis of LDH, including mechanical compression, inflammatory mediators, autoimmune mechanism, and microcirculation disorder, it cannot be explained by a single mechanism. Therefore, although the curative effect of traditional Chinese medicine hot compress is positive, the effect is limited, and it is difficult to fundamentally relieve the pain; (2) because the clinical symptoms of LDH will be different according to the duration of the disease, the grouping of patients is mainly based on the severity of symptoms, course of disease, and lesion segment, and there is no objective biochemical index. From the perspective of traditional Chinese medicine, there are still different syndrome types, so it is difficult to evaluate the difference of time difference in groups, so the results may be biased; (3) although the traditional Chinese medicine used in the process of hot compress is external medicine, its components are more complex; (4) During the study, due to the limited time and energy, the sample size is relatively small, and there is no long-term follow-up of patients, so the long-term clinical efficacy is not clear: (5) there is no unified standard for the heating method, heat preservation method and articles used in the treatment of hot compress, and the degree of thermal tolerance of patients during hot compress. The sensitivity to traditional Chinese medicine and the body constitution such as metabolic rate are the factors affecting the curative effect of hot compress, which have not been measured and compared. In view of the problems existing in the current research, some objective standard biochemical indexes need to be included in the future research, and the disease differentiation and dialectical use of traditional Chinese medicine according to different syndrome types. Different hot compress methods need to have clear standards and clinical paths. For the evaluation of the therapeutic effect of LDH, patients need to be followed up for a long time to understand its long-term effect. The limitation and deficiency of this study lies in the failure to add a blank group without intervention in the first part. LDH patients have different personal living habits due to their own diseases. The prognosis of the disease itself cannot be known without treatment. Due to the limitation of research conditions and personnel energy, this study failed to select the group without any intervention for LDH patients. I hope it can be improved in future research.



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*Source: 1288233-2022-05-18.xml*