Mr. Wang, who lives in Henan, is 45 years old, felt pain and discomfort in his neck half a year ago, and thought he must be suffering from cervical spondylosis, so he had a massage by a blind man near his home to relieve the symptoms. For three consecutive days, Mr. Wang repeatedly experienced sudden loss of consciousness, as if he had been struck by an evil spirit, suddenly passing out and not knowing anything, and then waking up again. In fact, medically this is called transient ischemic attack. He came to our hospital for further treatment after the initial examination at the local hospital. DSA angiography of the whole brain showed that the beginning of the right internal carotid artery was completely occluded, and the distal left vertebral artery was also completely occluded. This caused ischemia and hypoxia in the brain, and magnetic resonance imaging (MRI) of the head showed multiple foci of intracranial infarction and significant brain atrophy. Just like the crop in the crop field, lack of water irrigation, it slowly withered. Although the onset of the disease was only six months, but Mr. Wang’s head was like a 60-70 year old man. Tui Na massage should be carried out appropriately. Vigorous tui Na action can cause direct damage to the walls of the blood vessels in the neck, resulting in arterial entrapment and secondary stenosis and occlusion of the blood vessels. It is recommended that patients with cervical spondylosis actively go to the hospital, so as not to “cure” a minor illness into a major one. A joint statement by the American Heart Association (AHA) and the American Stroke Association (ASA) on neck thrusts and stroke risk states that strokes due to carotid artery entrapment may be caused by neck thrusts. Stroke due to carotid artery entrapment accounts for 2% of all strokes, and 8% to 25% of young and middle-aged strokes are due to carotid artery entrapment. Four studies that included carotid-related stroke were investigated to evaluate the association between neck massage and stroke risk. It was noted that other causes of carotid artery entrapment have been reported in addition to blunt contusion or penetrating injury. Carotid artery entrapment may occur after sudden abnormal extension or rotation of the neck during certain sports, neck sprains, violent coughing, vomiting, or neck thrusts. An AHA/ASA statement published online by Stroke magazine on August 7 of this year noted that patients with ischemic stroke associated with carotid artery entrapment are likely to have experienced different types of neck thrusts. The authors also noted that these studies were not able to determine what caused the patients to have strokes. It is possible that patients did take neck thrusts because they developed early stroke symptoms. The patients themselves or health care providers mistakenly believed that the neck pain occurred due to a strained neck. And patients may not seek treatment to relieve neck pain until after they develop carotid artery entrapment. The researchers noted that health care providers should inform patients of the association between carotid artery entrapment and neck strains before they begin neck strains. While acknowledging the AHA’s efforts to identify stroke risk factors, it has been noted that approximately 22% to 77% of the U.S. population sometimes experiences neck pain and that neck manipulation is one of the safest methods of treatment than other treatments such as medications and surgery. Some scholars also point out that these data are inconclusive, as indicated in the guidelines. The scholar personally believes that patients who have occult entrapment themselves or are prone to entrapment are susceptible to being triggered or aggravated by many different traumatic factors, and that carotid manipulation is likely to be one of the triggers or aggravators for the development of carotid entrapment. The absolute risk of carotid artery entrapment from neck thrusts is likely to be low in the current context of increasing attention to this problem by practitioners in the spine field. Therefore, neck manipulation should not be considered to cause carotid artery entrapment just because a patient presents to a chiropractor with headache or neck pain; to clarify the causal relationship between neck manipulation and carotid artery entrapment, it needs to be clear that the patient’s carotid artery entrapment was caused by neck manipulation and not by some cause or other trauma that occurred spontaneously before the patient’s visit. The scholar also noted the difficulty in sorting out the above results, but concluded that some evidence exists to support that carotid manipulation may be a risk factor for carotid artery entrapment, so to be fair, the chiropractor should be informed of the situation and advise the patient of the associated risks when the patient visits the chiropractor.