Cervical spondylosis refers to the corresponding symptoms and signs of degenerative degeneration of the cervical disc and its secondary degenerative degeneration of the intervertebral joints caused by spinal cord, nerve and vascular lesions. It is a Chinese medicine “item paralysis disease”.
I. Diagnosis
This disease is diagnosed with reference to the “Diagnostic and Curative Criteria for Chinese Medicine” promulgated by the State Administration of Traditional Chinese Medicine in 1995, and combined with clinical research in the department.
(I) Diagnosis basis
1. There is a history of chronic strain or trauma. Or there is congenital malformation of cervical spine or degenerative lesion of cervical spine.
2, Most often occurs in middle-aged people over 40 years old, long-term low head workers, often with chronic onset.
3, neck, shoulder and back pain, headache and dizziness, stiff neck, numbness of upper limbs.
4.The function of neck movement is limited, and there is often pressure pain in the spinous space of the cervical vertebrae, joint synovial joints and the upper angle of the scapula on the affected side, and hard nodes can be felt in the strips.
5.X-ray orthopantomographs show that the hook vertebral joint is hyperplastic and the dentate process may be skewed in the open position, while lateral radiographs show straightening of the cervical curvature, narrowing of the intervertebral space, osteophytes at the posterior edge of the vertebral body, calcification of the ligaments, and small intervertebral foramina in the oblique radiographs.CT and magnetic resonance examination are meaningful for qualitative localization and diagnosis.
(2) Classification of Chinese medicine symptoms
1, cold and damp obstruction: headache or posterior occipital pain, neck stiffness, unfavorable lateral rotation, soreness, pain and numbness in one or both shoulders, arms and fingers, or headache involving upper back pain, cold and damp skin, fear of cold and preference for heat, soft tissue swollen nodules can be palpated next to the cervical spine. The tongue is light red, the coating is thin and white, and the pulse is thin and stringent.
2. Blood stasis: pain in the neck like cone stabbing, the pain is lingering and not embroidered, especially when pressed, the pain has a fixed location, aggravated at night, accompanied by numbness of the upper limbs, dizziness, a little petechiae on the tongue, teeth marks on the edge of the tongue, white greasy moss or white smooth, pulse string or string smooth.
3. Liver and kidney deficiency: dizziness, vertigo, blurred vision or pain in the eyes, weakness, poor nausea, neck pain, or pain in both shoulders. The tongue is light red or light fat, with tooth marks on the sides. The coating is thin and white and moist, and the pulse is sunken and weak.
4.Phlegm-damp obstruction: vertigo, fainting head heavy as a wrap, numbness of limbs, numbness and vomiting, dark red tongue, thick and greasy moss, smooth pulse.
(3) Pathological typing
1, nerve root type: neck pain with upper limb radiating pain, aggravated by posterior cervical extension, decreased sensation in the distribution area of the skin segments of the compressed nerve root, abnormal tendon reflex, muscle atrophy, decreased muscle strength, limited cervical movement, positive brachial plexus pull test, positive head press test.
Cervical spine X-ray shows: vertebral body hyperplasia, hook vertebral joint hyperplasia is obvious, the vertebral space is narrowed, and the intervertebral foramen is small. posterior vertebral redundancy and narrowing of the nerve root canal can be seen in CT.
2, vertebral artery type: headache, vertigo, tinnitus, deafness, blurred vision, postural sudden collapse, and symptoms are aggravated when the cervical spine is laterally bent and backward.
CT examination may show asymmetry in the size of the left and right transverse foramina and relative narrowing on one side.
3, spinal cord type: early tightness of the lower limbs, unstable walking, such as repeated beach, late paralysis of one lower limb or all four limbs, diaphoresis or urinary retention. Sensory impairment below the compressed spinal cord segment, increased muscle tone, hyperreflexia, positive vertebral body bundle sign.
Cervical spine X-ray shows: narrowing of the intervertebral space, hyperplasia of the posterior edge of the vertebral body or disc bulge compressing the spinal cord.
4, sympathetic nerve type: eyelid weakness, blurred vision, pupil dilation, eye sockets distension, lacrimation, headache, migraine, dizziness, occipital neck pain, tachycardia or bradycardia, precordial pain, increased blood pressure, cool extremities or red and hot fingers, excessive or little sweating on one limb, etc.
The cervical spine X-ray shows hooked spine hyperplasia, narrowing of the intervertebral foramen, change in the physiological arc of the cervical spine or different degrees of misalignment.
Optimized treatment plan of Chinese medicine
(I) Treatment of neurogenic cervical spondylosis
1.Manipulation treatment: first relax the tense and spastic muscles by rolling and pushing, taking and kneading, etc. for about 20 minutes, and then use the cervical spine supine positioning lifting and rotating trigger method or sitting rotating trigger method to adjust the displacement, misalignment and curvature change of the vertebrae and small joints in different directions to restore the normal sequence of the cervical spine. Each course of treatment for ten days, generally need two to three courses of treatment.
2, traction treatment: electric occipital traction, twenty minutes at a time, according to the different thickness of the lesion segments and neck muscles, set the traction weight of 7-14kg, once a day, ten days for a course of treatment, generally need two to three courses of treatment.
3.Acupuncture treatment: If the symptoms are not reduced after a course of manual treatment, the foci of cervical spondylosis can be precisely located according to the combination of symptom localization, palpation localization and imaging localization, and then local infiltration anesthesia is performed at the localization point with sterilized puff towel, and a small needle knife of type I-4 is used to puncture with pressure and carry out relaxation treatment in the affected area, and after the resistance under the needle knife is reduced or disappears, the needle knife is withdrawn and pressure is applied to stop bleeding, after the operation. The wound was dressed with a band-aid, and the cervical spine was immediately given a supine positioning lifting and rotating trigger method or a seated rotating trigger method to adjust the displacement, misalignment and curvature changes of the vertebrae and small joints in different directions to restore the normal sequence of the cervical spine and further release the adhesions. Ironing treatment and manipulation are prohibited within three days after acupuncture, and traction treatment can be performed the next day.
4.Ironing treatment: According to the identification and typing, use our homemade series of prescriptions (tendon and bone pain relieving liquid) to carry out herbal atomization transdermal treatment on the affected part. Once a day, once for forty to sixty minutes, ten times for a course of treatment, generally need two to three courses of treatment.
5.Chinese medicine fumigation therapy: according to the identification and typing, use this section of Chinese medicine to apply to the affected part, once a day, for 30 minutes each time, this method and the above method, choose one can.
6.Medium frequency electrotherapy: once a day, once for 20 minutes, ten times for a course of treatment, generally need one to three courses of treatment.
7.Oral administration of Chinese herbal soup: (one dose daily, morning and evening, usually one to two weeks)
(1) Blood stasis evidence.
Treatment: activate blood stasis, remove blood stasis, open ligaments and relieve pain
Recipe: Fuyuan Blood Invigorating Soup
Radix Bupleurum 12 g, Pollen 15 g, Gweiweiwei 10 g, Safflower 10 g, Imperata 6 g, Rhubarb 10 g, Peach kernel 12 g, Niu Knee 15 g
(2) Cold and dampness blocking the ligaments.
Treatment: dispel wind, remove dampness, disperse cold and relieve pain.
Formulation: Duluxiaosheng Tang
Doklam 10g, Sang Sang Sang 18g, Gentiana Macrophylla 12g, Cinnamon 6g, Chuanxiong 10g, Niu Knee 15g, Eucommia 12g, Radix Angelicae Sinensis 12g, Poria 12g, Radix Codonopsis Pilosulae 12g, Radix Rehmanniae 15g, Radix Paeoniae Alba 10g, Radix et Rhizoma Ginseng 3g, Fructus Anemarrhenae 10g, Glycyrrhiza Glabra 6g
(3) Liver and kidney deficiency.
Treatment: Tonifying the liver and benefiting the kidney, strengthening the tendons and bones.
Recipe: Tonifying the Liver and Benefiting the Kidney
Radix Rehmanniae 30 g Radix Angelicae Sinensis, Radix Paeoniae Alba, Astragalus Membranaceus, Cornu Cervi Pantotrichum, 15 g each
Chuanxiong 5 g chicken blood vine 9 g Aconite 10 g (melted and blended)
(4) Phlegm and dampness blocking the orifice
Treatment: Strengthening the spleen, drying dampness, resolving phlegm and quenching wind
Formulation: Radix et Rhizoma Atractylodis Macrocephalae Tang
Semen 9 g, Rhizoma Atractylodis Macrocephalae 9 g, Atractylodes Macrocephalae 9 g, Poria 9 g, Radix Angelicae Sinensis 6 g, Glycyrrhiza Uralensis 6 g, Ginger 6 g, Jujube 3
(B) vertebral artery type cervical spondylosis
1.Manipulation therapy: First, relax the tense and spastic muscles by rolling and pushing, taking and kneading, etc., for about 20 minutes, and then use the cervical spine supine positioning lifting and rotating trigger method or sitting rotating trigger method to adjust the displacement, misalignment and curvature change of the vertebrae and small joints in different directions to restore the normal sequence of the cervical spine. Each course of treatment for ten days, generally need two to three courses of treatment.
2.Laser acupuncture therapy: If the symptoms are not reduced after one week of manipulation, the imaging data is used as the main location, the acupuncture method is the same as the neurogenic type, and the postoperative manipulation is reset.
3.Oral administration of Chinese herbal soup: one dose a day, morning and evening, one to two weeks
(1) Blood stasis evidence.
Treatment: Invigorate blood stasis, remove blood stasis, open the ligaments and relieve pain
Formulation: Fuyuan and invigorate the blood
(2) Cold and dampness blocking the ligaments.
Treatment: dispel wind, remove dampness, disperse cold and relieve pain.
Formula: Douwuxiaosheng Tang
(3) Liver and kidney deficiency.
Treatment: tonifying the liver and kidney, strengthening the tendons and bones.
Recipe: Tonifying the Liver and Benefiting the Kidney
(4) Phlegm and dampness blocking the orifice
Treatment: Strengthening the spleen, drying dampness, resolving phlegm and quenching wind
Formulas: Sempervivum Album, Rhizoma Atractylodis Macrocephalae, TCM
4.Acupuncture and moxibustion therapy: the principle of acupuncture is based on the combination of local acupuncture points and meridian acupuncture points, and the corresponding acupuncture points are applied according to the patient’s pain location and the direction of pain radiation. The acupuncture points should be taken according to the location of the pain and the direction of pain radiation. For headache, Fengchi and Sishencong should be used; for nausea, Foot Sanli and Neiguan should be used for vomiting; for vertigo, Tai Chong and Baihui should be used; for phlegm, Fenglong should be used. Leave the needle for 10-20 minutes. Once a day, ten times as a course of treatment, usually two to three courses of treatment are needed.
(C) Spinal cord type
1.Acupuncture treatment: the same method as the nerve root type.
2, ironing treatment: according to the identification of the type, the use of our homemade series of prescriptions (tendon and bone pain relieving liquid) for the affected part of the Chinese herbal atomization transdermal treatment. Once a day, once forty to sixty minutes, ten times for a course of treatment, generally need two to three courses of treatment.
3.Chinese medicine fumigation: According to the identification and classification, Chinese medicine is used to fumigate the affected area once a day for 30 minutes each time, this method and the above method can be chosen.
4.Oral administration of Chinese herbal soup: one dose a day, morning and evening, for one to two weeks.
(1) Blood stasis evidence.
Treatment: Invigorate blood stasis, remove blood stasis, open the ligaments and relieve pain
Formulation: Fuyuan and invigorate the blood
(2) Cold and dampness blocking the ligaments.
Treatment: dispel wind, remove dampness, disperse cold and relieve pain.
Formula: Douwuxiaosheng Tang
(3) Liver and kidney deficiency.
Treatment: tonifying the liver and kidney, strengthening the tendons and bones.
Recipe: Tonifying the Liver and Benefiting the Kidney
(4) Phlegm and dampness blocking the orifice
Treatment: Strengthening the spleen, drying dampness, resolving phlegm and quenching wind
Formulas: Sempervivum Album, Rhizoma Atractylodis Macrocephalae, TCM
5.Acupuncture and moxibustion therapy: the principle of acupuncture is based on the combination of local acupuncture points and meridian acupuncture points, and the corresponding acupuncture points are applied according to the patient’s pain location and the direction of pain radiation. For headache, use Fengchi and Baihui; for dizziness, use Taichong; for phlegm, use Fenglong; for numbness in the limbs, use Hand Wuli and Foot Sanli. Leave the needle for 10-20 minutes. Once a day, ten times as a course of treatment, generally need two to three courses of treatment.
(iv) sympathetic type.
1.Manipulation therapy: relaxation techniques are the same as those for the nerve root type, with the addition of head and neck acupressure points.
2.Acupuncture treatment: If the symptoms are not reduced after one week of manipulation treatment, the imaging data will be used as the main location, and the acupuncture method will be the same as that of the neurogenic type, and the postoperative manipulation will be reset.
3.Oral administration of Chinese herbal soup:One dose a day, morning and evening, for one to two weeks.
(1) Blood stasis evidence.
Treatment: invigorate blood stasis, promote blood circulation and relieve pain
Formulation: Fuyuan and invigorate the blood
(2) Cold and dampness blocking the ligaments.
Treatment: dispel wind, remove dampness, disperse cold and relieve pain.
Formula: Douwuxiaosheng Tang
(3) Liver and kidney deficiency.
Treatment: tonifying the liver and kidney, strengthening the tendons and bones.
Recipe: Tonifying the Liver and Benefiting the Kidney
(4) Phlegm and dampness blocking the orifice
Treatment: Strengthening the spleen, drying dampness, resolving phlegm and quenching wind
Formulas: Sempervivum Album, Rhizoma Atractylodis Macrocephalae, TCM
4, acupuncture therapy: the principle of acupuncture acupuncture points is based on a combination of local acupuncture points and meridian acupuncture points, and with the results of the identification and application of the corresponding points. Headache with Fengchi, Baihui, chest tightness and panic with Neiguan, heart acupuncture, phlegm with Fenglong. The needle is left in place for 10-20 minutes. Once a day, ten times as a course of treatment, usually two to three courses of treatment.
Third, other
Each of the above types is given to activate blood circulation and nerve nourishing drugs orally and quietly according to different conditions.
IV. Care
(A) General care: according to the general Chinese medicine orthopedics one dose a day, morning and evening, one to two weeks care routine.
(B) Observation of the condition, make nursing records.
1.For patients in the acute stage, observe the site of pain, the nature in relation to the change of position and the presence of radiating pain and skin abnormalities.
2.Empty the urine and stool of the patient before pushing.
3.After pushing, ask the patient to rest in a low-pillow position and observe the pain and dizziness of both upper limbs.
4.Symptom relief should be adhered to the neck exercise.
5. Pay attention to whether the patient has dysfunctional stool and do skin care.
(C) Drug administration care Avoid cold and cold food during drug administration, and avoid wind and cold outside to avoid aggravating the disease.
(D) Dietary care Diet should be nutritious, avoid cold, spicy, nourishing and greasy products.
(E) Emotional care Pay attention to the emotional changes of the patient, do a good job of thought guidance, establish confidence, cooperate with treatment and care.
V. Regulate
Avoid prolonged exertion, head-down work, pay attention to emotional regulation, and keep a relaxed mood.
Sixth, functional exercise
Cervical spine functional exercises: look to the left, look to the right, look up, look at the sky, turn around and look back, massage around the neck.
VII. Assessment of therapeutic effect
Efficacy assessment according to the 1995 “Diagnostic Efficacy Standards for Chinese Medicine Evidence”: 1.
1.Cure: the original symptoms of each type disappear, muscle strength is normal, neck and limb functions return to normal, and can participate in normal labor and work.
2.Improved: the original symptoms of each type are reduced, neck and shoulder pain are reduced, and neck and limb functions are improved.
3.Unhealed: no improvement of symptoms.
VIII. Analysis of the difficulties of Chinese medicine treatment
(I) Problems.
1. The roughness of clinical manipulation and unreasonable exercise and medication can affect the efficacy and even bring adverse consequences to patients.
2. The lack of a strict access system for minimally invasive treatment, and even the existence of abuse, also have potential safety problems.
3. In clinical practice, the efficacy is relatively poor for patients with cervical instability. However, the clinical effect is not satisfactory, especially for patients with cervical instability associated with vertebral artery type and sympathetic cervical spondylosis, and the recent effect in clinical treatment is acceptable, but the long-term effect is poor and the recurrence rate is high.
Then we believe that the reason for this is that cervical instability is not well solved, and this is a problem that exists in other types of cervical spondylosis, so how to solve it is an urgent task.
4, and for spinal cord type cervical spondylosis, we use Chinese medicine therapy to explore the clinical treatment of the disease for many years, the treatment effect is still poor, and it is difficult to make a breakthrough in a short period of time, we will invest more energy in the disease and conduct research for a breakthrough.
(ii) Countermeasures.
For the nerve root type, vertebral artery type and sympathetic type of this disease, Chinese herbal medicine is relatively effective, especially for the nerve root type. However, some patients blindly and vigorously pushing the treatment with rough techniques, the symptoms can be relieved in a short time, but the pain is aggravated after several hours, which is because edema occurs in the muscles after rough pushing treatment, forming a non-benign cycle, as a result, the force is getting stronger and stronger, but the symptoms are not reduced, so patients with cervical spondylosis should avoid excessive pushing the treatment, in addition, some patients have excessive movement of the neck beyond the physiological range, which makes the cervical spine more prone to Osteomalacia, aggravate the condition, and even form new symptoms.
Therefore, neck exercises must be carried out under the guidance of a doctor to achieve the purpose of exercise. For patients who also have gastric disease try to reduce oral blood circulation and anti-inflammatory and analgesic drugs orally, if it is really necessary for treatment, patients are instructed to take the drugs after meals or with the oral gastric mucosa protector.
Although some attempts have been made in minimally invasive treatment in China (e.g., acupuncture treatment) and certain efficacy has been achieved, due to the influence of technical operation and equipment, as well as the low accuracy of positioning and the limitation of the treatment method itself, there are certain hidden dangers in its safety, and the indications for minimally invasive treatment are relatively narrow, and the main factors affecting the pathogenesis have not been completely solved. The indications for minimally invasive treatment are relatively narrow, and the main factors affecting morbidity have not been completely solved, which affects the treatment effect.
We believe that in addition to establishing a strict access system, it is necessary to improve the clinical theory, operational skills and image reading level of the treating physicians, and to vigorously carry out research and development of medical imaging equipment, so as to further improve the efficacy and reduce the medical trauma with the help of modern imaging equipment monitoring, and to improve the accuracy and safety of minimally invasive treatments such as needle knife, laser, plasma and ozone.
Minimally invasive treatment has improved the efficiency and shortened the treatment time of cervical spondylosis, but cervical instability has not been fundamentally solved. We believe that there is still potential for Chinese orthopedic manipulation and fixation.
Therefore, we must first emphasize palpation combined with film reading to achieve accurate positioning and precise and light manipulation to ensure successful reset. Secondly, the cervical spine should be fixed firmly, comfortably and effectively, and achieve sufficient fixation period, during which the X-rays should be reviewed by palpation in a timely manner to detect problems and adjust them in a timely manner, and then gradually reduce the time and start a moderate amount of functional exercise until the fixation is released. Although the treatment process is complicated, we believe that cervical instability can be solved with the cooperation of doctors and patients, and the cure rate and long-term effect of cervical spondylosis can be improved.
As for spinal cord cervical spondylosis, we think that in addition to carrying out more minimally invasive research, we should strengthen the development of the characteristic therapy of Chinese medicine, and we can make more articles on the screening of the formula of Chinese medicine tonics, which will have better curative effect on this type of cervical spondylosis.