Vertebral artery cervical spondylosis is a common disease in middle and old age. In modern society, with the advent of aging and the accelerated pace of life, especially the popularity of network technology, the incidence of vertebral artery cervical spondylosis is increasing, and there is a trend of rejuvenation. Due to its complex pathogenesis, it is difficult to obtain good results with a single treatment. In recent years, the author has used Chuan Ji Tang plus and minus with manipulation to treat vertebral artery cervical spondylosis with satisfactory results. The results are reported as follows.
1. Clinical data
1.1 General data 127 cases of hospitalized vertebral artery cervical spondylosis patients were randomly divided into two groups according to the order of hospitalization. In the treatment group, there were 64 cases, 31 males and 33 females; age ranged from 20 to 71 years old, with an average of 40.9 years; disease duration ranged from 1 month to 10 years, with an average of 3.4 years. In the control group, there were 63 cases, 30 males and 33 females; age ranged from 21 to 68 years old, with an average of 41.0 years; disease duration ranged from 2 months to 9.6 years, with an average of 3.5 years. There were no significant differences in gender, age and disease duration between the two groups, which were well comparable (P>0.05).
1.2 Diagnostic criteria Refer to the diagnostic criteria on vertebral artery-type cervical spondylosis formulated by the Second Symposium on Cervical Spondylosis.
(1) Previous episodes of sudden collapse with cervical vertigo;
② Positive neck rotation test;
(iii) X-rays showing segmental instability or crooked vertebral joint hyperplasia;
④Sympathetic symptoms;
⑤Excluding otogenic vertigo and oculogenic vertigo;
(6) Excluding insufficiency of blood supply of vertebral artery segment I and segment III, neurosis and intracranial tumor.
2. Treatment and observation methods
2.1 Treatment group: Chuan Ji Tang plus reduction, with 60g of yellow wine, 30g each of Radix et Rhizoma Puerariae and Salviae Miltiorrhizae, 15g each of Radix Paeoniae, Radix Angelicae Sinensis, Rhizoma Chuanxiong and Radix Bupleurum, 9g each of Peach kernel, Safflower and Ginger, 3 old onions and 7 red dates. For dizziness and vertigo, add 9g each of tianma, hooked vine and zedoary; for headache, add 9g each of mandrake and dahurica; for tinnitus, add 9g each of calamus and cicada; for numbness of upper limbs, add 9g of turmeric, 6g each of Chuanwu and Cao Wu; for vomiting, add 9g each of half asia and bamboo rhizome. decoction in two doses, 1 dose per day, 15 days as a course of treatment. At the same time, the treatment is combined with manual therapy, with kneading and rolling techniques on the back of the neck and shoulders, and pressure on the A-Ye point, and pushing techniques on the head and face along the Governor’s Vessel, Foot Sun Bladder Meridian and Foot Shaoyang Gallbladder Meridian, and finally ending with vibration at the Baihui point. The treatment was performed once a day for 30 minutes each time, and 15 days was considered as a course of treatment.
2.2 Control group: 5% glucose injection 250ml, nimodipine 4mg intravenously. Once a day, 15 days as a course of treatment.
2.3 Observation indexes.
①Changes in the main symptoms and signs before and after treatment;
②The improvement of the mean blood flow velocity of vertebral artery and vertebrobasilar artery before and after treatment.
2.4 Observation method: The main symptoms and signs were scored.
①Vertigo: 0 points for severe (unable to open eyes to see or moving, vertigo, sudden collapse); 1 point for moderate (intermittent vertigo, vertigo for a long time, vertigo when the head is twisted to a certain position); 2 points for mild (occasional vertigo, short time); 3 points for normal.
②Headache: severe pain (uncontrollable by non-analgesics) 0 points; moderate (tolerable) 1 point; mild (slightly felt headache) 2 points; normal 3 points.
(3) Neck rotation test: 0 points for dizziness if the head is turned laterally from the sagittal line 300; 1 point for dizziness if the head is turned from the sagittal line 300-600; 2 points for dizziness if the head is turned from the sagittal line 600-900; 3 points for normal.
2.5 Statistical treatment methods: SPSS10.0 software was used for statistical treatment, and the count data were expressed as ±s. The data before and after treatment were tested by paired t-test, and the two-sample mean t-test was used for comparison between groups.
3. Treatment results
3.1 Comparison of the main symptoms and signs scores before and after treatment between the two groups After one course of treatment, the statistical efficacy is shown in Table 1, and the difference in the improvement of symptoms and signs between the two groups is statistically significant (P<0.01); the treatment group is better than the control group (P<0.01).
3.2 Comparison of the mean blood flow velocity of vertebral artery and vertebrobasilar artery before and after treatment between the two groups After one course of treatment, the results are shown in Table 2, the mean blood flow velocity of vertebral artery and vertebrobasilar artery in both groups after treatment was significantly higher than that before treatment (P<0.01); the treatment group was better than the control group (P<0.01).
4.Discussion
The degenerative instability of the cervical spine compresses the atherosclerotic vertebral artery and the nerve plexus around the vertebral artery, causing increased sympathetic excitability and increased release of catecholamines, resulting in vasospasm of the vertebrobasilar artery and the internal carotid artery system and insufficient blood supply to the vertebral artery, which is the pathogenesis of vertebral artery-type cervical spondylosis. Because of the complex pathogenesis, it makes treatment difficult.
Vertebral artery cervical spondylosis belongs to the category of “vertigo” in Chinese medicine. In the Su Wen – Zhi Zhen Yao Da Lun, it is said that “all winds and dizziness belong to the liver”, and in the Ling Shu – Hai Lun, it is said that “if the marrow sea is insufficient, the brain turns to tinnitus”, and in the Dan Xi Xin Fa – Head Dizziness, it is also said that “no dizziness without phlegm”. “This indicates that deficiency, wind and phlegm play a dominant role in the development of this disease. However, “Medical Lamp Continued Flame” says: “Vertigo has due to dead blood, blood dead then the pulse condenses and weeps, pulse condenses and weeps then the force of upward injection is thin, thin then the upper deficiency and vertigo is born.” The “Straight Guide” also says: “Stagnation does not work, then vertigo is born.” In addition, the vertebral artery type cervical spondylosis is on a younger trend, so the author believes that qi stagnation and blood stasis is the main pathogenesis of this disease. The treatment should be to move qi, resolve stasis and promote clearing and clearing. The combination of all these medicines can smooth the flow of qi and blood and raise the clear yang. Modern medicine confirms that Pueraria Mirifica, Angelica Sinensis, Chuanxiong, Tao Ren, Safflower and Salvia can reduce the viscosity of whole blood, plasma viscosity and fibrinogen, improve microcirculation and eliminate local congestion and edema. On the one hand, the manual method can adjust the mechanical balance of the cervical spine, reduce the stimulation of the vertebral artery and the surrounding nerve plexus; on the other hand, it can activate blood circulation, slow down the pain, improve local blood flow and relieve the spasm of the vertebral artery. When combined with traditional Chinese medicine, the treatment mechanism is significantly better than that of the control group, which can only dilate blood vessels and relieve vascular spasm, thus achieving rapid results.