Outline:  
Cervical spondylopathy is also called cervical syndrome. It is a commonly and frequently encountered disease in the middle and old people more than 40 years old. Over the past 10 years, there occurs a tendency of gradual decrease in age of attack. The common pathogenic factors are insufficiency of the liver and kidney in the old, chronic neck strain, acute trauma of cervical spine (such as fracture, slight dislocation, serious contusion) and invasion of pathogenic wind, cold and dampness. These causes lead to pathological changes of degeneration of cervical intervertebral discs, hypertrophy and calcification of cervical ligament and cervical hyperosteogeny.

Thus, it results in stimulation and compression of neck soft tissues, root of spinal nerve, spinal cord, vertebral artery and sympathetic nerve. As a result, there appear a series of symptoms such as pain and numbness in the neck, shoulder and arm, dizziness and vertigo, and paralysis. The articulations between the fifth and sixth or the sixth and seventh vertebrae are of higher motility than the others because of their larger range of movement.
 
Major points for diagnosis  
1. The patient is middle-aged and older, with a history of a long-term neck strain or a traumatic history of neck.
 
2. In the neck type, the main clinical manifestations are pain in the neck and occiput, impaired movement of neck, rigidity of neck muscle, the head and neck limited in a fixed position, remarkable tenderness in both sides of neck.
 
3. In the nerve root type, the main clinical manifestations are pain in the neck and shoulder, aching pain in the occiput and nape. The pain radiates to the upper limb. The pain is of distending nature in mild cases and of stabbing or cutting nature in severe cases. There are esthesiodermia in the affected innervation region, tension of neck muscle and obvious tenderness. The traction test of brachial plexus or the compression test of intervertebral foremen is positive.
 
4. The spinal type mostly occurs in people aged 40 to 60. The main clinical manifestations are chronic and progressive sensory disturbance and dyskinesia. At the early stage, the patient complains of an uncomfortable neck, slow movement of the upper limb, disorder of minute act of the hand and staggering gait. There may appear some pathological reflexes. At the middle and late stages, there appear gradually hypokinesis in one or both sides of the upper or lower limbs, liability to fall down, numbness and pain in the limbs, or even paralysis of limbsand dyschesia.
 
5. In the vertebral artery type, the main clinical manifestations are headache, dizziness, tinnitus, dim eyesight, or nausea, vomiting, hypomnesis. Dizziness episode or even collapse may be induced by turning the head about, but the consciousness can quickly recover itself after a moment of faint because the position of neck has changed. The test of rotating neck is positive.
 
6. In the sympathetic nerve type, the main clinical manipulations are the symptoms of sympathetic excitation or inhibition: blepharoptosis, dim eyesight, platycoria, headache, migraine, dizziness, occipital pain, bradycardia or tachycardia, precordial pain and hypertension.

7. X-ray film can show decreased, straightened or even reverse-bowed deformities of physiologic curvature of cervical spine, hyperosteogeny of vertebraledge, narrowing of intervertebral space, stenosis of intervertebral foramen and ligament calcification. But the extent of the change is not directly proportional to the condition of disease. So, the diagnosis should be made mainly based on the clinical manifestations, CT and MRI examinations may give a further definite diagnosis.

Treatment  
The patient takes a sitting position:
The operator, standing behind him, first presses and kneads Fengchi (GB20) for one minute with his thumb and middle finger. Next, he grasps and pinches the tissues on both sides of cervical spine from Fengchi (GB20) to the root of neck for 3 minutes; then rolls the upper regions of both spines of scapulae for 4 minutes, and presses the painful points on nape for 30 seconds for each, and grasps and pinches Jianjing (GB21) of both sides 3 to 5 times. Then, he respectively makes the patient's head flex forward, extend backward, flex sideward and rotate 3 to 5 rounds; and obliquely pulls the cervical spine leftward and rightward one time. After that, he holds the mandible with one hand and the occiput with the other hand to do forceful traction of the cervical spine for one or two minutes. Finally he massages the rape for 2 or 3 minutes.

The above-mentioned procedure is the basic manipulation for the treatment of cervical spondylopathy. The manipulation for each type of cervical spondylopathy may be varied on the basis of its pathogenesis. For the nerve root type, the manipulation added may be grasping and kneading the sick limb from the upper to the lower for 5 to 8 times, pressing acupoints Jianzhen (SI9), Jianyu (LI15), Quchi (LI11), Shousanli (LI10) and Hegu (LI4), 30 seconds for each, and rubbing and shaking the sick upper limb. For the vertebral artery type, the manipulation added may be kneading and massaging the head with the palm root from the front to the back for 3 to 5 rounds, pressing acupoints Taiyang (EX-HN5), Cuanzhu (BL2), Baihui (GV20), Tinggong (SI19) and Tinghui (GB2), 30 seconds for each, and flicking the head from the front to the back for 3 to 5 rounds with the tips of five fingers of one or two hands.

For the spinal cord type, the manipulation added may be rolling, kneading, rubbing and pushing the urinary bladder meridians of foot Taiyang, that is, both  sides of spinal column, hips and posterior aspects of the lower limbs for 6 to 10 minutes, and pressing acupoints Shenshu (BL23), Guanyuanshu (BL26), Qihaishu (BL24), Huantiao (GB30), Yinmen (BL37), Weizhong (BL40), Chengshan (BL57), Kunlun (BL60), 30 seconds for each. For the sympathetic nerve type, the manipulation added may be pressing acupoints Xinshu (BL15) and Geshu (BL17) on both sides, 30 seconds for each.


Herbal therapy  
Internal treatment based on syndrome differentiation  
(1) Syndrome of blockage of pathogenic wind and cold  
Main symptoms and signs:
Pain in the head, nape, shoulder and back, rigid nape; or soreness, pain and numbness of the extremities, headache with heavy sensation, aversion to cold and wind, anhidrosis, pink or purple-darkish tongue with thin-white or white-greasy coating; floating-tense or floating-moderate pulse.

Therapeutic methods:
Expelling wind and cold, harmonizing the nutritive qi to alleviate pain.

Recipe and herbs:
Modified Gegen Decoction. Specifically, Gegen ( Radix Puerariae ) 15 g, Mahuang (Herba Ephedrae )6 g, Guizhi ( Ramulus Cinnamomi Cassiae)8 g, Baishaoyao ( Radix Paeoniae Alba )8 g, Danshen ( Radix Salviae Miltiorrhizae ) 15 g, Sbengjiang ( Rhizoma Zingiberis Recens )10 g, Dazao (Fructus Ziziphi Jujubae )10 g, Yanhusuo ( Rhizoma Corydalis Yanhusuo)15 g, Jixueteng (Caulis Spatholobi)20 g and Zhigancao (Radix Glycyrrhizae Praeparata)5g.
 
(2) Syndrome of blockage of pathogenic cold and dampness  
Main symptoms and signs:
Pain in the head, neck, shoulder and back, scurrying pain and numbness, spasm of the nape and back, heavy sensation in the limbs with palpable cord-like lump, or muscular atrophy, chest distress, poor appetite, white-greasy tongue coating, deep and slow pulse.

Therapeutic methods:
Expelling cold and dampness, removing blockage and dredging collaterals.
 
Recipe and herbs:
Modified Wutou Decoction. Specifically, Zhichuanwu ( Radix Aconiti Carmichaeli Praeparata ) 9 g, Mahuang ( Herba Ephedrae ) 9 g, Baishaoyao (Radix Paeoniae Alba )9 g, Huangqi (Radix Astragali seu Hedysari )12g, Xixin ( Herba Asari)3 g, Zexie ( Rhizoma Alismatis Orien talis )10 g, Jianghuang( Rhizoma Curcumae longae )12 g, Shengjiang ( Rhizoma Zingiberis Recens )6 g, Cangzhu (Rhizama Atractylodis)10 g and Zhigancao (Radix Glycyrrhizae Praeparata )5 g.

(3) Syndrome of collateral disharmony  
Main symptoms and signs:
Dull pain in the shoulder and back, or discomfort of the nape and back, or numbness of either nape or back, rustling sound in movement, no obvious limitation of movement, pink tongue with thin and white coating, choppy or moderate pulse.
   
Therapeutic methods:
Relaxing tendons and promoting blood flow, harmonizing collaterals to stop pain.

Recipe and herbs:
Modified Huoxue Shujin Decoction. Specifically, Danggui ( Radix Angelicae Sinensis )12 g, Honghua ( Flos Carthmi )10 g, Jingjie ( Herba Schizonepetae )10 g, Qianghuo ( Rhizoma seu Radix Notopterggii ) 10 g, Chishaoyao ( Radix Paeniae Rubrae )10 g, Jianghuang ( Rhizoma Curcumae longae )10g, Zhike (Fructus Citri Aurantii)6g, Qingpi ( Pericarpium Citri Reticulatae Viride )5 g, Wujiapi (Cortex Acanthopanacis )10 g, Duzhong ( Cortex Eucommiaeulmoidis )10 g, Weilingxian (Radix Clematidis)10 g, Yanhusuo (Rhizoma Corydalis)15 g and Gancao (Radix Glycyrrhizae )3 g.
 
 
Traction therapy:     
Usually traction in sitting position with occipitomandibular cloth band is used intermittently, the weight for traction starts from 3 to4 kg and gradually increases to 5 to 6 kg, one to three times a day, each for half to one hour. For the serious cases, traction in lying position should be taken see Fig. 41 and 42). It can alleviate muscular spasm, enlarge intervertebral spaces and relieve symptoms of compression and stimulation.

Fixation:    
The patient with cervical spondylopathy needs appropriate rest. At the acute attack stage, a leathery neckband or neck support may be used for fixation for one or two weeks.

Functional exercise:    
At the acute attack stage, rest should be taken as the principal measure and motion as the secondary one. At the chronic stage, motion should be taken as the principal one. Especially for those who bend over their desk working, more attention should be paid to work-break exercise on cervical activities, such as flexing forward, extending backward, turning left and right, and flexing leftward and rightward, 3 to 5 times for each act.

Acupuncture therapy:   
For the nerve root type, Fengchi (GB20), Jiaji (EX), Quchi (LI11), Hegu (LI4), Shousanli (LI10), etc. may be chosen. For the vertebral artery type, ear acupoints Pizhixia, Shenshangxian, Jiaogan, etc. may be chosen, once a day.