Outline:  
Stiff neck, also called crick in the neck, is a static injury resulting from a long term of hypertension of neck muscle and torsion of small articulation of cervical spine. It is often caused by excessive deviation or over-turn about of the head in sleep on a too high or too low or too hard pillow, or in sleep with unfavorable gesture. And invasion of pathogenic wind and cold on the neck is also a common factor. For example, cold attack in a severe winter or indulgence in coolness on midsummer may all lead to invasion of exogenous pathogenic wind and cold on the neck, which can cause stagnation of qi and blood and blockage of meridians in the muscle of neck. As a result, there will occur rigidity, pain and dysfunction of the neck. The disease mostly occurs in young adults and in spring and winter. A natural cure can be gained within several days in some mild cases. And in the severe cases, it can last up to several weeks.


Major points for diagnosis  
1. Sudden soreness and pain in the neck occur after getting up in the morning. Usually there is limitation of movement towards one side in the neck. The pain is aggravated by motion.
 
2. There are spasm and tenderness of neck muscle. A streaky lump may be felt. The head deviates to the sick side with chin deviated to the healthy side. The head often gets together with the upper body to turn about.
 
3. There may be a superficial syndrome manifesting itself as aversion to wind and cold, headache, etc., when the pain and stiffness of neck is causal by exogenous invasion of pathogenic wind and cold.

4. The onset is quick and the course is short. A cure may usually be effected in one week. It is likely to relapse if not being thoroughly treated. Radiographic examination is needed for the cases of prolonged courses. And it should be differentiated from cervical spondylopathy with pain in the neck and shoulder.


Treatment  
Tendon-smoothing manipulation:      
The patient sits erectly and the operator stands behind him. The operator first presses with his two thumbs the painful points and Fengchi (GB20) and Tianzhu (BL10) ;then he presses, rubs, grasps and pinches the painful parts with his thumb, index and middle fingers from the lower to the upper; finally he rolls with his hypothenarand palmoulnar dorsum on the sick part up and down and to and fro for 3 to 5 rounds. After that the patient is asked to sit on a lower bench. The operator holds up the patient's mandible with one hand and holds the occiput with the other hand, then, simultaneously lifts up his two hands. If the patient’s neck is tense, the patient should be asked to relax his neck muscle as much as possible. Then the operator slowly pulls the head upwards while shaking it so as to smooth tendons and collaterals and to move joints. Finally, he swings the head forward, backward, leftward and rightward, and rotates it 2 to 3 rounds. After the manipulation is done once, the symptom will be eased by a big half.

Herbal therapy  
Internal treatment based on syndrome differentiation  
(1) Syndrome of blockage of pathogenic wind and cold
Main symptoms and signs:
Pain and rigidity of the neck with impaired movement, the pain aggravated by cold and relieved by warmth, or aversion to wind and cold, headache, pale tongue with white and thin coating, floating and tense or stringy pulse.
 
Therapeutic methods:
Expelling pathogenic wind and cold, relaxing tendons and dredging collaterals.

Recipe and herbs:
Modified Gegen Decoction. Specifically, Gegen (Radix Puerariae)15 g, Guizhi (Ramulus Cinnamomi Cassiae )8 g, Mahuang ( Herba Ephedrae)5 g, Baishaoyao (Radix Paeoniae Alba)10 g, Duhue (RadixAngelicae Pubescentis)10g, Fangfeng (Radix Ledebouriellae Divaricatae )10 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong )10 g, Xixin ( Herba Asari )3 g, Gancao ( Radix Glycyrrhizae )5 g, Shengjiang (Rhizoma Zingiberis Recens ) 3 pieces and Dazao ( Fructus Ziziphi Jujubae) 3 pieces.

(2) Syndrome of stagnation of qi and blood
 
Main symptoms and signs:
Pain and swelling in the neck, impaired movement, difficulty in turning head about, fixed pain, ecchymoses on the tongue with white or thin-yellow coating, stringy or thready-choppy pulse.

Therapeutic methods:
Promoting blood to resolve the stasis, activating qi flow to stop pain.

Herbs: Modified Shentong Zhuyu Decoction. Specifically, Danggui ( Radix Angelicae Sinensis)15 g, Chishaoyao (Radix Paeniae Rubrae)10 g, Qinjiao ( Radix Gentianae Macrophyllae )10 g, Chuanxiong (Rhizoma Ligustici Chuanxiong)10 g, Qianghuo (Rhizoma seu Radix Notopterygii )10 g, Moyao ( Myrrha )10 g, Xiangfu ( Rhizoma Cyperi Rotundi)10 g, Niuxi (Radix Achyranthis Bidentatae )10 g, Gegen ( Radix Puerariae)10 g, Honghua (Flos Carthmi)6 g and Gancao (Radix Glycyrrhizae )3 g.
 
External therapy:    
Shexiang Zhuifeng Paste or Zhenghonghua Oil is externally applied.
 
Fixation:    
For the case of serious swelling, a leathery neckband is used to fix the neck for 2 to 3 days; or take a bed rest in combination with traction of cervical spine.

Functional exercise:     
For the case of no pain and swelling, active bending and lifting and rotating of the head should be done so as to relax tendons and activate collaterals. For the case of unmovable neck, activities of the neck will do harm to the neck.

Acupuncture therapy:    
Fengchi (GB20), Dazhui (GV14), Fengrnen (BL12), Waiguan (TE5) and Ashi points are selected. The reducing method is used with the needle retained for 5 to 10 minutes.