With the highest morbidity rate, cervical spondylosis of the nerve root type is most common among various other types. It is from this type of cervical spondylosis that people began to know the disease. In recent years, conservative treatment for this type of cervical spondylosis has been adopted by modern medicine for most patients, while surgical treatment has also been used for a small number of patients who were conservatively treated with unsatisfactory effect or lingered by obstinate disease with operation indications. It is often reported nowadays that adrenocortical steroids with anti-inflammatory and antioncotic actions were injected extradurally as conservative treatment to relieve inflammation and edema of the nerve root. However, such side--effects as dural and vascular stabs, extradural adhesion, and toxic effects of the drugs have also been reported. In view of the side effects of conservative treatment and the spinal instability (remote result of the operation), a safer and more effective therapeutic method becomes necessary for treatment of the disease. There is no specific term for cervical spondylosis of nerve root type in traditional Chinese medicine, but there have been accounts of the symptoms and treatments of the disease from the ancient times. For example, such remarks can be found in “Meridian/ Miraculous Pivot" “Nape pain with inability to turn round, dragging pain in the shoulder, severe pain in the upper arm as if the humerus are broken, pain in the nape, shoulder, upper arm, elbow, pain in the posteriolateral pat of the arm, Bi Jue (a disorder due to adverse flow of Qi in the arm) and pain in the shoulder, back, and nape with inability to turn round, with stagnation of Qi in the Meridian of Hand-Taiyang, should be treated with the drugs for expelling wind". This shows that the disease had been recognized long ago. Since 1980's there are more and more reports on treatment of cervical spondylosis of the nerve root type with Chinese herbal drugs. The present paper is a summary of the experience in treatment of the disease with Chinese herbal drugs.

Typing and Treatment Based on an Overall Analysis of Syndromes
There are different typings for this disease by various schools in TCM. Li Rong et al. classified the disease into four types, i.e.stagnation and obstruction syndrome due to wind-cold, affection by exopathogenic wind-dampness, stagnation and obstruction of Qi and blood, and deficiency of both the liver and kidney. It was classified by Guo Xueqin et al. into wind-cold syndrome, deficiency-cold syndrome, and blood stasis syndrome. Those classified by Li Jinxue et al. are type of stagnation-syndrome due to disorder of Taiyang Meridian, type of stagnancy of Qi and blood stasis, and type of deficiency of both the liver and kidney and classified by Gu et al. into type of stagnation of damp-heat, type of stagnation of blood in the small vessel, type of deficiency of kidney Yin and type of insufficiency of kidney Yang. To sum up, this disease can be classified into the type of stagnation and obstruction, the type of blood stasis, and the type of deficiency of both the liver and kidney according to the symptoms at ear1y, intermediate, and 1ate stages in the light of different views mentioned above.
l. Typing of stagnation and obstruction:
At the early stage of the disease, the resistance of the body is decreased due to invasion of pathogenic wind-cold, overstrain, and degeneration of the cervical vertebrae. The pathogenic factors will first invade Taiyang Meridian, resulting in disharmony between Ying and Wei systems. It is chiefly manifested by exterior syndrome at the stage, when it is advantageous to the treatment. This type includes stagnation and obstruction due to wind-cold, and stagnation and obstruction due to cold-dampness. Stagnation and obstruction due to wind-cold can be further classified into excess syndrome and deficiency syndrome. The former is chiefly manifested by radiating pain (as the dominant) and numbness of the affected limb, with aversion to wind and cold, and desire for warm and heat. Examination may reveal limited movement of the neck, spasm of the neck muscles, stringy and tense pulse, and white and thin tongue fur. The therapeutic principle of expelling wind and clearing away cold, and removing obstruction in the meridian to re1ieve pain should be adopted in the treatment of stagnation and obstruction due to wind and cold. “Gegen Tang (Pueraria root Decoction)" “Guizhi Jia Fuzi Tang (Decoction of Cinnamon Twig with Aconite)" “Juan Bi Tang (Decoction for Treating Rheumatic or Rheumatoid arthritis)" and modified “YangheTang (Yang-Activating Decoction)"could be administered. The patients with deficiency syndrome usually complain of numbness (as the dominant) and pain of the upper limbs, aversion to cold, fatigue and weakness, and cold sensation in the extremities. Examination may reveal enlarged tongue with white and thin tongue fur and stringy and thready pulse without strength. The principle of treatment should be warming Yang, replenishing Qi and dredging the collaterals. “Guizhi Jia Gegen Tang (Decoction of Cinnamon Twig with Pueraria)"and the modified “Mugua Tang (the modified Chaenomeles Decoction)"composed of Mugua (Fructus Chaenomelis), Huangqi (Rdix Astragali), Baishao (Radix Paeoniae Alba), Qianghuo (Rhizoma seu Radix Notopterygii), Duhuo (Radix Angelicae Pubescentis), Sangzhi (Ramulus Mori), Xuchangqing (Radix Cynanchi Paniculati), Chuanduan (Radix Dipsaci), Niuxi (Radix Achyranthes Bidetatae), Guizhi (Ramulus Cinnamomi), Wujiapi (Cortex Acanthopanacis Radicis), and Gancao (Radix Glycyrrhizae) could be administered. Clinically stagnation and obstruction due to cold–dampness are manifested by sense of heaviness and weakness, or pain and numbness of the upper limbs, difficulty in flexion and extension of the fingers, accompanied with heaviness in the head, oppressed feeling in the chest, and anorexia. Examination may reveal corpulent tongue with indented margin, and deep-slow or stringy and rolling pulse. “Qianghuo Sheng Shi Tang (Decoction of Notopterygium for Rheumatism)"and the modified “Dilong Tang (the Modified Decoction of Pheretima) composed of Dilong (Pheretima), Qianghuo (Rhizoma seu Radix Notopterygii), Duhuo (Radix Angelicae Pubescentis), Mahuang (Herba Ephedrae), Taoren (Semen Persicae), Danggui (Radix Angelicae Sinensis), Rougui (Cortex Cinnamomi), and Sumu (Lignum Sappan) could be used to expel cold and damness, and remove the obstruction of meridian. It was found that the drugs for expelling wind and dissipating cold, and promoting the flow of Qi by warming the meridian were usually used as the principal drugs in treatment of the stagnation and obstruction type. The drugs frequently used were Qianghuo (Rhizoma seu Radix Notopterygii), Guizhi (Ramulus Cinnamomi), Duhuo (Radix Angelicae Pubescentis), Jianghuang (Rhizoma CurcumaeLongae), Fuzi (Radix Aconiti Preparata), and so on. Modern pharmacological researches showed that the volatile oil from Qianghuo (Rhizoma seu Radix Notopterygii) can exert evident anti-inflammatory and analgesic actions, Guizhi (Ramulus Cinnamomi) is able to increase pain-threshold to relieve pain and spasm, and Wuzhuyu (Fructus Euodiae) and Fuzi (Radix Aconiti Preparata) possess evident analgesic effect. These results indicate that it is highly important to eliminate the pathogenic wind-cold-dampness for treatment of the early nerve-root-type of cervical spondylosis.
2. Type of blood stasis:
This type mainly results from stagnation of blood due to vessels injury caused by trauma, stagnation of exogenous pathogens in meridians due to protracted illness, and stagnation of Qi and blood in meridians due to poor blood circulation caused by weakness due to chronic disease, or weakness of the spleen and stomach, and deficiency of Qi and blood. Syndrome due to exogenous pathogens in the blood stasis type is milder than that in the stagnation and obstruction type, but syndrome due to stagnation of Qi and blood is more severe. This type is commonly encountered in the intermediate term of the nerve-root-type cervical spondylosis. Positive signs and changes in X-ray examination may be found in most patients. According to clinical manifestations, it could be classified into the excess syndrome and deficiency syndrome. The patient with excess syndrome usually complain of pricking-like and localized pain, and numbness in the neck, shoulder, back, and the upper limbs. The pain may be exacerbated at night, with pressing refusal. Examination may reveal dark-purple tongue or tongue with eccymosis, and stringy and forceful pulse. The therapeutic principles of promoting blood circulation to disperse blood stasis, and regulating the flow of Qi to alleviate pain were adopted in treatment of the blood stasis type. “Xue Fu Zhu Yu Tang (Decoction for Removing Blood Stasis in the Chest)" “Tong Qiao Huo Xue Tang (Decoction for Activating Blood Circulation)" “Shen Tong Zhu Yu Tang (Decoction for Relieving Pantalgia Due to Blood Stagnation)" "Tao Hong Si Wu Tang (Decoction of Four Ingredients Added with Semen Persicae and Flos Carthami)”in combination with “Shi Xiao San (Wonderful Powder for Relieving Blood Stagnation)" the “No. 2 Receipe for Treating Neck Disorder"including Gegen (Radix Puerariae), Moyao (Commiphora Myrrh), Taoren (Semen Persicae), Honghua (Flos Carthami), Baishao (Radix Paeoniae Alba), Gancao (Radix Glycyrrhizae)" “Decoction for Treating Cervical Spondylosis"including Danggui (Radix Angelicae Sinensis), Gegen (Radix Puerariae), Chishao (Radix Paeoniae Rubra), Chuanxiong (Rhizoma Chuanxiong), Taoren (Semen Persicae), Honghua (Flos Carthami), Danshen (Radix Salviae Miltiorrhizae), Baishao (Radix Paeoniae Alba), “Granules for Treating Osteophyma"including Xujie (Resina Draconis),Sanqi (Radix Notoginseng), Weilingxian (Radix Clematidis), Baihuashe (BungarusParvus) were often administered. The patient with deficiency syndrome complains of numbness in finger tip, dizziness and dim eyesight, dry skin and pruritus, unease due to fright. Examination may reveal amyotroph in the hands, matt nails, lustreless complexion, and stringy and thready pulse or thready and hesitant pulse. The therapeutic principles of nourishing the blood and promoting blood circulation, relaxing musc1es and tendons and activating the flow of Qi and blood in the meridians and col1aterals are recommended. “BuYang Huan Wu Tang (Decoction Invigorating Yang for Recuperation)" and “Gegen Er Teng Tang (Decoction of Radix Puerariae, Ramulus Uncedae cum Uncis and Caulis Spatholobi)"were administered. Fan et al held that congestion and edema of the tissues around the nerve root should fall into the category of stagnancy of Qi and blood stasis in traditional Chinese medicine, which can further form the granuloma that compresses the nerve root. It was found by the experimental studies that promoting blood circulation to remove blood stasis was able to produce an improvement in the inflammation around the nerve root and an increase in the cAMP level in cerebral tissue of the rats as comparing with that of the controls, showing that the Chinese herbal drugs with the effect of promoting blood circulation to remove blood stasis can exert an anti-inflammatory and analgesic action, and promote the functional restoration of the nerve. According to the theory of Qi acting as the commander of blood and that of Qi in motion promoting blood circulation, it is considered that the drugs for invigorating Qi can enhance the effect of the drugs for promoting blood circulation to eliminate blood stasis. The experiment exhibiting sciatic nerve of the rat four weeks after forcipression by retrograde labeling with horse radish peroxidase (HRP) was carried out by Shi et al. The results showed that “Decoction of Invigorating Yang for Recuperation"was able to speed up the axoplasmic transport of sciatic nerve of the rats in the experimental group and labeled cytosomes in group taking the drugs were more than those in control group when HRP was introduced for 48 hours. This indicated that Radix Astragali seu Hedysari could play a role in promoting the flow of Qi and blood, improving microcirculation, strengthening immunity and enhancing the effect of the drugs for promoting blood circulation.
3. Type of deficiency of the liver and kidney:
On the basis of the pathologic changes of the above-mentioned two types, the pathogen may secondarily affect the patient with Bi-syndrome involving the bone and then transmit inward to the kidney or the pathogen may secondarily affect the patient with Bi-syndrome involving the tendons and then transmit inward to the liver due to protracted course of disease and consumption of essence and blood. Because the liver is in charge of the tendons and the kidney is in charge of the bones. This stage of nerve root type of cervical spondylosis is characterized by deficiency in origin and excess in superficiality and manifested by pain and numbness in the affected limbs, soreness and weakness in the lumbar region and knee joints, dizziness and dim eyesight, tinnitus, and insomnia and dreamful sleep. Examination reveals retracted and crimson tongue with little fur or without fur and stringy and thready pulse or thready and rapid pulse. The theapeutic principles of nourishing the liver and kidney and regulating Qi and blood were adopted in the treatment. “Er Xian Tang (Decoction of Curculiginis and Epimedii)" “Shaoyao Gancao Tang (Decoction of Radix Paeoniae Alba and Radix Glycyrrhizae)" “Jing Tong Ling (Liquid for Relieving Pain in Neck)" containing Renshen (Radix Ginseng), Lurong (CornuCervi Pantotrichum), Shudi (Radix Rehmanniae Preparata), Heizhima (Semen Sesami), Huangqi (Radix Astragali), Gouqizi (Fructus Lycii), Gegen (Radix Puerariae), and so on, “Jing Yu Tang (Decoction for Treating Cervical Spondylosis)" composed of Huangqi (Radix Astragali), Xianmao (Rhizoma Curculiginis), Luiaojiao (Colla Cornus Cervi), Yinyanghuo (Herba Epimedii),Baishao (Radix Paeoniae Alba), and so on, and “Tian Sui Dan (Pellet for Replenishing Essence and Marrow) composed of over 20 ingredients including Shudi (Radix Rehmanniae Praeparata), Renshen (Radix Ginseng), Duzhong (Cortex Eucommiae), Lujiaojiao (Colla Cornus Cervi), Sangiisheng (Ramulus Loranthi) and Danggui (Radix Angelicae Sinensis) were used respectively by the different scholars in the treatment of deficiency of the liver and kidney
These reports showed that no doctor who had not laid a special emphasis on the selection of recipes in the light of clinical symptoms of different types in treatment of nerve root type of cervical spondylosis, which featured diagnosis and treatment based on overall analysis of symptoms and signs in TCM and ensured a good therapeutic effect. However, there are some scholars who suggested that the therapeutic principles and recipes in the treatment should be worked out and selected in the light of features of pathological changes on the basis of combining differentiation of the symptoms and signs with differentiation of the disease. Guo et al held that retention of blood stasis in the interior due to stagnation of Qi and blood and stagnation of blood stasis in the vessels was the principal pathogenesis of the disease. Therefore, he suggested that promoting blood circu1ation to disperse blood stasis should be taken as the main therapeutic principle for treatment of various types of the disease. At the same time, special drugs were selectively used according to the deficiency or excess of the syndrome. “Guizhi Jia Gegen Tang (Decoction of Cinnamon Twig with Pueraria) was used by Yan et al in treatment of the disease, which laid a special emphasis on promoting b1ood circulation and nourishing blood and harmonizing nutrient Qi with defensive Qi by expelling pathogenic factors from the muscles and skin. “Lujiao Sichong San (Powder Composed of Cornu Cervi, Radix Clematidis, Pheretima, Radix Notoginseng, Eupolyphaga seu Steleophaga, Scorpio, Scolopendra, and Agkistrodon Acutus)"was adopted by Yi et al. in treatmnt of the disease. The powder can exert actions of promoting blood circulation to disperse blood stasis and relieving pain, and concurrently possesses the effects of dispelling wind and removing obstruction in the collaterals. In addition, “Shaoyao Gancao Tang (Decoction of Radix Paeoniae Alba and Radix Glycyrrhizae)"and “Sou Feng Tang (Decoction for Expelling Wind)"could also be administered.

Combined Treatment
Integrated treatment means that traction or massage is performed on the basis of treatment with Chinese herbal drugs, which can exploit particular advantages of treatment by TCM and enhance the cure rate of the conservative treatment. Wang et al treated 38 cases of cervical spondylosis of nerve root type by combining Chinese herbal drugs with traction, with a total effective rate of 96.7%; Yuan et al treated 87 cases by “Tao Hong Si WuTang Jia Wei (Decoction of Four Ingredients, plus Semen Persicae, Flos Carthtal, and others) in combination with traction, with a total effective fate of 97.7%; Guo et al treated l00 cases by Chinese herbal drugs plus traction, with a total effective rate of 92.0%; and Yu et al treated 117 cases by Chinese herbal drugs in combination with traction and functional exercise, with a total effective rate of 94.8%.

External Treatment
External treatment includes hot application with Chinese herbal drugs, direct current iontherapy, medicated pillow and point-injection with Chinese herbal drugs. Dr. He et al treated l27 cases of cervical spondylosis of nerve root type by hot application with Chinese herbal drugs over the affected area, with a total effective rate of 95.2%. Yang et al treated 2l0 cases by hot application with Chinese herbal drugs plus mature vinegar over the affected region with satisfactory result. Wang et al treated l86 cases of the disease by direct current iontherapy of compound Chinese herbal drugs, with a total effective rate of 95.7%. And Sun et al treated 100 cases (62 cases of cervical spondylosis of nerve root type) by medicated pocket filled with Chinese herbal drugs, with a total effective rate of 880%.

Summary
Cervical spondylosis of the nerve root type can be treated either by selected recipes in the light of overall analysis of symptoms and signs, or by the integrated therapy of Chinese herbal drugs, traction, manipulation, and external treatment. The therapeutic effects have been shown to be satisfactory However most of the previous studies on the treatment of the disease by Chinese herbal drugs were confined to clinical treatments, and were retrospective without strict research plan and control groups, so it is difficult to exactly identify the therapeutic effect of the treatment. Therefore, it is highly necessary that strict clinical observation indexes, and a universally-used standard for the therapeutic effect be worked out in the future, so as to upgrade the treatment of the disease.

By Zhang Jun, Yi Jingen etc.