by Zhao Xiuyuan
　　(Dep. of Traumatology and Orthopedics of Fu-district TCM Hospital, Qiqiha'er, Heilongjiang Province 161000, China)
　　Abstract From February of 1994 to February of 1996, the author of the present paper adopted combined therapies of potent traction, massage, acupuncture and Chinese medicinal herbs to treat 43 cases of cervical spondylopathy. Results showed that after 1-3 months' treatment, of the 43 cases, 30 (69.8%) were cured, 10 (23.3%) had marked improvement, 2 (4.6%) had improvement and 1 (2.3%) failed, with an effective rate of 97.7%.
　　Key Words   Cervical spondylopathy Potent traction Massage Acupuncture Chinese medicinal herbs

Cervical spondylopathy is referred to a complex syndrome induced by stimulated and oppressed tissues around the vertebral bodies due to retrograde affection of intervertebral discs and its subsequent pathological changes. It is thus called as cervical spondylotic syndrome. In clinic, it is generally divided into cervical type, nerve-root type, spinal-cord type, vertebral-artery type, sympathetic-nerve type and mixed type. From 1994 to 1996, the author adopted combined therapies of traction, massage, acupuncture and Chinese medicinal herbs to treat it and achieved satisfactory results. It is reported as follows:
　　Clinical Data
　　All the 43 cases were diagnosed as cervical spondylopathy by combining symptoms, signs and results of CT examination. Among them, 12 cases belonged to nerve root type; 6 to vertebral-artery type, 1 to spinal-cord type; and 24 to sympathetic nerve type. The shortest duration of disease was 2 months and the longest 23 years. 
　　Treatment Methods
　　1. Potent Traction Potent traction is the firstly important link in treatment of cervical spondylopathy. When treated, the patient was asked to take a lower sitting position. An assistant standing behind the patient used his or her both hands to press the patient's two shoulders forcefully downwards. At the same time, the operator stood on the opposite side of the patient to hold the patient's occipital part with the cubital fossa and axillary part of one hand, making his or her neck antiflexion slightly and mandible to be adducted (then, order the patient to relax his or her muscles and to have a deep breathing) and to press the repositioned part with the other hand (making the small joints relaxed). At last, the operator held the occipital part toward one side to forcefully make a stable oblique reposition. Ordering the patient and the assistant to keep same postures, the operator made the same manual reposition on the opposite direction ( by changing his or her arms and hands). In this way, clear sounds of reposition could be heard. The patient would feel his or her cervical part more comfortable immediately. It should be noted that this manual was not suitable for aged patients and those with ossification due to possible occurrence of fracture or other accidental situations; and this manual reposition was conducted only once in the process of the treatment.
　　2. Massage After potent traction, the operator immediately performed massage including rotatory kneading, finger flicking and poking to relieve muscular spasm, promote blood circulation to stop pain and relax adhesion of tissues. Manipulations of massage were 1). finger-pressing, i.e. using the thumb to press Baihui(GV 20), Tianzhu (BL 10), Fengchi (GB 20), Dazhui (BL 11), Jianjing (GB 21) and the tender point; then performed finger-flicking, poking, rotatory kneading and pressing at the sternocleidomastoid muscle and the spasmodic muscles; and 2). lifting, kneading the muscles and shaking the arm. Generally, tendon-cord with pressing pain could be touched at the cervical part, a mild kneading manipulation was advisable, starting from the sternocleidomastoid muscle near the tendon- cord, then to the broadest muscle of back and the greater psoas muscle continuously for 10 min. If so, the symptoms could be relieved clearly.
　　3. Acupuncture
　　 Acupoints selected were Tianzhu (BL 10), Dazhui (BL 11), Baihui (GV 20), Yintang (EX-HN 3) and Ershang-otopoint (a filiform needle inserted into the upper ear root with the needle tip toward the tender point) for nerve-root type; Dazhui (BL 11), after insertion, the needle was controlled to advance toward Shendao horizontally to a depth of about 2.5-4 cun) through Shendao (GV11), Yongquan (KI 1) and Sanyinjiao (SP 6) for vertebral-artery type; Dazhui (BL11, straight puncturing 0.5-1 cun), Tianzhu (BL10, straight puncturing 0.5-1.5 cun) and Yamen (straight puncturing 0.5-1.5 cun) for spinal-cord type; and Ximen (PC 4), Sanyinjiao (SP 6) and Kunlun (BL 60) for sympathetic-nerve type. (Note: for any type of cervical spondylopathy, Baihui (GV 20), Xinhui (GV 22), Lieque (LU 7) and Ashi point could be used).
　　4. Chinese Medicinal Herbs
　　Radix Astragali seu Hedysari (Huangqi) 30g, Radix Angelicae Sinensis (Danggui ) 15g, Ramulus Cinnamomi (Guizhi) 9g, Radix Rehmanniae Praeparata (Shudi) 12g, Fructus Lycii (Gouqi) 12g, Radix Clematidis (Weilingxian) 20g, Lumbricus (Dilong) 20g, Sequama Manitis (Chuanshanjia) 20g, Rhizoma Ligustici Chuanxiong (Chuanxiong) 10g, Radix Pueraiae (Gegen) 9g, Radix Achyranthis Bidentatae (Niuxi) 10g, Colla Corii Asini (Ejiao) 15g and Colla Cornu Cervi (Lujiaojiao) 15g were decocted in water and administered orally; combined with Ramulus Uncariae cum Uncis(Gouteng), Concha Haliotidis(Shijueming) and Folium Apocyni Veneti(Luobuma) for hypertention, and with Succinum(Houpo), Semen Biotae(Baiziren), Poria cum Ligno Hospite ( Fushen) and Radix Glycyrrhizae Preparata (Zhigancao) for cardiac disease. 
　　Observation on the Therapeutic Effect
　　1. Criteria of Therapeutic Effect
　　Cured: After treatment, clinical symptoms and signs disappeared and the patient's constitution turned to normal; Markedly effective: Clinical symptoms and signs improved strikingly and the patient's constitution recovered basically; Effective: Clinical symptoms and signs had an improvement to a certain degree; Ineffective: After treatment, clinical symptoms and signs had no any evident improvement.
　　2. Results
　　After 1-3 months' treatment, of the 43 cases, 30 (69.8%) were cured, 10 (23 .3%) had marked improvement, 2 (4.6%) had improvement and 1 (2.3%) failed, with an effective rate of 97.7%. The follow-up survey in two years showed no relapse in all the 30 cured patients.
　　A Typical Case
　　Mr. Yu, aged 48 years, an office worker, complained of having got headache and vertigo for 23 years. He had been treated in quite a few of hospital s but without evident effect. His first visit was on March 13th of 1995. Examination showed weak physique, pale complexion, red tongue with less coating, and taunt thready pulse. Cervical CT examination displayed disappearance of physiological curvature, formation of bone bridge in the C 3-5 vertebrae, and narrowing of the intervertebral canal. It was diagnosed as cervical spondylopathy of vertebral artery type and treated with potent traction and massage mentioned above. Then, let the patient take a sitting position, an acupuncture needle was punctured into Tianzhu (BL 10) straight about 0.5-1.5 cun. Baihui (GV 20), Xinhui (GV22), Dazhui (BL 11) through Shendao (GV 11), 2.5-4 cun at the depth were used and stimulated with uniform reducing and reinforcing method. The needles were manipulated once every 20 min, twice altogether. After withdrawal of the needles, performed massage for 5 min, then let the patient take a lying position and performed massage once again for 5 min. The aforementioned Chinese medicinal herbs, combined with Succinum(Houpo), Semen Biotae(Baiziren), Poria cum Ligno Hospite(Fushen) and Radix Glycyrrhizae Preparata(Zhigancao) were prescribed to the patient, one dose every day. 10 sessions were made up one therapeutic course, with an interval of 3 days between two courses. After 9 courses of treatment, his all symptoms and signs vanished, and CT examination showed everything in the topical focus was normal. He was cured. The follow-up survey in the following 2 years displayed no relapse and the patient recovered in health, with a bright complexion and was full of energy. DISCUSSION In regard to the pathogenesis of cervical spondylopathy, it mostly resultes from chronic overstrain-induced retrograde degeneration of the intervertebral discs, edema of the neighboring tissues, hyperplasia, calcification, transposition of the small intervertebral joints, etc., followed by appearance of various symptoms and signs due to oppression of nerve roots, vertebral artery and spinal cord. Massage stimulation can accelerate blood circulation, improve nutrition of the tissues, favoring absorption of inflammation, release of muscular spasm and rigidity of joints, separation of adhered tissues, restoration of body's compensatory function, enhancement of the stability of the cervical vertebrae and remission of the oppression and stimulation of nerve roots. The potent traction used here is aimed at causing the dislocated small joints to recover their normal locations, regulate the physiological curvature and the narrowed intervertebral foramen and to promote the restoration of the functional activity of the cervical vertebrae. Acupuncture serves to relieve headache, dizziness, tinnitus, and radiation pa in and numbness of the arms directly. It is also capable of dredging meridians, promoting blood circulation to remove blood stasis, dispelling cold and stopping pain, accelerating resolution and absorption of the local inflammation and improving the substance metabolism of local tissues.
　　Chinese medicinal herbs are employed here to treat the radical cause of cervical spondylopathy, i.e. to strengthen both muscles and bones by reinforcing the liver and the kidney.
　　My clinical practice demonstrates that the above-mentioned combined therapies for treatment of cervical spondylopathy are rather effective.