By Fang Cunzhong, Fan Yongxin, and Wang Tong.
(Institute of Acupuncture and Moxibustion, China Academy of Traditional Chinese Medicine, BeIjing 100700)

In recent years, great attention has been paid to basic theories of microcirculation and its clinical applications both at home and abroad. It has been applied in hematopathy, angiocardiopathy and many other diseases, but no report of its application in orthopedics and traumatology was available. In this study, the nail-fold microcirculation was examined on the healthy and affected limbs in 20 cases of the nerve-root-type cervical spondylopathy treated by massotherapy. A report is as follows.

Clinical Data
　　All the cases in this series were outpatients. Of them, 8 cases were male and 12 female, aged 47--62 years. 14 cases had their right upper limbs affected, and 6 the left ones. The duration of the illness varied from 2months to 2 years. All the patients had the following symptoms: rigidity of the neck, limited cervical movement, pain in the cervical region, with numbness in the affected arm and pain radiating to the fingers.
　　Clinical examination showed that all the 20 cases suffered from neck rigidity, cervical dysfunction with tenderness found on the spinous processes of C.--C6. Mild myoatrophy in the affected limb and hand were found in 14cases with a history of over 3 months. The grip strength reduced by an average of 1.5 kg compared with the healthy hand, and the tendon reflex of brachial biceps and triceps muscle decreased. Hypoalgesia was found in areas innervated by radial, median or ulnar nerves. Temperature of the affected hand decreased by an average of 0.8'C. Spurting's sign and Eaten's signs were found positive in all cases by intervertebral foramen compression test and brachial plexus traction test, and the cervical extraction test also positive. Roentgenogram taken for the 20 cases in orthophoric, lateral, oblique, hyper-traction and hyper-flexion positions showed lateral curvature of cervical vertebrae and formation of joints of Luschka with hyperosteogeny in C3—C7. The physiological curvature in the cervical region disappeared or became shallower, and hyperosteogeny was found on the anterior and posterior border of vertebral body of C4-C7, especially marked in C4, C5 and C6, with narrowed intervertebral spaces. Calcification of nuchal ligament was found in5 cases. Deformation and narrowing of left intervertebral foramen was found in 14 cases, and that of the right ones in 6 cases. Instability was found in intervertebral segment of C4-C5 and C5-C6 in 14 cases.

Microanglography and Range of Normal Values
　　The microcirculation-display device is produced by Xuzhou Optical instrument Factory (including a cold-light source, a support, a microscope, eye-piece and stage micrometers, and a stopwatch). The nail-fold microcirculation of the ring finger on the affected side was examined first, and the contralateral healthy one followed for comparison. In an air-condihoned room (20-25"C), the patient took sitting position. The finger was coated with a film of liquid paraffin after fixed in a comfortable position. The number, length and diameter of capillary loops in each millimeter and velocity of blood flow were determined by measurement with a micrometer mounted in the eye-piece. The time that an erythrocyte in a particular capillary loop took for travelling a certain distance was registered with the aid of a stopwatch or more accurately by synchronous following the movement of the particular erythrocyte with the light spot generated from an oscilloscope after the area to be examined was obliquely illuminated (35-45o) by the cold-light source. And the velocity of blood flow was calculated. Normal reference value and cumulative scores were adopted from Handbook of Clinical Microcirculatory Examinations, in which a cumulative score of �?.0 was taken as a normal range. On the healthy side, it was l.925, i.e. within the normal range; on the affected side, it was 3.375, i.e. slightly abnormal, indicating that microcirculation was indeed affected in the affected limbs.

Therapeutic Methods
　　All the cases in the series were treated by massotherapy. 10 sessions constituted one therapeutic course. The treatment was given every other day, once daily for 25 minutes.
　　Pushing with the palm: The patient took sitting position, and the operator stood behind. Pushing was performed several times from the neck to shoulder along the traperius muscle with the thenar of both hands.
　　Grasping: Neck, both the shoulder and theuPPer limb were grasped strenuously several times with the thumb and other four fingers.
　　Poking with the palm: Muscles in the neck and shoulder were poked by the palm.
　　Poking with the finger: The neck and shoulder were poked by the thumb, particularly on the points Fengchi (GB 20), Fengfu (GV 16), Dazhui (GV 14), Tianzong(SI 11), Quepen (ST 12), Jianzhen (SI 9), Quchi (LI 11), Hegu (LI 4), and vertebral spinous processes of C4-C7.
　　Plucking the muscle and poking the meridian: Subclavian plexus, axillary plexus, and trunks of the radial and ulnar nerves were plucked and poked with the thumb and index finger to elicit a sense of electric shock from the whole upper limb to the fingers. Traction of the cervical part: Holding the patient's head with the thumb at the occiput and supporting the madibula with the other four fingers to lift up the head to extend the intervertebral spaces.
　　Rotating and oblique-pulling: With one hand supporting the mandible and the other hand holding the occiput, the operator gently lifted the neck and rotated it for 2-3 times. Then, at the moment the neck was rotated towards one side to its limit, a sudden oblique-pulling was performed. At this time, a click sound could be heard. Traction and shaking: Both hands of the operator grasped the palm and fingers of the affected hand of the patient to shake up and down several times. It is the best to hear a click sound from the joints of the fingers upon traction of the fingers.
　　Tapping: The neck and the shoulder were tapped several times with both hypothenars of the operator.

Therapeutic Results
　　The 20 cases in the series were treated forl-3 therapeutic courses. 16 cases were cured: pain and symptoms induced by stimulation and pressure on the nerve root disappeared completely; the temperature of the both hands was symmetric; roentgenogram showed that physiological curvature of the cervical part had been restored. 4 cases were improved: the symptoms disappeared on the whole, and physiological curvature restored to certain extent. Microangiographic examination made after treatment showed that in the 20 cases the mean score on the healthy side was l.925 (still within the normal range); on the affected side, however it was 2.15, which was reduced by1.225 as compared with that before the treatment, indicating that microcirculation had been obviously improved.

Comments
　　The nerve-root-type cervical spondylopathy is caused by stimulation of unilateral nerve root due to degeneration of intervertebral discs, narrowing of the intervertebral spaces, hyperosteogeny of posterior surfaces of the vertebral bodies, and protuberance formations, inducing pain and numbness in the cervical region (with pain radiating from upper limb to fingers), decrease of temperature of the hand, and myoatrophy and disturbance of blood circulation. Good therapeutic results can be expected for most of the patients after massotherapy. Clinically, it is easy to make the diagnosis, but hard to assess the recovery of blood circulation in the affected limb. Therefore, in the present study, the nail-fold-microcirculation was examined to solve the problem.
　　Traditional Chinese medicine holds that persons over middle age will be deficient of Qi and blood, leading to obstruction of the meridians and collaterals and resulting in pain. Massotherapy may relax the muscles and tendons and promote the flow of blood in meridian and collaterals, so as to accelerate blood circulation in the neck, the shoulder and the affected limb, relax myospasm, improve derangement and adhesion of the small joints of the cervical vertebrae, and relieve the symptoms caused by pressure and stimulation of the cervical nerve root. The present study showes that massotherapy is very effective for treating the disease, and improving the local blood circulation; and that the nail-fold-microcirculation examination can be given to offer reliable objective index for evaluating the therapeutic effect.