Cervical spondylosis is called "neck arthralgia" in TCM. Clinical syndromes are divided into the following four types: cold-dampness stagnation type, characterized by headache or occipital pain, stiff neck, unfavorable lateral rotation, acid, swelling, pain and numbness on one or both sides of shoulders, arms and fingers; Or headache involves upper back pain, wet and cold skin, fear of cold and love of heat, and soft tissue swelling nodules can be touched beside the cervical vertebra. The tongue is red, the fur is thin and white, and the pulse is slender. Phlegm and blood stasis blocking collateral type, manifested as a stabbing pain in the neck, lingering pain, especially pressing it, the pain is localized, aggravated at night, accompanied by numbness, dizziness and nausea in the upper limbs. The tongue is dark, with a little petechiae on the body, teeth marks on the edge of the tongue, white greasy or slippery fur, and unsmooth or slippery pulse. Deficiency of qi and blood, manifested as dizziness, dizziness or visual pain, fatigue, anorexia, neck pain or shoulder pain. The tongue is reddish or chubby, with teeth marks on the edge. The moss is thin and white, and the pulse is thin and weak. Deficiency of both spleen and kidney, manifested as neck pain, weakness of limbs, weakness of both lower limbs, difficulty in walking, dizziness and tinnitus. The tongue is pale or has teeth marks, or dry red with little fur, and the pulse is thin or weak.
Chinese medicine treatment of cervical spondylosis should follow the principles of "excess diarrhea, tonifying deficiency, removing blood stasis, dispersing stagnation and heat and cold"; The therapeutic principle of "learning from the scriptures when you are not full" The specific treatment should be determined according to the specific dialectical results. Cold-dampness blocking collaterals is treated by warming meridians and activating blood circulation, eliminating cold and dampness, dredging collaterals and relieving pain. The type of phlegm and blood stasis blocking collaterals is treated by strengthening spleen and resolving phlegm, promoting blood circulation and dredging collaterals and relieving pain. Deficiency of both qi and blood can be treated by supplementing qi and nourishing blood, refreshing the brain and calming the nerves, promoting blood circulation and dredging collaterals. Spleen and kidney deficiency type, the treatment is to strengthen the spleen and kidney, warm the kidney and consolidate the yuan.
Acupuncture for dredging collaterals and relieving pain
The principle of acupoint selection is mainly based on the combination of local acupoint selection and acupoint selection along meridians, and the corresponding acupoints match the results of syndrome differentiation. All types of cervical spondylosis should select tenderness points and round or rope-like positive reaction points beside cervical spinous process, with Fengchi, Dazhui, Shoujing, Tianzong, Lieque, Zhongzhu and Houxi as the main points, and select 3-4 points at a time. Then according to the pathological classification of cervical spondylosis, the results of syndrome differentiation and the location along the meridian, the points are selected respectively.
Typing acupuncture
According to the classification of cervical spondylosis, choose different acupoints. Nerve root type can be matched with rafter, acromion, Tianzong, axilla, Sanjian, Waiguan, Pension and other points. Vertebral artery type can be matched with Taiyang, Touwei, Baihui, Sishencong, Neiguan, Sanyinjiao, Taichong and Zusanli. Sympathetic nerve type can be matched with acupoints such as Sun, Mingming, retrobulbar, Yifeng, Neiguan, Zusanli, Sanyinjiao, Jiaoxin and Yinjiao.
Syndrome differentiation acupuncture
Wind house, wind pool, Hegu and Quchi are added to the type of cold-dampness obstruction; Phlegm and blood stasis blocking collaterals plus Fenglong, Xue Hai, Shu Ge and warm moxibustion for spleen and stomach; Qi and blood deficiency plus Shu Fei, warm moxibustion on hands, Zusanli and Pishu; The deficiency of liver and kidney is aggravated, and moxibustion warms the kidney.
Acupuncture along meridian
Choose acupoints according to the meridians where symptoms appear. Hand Yangming selected three swords and curved pool; Hand Taiyin was selected by Lieque and Chize; Holding the old man and Xiaohai was selected; Selecting Shenmen and Shaohai by the Meridian of Hand-shaoyin; Hand shaoyang is selected for the central column and patio; Hand Jueyin Meridian Selection Daling, Qu Ze; Dazhui, Zhiyang and Houxi are the governor vessels.
Acupuncture method
The needle tool is a sterile disposable millineedle with a diameter of 0.3 mm. When acupuncture the tender point or positive reaction point of the neck, the needle tip points to the affected area, and the method of flat reinforcing and purging is used; After acupuncture at acupoints on shoulders and upper limbs, it is better to radiate air to the hands; The purgative method should be used for excess syndrome, and the flat reinforcing and purging method or reinforcing method should be used for deficiency syndrome. Combined with electroacupuncture dense wave stimulation to enhance and maintain the sense of acupuncture, the needle was left 15~20 minutes. When the pain in the neck, shoulders, back and upper limbs of patients is mainly cold pain or soreness, warm acupuncture should be performed at the parts with strong pain, and the needle should be kept for 15~20 minutes. If the symptoms of pain are severe and the syndrome differentiation is blood stasis blocking collaterals, the method of selecting points along meridians should be used to puncture collaterals. Every 10 is a course of treatment, with an interval of 2 days, and the curative effect is evaluated after 2~3 courses.
Acupuncture treatment is suitable for all types of cervical spondylosis except acupuncture contraindications. Electroacupuncture stimulation is suitable for the symptoms of pain and numbness in neck and limbs, warm acupuncture is suitable for those with cold and dampness blocking collaterals or deficiency of qi and blood and liver and kidney, and pricking collaterals is suitable for those with obvious blood stasis blocking collaterals.
Massage chiropractic method
After the acupuncture treatment is completed. In the process of massage, patients are required to be quiet, relaxed, breathe evenly, and carefully understand the doctor's techniques. Doctors should concentrate on everything from the luck and urge in the abdomen to the manipulation of patients with arms through elbows to hands. Manual therapy is divided into two parts, one is muscle relaxation and spasm, and the other is adhesion release and correction.
Relaxing tendons and relieving spasms
Including kneading method, rolling method, point pressing method and pushing method. This technique is mainly relaxation, which is suitable for all types of cervical spondylosis except cervical spondylotic myelopathy with severe compression of the spinal cord.
The masseur stands behind the patient or on the affected side, and massages the patient's neck muscles, trapezius muscles, sternocleidomastoid muscles, shoulder and back muscles and affected limb muscles with both hands or one hand, with moderate intensity, and does it 2 ~ 3 times from top to bottom.
The rolling method uses the back of the hand and thenar, rotates the wrist inside and outside, and pushes forward forcefully while rolling. You can also make a fist with your right (left) hand, focusing on the knuckles and metacarpophalangeal joints of the index finger, middle finger, ring finger and little finger, and do wrist flexion and extension movements, rolling and pushing back and forth from top to bottom and from bottom to top for 3 to 5 times along the neck, shoulders, back and back of the affected limb. The operation should have a sense of rhythm and penetration, and the frequency should not be too fast. The purpose of this method is to further relax the muscles of the neck, shoulders, back and upper limbs, thus relieving pain.
Point pressure method is divided into ten-point pressure, single-point pressure and overlapping point pressure. Ten-point pressing is suitable for the head. The manipulation is that the doctor puts the fingertips of two hands on both sides of the patient's head, presses the Fengchi point with his thumb, and the other four points are pressed on the gallbladder meridian points on both sides of the head. Press the acupoint for about10 for 20 seconds each time, and repeat it for 2 3 times. The intensity of the point is moderate, try to pursue the sense of penetration, and cooperate with the tremor method. Single-point pressing refers to pressing the circular or strip-shaped positive reaction points of the neck, shoulders and upper limbs with the radial point of the thumb, and dialing left and right several times at the same time, with the strength from light to heavy; Overlapping acupoints refers to pressing Fengfu, Dazhui, Shoujing, Shouyi, Quepen, Tianzong, Quchi, Shousanli, Neiguan, Zhongzhu, Hegu and other acupoints with the overlapping points of the index finger and middle finger, and each acupoint presses10 20 seconds. Tremor method can be used properly in the process of point pressure. It requires uniform stress and strong permeability. At the end of each pressure point, stir the muscles and tendons with appropriate force.
Push-off method: press the thumb pulp of both hands on Fengchi point on the opposite side of the neck, and put the other four fingers on the outside of the neck. Push it alternately along Jiaji point on both sides to Dazhui point with appropriate force, then push it along the shoulders on both sides to Jianjing point, and then press this point for 5 10 second. Do it again.
Reset, loosen and correct.
Including the push-pull method of intervertebral joint, shoulder shaking method, supine traction rotation method and terminal neck lifting rotation method, which can be selected according to illness, age and physique.
Push-pull loosening method of intervertebral joint The physician puts one thumb against the spinous process of the affected cervical vertebra, and the other forearm supports the patient's head to bend forward and rotate to the affected side. At the same time, put your thumb next to the spinous process of the affected side and push the wrench from 2 7 vertebrae respectively. This method is suitable for patients with cervical spondylosis of nerve root type, vertebral artery type and sympathetic nerve type whose neck activity is obviously limited.
Shake the shoulder joint. The healer holds the finger of the affected limb with one hand, pulls it down directly with the other hand, and gently shakes it up and down. This method is suitable for patients with upper limb pain and numbness and limited shoulder movement.
Supine hand traction rotation method The patient lies on his back on the treatment bed with his head sticking out of the bed. The doctor sat in front of the patient's head, with one hand behind the pillow and the other under his chin. Pull the neck with both hands and shake it gently to relax the neck muscles, and then the patient's head rotates to the maximum under traction. Do not use too much force when casting methods. This method is suitable for the elderly and weak and cervical spondylosis of vertebral artery type.
The neck-lifting and neck-turning method, the patient sits, the doctor stands behind the patient, the thumb is placed on the pillow, the other fingers are slightly spread out and supported on the chin and jaw, the forearm is pressed against the shoulder well area of the patient as a support point, and both hands are lifted up forcibly at the same time. When the patient's cervical facet joint is slightly loose, turn his head to the left and right respectively to the maximum angle, and gently and forcefully pull the neck quickly, with a maximum of 3 degrees.
The above operation is performed after acupuncture. 10 is a course of treatment, and the interval between each course of treatment is 2 days, and the curative effect is evaluated after 2 courses of treatment.
Oral and external application of traditional Chinese medicine
Oral Chinese medicine
Based on Fang Shu Jing Tang (Radix Puerariae, Radix Angelicae Sinensis, Ramulus Cinnamomi, Radix Astragali, fried atractylodes, Radix Paeoniae Alba, Poria, Rhizoma Cibotii, Scorpio and Radix Glycyrrhizae Preparata). Notopterygii Rhizoma, Radix Angelicae Pubescentis, and Radix Stephaniae Tetrandrae are added for cold-dampness arthralgia type; Rhizoma Pinelliae, Pericarpium Citri Tangerinae, Carthami Flos, and Saviae Miltiorrhizae Radix are added to those with phlegm and blood stasis blocking collaterals; Codonopsis pilosula and Radix Rehmanniae Preparata are used for patients with deficiency of both qi and blood; Rhizoma Dioscoreae and Semen Ziziphi Spinosae are added for liver and kidney deficiency, Carapax et Plastrum Testudinis, Semen Cuscutae and Fructus Ligustri Lucidi are added for yin deficiency, and cornu Cervi Degelatinatum, Cortex Cinnamomi and Herba Cistanches are added for yang deficiency. Decoct in water for 3 times, and take the juice together. Take 1 time in the morning and evening, 1 dose every day, 5 times 1 dose is1course of treatment, every course of treatment is 2 days apart, and generally 2-3 courses of treatment are taken orally.
External application of traditional Chinese medicine
It is suitable for cervical spondylotic radiculopathy. Is prepared from Radix Saposhnikoviae, Rhizoma Cibotii, Eupolyphaga Seu Steleophaga, Carthami Flos, Herba Lycopi, Radix Aucklandiae, Rhizoma Sparganii, etc. Apply it to the neck, shoulders, back and upper limbs with severe pain for 24 hours and replace it every day or every other day. Application therapy should be used continuously for no more than 10 times. People who are allergic to skin are prohibited.
traction therapy
The patient sits in a traction chair, is tied with a traction belt, and is fixed on the occipital bone and mandible of the patient respectively. The head leans forward slightly 15 degrees, and the initial traction weight is about 3±5kg. Later, the maximum weight did not exceed 10 kg, 20 for 30 minutes each time, 1 2 times a day. If the patient feels worse pain during traction in sitting position, or the symptoms get worse after traction, he should stop traction in time and take the supine position for manual traction. The author does not advocate continuous traction. Long-term traction and overload traction are easy to cause elastic fatigue of soft tissues such as muscles and ligaments, which is not conducive to recovery. The author found in clinic that about 30% patients are not suitable for traction treatment, and the traction weight should be based on the comfort of patients receiving cervical traction.
Psychological counseling therapy
Most patients with cervical spondylosis have different degrees of psychological disorders. Therefore, psychological counseling is very suitable for the treatment of cervical spondylosis. According to the psychological quality of patients, various therapies should be given to adjust their emotions, so as to improve or adjust their mental and emotional state and promote their physical and mental rehabilitation. This therapy can be carried out with the cooperation of family members.
interconnection
Physical therapy of cervical spondylosis
Prevention is the key to cervical spondylosis. Usually pay attention to the rationality of the correct rest posture and sleeping posture, and correct bad posture and habits. Strengthen exercise, strengthen physical fitness, especially the functional exercise of neck and upper limbs. Pay attention to keep warm at ordinary times, don't be greedy for cold, and don't like cold. Moreover, self-physical therapy should always run through the whole process of treatment, rehabilitation and prevention of recurrence. According to the condition, constitution and age, you can choose neck exercise and self-massage body therapy, and pay attention to step by step.
Neck exercise
It can be done during the break. The method is that the patient sits in a chair, straightens his back, looks straight into his eyes, breathes evenly and relaxes his whole body.
Bow your head slowly, stick your chin on your chest as much as possible, and keep it for 10 15 seconds, then slowly restore your head to its original position.
Looking up requires the head to slowly look up at the sky 10 15 seconds, and then slowly restore the head to its original position.
The left-right deviation of the head requires that the head slowly shift to the left and keep the left ear close to the left shoulder 10 15 seconds, then slowly restore the head to its original position and do the same action to the right again.
Rotation of the head from left to right requires that the head slowly turn left, look back from above the left shoulder as far as possible, and hold for 10 15 seconds, then slowly restore the head to its original position, and then do the same action to the right. Complete the above formula 4 once, rest for 30 seconds and do it again, which can be repeated 5 10 times.
Self-massage of cervical spondylosis
Massage Baihui point on the top of your head with your middle finger or forefinger, and press and rub it 20 ~ 30 times from light to heavy.
Put your thumbs on the temples on both sides of your forehead, and the other four fingers are differentially spread on both sides of your head. Press and knead your hands vigorously for 20 ~ 30 times at the same time.
Press Fengchi point, press the thumb of both hands on the same side Fengchi point respectively, and stick the rest fingers on both sides of the head, and press and knead for 20 ~ 30 times from light to heavy.
Hold the neck muscles, put the left (right) hand behind the neck, put the thumb on the outside of the ipsilateral neck, and put the other four fingers on the contralateral neck muscles. Put your hands together hard, lift the neck muscles upward and relax, and press down along Fengchi point to Dazhui point, repeating for 20 to 30 times.
Use the four fingers of the left (right) hand to press the pelvic cavity at Yifeng point under the opposite ear, and press it along the sternocleidomastoid muscle to the pelvic cavity 10 for 20 times. Be careful not to move too fast and too heavy, and both sides should alternate.
Press the shoulder well on the opposite shoulder well point with the left (right) fingertip, and then press it from light to heavy 10 20 times, alternately on both sides.
Knead Dazhui point with the four fingers of the left (right) hand together on the upper back, and rub Dazhui point repeatedly for 20 ~ 30 times until the local fever improves and the two sides alternate.
When pressing the inner and outer points, put the thumb tip of the left (right) hand on the Neiguan point of the right (left) hand and the middle finger on the opposite Waiguan point. At the same time, press and knead hard for 0.5 1 min, alternating hands.
Knead the valley. Put the thumb tip of the left (right) hand on Hegu point of the right (left) hand, and the other four fingers on the back of the hand. Rub Hegu point10 with your thumb for 20 times, alternating your hands.
Comb the top of your hair with your hands, with your fingers slightly bent on both sides of the top of your head, and make a "comb" shape with a little force from the front hairline to the back of your head for 20 to 30 times.
Do the above 10 method 1 time, and have a rest every morning and evening or during work, usually twice a day.