Clinical study on treatment of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) with Gao’s nape needle and Shentong Zhuyu decoction

Abstract

Background:

Cervical spondylotic radiculopathy is currently one of the common orthopedic diseases, mainly characterized by neck pain, stiffness, limited mobility, and related symptoms of nerve root compression, which seriously troubles people’s work and life.

Methods:

Ninety cases of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) were randomly divided into treatment group and control group, 45 cases in each group. The control group was treated with western medicine (nerve nutrition, pain relief, and circulation improvement drugs), and the treatment group was treated with Gao’s nape needle combined with modified Shentong Zhuyu decoction on the basis of the control group. Before and after 2 weeks, TCM syndrome score, TCM curative effect, visual analogue scale score, numbness score, neck disability index score, related serum inflammatory factors (interleukin-10 [IL-10], interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), related hemorheological indexes (plasma viscosity, high shear whole blood viscosity, low shear whole blood viscosity level) were used as evaluation indexes to evaluate the effect.

Results:

After treatment, the total effective rate of the treatment group was 91.11%, which was better than that of the control group (78.78%), and the TCM syndrome scores of the 2 groups were decreased, the treatment group was better than that of the control group, and the differences were statistically significant (P < .05). After treatment, the visual analogue scale score, numbness score, and neck disability index score were decreased in both groups, and the decrease in the treatment group was more significant than that in the control group, and the differences were statistically significant (P < .05). After treatment, the related serum inflammatory factors (IL-10, IL-6, TNF-α) and related hemorheological indexes (plasma viscosity, high-shear whole blood viscosity, low-shear whole blood viscosity) were decreased in both groups, and the decrease in the treatment group was more significant than that in the control group, and the differences were statistically significant (P < .05).

Conclusion:

The treatment of cervical spondylotic radiculopathy (Qi stagnation and blood stasis syndrome) with Gao’s nape needle and modified Shentong Zhuyu decoction can improve the curative effect of traditional Chinese medicine, improve the related discomfort symptoms (neck tenderness, adverse activity, numbness, etc), improve the neck function, reduce IL-10, IL-6, TNF-α, and other related serum inflammatory factors, and improve hemorheological indicators.

1. Introduction

The main clinical symptoms of cervical spondylotic radiculopathy are neck pain, stiffness and limitation of movement. It is also accompanied by symptoms related to nerve root compression, such as numbness in the shoulder, back and upper limbs, radiating pain or hypersensitivity.^[1] The incidence of cervical spondylotic radiculopathy is the most common, accounting for about 50% to 60% of cervical spondylosis.^[2] With the progress of society and the development of science and technology, great changes have taken place in people’s way of life and work. For example, the number of mental workers is increasing year by year, and the popularity of electronic products such as mobile phones and computers. The incidence of cervical spondylosis is gradually increasing.^[3] Therefore, how to effectively prevent and treat cervical spondylotic radiculopathy has become one of the urgent medical problems to be solved. There are many treatments for cervical spondylotic radiculopathy, such as modern medicine and traditional medicine. Modern medicine is mainly based on oral medication, surgery and other means, and the more commonly used treatment is oral medication; traditional medicine is mainly based on acupuncture, traditional Chinese medicine and other means, and the 2 treatment methods are often used in combination to improve the clinical effect. In clinical applications, modern medicine and traditional medicine are often used in combination to improve the therapeutic effect. In traditional Chinese medicine, there is no specific record of the specific name of cervical spondylotic radiculopathy. However, according to the clinical symptoms of cervical spondylotic radiculopathy, it can be classified into the category of “arthralgia syndrome” and “cervical spondylosis.” Among the TCM syndromes of cervical spondylotic radiculopathy, Qi stagnation and blood stasis syndrome is more common. In clinic, the author uses Gao’s nape needle and Shentong Zhuyu decoction to treat cervical spondylotic radiculopathy with qi stagnation and blood stasis syndrome. Obtains better clinical effect, and proves that the method not only can improve the clinical symptoms and the neck movable function. It can also improve the related serum inflammatory factors and improve hemorheological indicators, which will be introduced below.

2. Data and methods

2.1. General information

Ninety patients with cervical spondylotic radiculopathy of qi stagnation and blood stasis syndrome in this study were from Luchao, Pudong New Area, Shanghai from May 2021 to January 2023.Hong Kong Community Health Service Center and Massage Department of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine. The patients were randomly divided into treatment group and control group, 45 cases in each group. In the treatment group, there were 25 males and 20 females, aged between 18 and 65 years, with an average age of (46.45 ± 6.78) years, and the course of disease was between 3 and 18 months. Mean (9.89 ± 2.81) months; in the control group, there were 27 males and 18 females, aged 18 to 66 years, with an average age of (47.12 ± 6.79) years, and the course of disease was 3 to 18 months. The average was (9.18 ± 2.89) months, and the general data (gender, age, course of disease, etc) Of the 2 groups were compared. The difference was not statistically significant (P > 0. 05), are comparable. This study was approved by the ethics committee of our hospital (No.: LCGSQ20230301), fully respecting the individual wishes of patients. At the same time, the informed consent was signed.

2.2. Diagnostic criteria

2.2.1. Diagnostic criteria of western medicine.

The diagnostic criteria of western medicine refer to the expert consensus on the classification, diagnosis and nonsurgical treatment of cervical spondylosis in 2018. Formulation of relevant standards for cervical spondylosis.^[4]

2.2.2. TCM diagnostic criteria.

TCM diagnosis and syndrome type standards refer to the revised edition of TCM Disease and Syndrome Diagnosis and Efficacy Standards published by China Medical Science and Technology Publishing House in 2012.The syndrome diagnostic criteria of “TCM Syndrome Classification of Cervical Spondylosis” were formulated.^[5] Qi stagnation and blood stasis syndrome: (1) neck pain, which is aggravated by movement. Fixation of the pain point; (2) tenderness of the neck; (3) difficulty in moving the neck; (4) difficulty in moving the upper limbs; (5) it is often accompanied by numbness of limbs. Tongue and pulse: the tongue is light red or dark purple with ecchymosis, with thin and white coating, and wiry or astringent pulse.

2.3. Inclusion criteria

(1) Accord with that diagnostic criteria of traditional Chinese medicine and western medicine and the syndrome type criteria; (2) the onset age of the patient is between 18 and 66 years old; (3) those who did not participate in other clinical trials in the recent month; (4) those who were diagnosed as cervical spondylotic radiculopathy by magnetic resonance examination; (5) the patient gave informed consent and signed an informed consent form.

2.4. Exclusion criteria

(1) Those who did not meet the above inclusion criteria; (2) pregnant or lactating women; (3) cervical spondylosis with surgical indications; (4) combined with life-threatening malignant diseases, such as serious liver and kidney diseases, cardiovascular and cerebrovascular diseases, malignant tumors, etc; (4) patients with mental disorders; (4) patients who cannot accept traditional Chinese medicine and acupuncture treatment.

2.5. Method

Control group: ibuprofen sustained-release capsules (manufacturer: Zhongnan Tianjin Smithkline Pharmaceutical Co., Ltd., Tianjin, batch number: H10900089, specification: 0.3 g/capsule) for oral administration, 1 capsule twice a day after meals; Mecobalamin Tablets (manufacturer: Hunan Hansen Pharmaceutical Co., Ltd., Yiyang, Hunan, batch number: H43020225, 0.5 g/tablet), 1 tablet/day, 3 times orally; Flunarizine Hydrochloride Capsules (manufacturer: Jilin Qixingshan Pharmaceutical Co., Ltd., Jilin, batch number: H20083665, 5 mg/capsule) were taken orally. Take orally 2 capsules once a day for 14 days.

On the basis of the control group, the treatment group was treated with Gao’s nape acupuncture. Acupoint selection and operation: Main points: Fengchi (double), Gongxue (double), C3–C7 Jiaji;Matching points: Dazhui, Jianjing (on the affected side), Jiao (on the affected side), Quchi, Shousanli, and WaiguanPoint (affected side), Hegu point (affected side), Wailaogong point (suffered side) and Ashi point. According to the imaging examination (CT, MRI, etc). And the clinical symptoms of patients, the Jiaji acupoint of the lesion segment was selected. Operation: the patient was seated, and after routine disinfection, the deep needling method was used at Jiaji acupoint on the neck. An Andy brand disposable sterile acupuncture needle (specification: 0.25 mm × 50 mm) was used for deep straight puncture, so that the needle tip reached the periosteum of the vertebral lamina. Patients with local acid, numbness, swelling, heavy feeling or numbness electricity, to the neck, shoulder, and arm conduction is better; Fengchi, Gongxue, and other acupoints were punctured with an Andy brand disposable sterile acupuncture needle (0.25 mm × 40 mm). The method of reinforcing and reducing was used to make the patient get qi, in which Fengchi point and Gongxue point were treated with electroacupuncture, and the instrument was Great Wall brand KWD-808I electroacupuncture instrument. Continuous wave, 50 Hz, 30 minutes, once a day, 6 days, 1 day off, 14 days.

Modified Shentong Zhuyu decoction: Semen Persicae 20 g, Flos Carthami 20 g, Radix Angelicae Sinensis 20 g, Rhizoma Chuanxiong 20 g, Rhizoma Et Radix Notopterygii 15 g, Radix Gentianae Macrophyllae 15 g, Oletum Trogopterori 15 g, Myrrha 15 g, and XiangRadix Aconiti Lateralis Preparata 15 g, Radix Achyranthis Bidentatae 10 g, Pheretima 10 g, and Radix Glycyrrhizae Preparata 10 g. The traditional Chinese medicine decoction is uniformly decocted by the decoction room of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, one dose of 300 mL per day is taken warm in the morning and evening. The treatment is continuously taken for 14 days.

2.6. Observation index and curative effect standard

1. TCM syndrome score was used to evaluate the changes of TCM clinical symptoms. According to the severity of no symptoms, mild, moderate and severe symptoms, they were given 0, 2, 4, and 6 points in turn, with a total score of 30 points. The higher the score, the more severe the clinical symptoms, the lower the score, the lighter the symptoms, and there is a positive correlation between the score and the clinical symptoms.^[6]

2. Visual analogue scale (VAS) was used to evaluate the degree of clinical pain, 0 was painless, 10 was severe pain. The degree of pain is positively correlated with the score, that is, the higher the score, the heavier the pain, and the lower the score, the lighter the pain.^[7]

3. Numbness score was used to evaluate the change of numbness, which was divided into 4 grades according to the degree of numbness. Give 0, 1, 2, 3 points, 0 points means no numbness; 1 points means numbness occurs occasionally, but quickly relieved; a score of 2 indicates that the numbness persists but is relieved periodically; a score of 3 indicates that the numbness persists and is not relieved.^[8]

4. Vertebral dysfunction index (neck disability index [NDI]) was used to evaluate the functional activity of the neck. Including personal care, lifting heavy objects, pain intensity, reading, headache, work, sleep, driving, entertainment, sleep, and so on. Each item was scored 0, 1, 2, 3, 4, and 5 points according to the severity of the disease, and the higher the score, the more serious the cervical dysfunction. The lower the score, the better the cervical dysfunction, and the score is positively correlated with the cervical function.^[9]

5. Serum inflammatory factors were used to evaluate the level of inflammation, and 5 mL of fasting venous blood was taken before and after treatment. The supernatant was obtained by centrifuging in a centrifuge at 3500 R/min for 15 minutes. Serum levels of interleukin-1β (IL-1β) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA); serum tumor necrosis factor-α (TNF-α) was detected by immunoturbidimetry.

6. Related hemorheological indexes: before and after treatment, 5 mL of fasting venous blood was taken from the patients, and heparin sodium was used for anticoagulation. The Serum was centrifuged at 3000 R/min for 10 minutes and stored at −20 °C. Plasma viscosity, high-shear whole blood viscosity and low-shear whole blood viscosity were detected by automatic hemorheology detector.

2.7. Statistical methods

SPSS 21.0 statistical software was used for statistical analysis of the data obtained in this study, in which the measurement data were expressed as mean ± standard deviation (). If the distribution is normal, the t-test is used, and if the distribution is not normal, the nonparametric test is used. Chi-square test was used for count and grade data, and P < .05 represented that the difference was statistically significant $\overline{x}\pm s$.

3. Result

3.1. Comparison of TCM syndrome score, VAS score, numbness score, and NDI score between the 2 groups

Before treatment, there was no significant difference in TCM syndrome score, VAS score, numbness score and NDI score between the 2 groups (P > .05). After treatment, the TCM syndrome scores, VAS scores, numbness scores and NDI scores in the 2 groups were significantly lower than those before treatment (P < .05).The differences were statistically significant; after treatment, the TCM syndrome score, VAS score, numbness score and NDI score in the treatment group were significantly lower than those in the control group (P < .05).The differences were statistically significant (Table 1).

Table 1.

Comparison of TCM syndrome score, VAS score, numbness score, and NDI score between the 2 groups (n = 45, points) x̄±s.

Group		Scoring of TCM syndromes	VAS score	Numbness score	NDI score
Treatment group	Before treatment	18.23 ± 3.37	6.17 ± 1.38	2.12 ± 0.39	33.91 ± 6.89
	After treatment	7.23 ± 1.22#,△	1.13 ± 0.23#,△	0.46 ± 0.05#,△	10.18 ± 2.19#,△
Control group	Before treatment	18.77 ± 3.67	6.21 ± 1.46	2.23 ± 0.41	34.12 ± 7.12
	After treatment	12.25 ± 2.31△	2.98 ± 0.82#,△	1.22 ± 0.19△	21.19 ± 3.45△

^△P ≤ .05 for intragroup comparison.

^#P ≤ .05 for inter-group comparison.

TCM syndrome score is an important index to evaluate TCM clinical symptoms, which has positive significance for the change of TCM symptoms of patients; VAS score is an important index to evaluate pain, and it is one of the commonly used pain scales in clinic. Numbness score is an important scale to evaluate the numbness of cervical spondylotic radiculopathy, which has guiding significance for the evaluation of numbness symptoms. NDI score is one of the commonly used scales to evaluate cervical spine function, which has positive significance for the actual evaluation of cervical spine function. This study showed that the clinical symptoms of traditional Chinese medicine such as neck pain, tenderness and difficulty in activity were greatly improved in the treatment group. This may be related to the efficacy of Gao’s Nape Needle and Shentong Zhuyu decoction in promoting blood circulation and removing blood stasis, dredging meridians and relieving pain, expelling wind and removing dampness; in addition, the treatment group can relieve the discomfort symptoms of neck pain, upper limb numbness, pain and so on. At the same time, it can also improve the neck movement function of patients and improve the quality of life of patients. This may be related to Gao’s nape needle and Shentong Zhuyu decoction to improve blood circulation, accelerate the metabolism of pain factors and promote the recovery of nerve function. Repair of ruptured annulus fibrosus and so on.

3.2. Comparison of serum inflammatory factors in 2 groups

Before treatment, there was no significant difference in IL-6, TNF-α, and IL-10 between the 2 groups (P > .05);After treatment, the levels of IL-6, TNF-α and IL-10 in the 2 groups were significantly lower than those before treatment (P < .05). The differences were statistically significant; after treatment, the levels of serum IL-6, TNF-α and IL-10 in the treatment group were significantly lower than those in the control group (P < .05). The differences were statistically significant.

Studies have shown that the occurrence and development of cervical spondylotic radiculopathy is closely related to inflammatory factors. The expression of IL-6 and TNF-α was positively correlated with the degree of intervertebral disc degeneration and pain. That is to say, the higher the expression of IL-6 and TNF-α, the more serious the degeneration and pain of intervertebral disc; IL-6 can also aggravate the inflammatory damage of the body and the hypersensitivity of the nerve root, and aggravate the clinical manifestations of pain and numbness. In addition, IL-10β is also one of the important inflammatory factors causing inflammation and joint destruction, causing related clinical symptoms.^[10–12] After treatment, the levels of serum inflammatory factors (IL-10, IL-6, TNF-α) in the 2 groups decreased, and the decrease in the treatment group was more obvious. Compared with the control group, the difference was statistically significant (P < .05). The results showed that the treatment group could reduce the expression of IL-10, IL-6, and TNF-α in serum and reduce the inflammatory reaction. This may be related to the anti-inflammatory effect of Gao’s nape needle and Shentong Zhuyu decoction (Table 2).

Table 2.

Comparison of serum inflammatory factors in the 2 groups (n = 45, ng/L) x̄±s.

Group		IL-6	IL-10	TNF-α
Treatment group	Before treatment	59.12 ± 8.87	9.13 ± 1.33	26.34 ± 4.12
	After treatment	20.21 ± 3.11#,△	2.98 ± 0.55#,△	9.22 ± 1.01#,△
Control group	Before treatment	58.23 ± 7.97	9.29 ± 1.15	25.89 ± 3.99
	After treatment	32.22 ± 3.98△	5.86 ± 1.21△	14.7 ± 2.23△

^△P ≤ .05 for intra-group comparison.

^#Comparison of results between two groups after treatment.

3.3. Comparison of related hemorheological indexes between the 2 groups

Before treatment, the hemorheological indexes related to plasma viscosity, high-shear whole blood viscosity and low-shear whole blood viscosity were compared between the 2 groups (P > .05). The differences were not statistically significant; after treatment. The indexes of hemorheology related to plasma viscosity, high shear whole blood viscosity and low shear whole blood viscosity in both groups were significantly lower than those before treatment (P < .05), the differences were statistically significant; after treatment. The indexes of hemorheology related to plasma viscosity, high-shear whole blood viscosity and low-shear whole blood viscosity in the treatment group were significantly lower than those in the control group (P < .05). The differences were statistically significant (Table 3).

Table 3.

Comparison of related hemorheological indexes between the 2 groups (n = 45, mPa · s) x̄±s.

Group		Plasma viscosity (mPa · s)	Whole blood viscosity at high shear rate (mPa · s)	Low shear whole blood viscosity (mPa · s)
Treatment group	Before treatment	2.34 ± 0.37	13.85 ± 1.89	5.34 ± 0.69
	After treatment	1.18 ± 0.13#,△	7.47 ± 1.03#,△	3.31 ± 0.35#,△
Control group	Before treatment	2.23 ± 0.35	13.91 ± 1.99	5.29 ± 0.61
	After treatment	1.72 ± 0.19△	10.68 ± 1.57△	4.31 ± 0.48△

^△P ≤ .05 for intra-group comparison.

^#Comparison of results between two groups after treatment.

Studies have shown that the occurrence of cervical spondylosis is closely related to abnormal blood flow. Blood viscosity is in a state of high viscosity, plasma viscosity, fibrinogen, high-shear whole blood viscosity, and low-shear whole blood viscosity are important indexes to observe blood viscosity. Therefore, the change of blood viscosity can also be used as an important reference for the change of cervical spondylotic radiculopathy.^[13,14] After treatment, the related hemorheological indexes (plasma viscosity, high-shear whole blood viscosity, and low-shear whole blood viscosity) of the 2 groups decreased more significantly in the treatment group than in the control group. Compared with the control group, the difference was statistically significant (P < .05). The treatment group can better reduce the plasma viscosity, fibrinogen, high shear whole blood viscosity, low shear whole blood viscosity levels. The improvement of hemorheology may be related to the improvement of blood circulation by Gao’s nape needle and Shentong Zhuyu decoction.

4. Discussion

The pathogenesis of cervical spondylotic radiculopathy is not clear at present. However, it may be related to degenerative changes of cervical intervertebral disc, ligament calcification, hyperosteogeny and other factors.^[15] For the treatment of cervical spondylotic radiculopathy, oral medication is the main treatment in modern medicine. Commonly used drugs are mainly used to nourish nerves, diminish inflammation and ease pain, and improve circulation, although they have certain clinical effects. However, there are some shortcomings, such as liver and kidney damage, gastrointestinal reactions, and other side effects. At the same time, it also has clinical disadvantages such as easy recurrence and recurrence.^[16] Therefore, on the basis of the above treatment methods, it is necessary to assist other treatment methods in order to obtain better clinical results.

Cervical spondylotic radiculopathy belongs to the category of “arthralgia syndrome” and “neck stiffness” in traditional Chinese medicine. Among the TCM syndromes of cervical spondylotic radiculopathy, cervical spondylotic radiculopathy of qi stagnation, and blood stasis type is more common.^[17] Traditional Chinese medicine using traditional Chinese medicine, acupuncture and other methods to treat cervical spondylotic radiculopathy of qi stagnation and blood stasis type can achieve relatively satisfactory clinical results. The mechanism of acupuncture in the treatment of cervical spondylosis is not yet clear. At present, it is mainly considered to reduce the level of inflammatory factors, promote blood circulation, improve the metabolism of oxygen free radicals in the body, and restore the movement of the cervical spine itself. It is related to the mechanism of state balance and relieving muscle spasm.^[18] Zhang Yanxiang and others used acupuncture to treat cervical spondylotic radiculopathy, which can significantly reduce neck pain and improve the function of cervical spine. It can also reduce the level of inflammatory factors.^[19] In addition, Zhang Xiajie and others also confirmed that the use of acupuncture can improve the range of motion of cervical spine function, and also improve hemorheological indicators.^[20] Traditional Chinese medicine is also widely used in the treatment of cervical spondylotic radiculopathy, and its effect has been clinically recognized. Du Longxue^[21] used Shentong Zhuyu decoction to treat cervical spondylotic radiculopathy with qi stagnation and blood stasis syndrome, and proved that it could relieve neck pain. Improve the neck function, improve the quality of life of patients, while no toxic side effects were found to ensure a certain degree of safety. Qi Dazhou has also achieved satisfactory clinical results in the treatment of cervical spondylotic radiculopathy with modified Shentong Zhuyu decoction. No adverse reactions were found during the treatment.^[22] On the basis of oral administration of modern medicine, the treatment of cervical spondylotic radiculopathy of qi stagnation and blood stasis syndrome with Gao’s nape needle and modified Shentong Zhuyu decoction has achieved good results. For the clinical effect of acupuncture combined with modified Shentong Zhuyu decoction in treating cervical spondylotic radiculopathy of Qi stagnation and blood stasis type, other scholars have also confirmed it. Lu Tianchen and others confirmed through research that acupuncture combined with modified Shentong Zhuyu decoction can be used to treat cervical spondylotic radiculopathy of Qi stagnation and blood stasis type in clinic. The synergistic effect can significantly reduce neck pain and improve the quality of life of patients, thus achieving satisfactory clinical results.^[23] Shentong Zhuyu decoction is prepare from semen Persicae, Carthami Flos, Radix Angelicae sinensis, Rhizoma Ligustici Chuanxiong, Notopterygii Rhizoma, Radix Gentianae Macrophyllae, Oletum Trogopterori, Myrrha, Rhizoma Cyperi, Achyranthis Radix, Lumbricus, and Radix Glycyrrhizae Preparata. Is composed of 12 traditional Chinese medicines and has the clinical effects of promoting blood circulation, relieving pain, removing blood stasis, dredging arthralgia, expelling wind and removing dampness. Studies have shown^[24,25] that Shentong Zhuyu decoction has many pharmacological effects. Uch as diminishing inflammation and relieving pain, protecting skeletal muscle, delaying protrusion of intervertebral disc, improving blood circulation, regulating immunity and the like. It is widely used in clinic, especially in the treatment of cervical spondylotic radiculopathy, with obvious effect.

Gao’s neck needle was founded by Professor Gao Weibin, a famous veteran doctor of traditional Chinese medicine. Commonly used acupoints in the treatment of cervical spondylotic myelopathy include Fengchi, Gongxue and cervical Jiaji acupoints.^[26] Fengchi acupoint has the clinical functions of dispelling wind, relieving exterior syndrome, clearing head and head, and circulating qi and blood in the head and neck. Traditional Chinese medicine classic “Acupuncture and Moxibustion Dacheng” clearly put forward that Fengchi acupoint can treat cervical spondylosis. The anatomical location of Fengchi point is in the depression of the upper end of sternocleidomastoid muscle and trapezius muscle. The branches of occipital artery, vein and occipital nerve are distributed in the superficial layer, and the branches of vertebral artery, vein and occipital nerve are distributed in the deep layer. Acupuncture at Fengchi acupoint can relieve muscle spasm in the neck and balance the strength of neck muscles; it can also promote muscle blood circulation under nerve regulation, accelerate the metabolism of pain-causing factors such as 5-tryptamine and lactic acid, and relieve pain. In addition, acupuncture at Fengchi point can promote blood circulation and improve insufficient blood supply of basilar artery. It can also reduce the pressure stimulation to the cervical disc and relieve the symptoms of disc compression.^[27,28] Blood supply acupoint was invented by Professor Gao Weibin. It is named blood supply acupoint because it has a good effect on improving blood circulation. The blood supply point is located 1.5 cun below the Fengchi point, which has the function of relieving neck pain and circulating neck Qi and blood. When the Fengchi acupoint and the blood supply acupoint are stimulated by electroacupuncture, the neck muscles can beat rhythmically. It can not only relax the neck muscles, but also improve the blood circulation through the action of the muscle pump. So as to accelerate the metabolism of pain-related factors, thereby achieving the purpose of treatment.^[29,30] Jiaji points on the neck are extrameridian points, which have the function of improving the circulation of qi and blood in the neck. Analyzed from the anatomical location, abundant nerves (posterior rami of cervical spinal nerves), blood vessels (accompanying arteriovenous plexus), and lymphoid tissues were distributed under the cervical Jiaji points. Deep needling of Jiaji (EX-B2) of the corresponding lesion segment can make the meridian Qi directly reach the lesion site and promote the circulation of qi and blood at the lesion site. Improve the ischemia and hypoxia state of local tissues and nerves, and promote the recovery of damaged nerve function; it can also accelerate the metabolism of related inflammatory substances, reduce nerve root inflammation and edema, thereby improving the clinical symptoms of nerve compression; at the same time, it can repair the ruptured annulus fibrosus to a certain extent and accept the herniated cervical intervertebral disc tissue.^[31] Dazhui, Jianjing, Jiao, Quchi, Shousanli, Waiguan, Hegu, Wailaogong, and Ashi were used as auxiliary points. Can effectively relieve that problem of upper arm pain, numbness and the like caused by the compression of cervical nerve, so as to alleviate local pain, numbness, and other symptoms.

To sum up, patients with cervical spondylotic radiculopathy of Qi stagnation and blood stasis syndrome were treated with Gao’s nape needle and modified Shentong Zhuyu decoction. Can improve relate discomfort symptoms such as neck tenderness, difficulty in activity, numbness and that like, and can also improve the function of the neck, reduce IL-10, IL-6, TNF-α, and other related serum inflammatory factors, improve hemorheological indicators, worthy of clinical promotion. However, in this clinical study, there are also some shortcomings, such as the limitations of the clinical trial itself. Failure to use a double-blind clinical trial method may have an impact on the psychological impact of the patient, which may affect the results of the study. In addition, due to the limitation of objective conditions, only 2 related cases were used in this clinical study. There may be a lack of credibility in the findings. Therefore, it is hoped that further clinical studies will be conducted to clarify the clinical significance of this study when conditions permit in the future.

Author contributions

Conceptualization: Guan Ruiqian.

Data curation: Zhao Haishen, Guan Ruiqian.

Formal analysis: Guan Ruiqian.

Funding acquisition: Zhao Haishen, Wang Manya.

Investigation: Zhao Haishen.

Methodology: Zhao Haishen, Wang Manya.

Resources: Shi Kejun.

Software: Zhao Haishen, Wang Manya.

Supervision: Zhao Haishen, Ye Hong.

Validation: Zhao Haishen, Ye Hong, Shi Kejun.

Visualization: Zhao Haishen, Ye Hong, Shi Kejun.

Writing – original draft: Zhao Haishen.

Writing – review & editing: Zhao Haishen, Guan Ruiqian.