A 46-year-old woman with a three-month history of severe neck pain, left arm numbness, and weakened grip strength was successfully managed using a blood-invigorating herbal strategy combined with spinal adjustment and acupuncture.

Case ID: CHC-0064

Case Summary

This case describes a 46-year-old woman who presented with a three-month history of chronic neck pain radiating into her left arm, accompanied by numbness and significant grip weakness. The original report documented a conventional diagnosis of cervical spondylotic radiculopathy (pinched nerve root) and a TCM assessment of Neck Impediment (Xiang Bi) driven by Blood Stasis, Qi Stagnation, and Vessel Blockage. She was managed through a highly integrative approach utilizing “Zhao’s Balanced Spinal Adjustment” to physically decompress the nerve root, alongside acupuncture, targeted acupoint injections, and a blood-invigorating herbal decoction to clear inflammation and restore nerve function.

Patient Presentation

• Patient: 46-year-old female (Surname: Chen).
• Main Complaint: Neck pain accompanied by left upper limb numbness and pain for 3 months.
• History: The patient sought consultation on September 24, 2013. Three months prior, without any obvious trigger, she developed neck pain and left arm numbness. After seeking examinations at multiple hospitals, she was diagnosed with cervical spondylosis.
• Physical Exam: The neck was stiff with palpable muscle spasms. There was localized tenderness at the C4-C6 spinous processes and 1.0cm to the left. She experienced radiating pain down the left arm, with reduced sensation in her right thumb, index, and middle fingers. Both hands showed weakened grip strength (left worse than right), and her triceps reflex was diminished. Cervical mobility was restricted. Neurological tests, including the brachial plexus tension test and intervertebral foramen compression test (Spurling’s test), were both positive (+), indicating direct nerve root compression. Hoffman’s sign was negative (-).

Examination and Diagnosis

• Imaging (X-ray): Showed disappearance and straightening of the cervical physiological curvature, uncovertebral joint hypertrophy (bone spurs) at C4-C6, and marginal osteophytes. The C4-C5 and C5-C6 intervertebral spaces and corresponding intervertebral foramina were narrowed, most obviously at the C5-C6 segment.
• Conventional Diagnosis: Cervical spondylotic radiculopathy.
• TCM Tongue and Pulse: The tongue body was dark red with a thin, white coating. The pulse was choppy (脉涩).

TCM Assessment

The original practitioner interpreted the presentation as Neck Impediment driven by Blood Stasis, Qi Stagnation, and Vessel Blockage (项痹 – 血瘀气滞，脉络闭阻证).

According to the holistic principles of yin and yang Chinese Medicine the Governing Vessel (Du Mai) and the Yang and Yin meridians of the arm run directly through the cervical spine. In this patient, underlying structural degeneration (bone spurs and narrowed discs) combined with daily strain caused the localized Qi and Blood to stagnate.

Because the blood could not flow smoothly, the meridians became physically blocked. This stagnation trapped the muscles in a state of spasm and starved the nerves of nourishment, directly resulting in the sharp radiating arm pain, numbness, and grip weakness. The dark red tongue and choppy pulse provided textbook objective confirmation of this deep, chronic blood stasis obstructing the micro-circulation of the neck and arm.

Treatment Approach

The primary treatment principle was to invigorate blood and resolve stasis, regulate Qi and stop pain (活血化瘀，理气止痛). The strategy required a multi-pronged approach: mechanically opening the narrowed intervertebral foramina to stop the nerve compression, while using systemic herbs and localized acupuncture to dissolve the inflammatory blood stasis surrounding the nerve root.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • Muscle Relaxation: The practitioner first applied preparatory massage to release the severe cervical muscle spasms.
  • Spinal Adjustment: Focusing on the pronounced left-sided tenderness at C5, the patient was seated and relaxed. The practitioner tilted her head back 15°–20° and rotated it to the left 15°–20°. Stabilizing the painful point with the left thumb, the practitioner used the right hand to apply a swift, controlled rotational thrust to the lower left. A crisp “popping” sound was heard, and the localized tenderness immediately disappeared.
• Acupuncture & Acupoint Injection:
  • Acupuncture: Points included Dazhui (GV14), Cervical Jiaji points, Jianjing (GB21), Geshu (BL17), Yanglao (SI6), Jianyu (LI15), Quchi (LI11), Hegu (LI4), Waiguan (TE5), and Tianzong (SI11). Needles were retained for 30 minutes, once daily.
  • Acupoint Injection: Every two days, 2ml of a bone-strengthening injection (健骨注射液) was administered directly into two affected Cervical Jiaji points.
• Internal Herbal Formula (September 24, 2013): An 8-herb decoction designed to relax the neck, aggressively move blood, and stop pain.
  • Ge Gen (Pueraria, 10g) and Mu Gua (Papaya, 10g) specifically target the neck and upper back to soften the stiff, spasmodic sinews.
  • San Qi (Notoginseng, 5g), Chuan Xiong (Ligusticum, 5g), and Yan Hu Suo (Corydalis, 10g) form a powerful matrix to break up localized blood stasis, promote micro-circulation, and strongly relieve the radiating nerve pain.
  • Gui Zhi (Cinnamon Twig, 10g) warms the channels and unblocks the vessels in the upper limbs, while Qiang Huo (Notopterygium, 5g) drives out deep-seated cold and dampness from the upper body joints. Bai Shao (10g) works with Gui Zhi to harmonize the Ying and Wei Qi and relax muscle spasms.
  • Administration: 3 doses prescribed, water decocted, taken warm morning and evening.

Follow-Up

• Three Days Later: The patient’s neck pain and arm numbness were significantly improved. Manual therapy was continued 2 to 3 times per week to consolidate the structural changes.
• Outcome: After a total of 5 treatments, her clinical symptoms had essentially disappeared. She was instructed to adjust her sleeping pillow height, avoid poor working postures, keep her neck warm, and maintain functional neck exercises. A 2-year follow-up confirmed no recurrence of the symptoms.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the seamless parallel between modern pathology and classical TCM theory. Radiculopathy (nerve root compression) is the most common type of cervical spondylosis.

The original commentary notes that in Western medicine, bone spurs and narrow discs mechanically compress the nerve root, causing venous congestion, swelling, and a breakdown of local micro-circulation (inflammation). In TCM, this exact micro-circulatory breakdown is recognized as “Blood Stasis and Vessel Blockage.” Professor Zhao’s treatment brilliantly addresses both aspects: the bone-setting physically opens the narrowed bone canal (removing the mechanical compression), while the blood-moving herbs (San Qi, Chuan Xiong) and acupuncture chemically flush out the inflammatory edema surrounding the nerve root, achieving a rapid and permanent cure.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine Original title: 【以案说医】招仕富：活血通络，散寒止痛法治疗神经根型颈椎病案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 30, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation