A 25-year-old woman with a six-month history of recurrent neck stiffness and restricted mobility triggered by catching a cold was successfully managed using a meridian-warming herbal strategy combined with spinal adjustment and acupuncture.

Case ID: CHC-0065

Case Summary

This case describes a 25-year-old woman who presented with a six-month history of recurrent neck stiffness and pain that initially began as a standard “stiff neck” (wry neck / luo zhen) after catching a cold. Despite temporary relief from hot compresses, the condition persistently relapsed. The original report documented a conventional diagnosis of neck-type cervical spondylosis and a TCM assessment of Neck Impediment (Xiang Bi) driven by Wind-Cold-Dampness. She was managed through a highly integrative approach combining a modified Gegen Tang herbal decoction, “Zhao’s Balanced Spinal Adjustment,” acupuncture, and targeted acupoint injections to warm the meridians, relax the muscle spasms, and realign the cervical spine.

Patient Presentation

• Patient: 25-year-old female (Surname: Zhang).
• Main Complaint: Neck discomfort, stiffness, and restricted mobility in the neck and upper back, accompanied by an aversion to cold. Her pain consistently worsened with cold exposure and improved with warmth.
• History: The patient sought consultation on March 6, 2014. Six months prior, she caught a cold and developed a “stiff neck” (luo zhen). This progressed into chronic neck and upper back stiffness and pain, severely restricting her movement. While hot compresses provided some temporary relief, the symptoms repeatedly flared up, significantly impacting her daily life and work.
• Physical Exam: Cervical mobility was severely restricted and stiff, with palpable cervical muscle spasms. There was distinct localized tenderness on both sides of the C2-C3 and C3-C4 spinous processes. The brachial plexus tension test and the head compression test (Spurling’s test) were both negative (-), indicating no nerve root compression.

Examination and Diagnosis

• Imaging (DR – Digital Radiography): Showed a straightened cervical physiological curvature and segmental instability at C3-C4. No significant bone hyperplasia (spurs) or calcification was observed.
• Conventional Diagnosis: Neck-type cervical spondylosis.
• TCM Tongue and Pulse: The tongue body was pale with a thin, white coating. The pulse was floating and tight (脉浮紧).

TCM Assessment

The original practitioner interpreted the presentation as Neck Impediment driven by Wind-Cold-Dampness (项痹 – 风寒湿痹型).

According to the holistic principles of yin and yang Chinese Medicine an external Wind-Cold pathogen invading the neck rapidly causes localized Qi and blood to stagnate. The cold physically constricts the meridians, leading to severe muscle spasms and the inability to turn the head smoothly.

Because the cold pathogen was never fully expelled from her initial illness six months ago, the localized stagnation gradually compromised the structural stability of her cervical spine (leading to the C3-C4 instability seen on the X-ray). The patient’s aversion to cold, combined with her pale tongue and floating-tight pulse, provided objective textbook confirmation of an active external cold pathogen locked tightly in the exterior muscle layer.

Treatment Approach

The primary treatment principle was to warm the meridians and scatter cold, dispel wind and stop pain (温经散寒，祛风止痛). The strategy utilized a dual mechanical-internal approach: mechanically realigning the cervical spine and releasing muscle spasms, while using a classic warm-acrid herbal decoction to sweat the trapped cold out of the muscle layer.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • Muscle Relaxation: The practitioner first applied cervical muscle-relaxing and sinew-smoothing techniques for 5–10 minutes to release the severe spasms.
  • Spinal Adjustment: Focusing on the upper cervical spine (e.g., the left-sided tenderness at C3), the patient was instructed to relax entirely. The neck was flexed forward about 20° and rotated to the left 10°–15°. The practitioner stood behind the patient, stabilizing the painful point with the left thumb while placing the right hand on the patient’s forehead. Slowly rotating downward and to the left to find the exact angle of resistance, the practitioner then applied a swift, momentary rotational thrust. A crisp “popping” sound confirmed the realignment.
• Acupuncture & Acupoint Injection:
  • Acupuncture: Points included Dazhui (GV14), Cervical Jiaji points, Jianjing (GB21), 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 (March 6, 2014): An 8-herb decoction acting as a modified Gegen Tang (Kudzu Decoction).
  • Releasing Muscle Layer and Dispersing Wind-Cold: Ge Gen (Pueraria, 10g) is the emperor herb, specifically renowned for directing fluids to the neck and upper back to instantly relieve stiffness. Gui Zhi (Cinnamon Twig, 10g) warms the meridians and scatters the cold, while Fang Feng (Saposhnikovia, 10g) and Qiang Huo (Notopterygium, 5g) forcefully drive out the trapped wind and dampness.
  • Relaxing Spasms and Harmonizing: Bai Shao (10g) and Mu Gua (Papaya, 10g) soften the rigid sinews, nourish blood, and relieve the muscle spasms. Sheng Jiang (Fresh Ginger, 10g) supports the exterior release, and Gan Cao (10g) harmonizes the decoction.
  • Administration: 3 doses prescribed, water decocted, taken warm morning and evening.

Follow-Up

• Three Days Later: After just the initial round of treatment (3 doses of herbs and manual therapy), the patient’s symptoms had basically disappeared.
• She received one additional manual therapy session to consolidate the structural correction and was instructed to keep her neck warm and perform regular neck functional exercises.
• Outcome: A one-year follow-up confirmed that she experienced absolutely no recurrence of the neck stiffness or pain.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is identifying recurrent “stiff neck” (luo zhen) as an early presentation of cervical spondylosis.

The original commentary emphasizes that while neck-type cervical spondylosis has mild early symptoms, it is highly prone to relapse if not treated at its root. Many patients who suffer from chronic, recurring “stiff necks” actually have underlying mechanical instability (like this patient’s C3-C4 segmental instability) triggered by wind-cold. Merely applying a hot compress treats the symptom but ignores the trapped pathogen and the misaligned bone. By utilizing the classic formula Gegen Tang to flush the cold out of the muscle layer, combined with precise bone-setting and acupuncture to restore local blood flow and mechanical balance, the practitioner achieved a rapid, complete cure and prevented the condition from worsening into nerve root compression.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】招仕富：温经散寒，祛风止痛法治疗颈型颈椎病案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 29, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation