A 32-year-old woman with a two-year history of debilitating neck stiffness, severe vertigo, and nausea—aggravated by cold air and prolonged desk work—was successfully managed using a sophisticated synthesis of four classical Shanghan (Cold Damage) formulas to simultaneously release the exterior and drain internal fluid-phlegm.

Case ID: CHC-0090

Case Summary

This case describes a 32-year-old woman who presented with a two-year history of recurrent, severe neck stiffness and vertigo. Working a job that required long hours at a computer, her symptoms frequently flared up and were markedly aggravated by exposure to cold or air conditioning. Despite seeking various TCM and physical therapies elsewhere, she experienced little relief, and an MRI confirmed cervical spondylosis with C3 bone marrow edema. The original report documented a conventional diagnosis of cervical spondylosis and a TCM assessment of Concurrent Taiyang and Taiyin Disease, driven by Ying-Wei disharmony, malnourished sinews, and Spleen deficiency causing wind-phlegm and water-rheum to disturb the head. She was managed by Professor Hu Shiping using a grand combination of Guizhi jia Gegen Tang, Linggui Zhugan Tang, Zexie Tang, and Banxia Baizhu Tianma Tang, resulting in a rapid clinical cure and the complete radiographic resolution of her bone marrow edema.

Patient Presentation

• Patient: 32-year-old female (Surname: Yao).
• Main Complaint: Recurrent neck stiffness and discomfort accompanied by vertigo and nausea for over 2 years.
• History: The patient sought her initial consultation on May 10, 2021. Due to work requirements, she spent long hours at a desk using a computer. Whenever she worked at her desk for prolonged periods, she developed severe neck stiffness, profound vertigo, and nausea. These symptoms were distinctly worsened by catching a chill or being exposed to air conditioning. Previous TCM physical therapies and other medical treatments had been ineffective. A prior cervical MRI indicated a bone marrow edema signal in the C3 vertebral body and mild bulging of the C4/5 intervertebral disc.
• Associated Symptoms: During flare-ups, her neck was stiff with limited mobility. The vertigo was severe, causing a spinning sensation (天旋地转) and an inability to stand steadily. This was accompanied by vomiting clear fluids, palpitations, systemic cold sweats, and an aversion to wind. The episodes severely impacted her ability to work and her quality of life. Her appetite and sleep were average; she occasionally had sticky stools, and her urination was normal.

Examination and Diagnosis

• Conventional Diagnosis: Cervical Spondylosis.
• TCM Tongue and Pulse: The tongue body was pale and puffy with teeth marks and stasis spots (舌淡胖有齿痕有瘀斑), covered by a white, greasy coating. The pulse was sunken, fine, stringy, and weak (脉沉细弦无力).

TCM Assessment

The practitioner interpreted the presentation as a Concurrent Taiyang and Taiyin Disease (太阳太阴合病). Specifically: Ying-Wei disharmony, malnourished sinews, Spleen deficiency with wind-phlegm and water-rheum disturbing upward, and internal blood stasis.

According to classical Shanghan Lun theory, the severe neck stiffness aggravated by wind and cold is the hallmark of a Taiyang (exterior) meridian disease—described by Zhang Zhongjing as “the neck and back are stiff and tight” (项背强几几). However, her systemic symptoms (vomiting clear fluid, sticky stools, pale/puffy tongue with a greasy coating) pointed to a deep internal dysfunction of the Spleen—a Taiyin disease.

Because her Spleen was weak (Taiyin deficiency-cold), it could not metabolize fluids, generating internal “water-rheum” and wind-phlegm. When this heavy, cold fluid rushed upward to the head, it caused the severe, spinning vertigo, palpitations, and cold sweats. The stasis spots on her tongue indicated that the chronic illness had led to stagnant blood in the collaterals of her neck. The sunken, stringy, and weak pulse provided objective confirmation of this complex mix of underlying deficiency (weak) complicated by internal fluid (sunken/stringy).

Treatment Approach

The primary treatment principle was to harmonize Ying and Wei and soften the sinews, fortify the Spleen and transform phlegm and rheum, invigorate blood, dispel wind, and unblock the collaterals (调和营卫柔筋，健脾祛痰化饮，活血祛风通络). The strategy required a multi-targeted approach to simultaneously release the trapped cold in her neck muscles (exterior) while aggressively drying the phlegm and draining the water-rheum from her digestive center (interior).

Interventions and Herbal Formulas

• Initial Herbal Formula (May 10, 2021): A 14-herb decoction elegantly fusing four classic formulas: Guizhi jia Gegen Tang, Linggui Zhugan Tang, Zexie Tang, and Banxia Baizhu Tianma Tang.
  • Releasing the Exterior and Softening Sinews (Taiyang): Ge Gen (Kudzu Root, 30g), Gui Zhi (Cinnamon Twig, 15g), Bai Shao (White Peony, 30g), and Gan Cao (Licorice, 5g). Ge Gen specifically targets the neck to relieve stiffness and spasm. Gui Zhi and a heavy dose of Bai Shao harmonize the exterior (Ying and Wei) to stop the cold sweats and soften the tight ligaments.
  • Draining Water-Rheum and Stopping Vertigo (Taiyin): Fu Ling (Poria, 15g) and Ze Xie (Alisma, 15g). Combined with Gui Zhi and Bai Zhu, these form Linggui Zhugan Tang and Zexie Tang to strongly warm the Yang, drain the rogue water-rheum out through the urine, and immediately halt the spinning vertigo and palpitations.
  • Transforming Wind-Phlegm: Cang Zhu (15g), Fa Ban Xia (Pinellia, 15g), and Tian Ma (Gastrodia, 20g) heavily dry Spleen dampness, stop the vomiting of clear fluids, and calm internal wind.
  • Invigorating Blood and Unblocking Collaterals: Chuan Xiong (15g), Wei Ling Xian (Clematis, 20g), Ji Xue Teng (Spatholobus, 20g), and Mu Gua (Papaya, 15g). Adhering to the principle “to treat wind, first treat blood,” this group dissolves the chronic blood stasis in the cervical spine and relaxes the neck tendons.
  • Administration: 7 doses, water decocted, taken warm in two divided doses daily. The patient was instructed to avoid raw/cold foods, greasy foods, and direct exposure to cold wind.

Follow-Up

• Initial Outcome: After taking just 2 doses, the symptoms were significantly relieved. After completing all 7 doses, the neck stiffness, vertigo, and nausea completely disappeared.
• Long-Term Management: Whenever she experienced mild recurrences after extremely long hours of desk work, the symptoms were drastically less severe than before and did not impact her life or work. Taking 3 doses of the original formula would immediately clear the flare-up.
• Radiographic Resolution (3 Months Later): A follow-up cervical MRI three months later showed that the C3 vertebral body bone marrow edema signal had completely disappeared.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is Professor Hu Shiping’s masterful application of classical Shanghan Lun (Treatise on Cold Damage) diagnostic frameworks to effectively cure a modern occupational disease (cervical spondylosis from desk work).

In modern clinics, cervical spondylosis is often treated purely structurally (as a bone/nerve issue) or with simple blood-invigorating herbs. However, Professor Hu recognized the systemic pathogenesis: the patient suffered from a “Concurrent Taiyang and Taiyin Disease.” The external neck spasms were Taiyang pathology (treated perfectly by Guizhi jia Gegen Tang), while the severe vertigo and vomiting were caused by Taiyin (Spleen) water-rheum sloshing upward. By combining Linggui Zhugan Tang and Zexie Tang—classical formulas specifically designed for fluid-induced vertigo and palpitations—with modern blood-moving herbs (Ji Xue Teng), he addressed both the structural stasis in the neck and the systemic fluid metabolic failure. The fact that this herbal intervention not only cleared the symptoms but objectively resolved the bone marrow edema on the MRI demonstrates the profound power of accurate classical pattern differentiation.

Source Original source: Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang) / Traditional Chinese Medicine Bureau of Guangdong Province Original title: 【以案说医】胡世平：晕病太阳与太阴，经方合治功效彰 Practitioner: Professor Hu Shiping (胡世平) Publication date: July 28, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation